PMC8777097_01
Clinical, HRCT and histological features of our patient. (A) Multiple flesh-colored to pinkish papules and nodules were noted on his face (before treatment). (B) Flesh-colored to pinkish papulonodular lesions were observed on the right hand (before treatment). (C) Flesh-colored to pinkish papulonodular lesions were observed on the left hand (before treatment). (D) HRCT of the chest revealed a mass of lymphoglandula within the posterior mediastinum. (E) Biopsy of papule skin lesions showed proliferation of abundant foamy macrophages and histocytes in the dermis (HEx400). (F) Dermal and epidermotropic foamy macrophages were strongly positive for CD68 (x200).
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On admission, a physical examination revealed multiple flesh-coloured to pinkish papules and nodules on his face ( Figure 1A ), distal interphalangeal and proximal interphalangeal areas, and papulonodular lesions arranged around the nail plica in a typical "coral bead" pattern ( Figures 1B, C ). High-resolution computed tomography (HRCT) of the chest revealed emphysema and an inconspicuous mass of lymphoglandula within the posterior mediastinum ( Figure 1D ). On day 7, the histopathologic features of the papulonodular skin lesions showed proliferation of abundant foamy macrophages and the presence of histocytes ( Figure 1E ). These lesions contained CD68-positive cells ( Figure 1F ) that were negative for S100, CD1a, Langerin, and Factor VIII markers ( Supplementary Material 2 ).
FDG-PET/CT showing increased glycometabolism in the mediastinal lymph nodes and soft tissue around the joints of the extremities (A, B).
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TTF-1, P63, D2-40 and CgA were negative, and a diagnosis of epithelial neoplasia was made. To identify the primary lesion, fluorodeoxyglucose positron emission tomography/CT (FDG-PET/CT) was carried out, revealing increased glycometabolism in the soft tissue around the joints of the extremities and the mediastinal lymph nodes; the subcarinal lymph node findings confirmed the suspicion of malignancy ( Figure 2 ).
Clinical course of the patient.  Date of admission;  Date of discharge;  Date of chemotherapy; EBUS, Endobronchial ultrasound; MDT, Multidisciplinary treatment; VATS, Video-assisted thoracoscopic surgery.
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The patient's clinical course is shown in  Figure 3 .