Magnetic resonance imaging of a tumor developing from the left testis in a patient with androgen insensitivity syndrome. (A) Before chemotherapy, a T2-weighted image showed that the internal intensity was slightly high.


Magnetic resonance imaging of a tumor developing from the left testis in a patient with androgen insensitivity syndrome. (B) Marked shrinkage of the tumor occurred after 3 cycles of neoadjuvant chemotherapy (NAC).


Laparotomy after NAC. (A) The tumor shrank following NAC.


Laparotomy after NAC. (B) The right testis is indicated by an asterisk.


Laparotomy after NAC. (C) The uterine streak is indicated by arrows.


A; The invasive ductal breast carcinoma specimen that was resected when the patient was 32 years old (H&E).


B; The lung metastasis from breast cancer that was resected when the patient was 42 years old (H&E).


A; On a hypopharyngeal fiberscopic image, a tumor was observed in the postcricoid area (a white arrow).


B; On a contrast-enhanced computed tomography scan of the neck before treatment, an enhanced tumor was observed in the postcricoid area of the hypopharynx (a white arrow).


C; On a fluorodeoxyglucose positron emission tomography scan of the neck before treatment, an enhanced tumor was observed in the hypopharynx (a black arrow) and the left side of the neck (arrowhead).


A E-cadherin was expressed in the lymph node specimen. B; Positive VEGF-A receptor immunostaining.


A E-cadherin was expressed in the lymph node specimen. C; Positive VEGFR2 receptor immunostaining.


A E-cadherin was expressed in the lymph node specimen. D; Electrophoresis of methylation-specific PCR products that were amplified using DNA from the lymph node specimen. The results show that only unmethylated alleles of CDH1 and VEGFR2 were detected. M methylated alleles, UnM unmethylated alleles, B water blank.


Microscopic section of the left testicular tumor shows a typical pattern of clear cell renal carcinoma. All the disseminated lesions, which were surgically resected, showed the same findings (hematoxylin and eosin, magnification, x200).


Histopathologic stains from the pulmonary biopsy. (A) hematoxylin and eosin.


Histopathologic stains from the pulmonary biopsy.


Histopathologic stains from the pulmonary biopsy. CK5/6. CK7.


Histopathologic stains from the pulmonary biopsy. (D) thyroid transcription factor-1.


Histopathologic stains from the pulmonary biopsy. (E) Naspin A.


Histopathologic stains from the pulmonary biopsy. (F) P63.


Histopathologic stains from the pulmonary biopsy. (G) P40.


Next-generation sequencing findings of MYH9-RET fusion. (A) The Integrative Genomics Viewer snapshot of MYH9-RET.


Next-generation sequencing findings of MYH9-RET fusion. (B) Schematic representation of the MYH9-RET fusion protein domain structure.


CT scan showed a 50 x 42-mm rounded, solid, homogeneous expansive lesion of distinct borders in the left adrenal gland.


CT scan showed a slightly enhanced tumor in the left adrenal gland.


Gastroesophageal transit showing a huge mass involving the esophagogastric junction and the gastric fundus.


CT scan showing an exophytic mass in the lesser gastric curvature referring to the known gastric cancer (asterisk).


A and B - CT-scans revealing a major tumoral response, with almost complete recovery of the gastric wall (black arrow), but a lymph node of 20 mm remained in the celiac axis (white arrow).


Preoperative extraoral.


Preopertaive intraoral.


Intraoperative facial nerve.


Postoperative intact facial nerve function.


Computed tomography scan showing a high-density tumor in the pineal region accompanied by obstructive hydrocephalus.


Preoperative magnetic resonance imaging. The tumor was heterogeneously hyperintense on T1.


Preoperative magnetic resonance imaging. And iso- and low-mixed intense on T2-weighted images.


Preoperative magnetic resonance imaging. It contained hemorrhagic components of very low intensity on T2* images (c).


Intraoperative photograph (left occipital transtentorial approach) showing a dark red solid tumor in the pineal region.


Whole-body 18-fluoro-deoxyglucose positron emission tomography showing no abnormal uptake.


Magnetic resonance imaging after 56 months of surgery. Axial T1-weighted images.


Magnetic resonance imaging after 56 months of surgery. T2-weighted images. Showing no lesion in the pineal gland.


Pathological examination. X100.


Pathological examination. X400. Hematoxylin and eosin staining shows a large number of small, round malignant cells.


Pathological examination. Immunohistochemical staining for. Creatine kinase (CK).


Pathological examination. Friend leukemia virus integration 1 (FLI-1).


Pathological examination. Neuron-specific enolase (NSE).


Pathological examination. CD99.


Pathological examination. Anaplastic lymphoma kinase (ALK).


Pathological examination. KI-67.


Abdominal CT scan with contrast. Findings of bilateral enhancing lesions in the kidneys. Multiple rounded hyperdense lesions throughout the renal parenchyma bilaterally, more pronounced in the left kidney. Left perinephric hematoma 8.8 x 5.2 cm. Axial view (left). Diffuse thickening of the stomach wall. No evidence of liver lesions.


Abdominal CT scan with contrast. Findings of bilateral enhancing lesions in the kidneys. Multiple rounded hyperdense lesions throughout the renal parenchyma bilaterally, more pronounced in the left kidney. Left perinephric hematoma 8.8 x 5.2 cm. Axial view (right).


Abdominal MRI. Multiple rounded hypo enhancing lesions noted throughout the renal parenchyma bilaterally. Axial view (left).


Abdominal MRI. Multiple rounded hypo enhancing lesions noted throughout the renal parenchyma bilaterally. Coronal view (right).


Microscopic appearance of the high-grade Burkitt's lymphoma. Stomach. Gastric mucosa with a dense lymphoid infiltrate in the lamina propria consisting of intermediate size monotonous lymphoma cells with round nuclei, fine chromatin, and multiple nucleoli. Mitoses are conspicuous. Multiple apoptotic bodies impart a starry sky pattern to the lesion (A, B: hematoxylin & eosin).


Microscopic appearance of the high-grade Burkitt's lymphoma. Stomach. Gastric mucosa with a dense lymphoid infiltrate in the lamina propria consisting of intermediate size monotonous lymphoma cells with round nuclei, fine chromatin, and multiple nucleoli. Mitoses are conspicuous. Immunohistochemistry was positive for CD20, CD10, BCL6.


Microscopic appearance of the high-grade Burkitt's lymphoma. Stomach. Gastric mucosa with a dense lymphoid infiltrate in the lamina propria consisting of intermediate size monotonous lymphoma cells with round nuclei, fine chromatin, and multiple nucleoli. Mitoses are conspicuous. C-MYC MUM1, and are negative for CD5, BCL2, CD30, and terminal deoxynucleotidyl transferase (TdT). Fluorescence in situ hybridization (FISH) was 73% positive for MYC-IGH fusion and negative for IGH-BCL2 and BCL6 rearrangements.


Extensive hepatic metastasis present before initiation of VIC (left).


In remission after 40 cycles of VIC (right).


Timeline of management of metastatic BRAFV600E-mutant CRC (colorectal cancer).


Abdominal CT findings. A; CT scan showing diffuse hypodense enlargement of the pancreatic head (arrow). . Notes:. Unenhanced.


Abdominal CT findings. . Notes:. Unenhanced.


Abdominal CT findings. Arterial phase. . Abbreviation: CT, computed tomography.


A gross pathological examination revealed a 3.0 x 4.0 cm multiseptated mass in the pancreatic head (arrow). The cut surface of the tumor was yellowish (arrow).


Histopathology showed small tumor cells without cell adhesion or tissue structure proliferation,HE immunochemical staining was positive for B-cell markers CD20, and . (A-C x400; D x200). . Abbreviation: HE, hematoxylin and eosin.


CD79a , compatible with the diagnosis of diffuse large B-cell non-Hodgkin lymphoma.


HE immunochemical staining confirmed a proliferative index of over 50-60% (D).


A; PET-CT did not detect any signs of disease recurrence after 16 months.


Abbreviations: R, right; L, left; PET-CT, positron emission tomography-computed tomography.


(A, B) A CT scan showing diffuse hypodense enlargement of the pancreatic tail (arrow).


Pathological findings. (A) HE shows irregularly-shaped, atypical lymphocyte infiltration (x40).


Pathological findings. (B) CD20 positive atypical lymphocytic cells (x400).


Pathological findings. (C) A high Ki-67 proliferation index (80%; x200). . Abbreviation: HE, hematoxylin and eosin.


Lesions were significantly reduced after 2 cycles of CHOP chemotherapy regimen (A, B).


After 4 cycles of CHOP chemotherapy regimen (C, D).


Multiple, bean, hazelnut-sized slightly reddish nodules on the scrotum.


Haematoxylin and eosin stains positive for carcinoma cells under the squamous epithelium.


Higher power (100x) histology showing atipic glandular formation.


Histopathology of the tumors.


Immuno-histochemical colorations and fluorescence in situ hybridization (FISH) of the bioptical specimen.


Intraoperative sequences.


Pedigree presenting VHL gene mutation status and malignancy. Both brothers were diagnosed with renal cell carcinoma (RCC) with VHL gene mutation and one of his sons was confirmed VHL mutation without clinical manifestation.


(A) Spine magnetic resonance imaging showed multiple enhancing nodular lesions of the spinal canal suspected leptomeningeal metastasis of unknown primary malignancy.


Positron emission tomography computed tomography whole body scan showed a 3-cm enhancing heterogenous mass in the right kidney (arrow).


Focal mural thickening with intense fludeoxyglucose uptake in the sigmoid colon.


Polymerase chain reaction sequencing analysis of von Hippel-Lindau (VHL) gene showed a p. Glu70Lys (c.208G > A)
mutation in exon 1, confirming the diagnosis of VHL disease.


Brain magnetic resonance imaging showed three enhancing lesions (arrows) in bilateral cerebellar hemispheres.


Left cerebellar tonsil , suggesting hemangioblastomas. N.


Abdomen-pelvic computed tomography scan showed newly developed hepatic metastasis in S6.


An enlarged aortocaval lymph node (arrow) n.


Pretreatment MRI scan with intravenous gadolinium shows a mass in the right lentiform nucleus and internal capsule, with rim enhancement. Wall irregularity is more prominent along the medial aspect.


Second post-treatment MRI scan with intravenous gadolinium enhancement shows increased wall thickness, with enhancement. These could represent viable tumor or postradiation therapy inflammation. The first post-treatment MRI scan (not shown) had demonstrated reduction in tumor size and hydrocephalus. An enhancing nodule has developed along the medial wall of the mass. The enhancing area is concordant with the PET scans [Figures 3-5].


