PMC7364794_01
Tumor from the nasopharyngeal mass and the lung. (a) The tumor in the nasopharynx is composed of dyscohesive cells, with abundant acidophilic cytoplasm, and large pleomorphic nuclei, with prominent nucleoli (H&E X40). Some tumor cells contain vacuolated cytoplasm containing mucin as highlighted by mucicarmine special stain (inset). (b) The tumor cells are diffusely positive for TTF-1 (X40). A biopsy was obtained from the lung mass that showed (c) poorly formed glands with pleomorphic nuclei (H&E X40) and (d) positive TTF-1 immunostain (X40).
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PMC7364794_01_10.1177_2050313X20939826-fig1.jpg
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Review of the biopsy at our center revealed the presence of poorly cohesive pleomorphic cells with abundant acidophilic and focally vacuolated cytoplasm (Figure 1(a)). The tumor cells were immunoreactive for CK7 (not shown) and thyroid transcription factor-1 (TTF-1) (Figure 1(b)) and negative for CK20, PAX8, CDX2, and S100 immunostains (not shown). The mass in the upper lobe of the left lung was then biopsied and diagnosed as a poorly differentiated adenocarcinoma (Figure 1(c)) immunoreactive for TTF-1 (Figure 1(d)) and CK-7 (not shown), similar to the metastatic carcinoma in the nasopharynx.
Maximum intensity projection image (MIP) of the FDG-PET/CT scan. (a) The red arrow points toward the intensely hypermetabolic left lung mass and the green arrow points toward the hypermetabolic right nasopharyngeal lesion. (b) shows an axial fused PET/CT image at the level of the nasopharynx, the green arrow demonstrates the abnormal FDG metabolic activity in the right side of the nasopharynx, at the Rosenmuller fossa. (c) shows an axial fused PET/CT image at the thorax, the blue arrow demonstrates the intensely hypermetabolic left upper lobe lung mass; the green arrow points toward the hypermetabolic mediastinal lymph nodes in the aorto-pulmonary (A-P window) group. (d) shows an axial fused PET/CT image and the green arrow points toward the hypermetabolic left axillary lymph nodes.
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PMC7364794_01_10.1177_2050313X20939826-fig2.jpg
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Maximum intensity projection image of the FDG-PET/CT scan demonstrated an intensely hypermetabolic left lung mass and a hypermetabolic right nasopharyngeal lesion (Figure 2(a)). Axial fused PET/CT images at the level of the nasopharynx demonstrated the abnormal FDG metabolic activity in the right side of the nasopharynx, at the Rosenmuller fossa (Figure 2(b)). In the thorax, an intensely hypermetabolic left upper lobe lung mass was seen, as well as hypermetabolic mediastinal lymph nodes in the aorto-pulmonary (A-P window) group (Figure 2(c)). Axial fused PET/CT images also demonstrated hypermetabolic left axillary lymph nodes (Figure 2(d)).