case_images: PMC11682481_01
case_images: 47 year-old female patient post mastectomy, axillary dissection and radiotherapy to left axilla had developed gradually increasing lymphedema of the left arm 18 months post radiotherapy. The patient complained of muculopapular rash like lesion in the edematous arm approximately seven years after the onset of edema, which later progressed to nodular ulcerated lesion. FDG PET MIP images; (A. axial) show nodular foci of uptake along anterolateral aspect of left arm (blue arrow), and in the region of left humeral shaft (red arrow). B. Coronal PET images show linear FDG uptake in the left arm (red arrow) and few foci of FDG upake in the mediatinal region (green arrow). The left arm appears edematous with cutaneous thickening (black arrow)
case_images: AOJNMB-13-107-g001.jpg
case_images: PMC11682481_01_AOJNMB-13-107-g001.jpg
case_images: F1
case_images: There were also identified FDG-avid lymph nodes in the right supraclavicular and mediastinal regions (SUVmax=8.8~1.1x1.0 cm; subcarinal) (Figures 1.1, a.2 and 1.3).
case_images: Corresponding fused axial A. FDG PET/CT and B. CECT images show FDG avid (SUVmax 20.8) heterogenous enhancing slightly exophytic cutaneous lesion in antero lateral aspect of left arm ( white arrow), with adjacent cutaneous thickening( SUVmax 7.8) ( blue arrow), edema and stranding of the subcutaneous fat (green
  arrow) and a subcentimetric nodular soft tissue ( SUVmax 6.3) abutting the shaft the humerus ( blue arrow head)
case_images: AOJNMB-13-107-g002.jpg
case_images: PMC11682481_01_AOJNMB-13-107-g002.jpg
case_images: F2
case_images:  A biopsy of the lesion was performed, and histological examination (Figure 2.1) showed vascular breakthroughs in the dermis, with round to oval-shaped cells with hyperchromatic and pleomorphic nuclei, large nucleoli, and mitotic figures.  Immunohistochemical studies (Figure 2.2) revealed that the tumor cells were positive for CD31, FLI-1, D2-40, Prox-1, and Myc amplification and negative for Cytokeratin, epithelial membrane antigen, CD20, and CD34.