case_images: PMC10413900_01
case_images: Chest x-ray showing moderate right pleural effusion (blue arrow) and left upper lobe nodular opacities (red arrow).
case_images: 10.1177_23247096231191872-fig1.jpg
case_images: PMC10413900_01_10.1177_23247096231191872-fig1.jpg
case_images: fig1-23247096231191872
case_images: A chest x-ray showed moderate right pleural effusion and left upper lobe nodular opacities [Figure 1] which was confirmed by a chest computed tomography without contrast demonstrating large confluent right perihilar mass-like consolidations, numerous bilateral solid nodules, and moderate right pleural effusion (Figure 2) in addition to widespread sclerotic and mixed sclerotic/lytic lesions throughout the axial and appendicular skeleton (Figure 3).
case_images: Axial view computed tomography of the chest showing pleural effusion (blue arrow) and multiple bilateral solid nodules (red arrows).
case_images: 10.1177_23247096231191872-fig2.jpg
case_images: PMC10413900_01_10.1177_23247096231191872-fig2.jpg
case_images: fig2-23247096231191872
case_images: A chest x-ray showed moderate right pleural effusion and left upper lobe nodular opacities [Figure 1] which was confirmed by a chest computed tomography without contrast demonstrating large confluent right perihilar mass-like consolidations, numerous bilateral solid nodules, and moderate right pleural effusion (Figure 2) in addition to widespread sclerotic and mixed sclerotic/lytic lesions throughout the axial and appendicular skeleton (Figure 3).
case_images: Sagittal view computed tomography of the spine showing sclerotic (blue arrow) and mixed sclerotic/lytic (red arrow) lesions in the thoracic vertebrae.
case_images: 10.1177_23247096231191872-fig3.jpg
case_images: PMC10413900_01_10.1177_23247096231191872-fig3.jpg
case_images: fig3-23247096231191872
case_images: A chest x-ray showed moderate right pleural effusion and left upper lobe nodular opacities [Figure 1] which was confirmed by a chest computed tomography without contrast demonstrating large confluent right perihilar mass-like consolidations, numerous bilateral solid nodules, and moderate right pleural effusion (Figure 2) in addition to widespread sclerotic and mixed sclerotic/lytic lesions throughout the axial and appendicular skeleton (Figure 3).
case_images: Sagittal view magnetic resonance imaging showing spinal cord compression at levels T9, 10, and 11 (blue arrows).
case_images: 10.1177_23247096231191872-fig4.jpg
case_images: PMC10413900_01_10.1177_23247096231191872-fig4.jpg
case_images: fig4-23247096231191872
case_images: (A) Hematoxylin and eosin stain (lymph node biopsy) showing malignant cells (20x magnification). (B) Pancytokeratin stain (lymph node biopsy) showing stained malignant cells (20x magnification). (C) SALL4 stain (lymph node biopsy) showing stained malignant cells (20x magnification). (D) Hematoxylin and eosin stain (L1 vertebral body bone biopsy) showing new bone formation (osteoblastic).
case_images: 10.1177_23247096231191872-fig5.jpg
case_images: PMC10413900_01_10.1177_23247096231191872-fig5.jpg
case_images: fig5-23247096231191872
case_images: Immunohistochemical stains revealed strong positivity of cytokeratin AE1/AE3 and SALL4, consistent with either an embryonal carcinoma or a yolk sac tumor.   The L1 vertebral bone biopsy demonstrated osteoblastic bone formation (Figure 5).