case_images: PMC11135375_01
case_images: Fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET-CT) images. Maximum intensity projection: (a) Fused PET-CT images coronal (b) and axial sections (c-h), showing a FDG-avid exophytic mass lesion arising from the lateral aspect of the upper pole of the left kidney (purple arrow, b, e and f), with multiple FDG-avid retroperitoneal, abdominopelvic, mediastinal, and bilateral cervical level IV and bilateral supraclavicular (blue arrow, g and h) lymph nodes, bilateral lung nodules (orange arrow, c and d), and lesion in the liver (red arrow, e and f)
case_images: IJNM-39-55-g001.jpg
case_images: PMC11135375_01_IJNM-39-55-g001.jpg
case_images: F1
case_images: PET-CT for baseline staging. PET-CT demonstrated increased FDG uptake in a mass lesion arising from the lateral cortex of the upper pole of the left kidney (size 3.7 cm, SUVmax: 10.0) with multiple FDG-avid abdominal, pelvic, retrocrural, mediastinal, and bilateral lower cervical lymph nodes (largest 4.6 cm, SUVmax: 16.7), multiple FDG-avid lesions in the liver, bilateral adrenals, bilateral lungs, multiple bones, and a FDG-avid subcutaneous nodule in the anterior abdominal wall [Figure 1].
case_images: (a) Biopsy from liver space-occupying lesion shows tumor cells arranged in solid sheets with focal necrosis, H and E x 200. (b) The tumor cells display a high nucleocytoplasmic ratio, markedly pleomorphic hyperchromatic nuclei with molding, and inconspicuous nucleoli along with apoptoses and mitoses, H and E x 400. These cells are immunopositive for pancytokeratin (c), synaptophysin (d), chromogranin (e) and show a high Ki67 proliferation index (f), Immunohistochemistry x 200
case_images: IJNM-39-55-g002.jpg
case_images: PMC11135375_01_IJNM-39-55-g002.jpg
case_images: F2
case_images: The IHC analysis revealed positivity for pancytokeratin, synaptophysin, and chromogranin with high Ki-67 proliferation index (75%-80%) indicating a diagnosis of SCC [Figure 2].