PMC8059040_01
A whole-body positron emission tomography showing a hypermetabolic mass in the lower posterior triangle of the right neck (blue arrow).
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A whole-body positron emission tomography (PET) showed only a hypermetabolic mass in the lower posterior triangle of the right neck (Figure 1).
Magnetic resonance imaging of the brain with contrast showing a 2-cm mass in the right temporal lobe (blue arrow).
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A magnetic resonance imaging of the brain with contrast demonstrated a 2-cm mass in the right temporal lobe (Figure 2).
Pathology from excisional biopsy of the mass with hematoxylin and eosin stain showing tightly packed pleomorphic malignant cells with prominent mitotic activity and necrosis.
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Immunohistochemistry stains on tumor cells were positive for SOX-10, vimentin, and S-100, and negative for cytokeratin AE1/AE3, cytokeratin 5/6, p63, p16, CAM 5.2, EMA, CD45, CD56, CD34, smooth muscle actin, and desmin (Figures 3 and 4).
Immunostaining with SOX-10 positive in the tumor cell nuclei.
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Immunohistochemistry stains on tumor cells were positive for SOX-10, vimentin, and S-100, and negative for cytokeratin AE1/AE3, cytokeratin 5/6, p63, p16, CAM 5.2, EMA, CD45, CD56, CD34, smooth muscle actin, and desmin (Figures 3 and 4).
Repeat whole body positron emission tomography after 7 cycles of treatment showing an increased hypermetabolic activity in the right supraclavicular area (blue arrow) and new hypermetabolic activity in the mediastinal and hilar lymph nodes (arrow heads).
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A repeat whole-body PET/CT after 7 cycles of treatment demonstrated an increase in hypermetabolic activity in the right supraclavicular area and development of hypermetabolic activity in the infraclavicular, hilar, and mediastinal regions (Figure 5).
A repeat computed tomography of the chest after 2 months of treatment with BRAF/MEK inhibitor showing an enlarged mediastinal lymph node (blue arrow).
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A repeat CT after 2 months of treatment with the combination BRAF/MEK inhibitors showed a significant decrease in size of the neck mass; however, mediastinal and hilar lymph nodes had increased in size (Figure 6).
Pathology from fine needle aspiration of mediastinal lymph node with hematoxylin and eosin stain showing giant cells, epithelioid histiocytes, and lymphocytes are present, consistent with granulomatous process.
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He subsequently underwent bronchoscopy and the pathology from the fine needle aspiration of the enlarged mediastinal lymph node showed giant cells, epithelioid histiocytes, and lymphocytes consistent with a granulomatous process, and no malignant cells were found (Figure 7).
A follow-up whole body positron emission tomography after treatment with the combination BRAF/MEK inhibitor and corticosteroids showing resolution of hypermetabolic lymph nodes.
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On subsequent follow-ups, he showed radiological improvement suggested by PET scan, and CT scans of chest (Figure 8).