case_images: PMC11817252_01
case_images: Microscopic aspects of the HE staining slides: (a) large tumor cells with a syncytial growth pattern, ob. 20x (b) tumor cells intermingled with inflammatory infiltrate, ob. 40x; (c) carcinomatous nodular metastasis, ob. 5x; (d) cervical lymph node with granuloma, ob. 5x; (e) necrotizing epithelioid granuloma with extensive areas of caseous necrosis, ob. 20x.
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case_images: The granuloma showed variable sizes and a tendency to confluence (Figure 1, Figure 2 and Figure 3).
case_images: Immunohistochemical profile of tumor cells: (a) diffuse and moderate/intense reaction for CK5, ob. 20x; (b) diffuse and weak/moderate reaction for p63 protein, ob. 20x; (c) diffuse and intense reaction for 34betaE12, ob. 20x; (d) intense positive reaction for EMA in the marginal areas of the tumor islands, ob. 20x; (e) weak positive reaction for p53 protein in 25% of tumor cells, ob. 20x; (f-h) negative reactions for CK7, CK20, and p16 protein, ob. 20x.
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case_images: The granuloma showed variable sizes and a tendency to confluence (Figure 1, Figure 2 and Figure 3).
case_images: Immunohistochemical profile of inflammatory cells: (a) positive reaction of intra- and peritumoral lymphocytes, ob. 20x; (b) CD4 positive in T cells, ob. 20x; (c) CD8 positive in T cells, ob. 20x; (d) CD20 positive in B cells, ob. 20x; (e) CD68 positive in dendritic cells, ob. 20x; (f) CD117 negative reaction, ob. 20x.
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case_images: The granuloma showed variable sizes and a tendency to confluence (Figure 1, Figure 2 and Figure 3).
case_images: MRI examination of the cervical regions: multiple cervical masses with confluent nodes in the right superior and inferior jugular-carotid groups (circle).
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case_images: MRI examination of the cerebral and cervical regions. Multiple bilateral small ischemic lesions were identified, in the frontal supratentorial region, as well as cervical adenopathy with confluent lymph nodes in the following groups: right superior jugular-carotid (13.5/24.5 mm), left superior jugular-carotid (11/18.5 mm), and right inferior jugular-carotid (17/22 mm) (Figure 4).
case_images: MRI examination of the cerebral regions: aspects before and after chemotherapy: (a) initial aspect of the nasopharyngeal tumor mass (circle); (b) visible tumor size reduction (circle) with subsequent inflammation of the left maxillary sinus mucosa (arrow).
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case_images: The tissue mass was 19.5/11 mm in size and crossed the midline, distorting the adenoidal septa (Figure 5a). An ENT consultation confirmed no signs of recurrence at 6 months and 1 year post-radiotherapy (Figure 5b).
case_images: Cervical region MRI: cervical superior confluent lymph node on the left side, tangent to the jugular-carotid vascular bundle and the lower pole of the left parotid gland (circle).
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case_images: Due to the metastasis of the left cervical lymph nodes (Figure 6), the patient was admitted to the oncology department for treatment with Doxorubicin 70 mg and Docetaxel 105 mg (AT*6 chemotherapy).
case_images: (a) Large left cervical lymph node mass; (b) enlarged left cervical lymph node block.
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case_images: diagnostics-15-00357-f007
case_images: Contrast-enhanced MRI of the cerebral and cervical region revealed a large left cervical mass of 35/28 mm (Figure 7a) and bilateral maxillary sinusitis. Carboplatin 400 mg (ASC-5). Contrast-enhanced MRI of the cerebral and cervical region at 4 months post-chemotherapy revealed an enlarged left cervical lymph node block of 40/38 mm in diameter and no right cervical lymphadenopathy (Figure 7b).