case_images: PMC9037882_01
case_images: Initial transaxial images of positron emission tomography- computed tomography scan images of March (Column 1) show intensely fluorodeoxyglucose avid lesions in bilateral external auditory canal, fluorodeoxyglucose avid osteolytic lesion in mandible, fluorodeoxyglucose avid hypodense nodule in left lobe of thyroid. Latter positron emission tomography-computed tomography images of July and December (Column 2 & 3) show complete response in mandible and thyroid lesion and moderate response was seen in bilateral external auditory canal lesions
case_images: IJNM-37-78-g001.jpg
case_images: PMC9037882_01_IJNM-37-78-g001.jpg
case_images: F1
case_images: Her initial PET CT scan done in March [Figures 1 and 2], Column 1) showed intensely fluorodeoxyglucose (FDG) avid (SULpeak 9.7) thickening in bilateral external auditory canal,FDG avid osteolytic lesion in mandible,
case_images: Positron emission tomography-computed tomography scan images of March (Column 1) show mildly fluorodeoxyglucose avid nonfluorodeoxyglucose avid thick walled cystic lesions in bilateral lungs, multiple fluorodeoxyglucose avid hypodense lesions in liver and fluorodeoxyglucose avid thickening in perianal and vulvar regions. Positron emission tomography-computed tomography images of July and December (Column 2 & 3) show complete response in lung lesions, moderate response in liver lesions, and mild response in perianal and vulvar lesions
case_images: IJNM-37-78-g002.jpg
case_images: PMC9037882_01_IJNM-37-78-g002.jpg
case_images: F2
case_images: Her initial PET CT scan done in March [Figures 1 and 2], Column 1) showed intensely fluorodeoxyglucose (FDG) avid (SULpeak 9.7) thickening in bilateral external auditory canal,FDG avid osteolytic lesion in mandible,
case_images: Brain magnetic resonance imaging [ a (axial) & b (sagittal)- green arrow] and c (axial zoomed image) showed an isodense exophytic nodular lesion with homogeneous enhancement arising from the hypothalamus projecting into the suprasellar cistern with contiguous thickening of the pituitary infundibulum
case_images: IJNM-37-78-g003.jpg
case_images: PMC9037882_01_IJNM-37-78-g003.jpg
case_images: F3
case_images: To further evaluate, her brain magnetic resonance imaging (MRI) [Figures 3a-c] was done which showed an isodense exophytic nodular lesion with homogeneous enhancement arising from the hypothalamus projecting into the suprasellar cistern with contiguous thickening of the pituitary infundibulum and abnormal soft tissue within the external auditory canals.
case_images: Histopathology images (10 X and 100 X) from cervical, vulvar and perianal lesions revealed keratinized stratified squamous epithelium with ulceration and patchy inflammation comprising abundant histiocytes, lymphoplasmacytic and polymorphs, and few eosinophils in underlying tissues, suggestive of Langerhans cell histiocytosis
case_images: IJNM-37-78-g004.jpg
case_images: PMC9037882_01_IJNM-37-78-g004.jpg
case_images: F4
case_images: Maximum intensity projection image of positron emission tomography-computed tomography scan done on March 2, 2020 at baseline, July 2020 after she received four cycles of induction chemotherapy with injection cytarabine and steroids; and in December 2020 after she received five cycles of second line chemotherapy with injection cladribine and five cycles of chemotherapy with injection cytarabine showing complete response in lung lesions, moderate response in liver lesions, and mild response in perianal and vulvar lesions
case_images: IJNM-37-78-g005.jpg
case_images: PMC9037882_01_IJNM-37-78-g005.jpg
case_images: F5
case_images: Her third PET-CT scan was done in December 2020 which again showed partial treatment response Figure 5.