PMC5040106_01
Skull base to mid-thigh positron emission tomography-computed tomography, following intravenous injection of 18-fluoro-2-deoxyglucose. Multifocal hypermetabolic foci consistent with a metastatic malignancy with largest mass located in the thorax. (For improved resolution with enlargement of all images, please refer to the digital/online version of the article)
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F1
Several superficial hypermetabolic soft tissue densities were seen including subcutis overlying the upper abdomen and left anterolateral chest wall [Figure 1].
Cytological preparations; Diff-Quik (a and b) and Papanicolaou (c) stained fine needle aspiration smears. (a) Hypercellular specimen; loosely dispersed malignant cells and occasional tumor clusters (x200). (b) Single and clustered tumor cells with marked anisonucleosis and poorly defined cell borders (x400). (c) Prominent cell dissociation and background necrosis. Hyperchromatic nuclei with irregular borders, coarse chromatin, and scant cytoplasm (x400, digitally magnified). (For improved resolution with enlargement of all images, please refer to the digital/online version of the article)
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F2
No pigment or intranuclear inclusions were seen [Figure 2].
Cell block preparation (H and E) (a). Loosely cohesive clusters of malignant cells and background of necrosis (x200) (b). Radiating growth pattern around blood vessels and poor cell-to-cell adhesion (x400) (c). Adipose tissue infiltration by tumor cells (x400) (d). High N/C ratio, coarse chromatin pattern, irregular nuclear contours, occasional conspicuous nucleoli, and scant eosinophilic cytoplasm (x400, digitally magnified). (For improved resolution with enlargement of all images, please refer to the digital/online version of the article)
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F3
Mitotic figures and apoptotic bodies were identified [Figure 3].
S-100 protein expression (immunohistochemistry). (a) Positive control, strong and diffuse immunoreactivity with S-100 antibody. (b) Negative S-100 immunostaining in the current case (both x 400, digitally magnified). (For improved resolution with enlargement of all images, please refer to the digital/online version of the article)
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F4
TTF-1, p40, S-100, synaptophysin, and LCA that all yielded negative results [Figure 4].
Expression of other melanocytic-associated markers (immunohistochemistry). Positive immunostaining for: (a) SOX-10, nuclear (b) HMB-45, cytoplasmic, finely granular (c) Melan-A, cytoplasmic, diffuse (d). Microphthalmia transcription factor, nuclear (all x 400, digitally magnified). (For improved resolution with enlargement of all images, please refer to the digital/online version of the article)
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F5
The third round of stains comprised desmin, CD34, STAT-6, SOX-10, microphthalmia transcription factor (MITF), Melan-A, HMB-45, and INI-1. The lesional cells were immunoreactive with SOX-10, MITF, Melan-A, and HMB-45 and were negative for desmin, CD34, STAT-6, without INI-1 loss [Figure 5].