PMC9553713_01
(a) and (b) Dumbbell-shaped swelling involving the buccal and palatal aspect. (c) Intra-oral peri-apical radiograph showing interdental bone loss between maxillary central incisors; (d) CBCT showing bone loss in the mid-alveolus region.
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fig1
The dimension of the buccal swelling was 16 mm x 11 mm and the palatal swelling was 13 x 12 mm approximately (Figures 1(a) and 1(b)). Cone beam computed tomography (CBCT) evaluation revealed that the height of maximum bone loss in the mid-alveolus region of 11 and 21 measured about 10.80 mm (Figures 1(c) and 1(d)).
(a) Distal phalanx lesion on the third digit of the right hand. (b) and (c) Lesion with central necrotic crust involving the chin and forearm.
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fig2
On general examination, the patient presented with cancer cell deposits, presenting as a painless nodular swelling with a central necrotic crust on the tip of the middle finger of the right hand involving the fingernail, chin, scalp, and the upper arm (Figure 2).
(a) Pre-operative view of growth. (b) Immediate post-operative view after excision of the lesion. (c) 3 months post-operative view.
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On the removal of the lesion, the exposed underlying bone showed a moth-eaten appearance, which is characteristic of lytic lesions of the bone (Figure 3).
(a) Scanner view showing cohesive islands of tumour epithelial islands separated from the overlying surface epithelium by a grenz zone. Some tumour islands show central necrosis (4x); (b) Low power view shows cohesive islands of tumour epithelial islands and some tumour islands show central necrosis. (10x). (c) The surface epithelium and infiltrating epithelial tumour islands in the connective tissue were positive for Pan CK (4x). (d) IHC showing positive CK7 staining.
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fig4
The histopathological features were suggestive of infiltrating poorly differentiated adenocarcinoma (Figure 4).
PET scan images showing extensive FDG avid metastases all over the body.
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Fluorodeoxyglucose (FDG) avid metastases in the brain, lung, liver, pancreas, nodes, subcutaneous and intramuscular soft tissue nodules, and sacrum (Figure 5). FDG avid lesions in both breasts were also seen.