case_images: PMC4976921_01
case_images: Patient photos.. Notes: (A) Two years ago, normal skin color. (B) Before treatment. (C) After treatment.
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case_images: PMC4976921_01_ott-9-4815Fig1.jpg
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case_images: After that, he noticed a gradual blackening of dorsum on both hands and face during one year (Figure 1).
case_images: The patient's chest X-ray.. Notes: (A) Before treatment, nearly normal. (B) After treatment. The arrow represents the minimal enlargement of mediastinal lymph node.
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case_images: PMC4976921_01_ott-9-4815Fig2.jpg
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case_images: His chest X-ray looked roughly normal, but during careful investigation of the hilar area, we noticed some minimal enlargement (Figure 2).
case_images: Patient's chest computed tomography (CT).. Notes: (A and C) Before treatment. (B and D) After treatment. The arrows represent the minimal enlargement of mediastinal lymph node.
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case_images: The CT scan revealed mediastinal lymphadenopathies and a millimetric lesion on the left upper lobe (8 mm; Figure 3).
case_images: Biopsy images.. Notes: (A) EBUS-FNA for mediastinal subcarinal lymph node: cytological appearance of nonkeratinizing squamous cell carcinoma. Sheets of atypical squamous cells with large hyperchromatic nucleus, dense squamoid cytoplasm, and moderate pleomorphism are observed (MGG stain, original magnification x400). (B) A cell block section of tumor displaying few small atypical small squamous islands and scattered lymphocytes showing crushing artifact in a fibrinous background (H&E stain, original magnification x400). Cell block immunohistochemistry of the tumor: tumor cells display strong nuclear p63 (C) and cytoplasmic cytokeratin 5/6 (D) positivities, which are characteristics for squamous cell carcinoma.. Abbreviations: EBUS-FNA, endobronchial ultrasound-guided transbronchial fine-needle aspiration; MGG, May-Grunwald-Giemsa; H&E, hematoxylin and eosin.
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case_images: We performed an endobronchial ultrasound, and the cytological examination of mediastinal lymph node biopsy was reported to be consistent with squamous cell lung cancer (Figure 4).
case_images: The lesion manifests epidermal acanthosis and papillomatosis with increased deposition of melanin pigment along the epidermal basal layer (H&E stain, original magnification x46).. Abbreviation: H&E, hematoxylin and eosin.
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case_images: These biopsies confirmed to be consistent with AN (Figure 5).
case_images: The patient's hands.. Notes: (A) Before treatment, tripe palms. (B) After treatment.
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case_images: PMC4976921_01_ott-9-4815Fig6.jpg
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case_images: The patient skin and oral mucosal lesion healed after the treatment (Figure 6).