PMC4239128_01
(10x magnification) biopsy of the liver lesion shows a poorly differentiated neoplasm in a desmoplastic stroma.
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figure1
The tumour was negative for CK20, CA-125, TTF-1, NapsinA, Brst2, GATA3, oestrogen receptor (ER), progesterone receptor (PR), and Her2 (Figures 1-3).
(40x magnification). High-power magnification of the tumour shows pleomorphic cells without significant mitotic activity, inclusions, or pigment.
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figure2
The tumour was negative for CK20, CA-125, TTF-1, NapsinA, Brst2, GATA3, oestrogen receptor (ER), progesterone receptor (PR), and Her2 (Figures 1-3).
Immunohistochemical workup shows the tumour was strongly and diffusely positive for CK7 (10x magnification).
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figure3
The tumour was negative for CK20, CA-125, TTF-1, NapsinA, Brst2, GATA3, oestrogen receptor (ER), progesterone receptor (PR), and Her2 (Figures 1-3).
PET scan before (upper panel A) and two months after dabrafenib and trametinib combination (lower panel B), showing improvement in liver metastasis (blue arrow), resolution of malignant left pleural effusion and lung nodules (red arrow) and improvement of bone metastasis (blue circle).
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figure4
There was also evidence of new hypermetabolically active mediastinal and bilateral hilar lymph nodes, a 1.7 cm right lower lobe consolidation/nodule, a 3.1 cm left lower lobe mass, new active osseous metastases in the right first rib and right femoral neck, and other scattered metabolic areas of consolidation in the right lung (Figure 4, panel A).