PMC2763770_01
CT scan showing enlarged head of pancreas with heterogeneous soft tissue mass measuring 5 x 5 cm. with multiple porta hepatis and paraaortic lymph nodes with no evidence of hepatic focal lesions
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A computerized tomography scan (CT) of the abdomen revealed the enlarged head of pancreas with heterogeneous soft tissue mass measuring 5 x 5 cm with multiple porta hepatis and para-aortic lymph node enlargements and no evidence of hepatic focal lesions (Fig. 1).
The initial clinical eruption at the left side of the neck
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During treatment, she developed asymptomatic violaceous nodules and indurated plaques over the skin on the left side of the neck and she was referred to the dermatology department for consultation (Fig. 2).
Dermis occupied by numerous tumor nests (H&E x100 stain)
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A lymph node biopsy revealed metastatic carcinoma and skin biopsy revealed nests of poorly differentiated atypical cells throughout the dermis (Fig. 3).
Tumor cells show strong membrane staining (CA 19-9 stain H&E x100)
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Silver stain and chromogranin were negative, while EMA was reactive for tumor cells and CA 19-9 was focally positive (Fig. 4).
One month later, after receiving the treatment, the reddish, nontender indurated plaques increased in size to cover the entire left side of the neck
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One month later, while receiving the palliative cytotoxic treatment, the reddish, nontender indurated plaques increased in size covering the left side of the neck (Fig. 5).