case_images: PMC9149520_01
case_images: Multiple tumors (arrow) of the head, body (a), and tail (b) of the pancreas on contrast-enhanced CT. CT, computed tomography.
case_images: cro-0015-0388-g01.jpg
case_images: PMC9149520_01_cro-0015-0388-g01.jpg
case_images: F1
case_images: Contrast-enhanced computed tomography revealed multiple pancreatic tumors with dilation of the main pancreatic duct, bilateral adrenal tumors, right axillary lymph node enlargement, and multiple abdominal lymph nodes enlargement (shown in Fig. 1).
case_images: Pathological specimen of the left testis. a The resected left testis, measuring 46 x 40 x 32 mm, with the cut surface of the white solid tumor with bleeding and necrosis. b Histological findings with H&E staining show diffuse sheets of highly atypical cells with scant cytoplasm and irregularly fusiform nuclei with granular chromatin. Several mitoses are visible. c Immunohistochemistry shows labeling for synaptophysin (c1), chromogranin A (c2), CD56 (c3), and TTF1 (c4). d A Ki-67 proliferation index with MIB-1 stain of 80%. e An isochromosome of the short arm of chromosome 12 (i12p) is not apparent by FISH (green signal). The i12p/CEP12 ratio was 104/92 (<1.5). TTF1, thyroid transcription factor-1. H&E, hematoxylin and eosin.
case_images: cro-0015-0388-g02.jpg
case_images: PMC9149520_01_cro-0015-0388-g02.jpg
case_images: F2
case_images: The cut surface showed a white solid tumor with bleeding and necrosis (shown in Fig. 2a). Mitoses and apoptosis were observed remarkably (shown in Fig. 2b). In immunohistochemistry, these atypical cells were positive for synaptophysin (shown in Fig. 2c1), chromogranin A (shown in Fig. 2c2), CD56 (shown in Fig. 2c3), and thyroid transcription factor-1 (shown in Fig. 2c4), and the Ki-67 proliferation index was 80% (shown in Fig. 2d). These atypical cells did not show isochromosomes of the short arm of chromosome 12 (i12p) in fluorescence in situ hybridization (FISH) (shown in Fig. 2e).
case_images: Multiple metastases. a EGDS shows multiple gastric metastases (arrow) resembling submucosal tumors in the gastric body. b Contrast-enhanced MRI of the head shows multiple brain metastases (arrow). EGDS, esophagogastroduodenoscopy; MRI, magnetic resonance imaging.
case_images: cro-0015-0388-g03.jpg
case_images: PMC9149520_01_cro-0015-0388-g03.jpg
case_images: F3
case_images: Esophagogastroduodenoscopy showed multiple gastric metastases resembling a submucosal tumor in the gastric body (Fig. 3a). Contrast-enhanced magnetic resonance imaging of the head revealed multiple brain metastases (Fig. 3b).