case_images: PMC3876636_01
case_images: Blackening of skin of all the toes on both feet with swelling suggesting venous gangrene
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case_images: PMC3876636_01_SAJC-2-2b-g001.jpg
case_images: F1
case_images: Blackening of skin of all the toes on both feet with decreased local temperature and tenderness were revealed on local examination of feet. [Figure 1] Multiple nodules over scalp were seen as incidental finding.
case_images: CT scan thorax showing left sided massive pleural effusion with atelectasis of left lung
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case_images: PMC3876636_01_SAJC-2-2b-g002.jpg
case_images: F2
case_images: CT scan thorax were done and revealed left sided massive pleural effusion with atelectasis of left lung.[Figure 2] Pleural fluid study came as lymphocytic, exudative, ADA level 14 IU/ml with presence of malignant cell. Closed pleural biopsy and report suggested as metastatic squamous cell carcinoma.
case_images: (a) FNAC from scalp nodule showing atypical cells (yellow arrow) suggestive of metastatic squamous cell carcinoma (H and E x200). (b) Bronchial biopsy showing nuclear hyperchromasia with pleomorphism and keratinisation pearl (yellow arrow) suggestive of squamous cell carcinoma of lung (H and E, x200)
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case_images: PMC3876636_01_SAJC-2-2b-g003.jpg
case_images: F3
case_images: FNAC from scalp nodule was also positive for metastatic squamous cell carcinoma [Figure 3a]. On fiber optic bronchoscopy, there was an infiltrating growth in left upper lobe bronchus and biopsy suggestive of squamous cell carcinoma [Figure 3b].