PET/CT with 18FDG shows diffuse physiologic uptake in the normal brain cortex, and abnormal uptake in the wall of the right basal ganglia mass, especially along the medial aspect.


PET/CT with 18FCH shows selectively increased uptake in the wall of the mass, more prominent along the medial aspect. Normal brain parenchyma does not show uptake. Slight physiological uptake is seen in the choroid plexus.


PET/CT with 99Tc-MIBI shows similar distribution of uptake to 18FCH, without uptake by normal brain parenchyma. Physiological uptake by the choroid plexus is more prominent.


Images of patient and subcutaneous nodules. (A) Multiple subcutaneous soft tissue nodules of metastatic follicular thyroid carcinoma on the anterior neck.


Images of patient and subcutaneous nodules. (B) Gray-scale ultrasound shows a hypoechoic nodule in the subcutaneous soft tissue of left neck (size were 16 x 11 mm), with wider than taller, well-defined border, irregular margin, perinodular, and intranodular flow and absence of calcification and peripheral halo.


Images of patient and subcutaneous nodules. (C) Gray-scale ultrasound shows two solid hypoechoic nodules adjacent to each other in the subcutaneous soft tissue of right neck (size of the larger one were 28 x 23 mm), with wider than taller, partially well-defined border, partially regular margin, perinodular and intranodular flow and absence of calcification and peripheral halo.


Images of patient and subcutaneous nodules. (D) Computed tomography shows several low-density nodules in the subcutaneous of the anterior neck.


Images of patient and subcutaneous nodules. (E)
99mTcO4-SPECT reveals a shadow of a cold nodule in the right anterior neck region and a shadow of a nodule in the left anterior neck region.


Contrast-enhanced ultrasound and elastosonography appearance of the larger subcutaneous nodules on the bilateral neck. (A,B) Contrast-enhanced ultrasound showed both the larger nodule in the bilateral neck are hypervascular, heterogeneous enhancement, no ring enhancement, and partially clear enhanced boundary.


Contrast-enhanced ultrasound and elastosonography appearance of the larger subcutaneous nodules on the bilateral neck. (C,D) Elastosonography displayed both the larger one were mainly composed of blue color (at least 75% of the nodule was covered in blue).


Contrast-enhanced ultrasound and elastosonography appearance of the larger subcutaneous nodules on the bilateral neck. (E)
99mTcO4-SPECT whole body scan was performed and showed no abnormal uptake in the whole body.


Follicular thyroid carcinoma. (Hematoxylin and eosin staining of histological slides, x 200).


(a) Histopathological examination of mastectomy specimen, x10 low power showing squamous cell carcinoma with intraepithelial keratin.


(b) Histopathological examination of mastectomy specimen, x40 high power showing squamous cell carcinoma with intraepithelial keratin.


Selected sagittal.


Axial.


Coronal. Slices of CT, PET, and ,fusion images.


MIP image. Of PET-CT showing increased focal FDG uptake in the subcutaneous fatty tissue posterior to the proximal gluteal muscle planes at right thigh.


Typical vimentin positivity in the renal cell carcinoma cells (Vimentin Antibody, x100).


Malignant clear cell infiltration in the fibroadipose tissues, with vascular tumor embolus adjacent to the tumor (Hematoxylen and eosin, x40).


MIP image. Of PET-CT showing increased focal FDG uptake at the posteromedial part of proximal third of right cruris.


MRI shows a soft tissue lesion in the intermuscular area, with a diameter of 2.5 cm, which is hypointense on T1-weighted images.


Hyperintense on T2-weighted images. And showing intense contrast enhancement.


Ulceroproliferative growth at the penoscrotal junction and, suprapubic cystostomy (SPC) site with ulcerated, everted mucosal edges.


Computed tomography scan showing an ill-defined, enhancing mass in the region of posterior urethra infiltrating cavernosae (arrow).


Transverse section showing bladder and SPC tract (arrow head).


Fine-needle aspiration, left leg, Diff-Quik (x200), showing a cellular yield of cohesive, three-dimensional tumor clusters with cellular overlapping and architectural disorder.


Fine-needle aspiration, left leg, Diff-Quik (x400), columnar tumor cells arranged in glandular configuration with elongated nuclei, mild to moderate nuclear pleomorphism, and finely dispersed chromatin.


CT scan before introducing ceritinib.


6 weeks after treating with ceritinib Reduction of the primary tumor and plural effusion was revealed after the treatment.


A tumor measuring 30 x 40 mm in diameter was identified in the anterior wall of the gastric corpus.


Thickening of the gastric wall (arrowhead), high density of fat around the gastric wall, and the "station 3" enlarged lymph node.


Positron emission tomography/computed tomography revealed uptake by the gastric wall and perigastric lymphadenopathy.


Remarkable shrinkage in tumor size was observed, improvement of gastric wall thickness after chemotherapy and shrinkage of lymphadenopathy after chemotherapy (arrowhead).


After three cycles of chemotherapy, remarkable shrinkage in tumor size was observed.


The resected gastric tissue specimen of the angiosarcoma regressed.


Multiple metastases of liver and retroperitoneal region after the surgery.


A. Transthoracic echocardiography findings.


B. Computed tomography findings. . Massive pericardial effusion and large tumor were detected. . PE: pericardial effusion, LV: left ventricle.


Preoperative coronary arteriography findings. . Feeding vessel of the tumor extends from the circumflex branch (white arrows).


A. Operative findings. . The large tumor occupies the lateral to posterior pericardial space (dotted circle). . LV: Left ventricle, RV: Right ventricle.


B. Resected tumor.


Histopathological findings of the resected tumor. . The histopathological examination showed dense proliferation of spindle cells with hemorrhage and necrosis.


The histopathology and immunohistochemistry (IHC) of metastatic tumor tissues of this patient. (A) The H&E staining in the microscopic observation (100x).


The histopathology and immunohistochemistry (IHC) of metastatic tumor tissues of this patient. (B) Immunohistochemical staining for PD-L1 expression (400x) showed that the tumor cells were positive for PD-L1.


The histopathology and immunohistochemistry (IHC) of metastatic tumor tissues of this patient. (C) The positive control of the IHC of PD-L1 expression (200x).


The histopathology and immunohistochemistry (IHC) of metastatic tumor tissues of this patient. (D) The negative control of the IHC of PD-L1 expression (200x).


Cutaneous metastasis of lung adenocarcinoma. (A) Subcutaneous nodules in the chest and abdomen.


Cutaneous metastasis of lung adenocarcinoma. Skin metastasis biopsy from the left chest wall shows poorly differentiated metastatic adenocarcinoma (H&E, original magnification x100.


Cutaneous metastasis of lung adenocarcinoma. X200.


Cutaneous metastasis of lung adenocarcinoma. (D-F) Immunohistochemical staining shows positivity for, in order, CK7 (original magnification x200), TTF-1 (original magnification x200) and napsin A (original magnification x200), indicating that the metastasis is of lung origin.


Imaging of lung cancer. (A) PET-CT indicates that the largest tissue mass is in the lower left lung.


Imaging of lung cancer. During treatment, additional CT scans were performed in. December 2019.


Imaging of lung cancer. March 2020.


Gross appearance of tumors A and B at laparotomy. Tumor A was composed of yellowish exophytic nodular excrescences, and the adjacent tumor B showed white exophytic papillary excrescences.


Diagram of TP53 c.401T>G (p. F134C) alteration in Case 2.


Diagram of TP53 c.401T>G (p. F134C) alteration in Case 2. (B) The 3-dimentional model structure of TP53 wild-type analyzed by SWISSMODEL.


Diagram of TP53 c.401T>G (p. F134C) alteration in Case 2. (C) The Phe134 of TP53.


Diagram of TP53 c.401T>G (p. F134C) alteration in Case 2. (D) The Cys134 of mutated TP53.


Schematic representation of the BCL6-LPP fusion in Case 2. An 838 kb-sized deletion of chromosome 3q27.3-3q28 (base 187461439 on chromosome 3q27 to base 188299507 on chromosome 3q28), resulting in a fusion of the BCL6 with the LPP gene.


Pituitary MRI at two months from the beginning of chemotherapy demonstrated the tumor (size of about 2 x 1.5 x 3.2 cm) was larger than before without cavernous sinus involving in Case 2.


Pelvic CT shows the lymph node metastasis. (A) Before therapy (August 17, 2015).


Pelvic CT shows the lymph node metastasis. (B) Before therapy (October 22, 2015), the lymph node was bigger than 2 months earlier.


Pelvic CT shows the lymph node metastasis. (C) After 3 months of apatinib treatment (March 7, 2016), the lymph node was smaller than 4 months earlier.


Pelvic CT shows the lymph node metastasis. (D) After 9 months of apatinib treatment (August 30, 2016), the lymph node was smaller than 5 months earlier. Red arrows indicate the lymph node metastasis. . Abbreviation: CT, computed tomography.


Pelvic CT shows the metastatic mass in front of the rectum. (A) Before therapy (August 17, 2015).


Pelvic CT shows the metastatic mass in front of the rectum. Before therapy (October 22, 2015).


Pelvic CT shows the metastatic mass in front of the rectum. The mass was bigger than 2 months earlier. After 3 months of apatinib treatment (March 7, 2016), the mass was smaller than 4 months earlier.


Pelvic CT shows the metastatic mass in front of the rectum. (D) After 9 months of apatinib treatment (August 30, 2016), the mass was smaller than 5 months earlier. Red arrows indicate the metastatic mass in front of the rectum. . Abbreviation: CT, computed tomography.


Findings on upper GI endoscopy. (A) Erosions in the lower body and major and minor curvature of the stomach.


Findings on upper GI endoscopy. (B) Narrow band imaging revealed abnormal blood vessels (tree-like appearance) tapering to the erosion site.


Pathological findings. Dense proliferation of small to medium-sized lymphocytes is observed in the submucosal layer (haematoxylin, and ,eosin, original magnification x100).


Pathological findings. High magnification of the tumour (haematoxylin, and ,eosin, original magnification x400).


Pathological findings. Immunohistochemical staining showing positivity for CD3.


Pathological findings. CD8.


Pathological findings. Granzyme B.


Pathological findings. TIA-1.


Pathological findings. TCRbetaF1.


Pathological findings. Negativity for TCRCgammaM1. (immunoperoxidase, original magnification x400).


