PMC4976921_01
Patient photos.. Notes: (A) Two years ago, normal skin color. (B) Before treatment. (C) After treatment.
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After that, he noticed a gradual blackening of dorsum on both hands and face during one year (Figure 1).
The patient's chest X-ray.. Notes: (A) Before treatment, nearly normal. (B) After treatment. The arrow represents the minimal enlargement of mediastinal lymph node.
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His chest X-ray looked roughly normal, but during careful investigation of the hilar area, we noticed some minimal enlargement (Figure 2).
Patient's chest computed tomography (CT).. Notes: (A and C) Before treatment. (B and D) After treatment. The arrows represent the minimal enlargement of mediastinal lymph node.
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The CT scan revealed mediastinal lymphadenopathies and a millimetric lesion on the left upper lobe (8 mm; Figure 3).
Biopsy images.. Notes: (A) EBUS-FNA for mediastinal subcarinal lymph node: cytological appearance of nonkeratinizing squamous cell carcinoma. Sheets of atypical squamous cells with large hyperchromatic nucleus, dense squamoid cytoplasm, and moderate pleomorphism are observed (MGG stain, original magnification x400). (B) A cell block section of tumor displaying few small atypical small squamous islands and scattered lymphocytes showing crushing artifact in a fibrinous background (H&E stain, original magnification x400). Cell block immunohistochemistry of the tumor: tumor cells display strong nuclear p63 (C) and cytoplasmic cytokeratin 5/6 (D) positivities, which are characteristics for squamous cell carcinoma.. Abbreviations: EBUS-FNA, endobronchial ultrasound-guided transbronchial fine-needle aspiration; MGG, May-Grunwald-Giemsa; H&E, hematoxylin and eosin.
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We performed an endobronchial ultrasound, and the cytological examination of mediastinal lymph node biopsy was reported to be consistent with squamous cell lung cancer (Figure 4).
The lesion manifests epidermal acanthosis and papillomatosis with increased deposition of melanin pigment along the epidermal basal layer (H&E stain, original magnification x46).. Abbreviation: H&E, hematoxylin and eosin.
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These biopsies confirmed to be consistent with AN (Figure 5).
The patient's hands.. Notes: (A) Before treatment, tripe palms. (B) After treatment.
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The patient skin and oral mucosal lesion healed after the treatment (Figure 6).