PMC6205346_01
Clinical and biopsy images of the patient. (A) PET maximum intensity projection image at the first visit. Abnormal fluorodeoxyglucose (FDG) uptake is observed in the right chest or upper abdomen. The kidneys, urinary bladder, and part of the left ureter are also imaged in the abdomen. (B) Coronal PET/CT images identifying a mass in the right lung with FDG accumulation (left panel; arrow) and a cystic liver lesion (right panel). Uptake is seen in the cystic lesion (arrowhead). (C) Histopathological biopsy image: atypical cells with large nuclei and amphophilic cytoplasm proliferating in a hobnail pattern. Original magnification: x200.
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She visited our hospital and positron emission tomography and computed tomography (PET/CT) imaging found right lung and liver lesions (Fig. 1A and B). Histologically, atypical cells with large nuclei and amphophilic cytoplasm proliferated in a hobnail pattern (Fig. 1C) and were positive for cytokeratin (CK) 7 and napsin A (both cytoplasmic); CK20 (cytoplasmic) and thyroid transcription factor 1 (TTF-1) (nuclear) were negative (data not shown).
Gross and microscopic morphology of the lesions in the peritoneum. (A) Cut surface of the left lower abdominal lesion. Milky whitish and multinodular mass is observed. (B) Histopathological image of representative lesion: atypical cells with large nuclei and clear or pale eosinophilic cytoplasm forming papillary structures. (C) and (D) IHC analysis of the tumor: Tumor cells are positive for (C) napsin A in the cytoplasm and (D) PAX8 in the nucleus. Original magnification: x200.
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We found milky whitish cauliflower-like tumors, often with hemorrhage or mucin production, disseminated in the peritoneum, especially in the lower left abdomen (Fig. 2A). Histologically, the masses comprised atypical cells with large nuclei and clear or pale eosinophilic cytoplasm forming papillary structures (Fig. 2B). On immunohistochemistry (IHC), the tumor cells had identical immunophenotype to the lung biopsy specimen for CK7, CK20, TTF-1, and napsin A (Fig. 2C). In addition, nuclear staining for paired-box gene 8 (PAX8) was also positive, suggesting carcinoma of Mullerian origin (Fig. 2D).