Ultrasonography on day X reveals a hypoechoic lesion with ill-defined margins and irregular form, appearing avascular and heterogeneous (a).


Computed tomography of the neck on admission (day X + 5) also reveals a low-density lesion in the right thyroid gland, 37 x 37 x 42 mm in size with enhancement in the marginal area (b).


Cytology from FNA shows scant nuclear atypia.


With numerous neutrophils in the background.


Summary of the clinical course.


Barium swallow study (frontal view) does not show any fistula from the apex of the pyriform recess.


Gross.


Microscopic. Appearance of papillary carcinoma of the thyroid.


(A) Clinical photograph showing no globe displacement or ocular abnormalities.


(B) Additional clinical photograph demonstrating no mass on visual inspection.


Sagittal.


Axial CT images demonstrating a mass in the left inferior orbit, with suggestive orbital rim bone erosion (black arrows). . Abbreviation: CT, computed tomography.


(A) Inferior fornix approach showing a 3.5 cm x1.5 cm well-defined grayish mass in the anteroinferior left orbit.


(B) Operative photograph of inferior fornix approach, demonstrating complete removal of mass.


H&E microphotographs at. 4x.


10x magnification, demonstrating moderately differentiated spindle cells with almost no mitoses. The hyperchromatic cells, which have coarse chromatin with mild pleomorphism, are arranged in short fascicles that split and merge, giving the classical herringbone architecture of fibrosarcoma.


(D) Malignant spindle cells are seen in a fascicular pattern invading adjacent inferior orbital rim bone (black arrow). . Abbreviation: H&E, hematoxylin and eosin.


Chest computed tomography image showing a left upper lung mass associated with obstructive pneumonitis involving much of the left upper lobe.


Case timeline detailing therapeutic interventions and clinical responses.


Primary transitional cell carcinoma of the bladder invading muscle.


Metastatic inguinal lymph node of bladder cancer showing glandular differentiation (hematoxylin and eosin, x400).


Positive cytokeratine 7 staining in the metastatic lymph node (immunohistochemistry, x100).


Preoperative axial MR images showing an enhancing mass in the occipital lobe with isointensity on T1-weighted images.


Hyper intensity on a gadolinium enhanced T1-weighted image.


Hyper intensity on T2-weighted image.


Postoperative axial gadolinium enhanced T1-weighted image demonstrating complete resection of the mass with no regions of hyper intensity (d).


Imaging of multiple pulmonary nodules in the left lower and upper lobe seen on lateral.


Anterior posterior , X-ray views.


As well as on sagittal.


Axial. CT imaging.


Plantar keratoderma.


Genralised atrophy, dyschromia and xerosis; the hallmark features of poikiloderma.


Nodule over the palmar aspect of left hand (which later showed actinic keratosis).


Hypoplastic nails with longitudinal ridging.


Immunohistochemical analysis showed a marked reduction in the number of S100+ epidermal Langerhans cells.


Immunohistochemical analysis showing marked reduction in CD1a+ epidermal Langerhans cells.


(a) Some neuronal dysplastic elements (arrows) between glial neoplastic cells in a H and E, x40. (b) Microcalcifications in a H and E, x10. (c and d) Neuronal component was immunoreactive for neurofilament protein (c) and NeuN (d). (e) Glial component was positive for GFAP. (f) The Ki-67 (MIB-1) proliferation index was 1.


Mammography showed focal asymmetrical density (arrows) in the right breast with scattered fibroglandular density.


Ultrasonography. A large tumor (indicated by arrows) with an expansive growth pattern showed predominantly high-level internal echoes on ultrasonography.


Histological findings of the tumor. A; The tumor cells had a large nucleus and scant cytoplasm with abundant mitoses. HE. X400.


Histological findings of the tumor. B; A lot of fat cell interspersion was observed in and around the tumor cell conglomerate. HE. X100.


Gross view of the specimen after formalin fixation with multiple fatty to solid gray pedunculated masses some of which appeared to arise from the coalescence of the smaller nodules (black arrowhead). Note the variable sizes of these pedunculated (exophytic masses) (white arrowheads); one mass was endophytic (black arrow) projecting within the cecal lumen. The white arrow highlights the ileocecal valve; the black star highlights the external aspect of the largest exophytic mass.


The largest of the appendices showed a sclerosing phenotype with occasional lobules of fat (H&E, 100X). The hyperchromatic atypical stromal cells are evident.


The largest mass showed extensive myxoid stroma (H&E, 200X).


CT scan showing an irregular and circumferential thickening involving the cecum and the middle and distal thirds of the ascending colon with an extension of approximately 13.5 cm.


CT scan showing a hypodense nodule in segment IV measuring 1.2 cm.


Colonoscopy showing an ulcerated mass at the cecum and ascending colon.


Postoperative CT scan showing no evidence of macroscopic liver lesions.


FNAC showing cluster of oncocytic cells (PAP stain, 100X).


Nests of oncocytic tumor cells with amyloid in stroma (H & E, 100X).


Oncocytic tumor cells with nuclei showing stippled chromatin (H & E, 400X).


Synaptophysin-positive (100X).


Chromogranin-positive (100X).


Congo-red positive (birefringence under polarizing light).


Leukoplakia over the ventral aspect of the tongue.


Perforation of the hard palate with induration and necrotic tissue at the margins.


(a) Epithelial dysplasia with basement membrane intact from a biopsy taken from leukoplakia on. X100),. (b) epithelial dysplasia on. X400).


Magnetic resonance imaging with diffusion sequence shows an important restriction of diffusion in the peripheral region.


Hematoxylin-eosin stain showing both tumor components and transition area (x2).


Average percentage of MGMT methylation.


After combined therapy, the primary tumor size significantly decreased and the miliary lung metastasis almost wholly disappeared on 16-slice computed tomography.


External photograph showing swollen periorbital tissue with proptosis.


External photograph showing melting central corneal ulcer with hypopyon.


B-scan showing hyperechoic mass with surrounding exudative retinal detachment.


An MRI scan with and without gadolinium with the arrow indicating a 9-mm hypoenhancing lesion in the pancreas.


Pathological findings of the testis. A; Histopathological examination detected diffuse infiltration of the right testis by large atypical lymphocytes (HE, x400).


Pathological findings of the testis. B; These cells were positive for CD20 (x400).


Radiographs of the thigh at the initial presentation. A; Anteroposterior view.


Radiographs of the thigh at the initial presentation. B; Lateral view. Abnormal opacity without calcification can be seen in the posteromedial thigh (white arrowheads).


On MRI, the lesion was depicted as a low-intensity lesion on T1WI.


As a high-intensity lesion on T2WI. In the semimembranosus muscle.


The lesion was enhanced after gadolinium-based contrast administration (c, d).


The cut surface of the tumor showed a white to tan red solid mass encapsulated in the muscle (a).


Under hematoxylin and eosin staining, the tumor showed expansive growth inside the muscle.


Was composed of oval to polygonal neoplastic cells with small round-to-oval nuclei admixed with variable amounts of lymphocytes, compatible with type B2 thymoma.


Abdominal CT scan during the portal phase. (A) Pelvic mass (blue arrow).


Abdominal CT scan during the portal phase. (B) Multiple hepatic lesions.


(A) Omental endovascular tumor.


(B) Hepatic intraparenchymal lesions.


Marked endothelium with CD-31, inmunohistochemical to confirm the diagnosis.


Computed tomography scan (axial section) of thorax showing a large heterogeneously enhancing soft tissue mass lesion in the right perihilar region involving right lower lobe extending into the mediastinum with loss of fat planes with esophagus, aorta, and right crus of the diaphragm. There is no chest wall or pleural involvement.


Immunohistochemistry picture from lung lesion showing tumor cells positive for neuron specific enolase (x200).


Abdominal enhanced magnetic resonance imaging with T1 findings. . Notes: (A) An 8x6 cm mass in the head of the pancreas (white arrow).


Abdominal enhanced magnetic resonance imaging with T1 findings. (B) Liver metastasis from mixed acinar-endocrine carcinoma of the pancreas (red arrow).


Mammography in craniocaudal.


Mediolateral oblique views, showing a solid irregular lesion with 50x26 mm in the upper outer quadrant of the left breast, suspicious for malignancy.


Mediolateral oblique views, showing partial response to palbociclib in association with letrozole plus goserelin.


Photomicrographs of liver biopsy showing:. Positivity for CDX2, a specific marker of intestinal epithelial cells (x100).


Negativity for TTF1, a marker typically negative in extrapulmonary neuroendocrine tumors (x100).


Less than 1% of the tumor cell population was positive for Ki67 expression (x100).


PET 68Ga-DOTANOC showing A - liver metastases; and B - a primary tumor in the ileocecal topography with high expression of somatostatin receptors.


Percutaneous transhepatic cholangiodrainage (PTCD). . Conventional percutaneous cholangiogram with opacification of a dilated intra- and extrahepatic bile duct system (black arrow) with signs of a malignant stenosis at the level of the head of the pancreas (white arrows) (A).


Percutaneous transhepatic cholangiodrainage (PTCD). Control cholangiogram after positioning of a 8 F PTCD for combined external/internal drainage (black arrow: configuration of the pigtail of the PTCD in the duodenum; white arrows: bridging of the malignant obstruction via the 8 F PTCD) (B).


Histopathology (hematoxylin-eosin staining). . (A) Histopathology of the pancreatic head following Whipple s procedure reveals an intraductal tubulopapillary neoplasm (ITPN) with typical papillary growth and beginning invasion (arrow). In contrast to IPMN no overt mucin production was observed. (Original magnification, x 25).


Histopathology (hematoxylin-eosin staining). . (B) Intraductal tubulopapillary neoplasm (ITPN) with associated invasive ductal adenocarcinoma (arrow). (Original magnification, x 25).


Hematoxylin-eosin staining and immunohistochemistry with Cytokeratin 7. . (A) Hematoxylin-eosin staining in a higher magnification reveals atypical tumors cells with high-grade dysplasia and a high proliferation rate (arrow). (Original magnification, x 100).


Hematoxylin-eosin staining and immunohistochemistry with Cytokeratin 7. . (B) Immunohistochemical staining of the tumor shows ubiquitously positive results for Cytokeratin 7 (CK7) as marked in brown color indicating a highly malignant behavior of the tumor. (Original magnification, x 25).


Bone marrow aspiration revealed morphological findings compatible with ALL-L2 (May-Giemsa staining, 1000x).


