case_images: PMC6151222_01
case_images: T2 sagittal MRI cervical and lumbar spine.
case_images: CRIM2018-5326324.001.jpg
case_images: PMC6151222_01_CRIM2018-5326324.001.jpg
case_images: fig1
case_images: T11, T12, L3, L4 vertebral bodies, right sacrum, and ilium that were concerning metastatic disease. There was effacement of the right lateral recess and right neural foramen at the L3-L4 and effacement of the left lateral recess and left neural foramen at the L4-L5 due to tumor retropulsion (Figures 1-3).
case_images: T2 sagittal MRI lumbar spine.
case_images: CRIM2018-5326324.002.jpg
case_images: PMC6151222_01_CRIM2018-5326324.002.jpg
case_images: fig2
case_images: T11, T12, L3, L4 vertebral bodies, right sacrum, and ilium that were concerning metastatic disease. There was effacement of the right lateral recess and right neural foramen at the L3-L4 and effacement of the left lateral recess and left neural foramen at the L4-L5 due to tumor retropulsion (Figures 1-3).
case_images: T1 sagittal segment MRI lumbar spine.
case_images: CRIM2018-5326324.003.jpg
case_images: PMC6151222_01_CRIM2018-5326324.003.jpg
case_images: fig3
case_images: T11, T12, L3, L4 vertebral bodies, right sacrum, and ilium that were concerning metastatic disease. There was effacement of the right lateral recess and right neural foramen at the L3-L4 and effacement of the left lateral recess and left neural foramen at the L4-L5 due to tumor retropulsion (Figures 1-3).
case_images: CT chest with contrast showing enlarged pulmonary artery, mediastinal, and hilar lymphadenopathy.
case_images: CRIM2018-5326324.004.jpg
case_images: PMC6151222_01_CRIM2018-5326324.004.jpg
case_images: fig4
case_images: Since the findings were concerning diffuse metastatic disease, a CT scan of the chest, abdomen, and pelvis were performed and showed bilateral hilar and mediastinal adenopathy, mild cardiomegaly, and dilated main pulmonary artery measuring 3.6 cm (Figures 4 and 5).
case_images: CT chest with contrast showing lesions in the ribs and sternum.
case_images: CRIM2018-5326324.005.jpg
case_images: PMC6151222_01_CRIM2018-5326324.005.jpg
case_images: fig5
case_images: Since the findings were concerning diffuse metastatic disease, a CT scan of the chest, abdomen, and pelvis were performed and showed bilateral hilar and mediastinal adenopathy, mild cardiomegaly, and dilated main pulmonary artery measuring 3.6 cm (Figures 4 and 5).
case_images: CT abdomen/pelvis showing hepatosplenomegaly.
case_images: CRIM2018-5326324.006.jpg
case_images: PMC6151222_01_CRIM2018-5326324.006.jpg
case_images: fig6
case_images: Enlarged liver measuring 18.1 cm, enlarged spleen measuring 12.4 cm, and multiple bilateral enlarged pelvic sidewall, external iliac, and inguinal lymph nodes concerning lymphoma or metastatic disease are shown in Figure 6.
case_images: Fragments of respiratory epithelium with foreign body giant cells.
case_images: CRIM2018-5326324.007.jpg
case_images: PMC6151222_01_CRIM2018-5326324.007.jpg
case_images: fig7
case_images: Due to high suspicion of malignancy, he also underwent an endoscopic bronchial ultrasound with transbronchial needle aspiration of the inferior mediastinal lymph node which found non-necrotizing granulomas but did not reveal any malignant cells (Figures 7-9).
case_images: Left inguinal lymph node biopsy with necrotizing granuloma.
case_images: CRIM2018-5326324.008.jpg
case_images: PMC6151222_01_CRIM2018-5326324.008.jpg
case_images: fig8
case_images: Due to high suspicion of malignancy, he also underwent an endoscopic bronchial ultrasound with transbronchial needle aspiration of the inferior mediastinal lymph node which found non-necrotizing granulomas but did not reveal any malignant cells (Figures 7-9).
case_images: Left inguinal lymph node biopsy demonstrating necrotizing and non-necrotizing granulomas.
case_images: CRIM2018-5326324.009.jpg
case_images: PMC6151222_01_CRIM2018-5326324.009.jpg
case_images: fig9
case_images: Due to high suspicion of malignancy, he also underwent an endoscopic bronchial ultrasound with transbronchial needle aspiration of the inferior mediastinal lymph node which found non-necrotizing granulomas but did not reveal any malignant cells (Figures 7-9).
case_images: FDG-PET scan extensive hypermetabolic osseous and nodal disease.
case_images: CRIM2018-5326324.010.jpg
case_images: PMC6151222_01_CRIM2018-5326324.010.jpg
case_images: fig10
case_images: Since there was concern for a process with high metabolic activity, he also had an 18F-labeled fluorodeoxyglucose (18F-FDG) positron electron topography (PET) scan that was significant for extensive hypermetabolic osseous and nodal disease (Figure 10).