PMC5967207_01
(A) Arrow shows ulcerative growth in tonsillar fossa on the left side, and (B) arrow shows growth in the left tonsillar fossa on computed tomography scan image.
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F1
A 29 yr old male patient  presented to the Medicine department of GSL General Hospital at Rajamundry, India, in December 2015 with an ulcerative growth in the left tonsillar fossa and ear ache (Fig. 1A, B).
(A) Arrow shows hyper- and hypopigmented maculae and papules over lower limbs, and (B) arrows show hyper- and hypo-pigmented maculae and papules over upper limbs and absence of thumbs.
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F2
Areas of both hyper- and hypopigmentation were found on extremities with deformed right forearm and absence of thumbs in both hands (Fig. 2A, B).
(A) Arrow shows hypoplasia of radius and absence of thumb in the X-ray of the right forearm, and (B) arrow shows the absence of pisiform and trapezium bones in the X-ray of left forearm.
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F3
X-ray of forearms and wrist revealed hypoplastic radius on the right side and absence of pisiform and trapezium carpal bones on the left side (Fig. 3A, B).
(A) Arrow in the microphotograph of bone marrow picture shows 40 per cent cellularity with normal erythropoiesis, granulopoiesis and reduced megakaryopoiesis (H and E, x400) and (B) arrow in the microsection of tonsillar growth shows invasive nests, trabeculae and tongue-like processes of malignant squamous cells (H and E, x400).
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F4
Biopsy from the tonsillar growth demonstrated moderately differentiated squamous cell carcinoma (Fig. 4A, B).
(A) Chromosomal breakage study shows normal chromosomal pattern, (B) arrow shows markedly increased chromosomal breakage and rearrangement after treatment with mitomycin C.
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F5
Chromosomal breakage study displayed marked breakage (7.0/metaphase) compared to control (0.5/metaphase) and rearrangement after treatment with mitomycin C (Fig. 5A, B).