PMC5932342_01
Contrast-enhanced CT scans of chest, abdomen, and pelvis (A,B) showing renal, hepatic, and osseous metastases before chemotherapy (C,D) 2 weeks afterward showing significant interval improvement. (A) Hypoattenuated masses in the right renal pelvis and ureter (solid white arrow) and lytic lesions in the spine (black arrow). (B) Multiple hypoattenuated hepatic masses (dashed white arrows).
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F1
Contrast-enhanced CT scans of the chest, abdomen, and pelvis detected multiple hypoattenuated masses in the liver up to 3.3 cm in diameter, subcentimeter pleural nodules, multiple masses in the right renal pelvis and ureter up to 1.2 cm in diameter, necrotic lymph nodes, a heterogeneous enlarged mass in the region of the prostate invading the bladder, bilateral adrenal thickening, and lytic lesions in the pelvis and lumbar spine (see Figures 1A,B). Carboplatin and Etoposide chemotherapy targeting EPSCC, the patient's 6:00 a.m. cortisol decreased to 10 microg/dL (6.7-22.6 microg/dL) so Ketaconazole and Spironolactone were discontinued. CT scans obtained 2 weeks after chemotherapy initiation documented diminution or resolution of all prior findings (see Figures 1C,D).
Positive immunohistochemical stains and Ki-67 proliferation index of liver biopsy sample (20x magnification). (A) Neuron-specific enolase. (B) Synaptophysin. (C) Ki-67 proliferation index 98%.
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F2
Medical oncology was consulted when the biopsy of a liver lesion identified epithelioid malignancy with cords and nests of small to medium size cells with high N/C ratio, salt and pepper chromatin, evident mitoses and numerous apoptotic bodies, Ki proliferation index 98%, and immunohistochemistry (IHC) staining positive for synaptophysin, neuron-specific enolase, CD56, cytokeratins CAM 5.2 and AE1/AE3, and focally for CK20, consistent with high-grade small cell neuroendocrine carcinoma (see Figure 2).