PMC3876636_01
Blackening of skin of all the toes on both feet with swelling suggesting venous gangrene
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F1
Blackening of skin of all the toes on both feet with decreased local temperature and tenderness were revealed on local examination of feet. [Figure 1] Multiple nodules over scalp were seen as incidental finding.
CT scan thorax showing left sided massive pleural effusion with atelectasis of left lung
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F2
CT scan thorax were done and revealed left sided massive pleural effusion with atelectasis of left lung.[Figure 2] Pleural fluid study came as lymphocytic, exudative, ADA level 14 IU/ml with presence of malignant cell. Closed pleural biopsy and report suggested as metastatic squamous cell carcinoma.
(a) FNAC from scalp nodule showing atypical cells (yellow arrow) suggestive of metastatic squamous cell carcinoma (H and E x200). (b) Bronchial biopsy showing nuclear hyperchromasia with pleomorphism and keratinisation pearl (yellow arrow) suggestive of squamous cell carcinoma of lung (H and E, x200)
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F3
FNAC from scalp nodule was also positive for metastatic squamous cell carcinoma [Figure 3a]. On fiber optic bronchoscopy, there was an infiltrating growth in left upper lobe bronchus and biopsy suggestive of squamous cell carcinoma [Figure 3b].