PMC6160265_01
Imaging of scalp nodules, lung cancer, and its metastatic lesions.. Notes: (A, B) Multiple nodules in scalp and neck regions. (C) Brown spots in the labial mucosa. (D) A large tissue mass occupied the upper lobe of the left lung on PET-CT. (E) Multiple bones metastasis with increased metabolism on PET-CT. (F) Multiple ring-enhanced lesions in the brain parenchyma on Gd-enhanced MRI.. Abbreviation: PET-CT, positron emission tomography-computed tomography.
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On physical examination, multiple red nodules and papules were seen in the scalp and the neck (Figure 1A and B). Hyperpigmented patches were seen on the lower lip (Figure 1C). The mediastinal and hilar lymph nodes were enlarged (Figure 1D). In addition, bones were destructed extensively with increased metabolism, suggesting bone metastasis (Figure 1E). Multiple ring-enhanced lesions in the brain parenchyma were seen on Gd-enhanced brain magnetic resonance imaging (Figure 1F).
Histopathologic finding of scalp lesions.. Notes: (A, B) Hematoxylin and eosin staining showed circumscribed tumors in the middle and deep dermis, with tubulopapillary structures. Numerous papillary folds projecting into the cystic spaces were also seen. (C) High magnification showed round or oval nuclei, and some cells revealed atypia. Each of the numbers HE 40, HE 200, and HE 400 denotes the magnification of a microscope. (D-H) Immunohistochemical staining showed that nuclear negativity for P63 (D) and CK5/6 (E), and positivity for GCDPF-15 (F), CK7 (G), and TTF-1 (H).. Abbreviation: HE, hematoxylin and eosin.
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Numerous papillary folds projecting into the cystic spaces and tubulopapillary structures were also seen (Figure 2A and B). The tumor cells ranged from cuboidal to columnar, with nuclear pseudostratification and atypical features (Figure 2C). Immunohistochemically, tumor cells were positive for CK7, GCDFP-15, TTF-1, CA19-9, and CEA and negative for P63, CK5/6, SMA, S-100, and CK20 (Figure 2D-H).
Imaging of lung cancer on CT.. Notes: (A) Large masses involving the left upper lobe associated with extensive mediastinal lymphadenopathy in June 2016. (B) After the first cycle of chemotherapy for 1 month, the large tissue masses in the lung decreased in size in July 2016. (C, D) The decreasing tissue masses in the lung on a followed-up CT in September 2016 and November 2016.. Abbreviation: CT, computed tomography.
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The evidence of a decrease in the size of the mass in the upper lobe of the left lung was observed during a CT of the lung done in June 2016, July 2016, September 2016, and November 2016, respectively (Figure 3).