B) FISH analysis with PML/RARalpha-specific probes showing two orange (PML) and two green (RARalpha) signals. No PML/RARalpha fusion signal (which should appear yellow) was detected.


Arterial phase CT scan of a 54-year-old woman shows a high-density stent in the bile duct and a hypodense tumoral lesion in the periampullary region.


Contrast-enhanced T1-weighted MRI shows a hypointense lesion in the periampullary region near normal hyperintense pancreatic tissue.


T2-weighted MRI shows the hypointense tumoral lesion in the periampullary region which has a crescent-like shape.


MIP image of the MRCP shows significant dilatation of the intrahepatic and proximal extrahepatic bile ducts with maximum dimension of 14 mm. Note that the tumoral lesion extends to the distal part of extrahepatic bile duct.


In axial PET image, FDG 18 (fluorodeoxy-glucose) uptake is seen in the periampullary region.


A; Tumor location in the common bile duct.


B; Tumor invasion to the duodenum (on the left) and to the pancreas (on the right).


Tumor invasion to the common bile duct.


The presence of keratin pearls within the islets of atypical squamous cells.


Magnetic resonance imaging pre- and post-treatment. (A,B) Pre-treatment imaging demonstrated an avidly enhancing 11 x 7 x 12 mm lesion along the mesial surface of the right frontal lobe within the cingulate sulcus with surrounding vasogenic edema.


Magnetic resonance imaging pre- and post-treatment. (C,D) Post-treatment imaging with complete radiographic resolution of the lesion and associated vasogenic edema.


Extraoral photograph showing diffuse swelling on left side of the mandible, with facial asymmetry.


Intraoral photograph showing obliteration of left buccal sulcus.


Panoramic radiograph showing multilocular radiolucent lesion in ascending ramus.


CT scan showing expansion and perforation of buccal and lingual cortical plates.


Odontogenic epithelium showing mural proliferation in the form of odontogenic islands. The inset shows the odontogenic islands at a higher magnification.


Photomicrograph showing positive p53 staining in the invading odontogenic islands.


Pathological characteristics demonstrated by H&E staining of the patient (100x). . Notes: A large number of transparent cells with diffuse distribution were observed in the primary liver tumor, lung metastatic lesion, and adrenal metastatic lesion. (A) Histopathology of primary liver tumor in December 3, 2009.


Pathological characteristics demonstrated by H&E staining of the patient (100x). . Notes: A large number of transparent cells with diffuse distribution were observed in the primary liver tumor, lung metastatic lesion, and adrenal metastatic lesion. (B) Histopathology of lung metastatic lesion in July 20, 2012.


Pathological characteristics demonstrated by H&E staining of the patient (100x). . Notes: A large number of transparent cells with diffuse distribution were observed in the primary liver tumor, lung metastatic lesion, and adrenal metastatic lesion. (C) Histopathology of adrenal metastatic lesion in October 13, 2017.


Immunohistochemical staining of hepatocytes, PDGFR, and VEGFR in the primary tumor and metastatic lesion. . Notes: (A) High expression of hepatocytes in the lung metastatic lesion in July 20, 2012 (200x).


Immunohistochemical staining of hepatocytes, PDGFR, and VEGFR in the primary tumor and metastatic lesion. (B) High expression of hepatocytes in the adrenal metastatic lesion in October 13, 2017 (100x).


Immunohistochemical staining of hepatocytes, PDGFR, and VEGFR in the primary tumor and metastatic lesion. (C and E) Negative expression of PDGFR and VEGFR in the primary liver tumor in December 3, 2009 (100x).


Immunohistochemical staining of hepatocytes, PDGFR, and VEGFR in the primary tumor and metastatic lesion. (D and F) Negative expression of PDGFR and VEGFR in the adrenal metastatic lesion in October 13, 2017 (100x). . Abbreviations: PDGFR, platelet-derived growth factor receptor; VEGFR, vascular endothelial growth factor receptor.


Citological study.


Pathological study of the tumor (macroscopic and microscopica study).


CT/MRI scan showed widespread metastases in the lungs.


Liver, bilateral adrenals.


Thoracic and lumbar vertebrae.


Pelvis bones.


Histopathology of prostate and liver tumor. No visible tumor cell in prostate specimen.


Histopathology of prostate and liver tumor. Expression of P63.


Histopathology of prostate and liver tumor. 34BE12. Surrounding the gland.


Histopathology of prostate and liver tumor. Visible prostate adenocarcinoma in liver tumor.


Histopathology of prostate and liver tumor. With expression of AR.


Histopathology of prostate and liver tumor. , PSA.


Histopathology of prostate and liver tumor. And negative Syn.


Histopathology of prostate and liver tumor. And CgA.


Histopathology of prostate and liver tumor. , Hepatocyte.


Overall process of disease progression, related treatment and changes of the PSA level. The upper graph shows changes of the PSA level, the treatment course is in the middle and the progression of the disease is shown in the bottom. ADT, androgen deprivation therapy; DOC, docetaxel; IAD, intermittent androgen deprivation; ABI, abiraterone; NA, not available.


ctDNA SMSEQ analysis of CSF. Blue box, expected ERBB2 (HER2) gene counts; black dot, ERBB2 gene counts (HER2 amplification) in the patient's CSF.


Hematoxylin and eosin staining of the cauda equina demonstrating:. X100) pleomorphic spindle cells with prominent nucleoli.


Mitotic figures. X1250), and melanin pigment.


Spreading of neoplastic cells along subpial and perivascular spaces (c, x100).


Immunohistochemical stains for melanoma cocktail including Melan-A demonstrate cytoplasmic reactivity (d).


Midline sagittal magnetic resonance images (MRI) of thoraco-lumbar area. (a) T1-weighted MRI shows the spinal cord tumor at the level of T12, which has high signal intensity relative to that of the cord and combined syrinx.


Midline sagittal magnetic resonance images (MRI) of thoraco-lumbar area. (b) Contrast-enhanced T1-weighted MRI image shows homogenous enhancement.


The timeline of the patient's treatment course.


Changes in the immune microenvironment before and after neoadjuvant immunochemotherapy. (A) Biopsy before neoadjuvant immunochemotherapy (PD-L1, IHC).


Changes in the immune microenvironment before and after neoadjuvant immunochemotherapy. (B) Surgically resected tissue after neoadjuvant immunochemotherapy and surgery (PD-L1, IHC).


Changes in the immune microenvironment before and after neoadjuvant immunochemotherapy. (C) Representative images of the pretreatment biopsy (multiplex immunofluorescence staining, magnification, x200).


Changes in the immune microenvironment before and after neoadjuvant immunochemotherapy. (D) Representative images of surgically resected tissue (multiplex immunofluorescence staining, magnification, x200). With this staining technique, visible structures include CD8+ T cells (green), CD68+ macrophages (cyan), CD57+ cells (red), PD-1+ cells (magenta), and PD-L1+ cells (orange).


Changes in the immune microenvironment before and after neoadjuvant immunochemotherapy. (E, F) Quantitative multiplex immunohistochemistry results of pretreatment and posttreatment samples in the tumor and stroma regions.


(A) Schematics show the treatment history of the patient. Enhanced computed tomography scan reveals the clinical response to chemotherapy, radiotherapy, nivolumab alone, and nivolumab combined with anlotinib. Red arrows point to the masses in pulmonary and lymph node metastases.


(B) Immunohistochemistry presents the programmed death ligand-1 expression of the lymphoepithelioma-like carcinoma (LELC) tissues in pulmonary LELC.


(C) The genetic testing result of the new metastatic lymph node in our patient, when her disease progressed after nivolumab monotherapy.


(D) The curves showed serum tumor marker CYFRA21-1 levels before and after the combined nivolumab and anlotinib therapy.


(E) The curves showed Epstein-Barr virus copy numbers in the serum before and after the combined nivolumab and anlotinib therapy.


Histopathologic findings of the resected specimen. A; Specimen from the initial operation showed an aplastic carcinoma with osteoclast-like large cells.


Histopathologic findings of the resected specimen. B; Specimen from the second operation showed a well-differentiated tubular adenocarcinoma with glandular formation.


Histopathologic findings of the resected specimen. C; Specimen from the third operation showed an aplastic carcinoma similar to that of the initial operation.


Images of the third operation. A; CT scan during the third operation showing a tumor measuring 2.5 cm in diameter with cystic components in the remnant pancreatic body (arrow).


Images of the third operation. B; MRI after the third operation showing that the tumor had iso-intensity on a T1-weighted image and high intensity on a T2-weighted image (arrow).


Images of the third operation. C; FDG-PET showing a hot spot (arrow) in the body of the remnant pancreas.


Gastrointestinal stromal tumors' mass excised.


High power slide of gastrointestinal stromal tumors.


Laboratory data fluctuation. A line graph demonstrates the fluctuations of AST/ALT levels. The horizontal axis shows the number of weeks after nivolumab induction. At week 34, these enzymes were suddenly elevated. After corticosteroid initiation, the levels of these enzymes rapidly improved.


Histology-carcinoid tumor.


Primary tumour of the breast formed by uniform cells with scant, lightly eosinophilic cytoplasm, arranged in broad gyriform trabeculae. Invasive component is visible at the top, in situ component below it (H&E, 20x).


Liver metastasis of the neuroendocrine tumor, composed by monomorphic cells arranged in trabeculae (H&E, 20x).


Chromogranin A expression in cells of the metastatic tumour of the liver (20x).


ER expression in cells of the metastatic tumour of the liver (20x).


CT scan showing a tumor of the parotid area.


Digitally reconstructed radiography of the left lateral field.


CT scan showing a radiological complete remission.


Magnetic resonance imaging of metastatic pituitary lesion. (A) At the time of diagnosis, a 35-mm strongly enhancing mass was observed in the sellar and suprasellar regions (September 2012).


Magnetic resonance imaging of metastatic pituitary lesion. (B) Even after partial removal of the tumor via craniotomy and whole brain radiation therapy, viable tumor remained (27 mm, November 2012).


Magnetic resonance imaging of metastatic pituitary lesion. (C) The size of the enhancing lesion had increased slightly (29 mm) 4 months after discontinuation of lapatinib and capecitabine due to gastrointestinal sepsis (June 2013).


Magnetic resonance imaging of metastatic pituitary lesion. (D) After re-starting lapatinib monotherapy, the size of the enhancing mass decreased (25 mm, September 2013).


(A) Histology of invasive ductal carcinoma showing a predominantly trabecular pattern, high nuclear atypia, and high mitotic activity (H&E staining, x100).


