PMC3949738_01
Radiographic study by chest CT scan. (A) CT showing a focal thickening of the mid to distal esophagus. (B) CT showing a new 1.7-cm loculated soft-tissue lesion in the left lower lobe.
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After admission, a chest CT showed a focal thickening of the mid to distal esophagus (Figure 1A), and a new 1.7-cm loculated soft-tissue lesion in the left lower lobe (Figure 1B).
Radiographic study by PET scan. (A) Metabolically active lesion at right L3 pedicle and posterior vertebral body. (B) Metabolically active lesion at left L5 pedicle. (C) Metabolically active lesion within the liver. (D) Metabolically active lesion within the pacreatic head.
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PET showed disseminated metabolically active malignancy, and suspicious findings within the skeleton (Figure 2A, 2B), liver (Figure 2C), pancreatic head (Figure 2D), left pulmonary hilum, and left lower lobe.
Brain MRI showing multiple intracranial masses compatible with metastatic disease.
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Brain MRI showed multiple intracranial masses compatible with metastatic disease (Figure 3).
Immunohistochemical stains of the chest nodule. (A) >10 mitosis/2 mm2 (10 hpf), cytologic features: large size, low N: C, nucleoli, coarse chromatin. (B) Positive immunostaining with TTF-1. (C) Positive immunostaining with chromogranin.
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The pathology report of the nodule confirmed LCNEC (Figure 4A). Thyroid Transcription Factor 1 (TTF-1) (Figure 4B), CD56, Synaptophysin, and chromogranin (Figure 4C). They were negative for CK7, Napsin, cytokeratin 20, GATA-3, mammaglobin, and CEA.