PMC5943869_01
Soft tissue ultrasonography-subcutaneous hypoechogenic 4 mm nodular lesion in the region of the right inferior flank.
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F1
A soft tissue ultrasonography was performed and showed a hypoechogenic nodule with 4 mm size suggestive of epidermoid cyst (Fig. 1).
68Ga-DOTANOC PET/CT:small nodular lesion in the subcutaneous tissue in the lumbar right region with discrete pathological uptake. PET/CT = positron emission tomography-computed tomography.
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F2
Expanding nodule on the subcutaneous adipose tissue with abundant fibrous/desmoplastic stroma (A) [HE, x20]; solid area of the neoplasia (B) [HE, x200]; neoplastic cells with abundant weakly eosinophilic cytoplasm and round nuclei with inconspicuous nucleoli a "salt-and pepper" chromatin pattern   [HE, x400]; TTF-1 nuclear diffuse positivity (D) [TTF-1, x100]; chromogranin-A strong and diffuse cytoplasmatic positivity highlighting the cordonal and trabecular pattern of the neoplasia (E) [CgA, x100]; synaptophysin strong and diffuse cytoplasmatic positivity (F) [Syn, x100]. TTF-1 = thyroid transcription factor-1.
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F3
The morphological features, together with the immunohistochemical profile (namely TTF-1 positivity) of the tumor, in the patient clinical context, were consistent with subcutaneous metastasis of a carcinoid tumor of the lung (Fig. 3).