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case_images: Exophytic erythematous lesion on the tip of the nose with telangiectasia and central ulceration.
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case_images: On examination there was a palpable, exophytic, erythematous lesion with a large telangiectasia and central ulceration located on the tip of the nose (Figure 1).
case_images: (A) Subepidermal infiltration of moderately differentiated squamous cell carcinoma with focal keratinization; the tumor cells showed no epidermotropism. Of note, the overlying epidermis was not dysplastic, as it is often observed in precursor lesions of primary cutaneous SCC. In the superficial dermis prominent dilated lymphatic vessels were found. (hematoxylin and eosin stain - H&E, magnification: 100x). (B) Immunohistochemical study with CD34 antibody (marker of the endothelial cells) revealed numerous thrombi of neoplastic cells in the lumen of dilated thin-walled vessels. (CD34, 100x).
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case_images: The biopsy of the lesion was performed, and the histopathological findings revealed features of partially keratinizing squamous cell carcinoma (SCC) (Figure 2A and B).
case_images: Thoracic HRCT revealed an infiltrative lesion of the upper part of the left lung cavity with dimensions 54x38mm adjacent to the pulmonary artery trunk, entangling the aorto-pulmonary window with bronchial infiltration into segments 1-3 and the upper left pulmonary vein as well as enlarged lymph nodes.
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case_images: Tomography) revealed an infiltrative lesion of the upper part of the left lung cavity with dimensions 54 x 38mm adjacent to the pulmonary artery trunk, entangling the aorto-pulmonary window with bronchial infiltration into segments 1-3 and the upper left pulmonary vein as well as enlarged lymph nodes (Figure 3).
case_images: Infiltration of moderately differentiated squamous cell carcinoma (SCC) of the lung with focal keratinization (inset in top left); features of angioinvasion by tumor cells (arrow). Immunohistochemically the neoplastic cells showed strong expression of p63 and CK5/6, what is typical for squamous cell differentiation in lung tumors (not shown). (H&E, 100x).
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case_images: The histopathological examination of the biopsy taken from this lesion revealed partially keratinizing squamous cell carcinoma, CK5/6 (+), p63 (+) (Figure 4), which in combination with the result of histopathological examination from the skin lesion confirmed the diagnosis of disseminated squamous cell lung cancer. To exclude other metastases, diagnostic imaging was performed, and no other abnormalities were found.
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case_images: The ulceration covered with serous crust including the tip of the nose with the destruction of the right ala of the nose spreading to the upper lip.
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case_images: On examination, there was an ulceration covered with serous crust involving the tip of the nose with a visible destruction of the right ala of the nose spreading to the upper lip (Figure 5).
case_images: Subepidermal accumulation of atypical cells with hyperchromatic nuclei suggesting squamous cell carcinoma (SCC) (arrows) surrounded by subepidermal necrotic cells.
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case_images: The biopsy of the lesion was performed, and histopathological examination revealed a subepidermal concentration of atypical cells with hyperchromatic nuclei suggesting SCC surrounded by subepidermal necrotic cells (Figure 6).
case_images: HRCT revealed eight neoplastic infiltrations in both lungs with the biggest one present in the middle field of the left lung with dimensions 17.7x26.0 mm.
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case_images: HRCT revealed eight neoplastic infiltrations in both lungs with the biggest one present in the middle field of the left lung with dimensions 17.7 x 26.0 mm (Figure 7) and enlarged lymph node in the hilum of the left lung.