case_images: PMC2763770_01
case_images: CT scan showing enlarged head of pancreas with heterogeneous soft tissue mass measuring 5 x 5 cm. with multiple porta hepatis and paraaortic lymph nodes with no evidence of hepatic focal lesions
case_images: IJD-53-206-g001.jpg
case_images: PMC2763770_01_IJD-53-206-g001.jpg
case_images: F0001
case_images: A computerized tomography scan (CT) of the abdomen revealed the enlarged head of pancreas with heterogeneous soft tissue mass measuring 5 x 5 cm with multiple porta hepatis and para-aortic lymph node enlargements and no evidence of hepatic focal lesions (Fig. 1).
case_images: The initial clinical eruption at the left side of the neck
case_images: IJD-53-206-g002.jpg
case_images: PMC2763770_01_IJD-53-206-g002.jpg
case_images: F0002
case_images: During treatment, she developed asymptomatic violaceous nodules and indurated plaques over the skin on the left side of the neck and she was referred to the dermatology department for consultation (Fig. 2).
case_images: Dermis occupied by numerous tumor nests (H&E x100 stain)
case_images: IJD-53-206-g003.jpg
case_images: PMC2763770_01_IJD-53-206-g003.jpg
case_images: F0003
case_images: A lymph node biopsy revealed metastatic carcinoma and skin biopsy revealed nests of poorly differentiated atypical cells throughout the dermis (Fig. 3).
case_images: Tumor cells show strong membrane staining (CA 19-9 stain H&E x100)
case_images: IJD-53-206-g004.jpg
case_images: PMC2763770_01_IJD-53-206-g004.jpg
case_images: F0004
case_images: Silver stain and chromogranin were negative, while EMA was reactive for tumor cells and CA 19-9 was focally positive (Fig. 4).
case_images: One month later, after receiving the treatment, the reddish, nontender indurated plaques increased in size to cover the entire left side of the neck
case_images: IJD-53-206-g005.jpg
case_images: PMC2763770_01_IJD-53-206-g005.jpg
case_images: F0005
case_images: One month later, while receiving the palliative cytotoxic treatment, the reddish, nontender indurated plaques increased in size covering the left side of the neck (Fig. 5).