case_images: PMC10685408_01
case_images: Skin appearance of the patient. (a) Both calves and dorsum of both feet were edemata, large infiltrative erythema, covered with white scales, flaky erosions on both feet, and large areas of maceration on both feet. (b) After four cycles of oral temozolomide combined with capecitabine, the lower extremity skin edema and pain symptoms improved slightly. (c) After four cycles of surufatinib treatment, the lower extremity ulcers and pain symptoms disappeared, and normal skin tissue grew.
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case_images: Meanwhile, he complained of pain in both lower extremities, seriously affecting his quality of life (Figure 1a). At present, the patient's quality of life has been significantly improved, and the tumor is still regressing (Figures 1b and c and 3e-g).
case_images: Patient's liver biopsy and skin histological findings. (a) Liver biopsy results suggest neuroendocrine tumor. (b) Results of ki-67 staining indicated that the value-added index was about 3%. (c) Immunohistochemistry showed positive for Syn protein. (d) Skin pathology of the patient showed hyperkeratosis, fusion keratosis imperfect, subcortical pustules, "psoriasis-like" hyperplasia of the epidermis, and different amounts of lymphocyte infiltration in the superficial dermis.
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case_images: The final pathological result of the patient is particularly important for our initial judgment, considering the specificity of the anatomical location of the pancreas and the risks associated with a puncture, we performed an ultrasound-guided biopsy of liver metastases on August 18, 2021 (Figure 2a) (Table 1). The histological findings of the skin further support our diagnosis (Figure 2b). At present, the patient's quality of life has been significantly improved, and the tumor is still regressing (Figures 1b and c and 3e-g).
case_images: Manifestation of tumor on 68Ga-DOTA-TATE/PET and 18F-FDG PET/CT imaging and the images of patients after treatment. (a, c) PET-CT images of the patient, no obvious hypermetabolic lesions were found. (b, d) PET/MR images of the patient, the distribution of imaging agents in the body and tail of the patient's pancreas and liver is abnormally concentrated. (e) Liver and pancreas lesions at the patient's initial diagnosis. (f) MR image of the patient after four cycles of chemotherapy, indicating that the liver and pancreas lesions did not change significantly compared with the previous ones. (g) Patient was re-examined after four cycles of oral surufatinib, suggesting that the liver and pancreas lesions continued to shrink.
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case_images: Interestingly, the body of the pancreas was slightly distended locally, but no hypermetabolic lesions were found in the pancreas (Figure 3a and c). We could see that the distribution of imaging agents in the body and tail of the patient's pancreas and liver is abnormally concentrated, which is considered to be a somatostatin receptor-positive tumor, and the skin and subcutaneous tissue of bilateral calves are considered to be highly likely to be inflammatory (Figure 3b and d). At present, the patient's quality of life has been significantly improved, and the tumor is still regressing (Figures 1b and c and 3e-g).