PMC6885228_01
X-ray of left foot (AP lateral oblique views) demonstrating bony destructive lesion of the 2nd left toe.
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fig1
An X-ray of the foot revealed bone destruction involving the left second distal phalanx (Figure 1).
Lung adenocarcinoma metastasis to the left second toe. (a, b) The H&E section shows the dermal infiltration of adenocarcinoma; the tumor cells are arranged in a glandular growth pattern. No involvement of epidermis ((a) H&E 20x; (b) H&E 200x). (c, d) The immunohistochemical (IHC) stains reveal the tumor cells to be positive for CK7 ((c) 100x) and TTF-1 ((d) 100x), while negative for CK20, CDX-2, PAX-8, and NKX3.1 (data not shown). The previous lung fine needle aspiration slides were reviewed and found to be similar to the current specimen. Taken together, the morphology in combination with the immunoprofile are consistent with metastatic adenocarcinoma of the primary lung.
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fig2
He underwent a disarticulation and partial amputation of middle phalanx with pathology that was consistent with metastatic adenocarcinoma of the lung (Figure 2).
CT and fused PET/CT imaging (axial). (a, b) Staging CT and fused PET/CT of the base of the skull to midthigh showing a FDG avid mass in the left lower lobe of the lung with adjacent left hilar lymphadenopathy. Max SUV 14.83. (c, d) Restaging CT and fused PET/CT of the full body approx. 4 months after initiation of chemotherapy showing reduction in size of FDG avid mass in the left lower lobe of the lung with adjacent left hilar lymphadenopathy.
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fig3
Four months after initiation of chemotherapy, there was found to be an interval decrease in size and FDG activity of the left lower lobe lung mass on PET imaging (Figure 3).