PMC3999573_01
Inspection reveals an ulcerated tumor in the left lower gingiva.
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F1
On clinical examination, an ulcerative, circumferential tumor that arose in the left lower gingiva was visible (fig. 1).
Immunohistochemical examinations for adenocarcinoma are positive for CK20 (a) and CDX-2 (b), but negative for CK7 (c) and TTF-1 (d).
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F2
On the fifth day after the referral, the results of the immunohistochemical staining for adenocarcinoma turned out to be positive for CK20 and caudal-related homeobox transcription factor (CDX-2), and negative for CK7 and thyroid transcription factor-1 (TTF-1) (fig. 2).
a PET/CT with sagittal reconstruction reveals a large amount of FDG uptake behind the bladder. b Colonoscopy demonstrates a circular ulcerative tumor in the upper rectum.
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F3
Moreover, PET-CT showed an accumulation of 18F-fluorodeoxyglucose (FDG) with an SUVmax of 19.0 in the upper rectum (fig. 3a). Based on these additional findings, the patient was persuaded to undergo a colonoscopic examination, which then revealed advanced rectal cancer (fig. 3b).