(B) Histology of invasive ductal carcinoma metastasis to the brain, showing infiltration of malignant cells to the parenchyma (H&E staining, x100).


Due to gastrointestinal sepsis, the patient's serum sodium level changed radically (March to April, 2013), and it was stabilized after the tumor was controlled by lapatinib (November 2013).


Gross view of the subcutaneous mass (arrow).


Sections from the skin show malignant glands (arrow) with mucin in the subcutaneous area. H&E 100x.


Sections from the skin show malignant glands (arrow) with mucin in the subcutaneous area. H&E 400x.


Microscopic appearance of a fine-needle aspiration biopsy and cytological examination of the thyroid. Follicular cells are arranged as sheets, compatible with the smear of a nodular goiter. (Papanicolaou, x40).


Macroscopic appearance of a nodule in thyroid tissue. The cut surface revealed a lobulated, infiltrating, and solid gray-whitish tumor, with a thick, focal capsule. Dots outline the poorly differentiated carcinoma component and the arrowheads indicate the nodular goiter.


Microscopic appearance of a nodule in thyroid tissue. A widely invasive, cellular tumor (asterisks), with a nodular goiter (arrowhead) within a nodule partially encapsulated by a thick fibrous capsule (cap) was noted. (hematoxylin and eosin, x1.25).


The poorly differentiated thyroid carcinoma showed trabecular, solid and microfollicular histological patterns without the nuclear features of a papillary thyroid carcinoma a, as well as high mitotic activity b. Hematoxylin, and ,eosin,. . X10.


The poorly differentiated thyroid carcinoma showed trabecular, solid and microfollicular histological patterns without the nuclear features of a papillary thyroid carcinoma a, as well as high mitotic activity b. Hematoxylin, and ,eosin,. . X20).


The nodular goiter was composed of small or dilated follicles, and lacked the nuclear features of a papillary thyroid carcinoma. (hematoxylin and eosin, x10).


The Ki-67 labeling index of the nodular goiter was very low a; however, that of the PDTC was high b. (Ki-67 immunostain, a-b: x10).


51-year-old male presented with right facial pain of 2 years duration with no significant medical history and was later diagnosed with sinonasal adenoid cystic carcinoma. (a) CT bone window reveals a large expansive and infiltrative process involving the right nasal cavity, maxillary, and pterygomaxillary fossa (with arrows).


51-year-old male presented with right facial pain of 2 years duration with no significant medical history and was later diagnosed with sinonasal adenoid cystic carcinoma. (b) CT soft tissue window post intravenous contrast injection demonstrates moderate enhancement and, intracranial invasion involving sphenoidal sinuses and the right parasellar region (red arrows).


Pre-operative magnetic resonance images revealed a cystic lesion that was T1 hypointense, T2 hyperintense, and peripherally enhancing within the left cerebellopontine angle wrapping around the lateral brainstem. Adjacent to the cystic lesion was a T1 isointense, T2 hyperintense, avidly enhancing infiltrative component involving the brainstem, cerebellar peduncle, and cerebellum. (A) Coronal T1-weighted contrast enhanced.


Pre-operative magnetic resonance images revealed a cystic lesion that was T1 hypointense, T2 hyperintense, and peripherally enhancing within the left cerebellopontine angle wrapping around the lateral brainstem. Adjacent to the cystic lesion was a T1 isointense, T2 hyperintense, avidly enhancing infiltrative component involving the brainstem, cerebellar peduncle, and cerebellum. (B) Axial T1-weighted contrast enhanced.


Pre-operative magnetic resonance images revealed a cystic lesion that was T1 hypointense, T2 hyperintense, and peripherally enhancing within the left cerebellopontine angle wrapping around the lateral brainstem. Adjacent to the cystic lesion was a T1 isointense, T2 hyperintense, avidly enhancing infiltrative component involving the brainstem, cerebellar peduncle, and cerebellum. (C) Sagittal T1-weighted contrast enhanced.


Pre-operative magnetic resonance images revealed a cystic lesion that was T1 hypointense, T2 hyperintense, and peripherally enhancing within the left cerebellopontine angle wrapping around the lateral brainstem. Adjacent to the cystic lesion was a T1 isointense, T2 hyperintense, avidly enhancing infiltrative component involving the brainstem, cerebellar peduncle, and cerebellum. (D) Diffusion weighted-imaging.


Pre-operative magnetic resonance images revealed a cystic lesion that was T1 hypointense, T2 hyperintense, and peripherally enhancing within the left cerebellopontine angle wrapping around the lateral brainstem. Adjacent to the cystic lesion was a T1 isointense, T2 hyperintense, avidly enhancing infiltrative component involving the brainstem, cerebellar peduncle, and cerebellum. (E) Apparent diffusion coefficient.


Pre-operative magnetic resonance images revealed a cystic lesion that was T1 hypointense, T2 hyperintense, and peripherally enhancing within the left cerebellopontine angle wrapping around the lateral brainstem. Adjacent to the cystic lesion was a T1 isointense, T2 hyperintense, avidly enhancing infiltrative component involving the brainstem, cerebellar peduncle, and cerebellum. (F) Fluid-level attenuated inversion recovery.


Hemotoxylin and eosin stain demonstrating keratin material with small clusters of atypical squamoid cells and keratin pearls consistent with squamous cell carcinoma. (A) 10x magnification.


Hemotoxylin and eosin stain demonstrating keratin material with small clusters of atypical squamoid cells and keratin pearls consistent with squamous cell carcinoma. (B) 20x magnification.


Chest CT scan- Axial view: Normal parenchymal lung tissue without evidence of active chest disease or intrathoracic lymphadenopathy.


(a) Abdomen and pelvis CT scan: The liver is large measuring up to 24 cm (blue arrows). The spleen is large measuring 17.4 cm (red arrows), retrocrural lymphadenopathy (white arrows).


(b) Abdomen and pelvis CT scan: Retroperitoneal lymph nodes (white arrows).


Gallium scan: Large region of intense focal uptake midline abdomen compatible with mesenteric (blue arrows) and retroperitoneal lymphadenopathy (white arrows). No abnormal lung uptake is seen.


Lymph node biopsy: (hematoxylin and eosin stain) lymphohistiocytic infiltrate (red arrows).


Lymph node biopsy: Many acid-fast bacilli (blue arrows).


Imaging and histopathological characteristics of the patient before crizotinib treatment. . (A and B) PET/CT scans showed increased FDG uptake in multiple lymphatic metastases in the whole body and no FDG uptake in the small nodule located in the posterior segment of the right upper lung.


Imaging and histopathological characteristics of the patient before crizotinib treatment. (C) H&E staining confirmed the right neck lymph nodes as poorly differentiated metastatic carcinomas.


Imaging and histopathological characteristics of the patient before crizotinib treatment. (D and E) Immunohistochemical staining of the right neck lymph nodes showed positive staining of CK7 (2+) and negative staining of TTF-1 (x400). . Note: The red arrow in figure B indicates the small nodule located in the right upper lung. . Abbrevations: CK7, cytokeratin 7; FDG, fluorodeoxyglucose; H&E, hematoxylin & eosin; PET/CT, positron emission tomography/computed tomography; TTF-1, thyroid transcription factor-1.


Chest CT scans showing dynamic changes in metastatic right axillary lymph nodes. Before.


1 month after.


4 months after.


8.5 months after crizotinib treatment. . Note: The red arrows in all figure parts indicate the metastatic lesions located in the right axillary fossa. . Abbrevation: CT, computed tomography.


Physical examination showing darkening and thickening of the skin. Note the darkening skin in the neck and the velvety appearance in the infra axillary region.


Photomicrography of the skin showing epidermal thickening due to "finger-like" papillomatosis and hyperkeratosis without melanocytic proliferation.


Skin examination of the neck region 50 days after tumor removal. Note the almost complete disappearance of the acanthosis nigricans in this area.


(A) Sagittal CT head angiography demonstrates A2 aneurysm (arrow).


Diagnostic subtraction angiography.


Exhibit complete occlusion of A2 aneurysm after primary coiling (arrows). . Abbreviation: CT, computed tomography.


(A) Axial MR T1 with contrast demonstrates heterogeneously enhancing lesion along midline and left frontal area (arrow).


(B) Axial MR FLAIR demonstrates perilesional edema (arrow). . Abbreviations: MR T1, T1-weighted image magnetic resonance; MR FLAIR, magnetic resonance-fluid-attenuated inversion recovery.


Computed tomography slice of the patient pelvis showing a cervico-isthmic mass.


Cervical biopsy showing metastatic moderately differentiated adenocarcinoma cells: Ectocervical mucosa infiltrated by a carcinomatous proliferation of glands of varying size and focus of necrosis lined by atypical cells.


Immunohistochemical study of cervical tumor cells: Strong nuclear staining of tumor cells by the CDX2 marker.


A and B - Ultrasonography of the left scrotal sac showing a heterogeneous mass with some scattered cystic areas (notedly in B).


Abdominal CT. Coronal reformation showing a heterogeneous mass involving the aorta and left iliac artery.


Abdominal CT. Axial plane showing periaortic lymph nodes, delayed concentration/excretion of the contrast, and slight hydronephrosis.


Abdominal CT. Axial plane showing lymph nodes conglomerate with signs of central necrosis along the left iliac artery.


Abdominal CT. Axial plane - multiple bilateral enlarged inguinal lymph nodes.


Magnetic resonance imaging brain after surgery, showing no evidence of residual lesion or recurrence of meningioma.


Intraoral photograph showing lesion in-situ.


Midline split incision given.


Segmental mandibulectomy done.


Reconstruction using fibula flap.


Histopathology of the patient showing high cellular mesenchymal component that consists of numerous monomorphic spindle-shaped fibroblast and histiocyte like cells in varying proportions, multinucleated giant cells seen interspersed in the connective tissue stroma, and the tumour cells are invading the osseous tissue at the periphery (x40).


Postoperative orthopantomogram.


Timeline and histological transformation. H&E: Hematossil and Eosin staining (magnification 20X). Immunohistochemistry analyses were performed using mouse monoclonal antibodies anti TTF-1 and p40, clone 8G7G3/1 and clone BC28 respectively, on the Ventana Medical System (Roche). Immonuhistochemistry images have been reported with a 20X magnification. Gene mutational analysis was performed by Sequenom MassArray at baseline, EGFR mutational status was determined by digital droplet PCR at progression times. ALK and PD-L1 were evaluated by immunohistochemistry and gene fusions and amplifications by fluorescent in situ hybridization. LUAD, lung adenocarcinoma; LUSC, lung squamous-cell carcinoma.


