case_images: PMC10864049_01
case_images: (a) Preoperative left posterior temple labeled #1-small flesh-colored subcutaneous papule-biopsy proven cutaneous NET metastasis (labeled #2-biopsy proven seborrheic keratosis). (b) Prebiopsy left central parietal scalp-small flesh-colored subcutaneous papule -biopsy proven cutaneous NET metastasis with positive peripheral and deep margins.
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case_images: fig1
case_images: On physical examination, significant findings included a 3 mm flesh colored subcutaneous papule within his hair on the left posterior temple #1 (Figure 1(a)), a scaly brown verrucal plaque on the left posterior temple #2, and a pearly 3 mm flesh-colored papule on his nasal tip. During that visit, he identified a new tender 2 mm flesh colored papule on his left central parietal scalp (Figure 1(b)) that had appeared in the intervening 2-week period.
case_images: (a-c) Hematoxylin and eosin staining of the left temple biopsy at low (a), medium (b), and high (c) power. (d-f) Immunostaining of the left temple biopsy using INSM-1 (d), CK (e), and CDX2 (f).
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case_images: fig2
case_images: Nuclear atypia was mild, and mitoses were rare (Figures 2(a)-2(c)). The lesion was diffusely positive for a cytokeratin cocktail (Figure 2(e)), insulinoma-associated protein 1 (INSM-1, Figure 2(d)), and homeobox protein CDX-2 (CDX2, Figure 2(f)).
case_images: (a) Postexcision of left posterior temple (lesion #1 in Figure 1(a)): residual well-differentiated NET metastasis with clear margins. (b) 6 month follow-up postexcision of the left posterior temple lesion. (c) 6 months postbiopsy left central parietal scalp-lesion (lesion shown in Figure 1(b)) clinically resolved after PRRT.
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case_images: fig3
case_images: During this therapy, the parietal scalp metastatic lesion resolved and there was no recurrence of the left temple lesion (Figures 3(a) and 3(b)).