PMC9512062_01
A thick, hard, multiple grape-like appearance of nodules in and around the lower chest, abdominal wall, upper thighs, and buttocks.
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On physical examination (Figure 1), the patient had a huge lump with bunches of grape-like appearance in the abdominal wall.
PET/CT: High uptake of 18F-FDG was noted in some left clavicular fossa nodes (A), retroperitoneal lymph nodes, and nodules of the abdominal wall (B) (red arrows).
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The other FDG-positive pathological lesions were also observed in the superior apical segment of the right lung, multiple enlarged lymph nodes in bilateral neck roots, left upper and lower clavicular fossa (Figure 2A), mediastinum, double hilum, parastinum, sternum, retroperitoneum (Figure 2B), left side of rectum and bilateral iliac vessels, nodules in the upper right posterior lobe of the liver, as well as the left upper femur and nodules of the abdominal wall (Figure 2B).
Histological staining: Signet ring cells (white arrows) and dilated lymphatic vessels (A) (hematoxylin-eosin staining, x 200).The lesional cells were immunoreactive for CK7 (B), CK20 (C) and villin (D) (immunostaining, x 200).
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There was lymphatic dilation, and dermal mucin deposition in both lesions, but with scattered cells having a signet-ring morphology within the deep reticular dermis and subcutis only in the dark red patch (Figure 3A). Lesion cells stained positive with cytokeratin (CK), Cam 5.2, CK 7, CK 20 and Villin (Figure 3B-D), while negative with S100, caudal type homeobox 2 (CDX 2), thyroid transcription factor -1 (TTF-1), estrogen receptor (ER), and gross cystic disease fluid protein-15 (GCDFP-15). 