case_images: PMC10857807_01
case_images: Primary tumor - anal canal mass.
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case_images: F1
case_images: Physical examination revealed enlarged inguinal lymph nodes bilaterally and a protruding, painful, and bleeding anal mass measuring approximately 5 cm (shown in Fig. 1).
case_images: Pathology findings from primary tumor. a Whole section view of a polypoid, ulcerated, solid tumor with heavily pigmented areas (H&E. x4). b Detail from the transition between an area lined by squamous mucosa (left side) and ulcerated tumor with associated hemorrhage (H&E. x10). c Tumor was composed of areas with prominent spindle morphology (left side) and areas with more epithelioid cells (right side). d Scattered throughout both components, there was abundant melanotic pigment associated (H&E. x20) and lymph node metastasis where BRAF V600E mutation was detected.
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case_images: F2
case_images: A biopsy of the anal mass was performed, revealing nuclear hyperchromasia and vast cytoplasm with sparse dark pigmentation, S100 expression, and no AE1/AE3 or p63 expression (shown in Fig. 2).
case_images: Initial 18F-FDG PET/CT and CNS MRI staging showing pelvis, liver, lung, and single CNS metastasis in the right temporal lobe.
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case_images: F3
case_images: Staging with 18F-FDG PET/CT and central nervous system (CNS) magnetic resonance imaging (MRI) were performed, revealing distant metastasis in the pelvis, liver, lung and a single CNS metastasis in the right temporal lobe (shown in Fig. 3).
case_images: CNS MRI at progression of disease showing right temporal lobe, caudate nucleus, lenticular nucleus, and cortical lesions.
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case_images: F4
case_images: Local CNS treatment was discussed, and because of disease location [lesions in the right temporal lobe (1), caudate nucleus (1), lenticular nucleus (1), and cortical (1)] (shown in Fig. 4), SBRT on all lesions was the preferred treatment.
case_images: CNS MRI showing progression of the caudate nucleus lesion.
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case_images: F5
case_images: Follow-up at 1 year after local CNS treatment was done with 18F-FDG PET/CT, still showing complete remission, and CNS MRI showed progression of the caudate nucleus lesion (shown in Fig. 5).