PMC4090488_01
Large number of bulky, hyperemic nodules on the (a) face and (b) scalp.
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Fifty-two-year-old male patient has presented with recently increased complaints which started 1 year ago such as pain in his waist, back, and hips, and 2 months prior to his hospital visit maculopapular and erythematous lesions (Figure 1) appeared on his arm.
(a) Invasive and signet ring celled tumor infiltration on the dermis between the collagen fibers (HEX200). (b) In the paratrabecular area between the bone trabeculas, fibrosis and signet ring celled tumor are being observed (HEX100). (c) Signet ring cell-like tumor cells with large hyperchromatic nucleus in the stomach mucosa (HEX200). (d) HER-2-neu positiveness determined by the FISH method in the nucleus.
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In its pathology, tumoral tissue which has the feature of a signet ring cell (Figure 2(a)) was seen at some areas of malign epithelial tumor metastasis that was positively stained with Pan CK applied with immunohistochemical (IHC) method and negatively stained with CD20, CD3, LCA, S-100, and CD68 and biopsies of skin metastases were negatively stained with Her-2. According to the BM biopsy performed due to thrombocytopenia, Pan CK, mucin, PAS, d-PAS, and Her-2 were reported as positive, and hypercellular BM was observed including malign epithelial tumor cells with a signet ring cell view (Figure 2(b)). As a result of the examination of the pathology of the multiple biopsies taken from the mass lesion by IHC method, it was reported as signet ring cellular carcinoma which was diffuse strong positive with CK7, showed mucicarmine and intracytoplasmic staining with PAS, and was 40% 3+ with Her-2 (Figure 2(c)). The positiveness of Her-2 was verified by the fluorescent in situ hybridization (FISH) method (HER-2-neu/CEN 17 = 116/25 = 4.6) (Figure 2(d)).
This figure shows no 18F-fluoro-2-deoxi-D-glucose (FDG) involvement except bone metastases in PET ((a) coronal section and (b) sagittal section).
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In the axial and appendicular skeletal system, lytic/sclerotic and heterogeneous diffuse/local hypermetabolic changes on FDG PET were detected (Figures 3(a) and 3(b)).
Progression of Her-2 negative skin metastases after 6th cycle of chemotherapy. (a) Face and (b) scalp.
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However, Her-2 negative skin metastases were progressed after 6 cycles of chemotherapy (Figure 4).