Clinical Timeline. The immunohistochemistry evaluation of PD-L1 was performed using a monoclonal primary antibody SP263 clone on the Ventana Medical System (Roche). MET amplification was evaluated by fluorescence in situ hybridization using the probes: LSI MET spectrum red and CEP7 spectrum green (Vysis - Abbott). PR, partial response; SD, stable disease; PD, progression disease; NGS, Next Generation Sequencing; LUAD, lung adenocarcinoma; LUSC, lung squamous-cell carcinoma.


Hematoxylin-eosin-stained biopsy specimens. (10*10).


Hematoxylin-eosin-stained biopsy specimens. (40*10) showed the pathology of pleural biopsy specimens: Well-differentiated adenocarcinoma infiltration in small fibrous tissue, immunohistochemical feature: CK (+) EMA (-) Vim (-) MC (-) CR (-) P53 (-) Ki-67 (2% +) CK7 (-) TTF-1 (-) Villin (-) CK 20 (-) CDX-2 (-) CEA.


Hematoxylin-eosin-stained biopsy specimens. (40*10) showed the pathology of bronchoscopic biopsy specimens: (right lower lobe bronchial orifice) infiltrating adenocarcinoma, tumor thrombus was found in vascular cavity, immunohistochemical feature CK7 (+) TTF-1 (+) CEA (+) CK (+) CD31 (vascular+, tumor thrombus visible).


Systemic bone imaging. The metabolic activity of hypermetabolic focus in the middle part of left femur decreased significantly after treatment. At the initial visit.


Systemic bone imaging. The metabolic activity of hypermetabolic focus in the middle part of left femur decreased significantly after treatment. After targeted treatment of gefitinib.


A, B: Brain CT scan shows an expansile bone lesion in the right frontal bone, invading the surrounding soft tissues.


C: Chest CT scan shows a heterogeneous mass in the manubrium of the sternum composed of soft tissue and bone components.


A low-magnification (10x) pathology of the sternal mass showing fibromuscular tissue infiltrated with round tumour cells.


A high-magnification (40x) pathology shows round cells with small to moderate amounts of cytoplasm and high mitotic activity accompanied by vascular invasion.


A head MRI at 5 months after starting crizotinib showed a left orbital metastasis with multiple brain metastases.


Examinations and histopathological results during work-up of the patient. (A) Upper gastrointestinal X-ray showed a stricture in the second portion of the duodenum.


Examinations and histopathological results during work-up of the patient. (B) Upper gastrointestinal endoscopy detected a stricture with circumferential edematous friable mucosa, extending from the duodenal bulb to the second portion of the duodenum.


Examinations and histopathological results during work-up of the patient.


Examinations and histopathological results during work-up of the patient. PET/CT revealed duodenal wall was thickened and identified as metabolically active lesions (SUVmax=10.6).


Examinations and histopathological results during work-up of the patient. Thickened peritoneum and mesenteries and slightly larger lymph nodes in the mesenteries were found with intense FDG uptake (SUVmax=14.3).


Examinations and histopathological results during work-up of the patient. (G) Holistic view of PET/CT: metabolic lesions in the duodenum, peritoneum and mesenteries.


Examinations and histopathological results during work-up of the patient. Exploratory laparotomy showed three metastatic nodules in the peritoneal cavity, including one nodule on the ligamentum teres hepatis.


Examinations and histopathological results during work-up of the patient. The other two on the omentum. (arrows).


Examinations and histopathological results during work-up of the patient. Histopathological examination of primary breast cancer.


Examinations and histopathological results during work-up of the patient. Metastatic axillary lymph node.


Examinations and histopathological results during work-up of the patient. Metastatic peritoneal nodule. All revealed single-file strands of infiltrating small tumor cells dispersed in the fibrous matrix (circle).


Whole exome sequencing (WES) of tumor samples from primary lesion, regional lymph nodes and peritoneal metastatic lesions. (A) 3-way Venn Diagram showed the mutational overlaps in the three samples. There were 47 common mutations in the three samples, while another 21 common mutations between lymph node and metastatic site, and another 54 common mutations between lymph node and primary site.


Whole exome sequencing (WES) of tumor samples from primary lesion, regional lymph nodes and peritoneal metastatic lesions. (B) Somatic mutation heatmap. The mark "*" means that there are 2 or more mutations in the same gene, which was labelled with gene or amino acid changes. Yellow means there is variation, while blue means there is no variation.


Whole exome sequencing (WES) of tumor samples from primary lesion, regional lymph nodes and peritoneal metastatic lesions. (C) Variation frequency (VAF) distribution. The mark "*" means that there are 2 or more mutations in the same gene, which was labelled with gene or amino acid changes.


Acquired mutations were detected in the sample of peritoneal metastatic lesion and visualized through Integrative Genomics Viewer (IGV). (A) Variant PIK3CA p. D959N IGV plot (all reads: 181, alternative allele supported reads: 26).


Acquired mutations were detected in the sample of peritoneal metastatic lesion and visualized through Integrative Genomics Viewer (IGV). (B) Variant ESR1 p. E380Q IGV plot (all reads: 399, alternative allele supported reads: 70).


CT scan, October 2012 (before vemurafenib therapy). . Abbreviation: CT, computed tomography.


Comparison between PET at baseline (upper row) and PET after 1 month of vemurafenib therapy (lower row). . Abbreviation: PET, positron emission tomography.


A) Sheets of cells with reticular growth pattern and a more compact adenoid cystic morphology (Hematoxylin & Eosin stain, Zeiss Axioshop 40, magnificationx100).


B) Sickled erythrocytes (Hematoxylin & Eosin stain, Zeiss Axioshop 40, magnificationx400).


A) Lung metastasis, patient case #3.


B) Response after platin-based chemotherapy.


C) Mediastinal lymphadenopathy, patient case #3.


D) Response after platin-based chemotherapy.


The pathology and immunohistochemistry of the patient. . Notes: (A) H&E staining with surgical specimens. 200x.


The pathology and immunohistochemistry of the patient. (B) Immunohistochemistry: dot-like positivity for CK20. 400x.


The pathology and immunohistochemistry of the patient. (C) Immunohistochemistry: negativity for CK7. 400x.


Changes in lesions during treatment of the patient. . Notes:. After surgery, before treatment. From the pictures, masses reduced significantly during two cycles (A-C).


Changes in lesions during treatment of the patient. After the first treatment. From the pictures, masses reduced significantly during two cycles (A-C).


Changes in lesions during treatment of the patient. After the second treatment. From the pictures, masses reduced significantly during two cycles (A-C).


Changes in lesions during treatment of the patient. After the third treatment. From the third cycle (D), tumors had a recurrent trend. After three cycles (D-F), tumors had started disappearing.


Changes in lesions during treatment of the patient. After the fourth treatment. After three cycles (D-F), tumors had started disappearing.


Changes in lesions during treatment of the patient. After the fifth treatment. After three cycles (D-F), tumors had started disappearing.


Changes in lesions during treatment of the patient. After the sixth treatment. From the sixth to eighth cycles (G-I), the masses were increasing gradually.


Changes in lesions during treatment of the patient. After the seventh treatment. From the sixth to eighth cycles (G-I), the masses were increasing gradually.


Changes in lesions during treatment of the patient. After the eighth treatment. From the sixth to eighth cycles (G-I), the masses were increasing gradually.


Changes on CT scans during treatment. . Note:. Metastatic lymph node (2.2 cm) on July 31, 2017.


Changes on CT scans during treatment. Metastatic lymph node (2.2 cm) on October 23, 2017.


Changes on CT scans during treatment. Metastatic lymph node (1.3 cm) on December 26, 2017.


Changes on CT scans during treatment. Metastatic lymph node (1.3 cm) on March 5, 2018. . Abbreviation: CT, computed tomography.


Ultrasound showed a solid hypoechoic and irregularly shaped nodule 13 x 8 x 9 mm in size with microcalcifications, a taller-than-wide shape and suspicious extracapsular extension located in the upper pole of the right thyroid gland. Transverse view.


Ultrasound showed a solid hypoechoic and irregularly shaped nodule 13 x 8 x 9 mm in size with microcalcifications, a taller-than-wide shape and suspicious extracapsular extension located in the upper pole of the right thyroid gland. Longitudinal view.


Ultrasound showed a solid hypoechoic and irregularly shaped nodule 13 x 8 x 9 mm in size with microcalcifications, a taller-than-wide shape and suspicious extracapsular extension located in the upper pole of the right thyroid gland. Doppler blood flow signals.


Ultrasound showed a solid hypoechoic and irregularly shaped nodule 13 x 8 x 9 mm in size with microcalcifications, a taller-than-wide shape and suspicious extracapsular extension located in the upper pole of the right thyroid gland. Elastography.


A suspicious parathyroid gland was found in the superior left area of the thyroid bed.


TSH, hTg, and TgAb levels. The patient received RAI therapy 120 days after the operation.


PTH and Ca levels.


Left thigh medial aspect showed multiple papulonodular lesions that coalesced to form a plaque in dermatomal segment L2-L3.


The sole of the left foot showed a larger ulcerated, ill-defined, pigmented lesion of size 4 cm x 5 cm, present laterally, and a smaller pigmented firm plaque of size 2 cm x 3 cm with well-defined margins and a raised surface, present medially.


A. Photomicrograph from the primary origin ulcerated site simulated acantholytic bullous lesion in the scanner view (H & E; 100x).


B. Photomicrograph exhibiting neutrophilic and fibrinous exudate toward the ulcerated surface (arrow). Tumour cell nests are present deep in the reticular dermis (H & E; 200x).


C. Proliferation of single atypical pigmented melanocytes and nests (black arrow) seen in the epidermal layers. Increase in dermal blood vessels with proliferating new vessels present in the dermis (blue arrow) (H & E; 100x).


D. Photomicrograph showing dense infiltration of melanoma cells with pigment at places. Atypical cells have descended deep into the reticular dermis (H & E; 100x).


Photomicrograph from the metastatic site showing a circumscribed tumour nodule of hyperchromatic tumour cells in dermis with no junctional activity (green arrow). A small tumour nest (blue arrow) and perineural tumour focus (black arrow) are seen in upper dermis (H & E; 100x).


Sagittal T1-weighted (T1w) spinal MRI. . Notes: (A) Baseline MRI showed ribbon-like enhancement of the spinal pia mater (red arrow) and the multiple osseous destruction sites (white arrow).


