case_images: PMC4437418_01
case_images: MRI T2 images showing thoracic and lumbar vertebral metastatic disease.
case_images: LCI2011-912098.001.jpg
case_images: PMC4437418_01_LCI2011-912098.001.jpg
case_images: fig1
case_images: This finding was highly suggestive of neoplastic metastases (Figure 1).
case_images: (a) Ct Brain 1.5 x 1.16 cm hemorrhagic right frontal lobe metastatic disease. (b, c) Postgadolinium MRI shows multiple ring enhancing metastatic lesions.
case_images: LCI2011-912098.002.jpg
case_images: PMC4437418_01_LCI2011-912098.002.jpg
case_images: fig2
case_images: Subsequent brain CT and MRI showed multiple edematous hyperdense lesions, also consistent with metastatic disease (Figures 2(a), 2(b), and 2(c)). 
case_images: (a) CT of chest with contrast in mediastinal view displaying 2 cm right suprahilar soft tissue mass. (b) CT of abdomen showing multiple hepatic metastatic foci.
case_images: LCI2011-912098.003.jpg
case_images: PMC4437418_01_LCI2011-912098.003.jpg
case_images: fig3
case_images: Upon closer examination, CT showed a 2 cm right suprahilar soft tissue mass suggestive of a central pulmonary neoplasm with surrounding atelectasis, marked mediastinal and right hilar lymphadenopathy, numerous low-density hepatic lesions suspicious of metastatic disease, abdominal lymphadenopathy, and a left adrenal nodule suggestive of metastatic disease (Figures 3(a) and 3(b)).
case_images: (a) Liver Biopsy:light microscopy at 200x magnification of metastatic lesion. (b) Liver Biopsy:light microscopy at 600x magnification of metastatic lesion. (c) Liver Biopsy:positive immunostaining with CD56. (d) Liver Biopsy:positive immunostaining with chromogranin.
case_images: LCI2011-912098.004.jpg
case_images: PMC4437418_01_LCI2011-912098.004.jpg
case_images: fig4
case_images: The cuboidal shaped cells also consistently demonstrated increased nuclear/cytoplasmic ratios with numerous prominent nucleoli (Figures 4(a) and 4(b)). Factor 1 (TTF-1) (Figures 4(c) and 4(d)). Final pathology report was consistent with high-grade large cell neuroendocrine carcinoma. 