PMC10208082_01
Severe hypercalcaemia (19.8 mg/dL) was corrected with intravenous (IV) fluid therapy, IV sodium pamidronate (90 mg, single dose, on day 1) and intramuscular (IM) salmon calcitonin (300 I.U. q12 h, on days 1-3). Normocalcaemia was achieved on day 4.
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fig-1
Head CT scan revealed extensive osteolytic lesions, the largest in the right parietal (A) and left occipital (B) regions.
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fig-2
Thoracicabdominopelvic CT scan revealed extensive consolidation to the lower lobe of the left lung with foci of necrosis (A) and presumably metastatic lesions to lymph nodes, peritoneal cavity and bones (B).
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fig-3
We continued the study with cervicothoracoabdominopelvic contrast-enhanced CT (Figs. 3A and 3B), which revealed an extensive area of consolidation to the lower lobe of the left lung and cervical, supraclavicular, axillary and mediastinal adenopathies, the latter with hypodense centre probably reflecting necrosis.
Cell block of the cervical lymph node biopsy. (A) Neoplasm with solid and focal acinar pattern. Both components are composed of cells with eosinophilic cytoplasm, increased nucleus-cytoplasm ratio, pleomorphic nuclei and prominent nucleoli, HE 100x magnification. (B) Acinar component of the neoplasm, HE 400x magnification. (C) Immunohistochemistry for CK7, highlighting the acinar differentiation, 400x magnification. (D) Immunohistochemistry for CK5/6, highlighting the epidermoid component, 100x magnification.
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fig-4
Despite being negative for TTF1, the sample was compatible with adenosquamous cell carcinoma of the lung (Fig. 4).