PMC9938399_01
Bone scan - panels showing anterior and posterior views demonstrating multiple foci of involvement. Arrows point to a select number of metastatic bone lesions.
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F1
This led to a bone scan that revealed "multiple sclerotic metastatic lesions" (shown in Fig. 1).
Pericardial fluid on cytospin [Wright-Giemsa x50] showed hemorrhagic fluid sample with erythropoiesis - erythroid precursors at various stages. A Orthochromic normoblast. B Polychromatic normoblast. C Basophilic normoblast. D Pronormoblast.
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F2
The pericardial fluid cytology report was negative for malignancy; however, the cytospin morphology showed a hemorrhagic sample with a large number of erythroid precursors characteristic of EMH present (shown in Fig. 2).
Panel a: bone marrow biopsy [H&E x20] showed aggregates of neoplastic cells having mostly signet cell appearance. Arrows point to a select number of signet ring cells. Panel b: bone marrow biopsy [PAS x40] showed nuclei that were peripherally located and the cytoplasm was PAS [periodic acid Schiff] positive, indicating mucin production. Arrows point to a select number of signet ring cells. Panel c: bone marrow biopsy [Pan keratin x20] showed neoplastic cells with strong staining for pan keratin marker, confirming the diagnosis of metastatic carcinoma.
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F3
TTF-1, CDX-2, and CK20 (shown in Fig. 3). This along with another repeat thoracocentesis were consistent with adenocarcinoma, likely of gastrointestinal or pancreaticobiliary origin.