PMC6022268_01
MRI brain: three abnormal bone marrow lesions (left clivus, right clivus, and occipital bone). The right clivus lesion appears to extend to the dura along the medial aspect of the middle cranial fossa which is likely the cause of cranial nerve sixth palsy. (a) Axial section at the level of the pons. (b) Axial section at the level of the medulla. (c) Sagittal section.
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CVA was ruled out; however bone marrow lesions involving the left and the right clivus, right Meckel's cave, and posterior margin of the right cavernous sinus were noted (Figure 1).
CT abdomen and pelvis: (a) bulky retroperitoneal adenopathy of the abdomen as well as bilateral iliac chain adenopathy. (b) Enlargement and nodularity of the uterus are seen, worrisome for diffusely infiltrative carcinoma.
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In addition, multiple pulmonary nodules were noted along with L sided neck, mediastinal, and right hilar adenopathy (Figure 2).
Cervical biopsy (40X): the infiltrative carcinoma is largely distorted by crush artifact. A preserved intravascular focus of carcinoma (arrow and inset A, 500X) is characterized by cells with variable clear to eosinophilic cytoplasm, round to oval nuclei, delicate chromatin, and punctate nucleoli. Scattered apoptotic cells are noted. The tumor cells are strongly immunoreactive for neuroendocrine markers synaptophysin (inset B, 400X).
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Cervical biopsies were obtained disclosing LCNEC of the cervix (Figure 3).