PMC9771712_01
Computed tomography chest November 2021. Fluid has filled the chest tube tract in the right lateral chest wall (arrow).
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Chest computed tomography showed fluid in the chest tube tract (Fig 1).
Physical exam January 2022. A well circumscribed violaceous indurated plaque on the patient's right flank surrounding the site of a previous pleural catheter (arrow) with expansion to the anterior chest.
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On exam, there was a 7 cm erythematous, non-tender scaly patch with poorly defined borders extending out from the former catheter site near the right costophrenic angle towards the anterior chest wall (Fig 2).
Physical exam June 2022. The plaque expanded outwards and became more violaceous. Papules formed in the superior-medial portion of the plaque. Previous catheter site is indicated by the arrow.
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On repeat exam, the patient had an erysipelas-like, indurated plaque with numerous surmounting lustrous papules on the right flank extending to the mid-abdomen measuring 35 cm x 30 cm (Fig 3).
Chest wall punch biopsy. A and B, Diffuse dermal infiltrate composed of large pleomorphic cells with prominent mitotic figures forming glandular structures with evidence of infiltration in vessel lumens (H&E). C, Thyroid Transcription Factor 1 (TTF1) positive cells. D, CK 7 positive cells (E) D2-40 stain demonstrates malignant infiltration of lymphatics.
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These findings were supported with strongly positive TTF1 and CK7 staining (Fig 4).