PMC6151222_01
T2 sagittal MRI cervical and lumbar spine.
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fig1
T11, T12, L3, L4 vertebral bodies, right sacrum, and ilium that were concerning metastatic disease. There was effacement of the right lateral recess and right neural foramen at the L3-L4 and effacement of the left lateral recess and left neural foramen at the L4-L5 due to tumor retropulsion (Figures 1-3).
T2 sagittal MRI lumbar spine.
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fig2
T11, T12, L3, L4 vertebral bodies, right sacrum, and ilium that were concerning metastatic disease. There was effacement of the right lateral recess and right neural foramen at the L3-L4 and effacement of the left lateral recess and left neural foramen at the L4-L5 due to tumor retropulsion (Figures 1-3).
T1 sagittal segment MRI lumbar spine.
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fig3
T11, T12, L3, L4 vertebral bodies, right sacrum, and ilium that were concerning metastatic disease. There was effacement of the right lateral recess and right neural foramen at the L3-L4 and effacement of the left lateral recess and left neural foramen at the L4-L5 due to tumor retropulsion (Figures 1-3).
CT chest with contrast showing enlarged pulmonary artery, mediastinal, and hilar lymphadenopathy.
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fig4
Since the findings were concerning diffuse metastatic disease, a CT scan of the chest, abdomen, and pelvis were performed and showed bilateral hilar and mediastinal adenopathy, mild cardiomegaly, and dilated main pulmonary artery measuring 3.6 cm (Figures 4 and 5).
CT chest with contrast showing lesions in the ribs and sternum.
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fig5
Since the findings were concerning diffuse metastatic disease, a CT scan of the chest, abdomen, and pelvis were performed and showed bilateral hilar and mediastinal adenopathy, mild cardiomegaly, and dilated main pulmonary artery measuring 3.6 cm (Figures 4 and 5).
CT abdomen/pelvis showing hepatosplenomegaly.
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fig6
Enlarged liver measuring 18.1 cm, enlarged spleen measuring 12.4 cm, and multiple bilateral enlarged pelvic sidewall, external iliac, and inguinal lymph nodes concerning lymphoma or metastatic disease are shown in Figure 6.
Fragments of respiratory epithelium with foreign body giant cells.
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fig7
Due to high suspicion of malignancy, he also underwent an endoscopic bronchial ultrasound with transbronchial needle aspiration of the inferior mediastinal lymph node which found non-necrotizing granulomas but did not reveal any malignant cells (Figures 7-9).
Left inguinal lymph node biopsy with necrotizing granuloma.
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fig8
Due to high suspicion of malignancy, he also underwent an endoscopic bronchial ultrasound with transbronchial needle aspiration of the inferior mediastinal lymph node which found non-necrotizing granulomas but did not reveal any malignant cells (Figures 7-9).
Left inguinal lymph node biopsy demonstrating necrotizing and non-necrotizing granulomas.
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fig9
Due to high suspicion of malignancy, he also underwent an endoscopic bronchial ultrasound with transbronchial needle aspiration of the inferior mediastinal lymph node which found non-necrotizing granulomas but did not reveal any malignant cells (Figures 7-9).
FDG-PET scan extensive hypermetabolic osseous and nodal disease.
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fig10
Since there was concern for a process with high metabolic activity, he also had an 18F-labeled fluorodeoxyglucose (18F-FDG) positron electron topography (PET) scan that was significant for extensive hypermetabolic osseous and nodal disease (Figure 10).