PMC6148153_01
Diffuse palpable purpuric rash over the forearm.
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A diffuse palpable purpuric rash was noticed over the upper and lower extremities, suggestive of vasculitis (Figure 1). Abdominal examination showed tender hepatomegaly with a liver span of 18 centimeters, with no ascites or splenomegaly.
Multiple low attenuated lesions of varying size distributed throughout the liver.
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CT of the abdomen showed multiple low, attenuated lesions of varying size distributed throughout the liver, the largest 4x5 centimeters, located in segment 7 (Figure 2).
Multiple abnormal signal intensity areas at T8, 9, 11, 12 and L1 consistent with bony metastasis.
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MRI of the spine showed multiple abnormal signal intensity lesions at T8, T9, T11, T12 and L1, consistent with bony metastasis, but there was no evidence of spinal cord compression (Figure 3).
Ocreotide scan of whole body images after injection of 219 MBq of Indium111 ocreotide (negative for uptake).
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An octreotide scan of whole body images following injection of 219 MBq of indium111 octreotide, by FDP-PET (fluorodopa-positron emission tomography), showed no uptake, and was therefore negative (Figure 4).
(A) Fine needle aspiration of the liver showing a highly cellular smear and clusters of individual cells with eccentric nuclei and abundant cytoplasm. (B) Cell stain positive for synaptophysin and chromogranin.
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A fine-needle aspiration from the liver mass was consistent with a neuroendocrine tumor; the cell stain was positive for synaptophysin and chromogranin, which are neuroendocrine tumor markers (Figure 5).