PMC3295533_01
Histologic section of the inguinal lymph node (a) and anal canal lesion (b) demonstrating small to intermediate malignant cells with little cytoplasm, nuclear molding, necrosis, and apoptosis. Both showed positive immunoreactivity for keratin AE1/3, synaptophysin and were negative for p63 (H&E 400x).
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fig1
Biopsy of the anal canal mass demonstrated small cell carcinoma which was histologically similar to that seen in the inguinal node (Figure 1).
PET scan showing uptake in right inguinal region (a) and anal canal (b).
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fig2
Staging CT of the chest, abdomen, and pelvis, and MRI of the brain did not reveal distant metastatic disease nor a primary lung tumor. 18F-FDG PET scan demonstrated uptake in the anal canal and right inguinal region (Figure 2).
Metastatic disease: (clockwise starting from upper left) left axillary lymph node, pancreatic lesions, multiple brain metastases, and right superior perinephric mass.
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fig3
Pancreas, adrenal gland, liver, breast, lung, brain, and lymph nodes all showed evidence of disease on imaging (Figure 3).