Sagittal T1-weighted (T1w) spinal MRI. (B) Repeat MRI after 4 months of treatment, showed reduced enhancement of the spinal pia mater (red arrow) and stable osseous destruction sites (white arrow).


Axial T1w C+ craniocerebral MRI. . Notes: (A) Baseline MRI showed three patches of enhancement along the sulci (white arrows).


Axial T1w C+ craniocerebral MRI. (B) After 4 months of treatment, MRI showed reduced enhancement of all lesions (white arrows).


Axial T1w C+ craniocerebral MRI. . Notes: (A) Baseline MRI showed a patch of inhomogeneous enhancement along the sulci (white arrow).


Axial T1w C+ craniocerebral MRI. (B) MRI after a 3-month interval showed a shrunken lesion (white arrow).


Axial T1w C+ craniocerebral MRI. (C) Repeat MRI in May 2019 showed a reduced lesion (white arrow).


Positron emission tomography scanning showed tracer uptake in the sigmoid colon tumour. Central necrosis was observed.


EML4-ALK fusion in the present case visualized using the Integrative Genomics Viewer (IGV). Diagrammatic sketch of EML4-ALK fusion result (A).


EML4-ALK fusion in the present case visualized using the Integrative Genomics Viewer (IGV). The IGV display of EML4-ALK fusion in an adenocarcinoma specimen of EML4-ALK fusion results (B).


EML4-ALK fusion in the present case visualized using the Integrative Genomics Viewer (IGV). The IGV display of EML4-ALK fusion in a squamous cell carcinoma specimen of EML4-ALK fusion results (C).


(A) Patient A, right inguinal squamous cell carcinoma 2 weeks after first cycle of experimental immune therapy. Tumor surface became smooth and epithelial margins symmetric compared to original tumor state.


Tumor images of patients A and B. (B) 11 weeks after second experimental treatment, the patient returned for the last cycle of intratumoral vaccinations and topical imiquimod therapy. The tumor measured 2 cm3.


(C) Patient B, hematoxylin and eosin stain of recurrent cervical cancer showing areas of invasive focally keratinizing, moderately differentiated squamous carcinoma involving entire thickness of the stroma (x20 magnification, scale 100 microm).


(D) Patient B, tumor identified and biopsied 3-4 weeks after completion of chemo-radiation for stage 3B squamous cell cancer of the cervix, pelvic exam, PET/CT, and biopsies confirmed radiation-refractory, recurrent disease.


(E) Radical hysterectomy and bilateral salpingo-oophorectomy following failed curative chemo-radiation (8,500 cGy total to point A) followed by two cycles of intratumoral vaccinations and imiquimod. No residual squamous cell carcinoma on pathological evaluation and negative HPV-HR testing of the cervix. Vaginal cuff ThinPrep. 6 weeks post-operatively was negative for dysplasia/malignancy and HPV-HR DNA.


Microscopic appearance: the tumor is composed of compact nests and sheets of epithelial cells surrounded by a prominent component of mature lymphocytes and plasma cells. Hematoxylin and eosin stain; original magnification x100.


Microscopic appearance: tumor cells are undifferentiated, large, with round, vesicular nuclei, containing a prominent nucleolus, and with an abundant, ill defined cytoplasm. Hematoxylin and eosin stain; original magnification x400.


positive immunohistochemical staining for cytokeratin 5/6.


Photomicrograph of the ovary. Tumor cells showed immunoexpression of estrogen receptor (ER) in A, and progesterone receptor (PR) in B - intense staining in 75-100% cells, plus strong and diffuse immunoexpression of CK7 in C and gross cystic disease fluid protein (GCDFP-15) in D.


PET scan showing 18F-FDG uptake in the left breast.


PET scan showing moderate 18F-FDG uptake in right ovary area and less uptake posteriorly and inferiorly, which could be peritoneal implants.


H-E staining showing both thyroid follicles in the down left part and tumor cells in the upper right part, original magnification x100.


Immunoperoxidase staining for CK20 showing positive tumor cells, original magnification x400.


Immunoperoxidase staining for NF showing positive tumor cells, original magnification x400.


Computed tomography scan of brain (plain and contrast).


Initial multimodal imaging after admission. (a) Cranial computed tomography without contrast. The image shows an approximately 3.5 cm measuring lesion thalamic lesion with compression of the right lateral ventricle and consecutive midline-shift of 4 mm. The lesion appears heterogeneous with peripheral enhancement and central hypodensity. No intense perifocal edema was present.


Initial multimodal imaging after admission. (b) Cranial magnetic resonance imaging. Axial T1 sequences without contrast show a poorly demarcated, circumscribed mass in the right thalamic area having a space-consuming effect with compression of the right lateral ventricle. T1 sequence with contrast reveals a heterogeneous pattern of avid enhancement. Axial T1 with gadolinium).


Initial multimodal imaging after admission. Focal hypertense margins surrounding a hypotense area. Axial MPRage).


Initial multimodal imaging after admission. (d) An axial T2 sequence displays dispositions of irregular blood products as well as enlarged vessels draining the lesion at its rostral and caudal margins.


Multimodal angiography. (a) Cranial computed tomography angiography with axial sections displaying a highly vascularized lesion with posteriorly located hemorrhage and focal calcification.


Multimodal angiography. (b, c) Correlating coronal and sagittal images demonstrate the specific aspect of this lesion with dilated marginal vessels almost entirely surrounding and draining it.


Multimodal angiography. (d, e) Cerebral digital subtraction angiography confirms arteriovenous malformation-like morphology with sagittal and coronal images visualizing a vascular lesion with enlarged draining veins and multiple vessels feeding into a nidus at the posterior margin of the lesion (arrows).


Multivoxel magnetic resonance spectroscopy reveals aberrant metabolic function. An increased creatinine/choline peak ratio of 2.41 ppm was found within the lesion, matching the metabolic signature of glioblastoma multiforme.


Three-dimensional planning of a frame-based stereotactic biopsy. (a, b) The target point was set to the lateral posterior margin of the lesion with respect to the major vascular aggregations for limiting the bleeding risk. The procedure was planned in a CRW frame using the Stereocalc software (Radionics, Burlington, MA).


Axial, contrast-enhanced computed tomography shows a hypodense and cystic lesion with ring enhancement, located in the deep neck-space on the left side of the neck.


CT brain. (a) Preoperative contrast CT brain showing heterogeneously enhancing parasagittal lesion.


CT brain. (b) Postoperative plain CT brain showing gross total tumor excision.


Pathological findings of primary sigmoid colon cancer and metastatic ovarian tumor. The primary sigmoid colon cancer. Represents a moderately differentiated adenocarcinoma.


Pathological findings of primary sigmoid colon cancer and metastatic ovarian tumor. The metastatic ovarian tumor. Is also identified as an adenocarcinoma.


Pathological findings of primary sigmoid colon cancer and metastatic ovarian tumor. Both the sigmoid colon cancer and ovarian tumor show negative staining for CK7. Sigmoid colon cancer.


Pathological findings of primary sigmoid colon cancer and metastatic ovarian tumor. . Ovarian tumor).


Pathological findings of primary sigmoid colon cancer and metastatic ovarian tumor. Positive results for CK20. Sigmoid colon cancer.


Chest CT coronal scan with 3D CT volume rendering picture of the tumor and the diaphragm.


Intraoperative picture: tumor is closely adjacent and connected with the right liver lobe (SVII, SVIII) by loose adhesions without signs of invasion.


The gross specimen.


Afteroperative chest X-ray: formed right diaphragmatic dome at the seventh intercostal space.


Immunohistochemical study (diaminobenzidine, hematoxylin), x200 magnification. Tumor cells express the progesterone receptor (Y85 clone, Cell Marque).


Appearance and symptoms of the patient on admission.


(a) A chest X-ray with right sided pneumothorax.


(b) A chest X-ray of the same patient after 2 days with intercostal tube in situ and fully expanded right lung.


(a) X-ray chest of the same patient with second episode of right sided pneumothorax.


(b) Chest X-ray of the same patient with intercostal tube in situ and a partially expanded lung.


High resolution computed tomography scan of the chest showing diffuse thin-walled cystic changes of the pulmonary parenchyma and right-sided pneumothorax with intercostal tube in situ, all findings characteristic of lymphangiomyomatosis.


Initial MRI of the brain with and without contrast. . A large right frontal lobe intra-axial mass with mass effect upon the right ventricular system and a leftward midline shift of approximately 1.3 cm is shown.


Hematoxylin and eosin staining of the tumor.


Synaptophysin immunohistochemical staining of the tumor typical of PNET.


Post-treatment MRI of the brain with and without contrast. . Postoperative changes in the right frontotemporoparietal region are shown. Irregular enhancement at the surgical site extends to the walls of the right lateral ventricle. This was unchanged in subsequent MRI scans.


Pelvis X-rays showing left iliac wing reconstruction with tibial autografts and stabilization with screw-rod type osteosynthesis.


Bone window CT scan in sagittal view obtained at the time of admission showing no osteolytic changes of the calvarial bone.


Preoperative axial.


Coronal. Postgadolinium T1-weighted MRI images, showing a strongly enhancing right frontoparietal tumor with sagittal venous sinus invasion. Note the dural tail indicating a meningeal tumor.


Intraoperative photograph of the bone flap showing extradural lobulated tumor tissue tightly attached to the inner calvarial bone.


Hematoxylin and eosin-stained tumor specimen showing densely packed, small round cells with scanty clear cytoplasm and regular vesicular and hyper chromatic nuclei; magnification, x200.


Postoperative coronal CT scan showing near total tumor removal with craniotomy defect.


Preoperative, intraoperative, and postoperative imaging. Head computed tomography (CT) at presentation indicating subarachnoid hemorrhage.


Preoperative, intraoperative, and postoperative imaging. Preoperative angiogram (anteroposterior view).


Preoperative, intraoperative, and postoperative imaging. Preoperative angiogram (oblique view).


Preoperative, intraoperative, and postoperative imaging. Preoperative 3D angiography of the neoplastic aneurysm.


Preoperative, intraoperative, and postoperative imaging. Intraoperative angiogram.


Preoperative, intraoperative, and postoperative imaging. Postoperative head CT.


Follow-up radiographic imaging. Digital subtraction angiography (DSA) of a new pseudoaneurysm arising from a distal branch of the left callosomarginal artery (red arrow).


Follow-up radiographic imaging. 3D DSA of the aneurysm (red arrow).


