PMC9170962_01
(A) Positron emission tomography and computed tomography (PET-CT) showed a multiple bone destruction with bone metastases including whole vertebra, occipital bone, ribs of double side, appendicular skeleton, and pelvis. (B) PET-CT showed a whole vertebra metastatic Primary EMPD, showing that a most obvious SUV of 18.9.
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F1
Positron emission tomography computed tomography (PET-CT) showed erosion and metastatic nodules in the occipital bone, entire vertebra, bilateral ribs, appendicular skeleton and the pelvic bone (Figures 1A,B). Sequencing analysis of the biopsied specimens revealed a mutation in AMER1 exon 2 (c.1724G > A, p.R575Q) (Supplementary Figure 1), which has been identified as the causative mutation of aberrant PI3K/AKT/mTOR signaling in gastric cancer cells, and promotes the progression and metastasis of gastric cancer.
The perineal lesions were about 4 cm x 3 cm in size, with obvious rash, erythema and erosion, accompanied by pruritus, no pain and exudation.
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F2
However, based on the clinical presentation and case history, we suspected that the primary tumor was eczema of scrotum (Figure 2).
(a) In epidermis and dermis, there are abundant pale-staining cytoplasmic, which are flaky, small nests or scattered cells in HE staining, involving both the dermis and skin appendages. Left arrow: Paget cell. Right arrow: infiltrating adenocarcinoma. (b) Positive expression of CK (7) in EMPD section 100x. (c) Negative expression of CK (20) in EMPD section 100x. (d) Negative expression of CD (56) in EMPD section 100x. (e) Negative expression of ChrA in EMPD section 100x. (f) Focal positive expression of synaptophysin in EMPD section 100x.
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F3
HER2 (2+), ER (1+), CEA (3+), and synaptophysin (focal+), and negative for CK20, P16, S-100, HMB-45, P40, PR, CD56, and ChrA. However, the FISH test for HER2 was negative (Figure 3).
(A) Positron emission tomography and computed tomography showed the patient achieved partial response (PR) according to the mRECIST1.1 on metastatic lesions. (B) PET-CT showed a whole vertebra metastatic Primary EMPD, showing that a most obvious decrease of SUV from 18.9 to 5.3.
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F4
The total PET-CT scan (Figures 4A,B), showed an obvious decrease in SUV from 18.9 to 5.3, and the serum level of