case_images: PMC11324281_01
case_images: Chest enhanced CT detected left hilar (a) and mediastinal lymphadenopathy (b) and an irregularly shaped nodule in the left upper lobe (c). CT, computed tomography.
case_images: cro-2024-0017-0001-540418_F01.jpg
case_images: PMC11324281_01_cro-2024-0017-0001-540418_F01.jpg
case_images: F1
case_images: Systemic computed tomography revealed multiple enlarged lymph nodes in the bilateral neck, left axilla, left hilum, and mediastinum; an irregularly shaped nodule in the upper lobe of the left lung; left pleural effusion; and peritoneal dissemination (Fig. 1a-c).
case_images: a Pathological examination of needle biopsy taken from the axillary lymph node revealed poorly differentiated adenocarcinoma. Immunohistochemical staining indicated diffuse expression of CK 7 (b) but negative for CK 20 (c), TTF-1 (d) and napsin A (e). f The tumor cells were also positive for PTH-rP.
case_images: cro-2024-0017-0001-540418_F02.jpg
case_images: PMC11324281_01_cro-2024-0017-0001-540418_F02.jpg
case_images: F2
case_images: Ultrasound-guided needle biopsy of the axillary lymph node was performed, and the histological findings indicated poorly differentiated adenocarcinoma (Fig. 2a). Immunohistochemical analysis showed diffuse positivity for cytokeratin (CK) 7 but negative for CK 20, thyroid transcription factor-1 (TTF-1), and napsin A (Fig. 2b-e). The tumor cells also showed strong expression of PTH-rP (Fig. 2f).
case_images: a Magnetic resonance imaging showed brain metastasis. Chest and abdominal CT showed increased size of the nodule in the upper lobe of the left lung (b), bilateral pleural effusion (c), and ascites (d) 15 days after admission. CT, computed tomography.
case_images: cro-2024-0017-0001-540418_F03.jpg
case_images: PMC11324281_01_cro-2024-0017-0001-540418_F03.jpg
case_images: F3
case_images: The serum calcium level was reduced to 8.3 mg/dL (9.9 mg/dL after correction for serum albumin), but the patient's general condition, including consciousness disorder due to brain metastasis (Fig. 3a) and increased ascites and bilateral pleural effusion, worsened (Fig. 3b, c).