PMC8573489_01
Images of the patient's right shoulder and dynamic serum alpha-fetoprotein levels throughout the episode of care. (a) Positron emission tomography-computed tomography image on admission, (b) T1-weighted magnetic resonance imaging scan with contrast on admission, (c) disease progression after first-line chemotherapy, (d) tumor progression after second-line chemotherapy, and (e) changes in serum Epstein-Barr virus (EBV) DNA status (blue) and serum alpha-fetoprotein levels (red) during treatment.
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Subsequent positron emission tomography-computed tomography (PET/CT) scanning indicated bone destruction in right scapula (Figure 1). Contrast-enhanced ultrasonography and MRI examinations of the liver showed no tumor site (Figure S1).
Representative images of hematoxylin and eosin staining and immunohistochemistry assay in (a-l) paraffin-embedded nasopharynx and (m-t) scapular mass tissues. (a) Hematoxylin and eosin staining of the nasopharynx sample biopsy confirmed the diagnosis of undifferentiated non-keratinizing carcinoma. Immunohistochemistry assay showed positive results for (b) CK, (c) CAM5.2, (d) EMA, (f) CK5/6, (g) and P40 in the nasopharynx sample biopsy; and negative results for (h) AFP, (i) HepPar, (j) GPC3, (k) CgA, and (l) HMB 45. (m) For the scapular mass biopsy, hematoxylin and eosin staining showed that the tumor comprised sheets of malignant cells with vesicular chromatin and prominent nucleoli; Tumor-infiltrating lymphocytes are conspicuous, maintaining identical morphology to primary lesions. Immunohistochemical staining showing positive expression of (o) CK and (n) P63. Tumor cells were negative for EBV-encoded small RNA by in situ hybridization in the (p) scapular mass and (e) nasopharynx tissue biopsies. (q) Tumors were positive for patchy alpha-fetoprotein by immunohistochemistry assay, and (r) alpha-fetoprotein mRNA was detected within the neoplasm by RNA in situ hybridization. According to immunohistochemistry assays, the tumor was negative for HepPar (s) and GPC3 (t).
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Immunohistochemistry examination indicated that the tumor was positive for pan cytokeratin (AE1/AE3) and negative for LCA, HepParl, and glypican-3 (Figure 2(m)-(t)). Immunohistochemistry assay results indicated that the tumor was positive for pan cytokeratin (AE1/AE3), CK5/6, p40, CAM5.2, EMA, and INI; and negative for Syn, CgA, CD56, MPO, CD20, CD3, CD 43, HMB 45, Melan-A, and S-100 (Figure 2(a)-(l)). Figure 2(a) and (m) represent histological view of the primary and recurrent tumors, which shows similar morphologic traits.