PMC10009095_01
Right nasal vestibular mass with an exophytic mass on the left nasal domus. (A) Oblique view, (B) frontal view, and (C) lateral view.
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In addition, there was a 1.5 cm exophytic mass on the left nasal domus (Figure 1A-C).
(A) Computerized tomographic (CT) scan of head and neck showing an ovoid mass in the right anterior nostril. (B) CT scan of head and neck showing exophytic mass originating from the right thyroid lobe. (C) CT scan of chest showing large mass in the RULL along with a spiculated mass in the right infrahilar region. (D) Magnetic resonance imaging of the brain showed a large left frontal lobe hemorrhagic mass with severe vasogenic edema resulting in midline shift.. Abbreviation: RULL, right upper lobe of the lung; CT, computerized tomographic.
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In addition, there was a 5.5 cm x 5.2 cm x 3.8 cm mass in the RULL along with a 3.2 cm x 3 cm x 2.3 cm spiculated mass in the right infrahilar region, and a 2.6 cm x 2.1 cm right thyroid lesion and sclerotic lesions in the thoracic vertebrae (Figure 2A-C). Magnetic resonance imaging (MRI) of the brain showed a 4.6 cm x 3.2 cm x 3.6 cm left frontal lobe hemorrhagic mass with vasogenic edema resulting in midline shift and subfalcine herniation along with parietal lesions (Figure 2D).
(A) Positron emission tomography scan with a right upper lobe mass with SUV of 15.3, reflecting site of suspected primary malignancy. (B) Whole-body PET scan with hypermetabolic lesions in lungs, hilum, vertebrae, pelvis, and right shoulder. (C) Hypermetabolic nasal lesion.. Abbreviations: SUV, standardized uptake values; PET, Positron emission tomography.
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There was a right upper lobe mass measuring up to 6.5 cm with SUV of 15.3, favored to reflect the site of primary malignancy, in addition to hypermetabolic lesions in the right hilum, thyroid, brain, prostate, and right proximal femur (Figure 3A-C).
(A) H&E (hematoxylin and eosin) sections show multiple infiltrating squamoid nest of poorly differentiated malignant cells with comedo necrosis. (B) The pleomorphic malignant cells are medium-to-large size with prominent nucleoli. Frequent mitotic figures and apoptotic cells are also present. (C and D) Both TTF-1 and CK7 highlight malignant cells, which favor adenocarcinoma. (E and F) CK5/6 and p40 highlight malignant cells and favor squamous cell carcinoma.. Abbreviations: TTF-1, thyroid transcription factor-1; CK7, cytokeratin 7; CK5/6, cytokeratin 5/6; ALK, anaplastic lymphoma kinase; BRAF, v-raf murine sarcoma viral oncogene homolog B1.
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Histopathology of right nasal vestibule biopsy revealed poorly differentiated non-small cell carcinoma with squamous and glandular features (Figure 4A and B). The stains were positive for positive for epithelial membrane antigen (EMA), anti-human epithelial antigen (Ber-EP40), thyroid transcription factor-1 (TTF-1), and cytokeratin 7 (CK7), which are markers for adenomatous differentiation (Figure 4C and D), while also being positive for cytokeratin 5/6 (CK5/6) and p40 marker for squamous differentiation (Figure 4E and F).