case_images: PMC8059040_01
case_images: A whole-body positron emission tomography showing a hypermetabolic mass in the lower posterior triangle of the right neck (blue arrow).
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case_images: A whole-body positron emission tomography (PET) showed only a hypermetabolic mass in the lower posterior triangle of the right neck (Figure 1).
case_images: Magnetic resonance imaging of the brain with contrast showing a 2-cm mass in the right temporal lobe (blue arrow).
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case_images: A magnetic resonance imaging of the brain with contrast demonstrated a 2-cm mass in the right temporal lobe (Figure 2).
case_images: Pathology from excisional biopsy of the mass with hematoxylin and eosin stain showing tightly packed pleomorphic malignant cells with prominent mitotic activity and necrosis.
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case_images: Immunohistochemistry stains on tumor cells were positive for SOX-10, vimentin, and S-100, and negative for cytokeratin AE1/AE3, cytokeratin 5/6, p63, p16, CAM 5.2, EMA, CD45, CD56, CD34, smooth muscle actin, and desmin (Figures 3 and 4).
case_images: Immunostaining with SOX-10 positive in the tumor cell nuclei.
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case_images: Immunohistochemistry stains on tumor cells were positive for SOX-10, vimentin, and S-100, and negative for cytokeratin AE1/AE3, cytokeratin 5/6, p63, p16, CAM 5.2, EMA, CD45, CD56, CD34, smooth muscle actin, and desmin (Figures 3 and 4).
case_images: Repeat whole body positron emission tomography after 7 cycles of treatment showing an increased hypermetabolic activity in the right supraclavicular area (blue arrow) and new hypermetabolic activity in the mediastinal and hilar lymph nodes (arrow heads).
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case_images: A repeat whole-body PET/CT after 7 cycles of treatment demonstrated an increase in hypermetabolic activity in the right supraclavicular area and development of hypermetabolic activity in the infraclavicular, hilar, and mediastinal regions (Figure 5).
case_images: A repeat computed tomography of the chest after 2 months of treatment with BRAF/MEK inhibitor showing an enlarged mediastinal lymph node (blue arrow).
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case_images: A repeat CT after 2 months of treatment with the combination BRAF/MEK inhibitors showed a significant decrease in size of the neck mass; however, mediastinal and hilar lymph nodes had increased in size (Figure 6).
case_images: Pathology from fine needle aspiration of mediastinal lymph node with hematoxylin and eosin stain showing giant cells, epithelioid histiocytes, and lymphocytes are present, consistent with granulomatous process.
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case_images: He subsequently underwent bronchoscopy and the pathology from the fine needle aspiration of the enlarged mediastinal lymph node showed giant cells, epithelioid histiocytes, and lymphocytes consistent with a granulomatous process, and no malignant cells were found (Figure 7).
case_images: A follow-up whole body positron emission tomography after treatment with the combination BRAF/MEK inhibitor and corticosteroids showing resolution of hypermetabolic lymph nodes.
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case_images: On subsequent follow-ups, he showed radiological improvement suggested by PET scan, and CT scans of chest (Figure 8).