PMC9154144_01
(a) Swelling in the anterior neck; nodules and ulcer in the anterior chest. (b) Ulcer in the presternal area with nodules in the periphery
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F1
On examination, a single ulcer of size 3 x 2 cm with irregular margins, purulent base with rolled edges, and tender on palpation was present over the presternal area in the upper part surrounded by multiple skin-colored discrete nodules of varying sizes ranging from 2 x 1 cm to 0.5 x 0.5 cm along with few nodules coalesced to form plaques of varying sizes ranging from 4 x 2 cm to 3 x 2 cm, hard in consistency with skin adherent to the nodule were present over the front of the chest in the periphery of the ulcer [Figure 1a and b].
(a) Metastatic deposits in mid-to-deep dermis and inflammatory infiltrates in the upper dermis (hematoxylin and eosin x10). (b) Tumor cells in cords and strands admixed with colloid in 2'o clock position:black arrow showing colloid (hematoxylin and eosin x 40). (c) Tumor cells engulfing eosinophilic amorphous material (hematoxylin and eosin x 40). (d) Pleomorphic cells with hyperchromatic small nuclei (hematoxylin and eosin x 100)
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F2
Skin biopsy showed a large nodular collection of metastatic deposits containing pleomorphic cells involving mid-to-deep dermis with one or two focal collections in the upper dermis [Figure 2a]. Those pleomorphic cells have atypical round cells with pale blue cytoplasm and hyperchromatic small nuclei [Figure 2d] of varying sizes in the center of the cells arranged in an acinar pattern engulfing eosinophilic amorphous colloid material trapped within [Figure 2c]. Tumor cells are also arranged in irregular strands and cords with large atypical oval to ellipsoidal cells admixed with colloid, especially in the deeper dermis [Figure 2b].