Follow-up radiographic imaging. DSA of small pseudoaneurysm arising from a distal M2 anterior division branch of the right middle cerebral artery (red arrow).


The polyp is consisted of clear cells sheets ( ), nests and cords separated by a delicate capillary vascular network (HEx50).


Details of tumor cells with an abundant clear cytoplasm ( ) and a round uniform nucleus (HEx200).


Negative staining for cytokeratin (IHCx200).


H & E stain of 10X view showing tumour cells arranged in alveolar pattern separated by fibrovascular stroma.


H & E stain 40x view showing Two distinctive types of cells - large cells arranged peripherally with abundant cytoplasm, round vesicular nucleus and brown pigment; and small cells with scanty cytoplasm and hyperchromatic round nuclei were seen in the center.


IHC Stain Cytokeratin.


IHC stain HMB45.


IHC Stain NSE.


IHC Stain Synaptophysin.


Histopathologic examinations of kidney and pleural specimens show primary and metastatic clear cell carcinoma. (A) Macroscopic image of the excised kidney tumor.


Histopathologic examinations of kidney and pleural specimens show primary and metastatic clear cell carcinoma. (B): Hematoxylin-Eosin (H&E) staining of the kidney, x 40.


Histopathologic examinations of kidney and pleural specimens show primary and metastatic clear cell carcinoma. (C): H&E staining of the kidney, x 200.


Histopathologic examinations of kidney and pleural specimens show primary and metastatic clear cell carcinoma. (D) Macroscopic image of the excised pleural tumor.


Histopathologic examinations of kidney and pleural specimens show primary and metastatic clear cell carcinoma. (E) H&E staining of the pleura, x 40.


Histopathologic examinations of kidney and pleural specimens show primary and metastatic clear cell carcinoma. (F) H&E staining of the pleura, x 200.


Preoperative noncontrast.


Contrast. T1-weighted sagittal MRI images suggestive of a midline tectal mass with central necrosis.


Pre- and postoperative sagittal and axial, noncontrast, CT scans. (a) Preoperative sagittal CT scan illustrating an ill-defined tectal mass.


Pre- and postoperative sagittal and axial, noncontrast, CT scans. (b) Postoperative sagittal CT scan illustrating partial resection of the lesion, decreased size of the mass, and improvement of hydrocephalus.


Pre- and postoperative sagittal and axial, noncontrast, CT scans. (c) Preoperative axial CT scan demonstrating marked hydrocephalus and the presence of a midline mass.


Pre- and postoperative sagittal and axial, noncontrast, CT scans. (d) Postoperative axial CT scan demonstrating improved hydrocephalus and decrease in the mass size after ventriculoperitoneal shunt and debulking of tumor.


Magnetic Resonance Spectroscopy with voxel in tectal lesion demonstrating elevated choline and lactate with decreased levels of creatine and N-acetylaspartate compatible with a high-grade glioma.


Arthroscopic images of working curette.


Working biter.


Tumor cavity after excision.


Tumor cavity after grafting These images were obtained via the single tunnel technique.


(A and B) Intraoperative arthroscopic image of PCL origin.


(C) Histological confirmation of ligamentous tissue biopsied from site.


Fluoroscopic image of two-tunnel technique being employed to curette lesion under arthroscopic assistance.


Arthroscopic image of curettage, performed via two-tunnel technique.


Periarticular chondroblastoma of the right distal femur in a 15-year-old female.


Fluoroscopic image of curettage performed through lateral tunnel.


(A) Rigid bronchoscopy revealed multiple intraluminal lesions in the upper trachea.


(B) Lesions resulting in severe central airway obstruction.


Bronchoscopic findings after chemotherapy and radiotherapy.


Clinical feature from 14 years ago. A black mole on the fifth toe of the left foot. A diagnosis of malignant melanoma in situ was made.


Clinical feature at the time of re-examination. A; A skin ulcer measuring 25 x 20 mm is located on the amputated surface of the fifth toe of the left foot.


Clinical feature at the time of re-examination. B; Multiple red nodules on the anterior surface of the lower left leg.


Clinical feature after 26 weeks. A; The skin ulcer on the amputated surface of the fifth toe of the left foot has healed.


Clinical feature after 26 weeks. B; The red nodules on the lower left leg have disappeared, and only pigmentation can be observed.


Clinical feature at 1 year and 9 months. A; There is no local recurrence on the fifth toe of the left foot.


Clinical feature at 1 year and 9 months. B; The pigmentation on the lower left leg has lightened.


Sigmoid colon growth.


Microabscesses and air pockets in the muscular planes along the sigmoid growth.


Section showing normal small intestinal mucosa (red star) with adjacent well differentiated keratinizing squamous cell carcinoma in the mucosa extending to deep aspect (black star).


Diagram presentation of multimodal treatment described in this report. The patient underwent three lines of therapies that consisted of radiotherapy, ALK inhibitor crizotinib, and surgery, with molecular monitoring. Notably, salvage thoracic surgery was performed after progression on second-line treatment based on crizotinib and was followed by a remarkable PFS of 31 months at last follow-up.


Time course after chemoradiotherapy. CRP, C-reactive protein (mg/dL); RBC, red blood cell transfusion; BPT, blood platelet transfusion.


Pre- and posttreatment T1 gadolinium-enhanced MRI brain. A pretreatment T1-gadolinium enhanced MRI brain. Contrast-enhancing lesions are shown in the right temporal lobe. Arrow).


Pre- and posttreatment T1 gadolinium-enhanced MRI brain. A pretreatment T1-gadolinium enhanced MRI brain. Thalamus. Arrowhead).


Pre- and posttreatment T1 gadolinium-enhanced MRI brain. A pretreatment T1-gadolinium enhanced MRI brain. Frontal lobe. Block arrow).


Pretreatment PET scan and MRI femur. There are hypermetabolic lesions of the left femur (block/black arrow) and vastus lateralis (arrow) (a and b). No radiotracer uptake is noted within the lungs (a).


Pretreatment PET scan and MRI femur. There are hypermetabolic lesions of the left femur (block/black arrow) and vastus lateralis (arrow) (a and b).


Pretreatment PET scan and MRI femur. MRI femur depicted a 4.2 cm x 4.1 cm vastus lateralos lesion.


Pretreatment PET scan and MRI femur. Which, following 7 atezolizumab cycles, regressed to 2.3 cm x 2.1 cm.


Eleven-month posttreatment T1 gadolinium-enhanced MRI brain. An eleven-month postoperatively MRI. The temporal lesion has not recurred.


Eleven-month posttreatment T1 gadolinium-enhanced MRI brain. An eleven-month postoperatively MRI. With near complete response of the thalamic lesion. Arrowhead).


Eleven-month posttreatment T1 gadolinium-enhanced MRI brain. An eleven-month postoperatively MRI. Stable frontal lesion. Block arrow).


Initial presentation of non-germinatous germ cell tumor causing obstructive hydrocephalus. Gadolinium-enhanced T1-weighted head MRI in the axial.


Initial presentation of non-germinatous germ cell tumor causing obstructive hydrocephalus. The FLAIR image in the axial plane (b) revealed some edema in the midbrain.


Initial presentation of non-germinatous germ cell tumor causing obstructive hydrocephalus. Coronal.


Initial presentation of non-germinatous germ cell tumor causing obstructive hydrocephalus. Sagittal. Axes performed at presentation showed a pineal region tumor compressing the tectum and causing obstructive hydrocephalus.


Rapid growth of non-germinatous germ cell tumor displacing the left substantia nigra and rostral-caudal fibers from midbrain. Gadolinium-enhanced T1-weighted head MRI in the axial.


Rapid growth of non-germinatous germ cell tumor displacing the left substantia nigra and rostral-caudal fibers from midbrain. Diffusion tensor imaging showed that the rostral-caudal fibers (blue color) from the midbrain were displaced anteriorly and laterally on the left and laterally on the right at the pineal.


Rapid growth of non-germinatous germ cell tumor displacing the left substantia nigra and rostral-caudal fibers from midbrain. The tumor extended caudally into the midbrain on the left exerted pressure medially and anteriorly (c).


Rapid growth of non-germinatous germ cell tumor displacing the left substantia nigra and rostral-caudal fibers from midbrain. Midbrain. Levels.


Rapid growth of non-germinatous germ cell tumor displacing the left substantia nigra and rostral-caudal fibers from midbrain. Coronal.


Rapid growth of non-germinatous germ cell tumor displacing the left substantia nigra and rostral-caudal fibers from midbrain. Sagittal. Axes performed before initiation of treatment showed a heterogeneously enhancing mass arising from the pineal region and measuring 34 x 28 x 23 mm. It caused 10 mm of midline shift and extended anteriorly into the left thalamus.


Second-look neurosurgical resection achieved additional cytoreduction. Gadolinium-enhanced T1-weighted head MRI obtained 1 day after surgery in the axial.


Second-look neurosurgical resection achieved additional cytoreduction. As well as T2-weighted image in the axial plane , demonstrated tumor cytoreduction and relief of compression on the tectum and the midbrain.


Second-look neurosurgical resection achieved additional cytoreduction. Coronal.


Second-look neurosurgical resection achieved additional cytoreduction. Sagittal. Axes.


Computed tomography (CT) images. (A) Pre-contrast CT revealing a large, solitary, well-defined mass in the spleen, with variable areas of necrosis and cystic degeneration.


Computed tomography (CT) images. Contrast-enhanced CT revealing the progressively-enhanced cystic wall, internal septa and solid portion during the. Hepatic arterial.


Computed tomography (CT) images. Portal venous.


Computed tomography (CT) images. Hepatic parenchymal phases. The areas of necrosis and cystic degeneration were non-enhancing.


GBM after three courses of bevacizumab. Gadolinium-enhanced T1-weighted MRI shows a reduction in tumor size as well as decreasing and discontinuous tumor enhancement.


The patient had a 10 cm x 5 cm cavity with a 10-cm-long fistula into the axilla when referred to our department.


A LD-flap was raised to cover the region of the excised fistula.


The fistula recurred (arrow) despite the transferred LD-flap.


Lymphangiography shows lymph vessels emptying into multiple cavities in the axilla and the lateral thoracic wall.


Two lymphatic vessels from the thigh are ready for transplantation.


Lymphoscintigraphy, performed 11 years after grafting clearly shows lymph flow along the route of patent lymphatic grafts from the left arm to the neck (arrows). Left, frontal view; right, dorsal view.


Axial T1-weighted.


T2-weighted. Magnetic resonance imaging at D9 level showing the lesion involving the left half of the vertebral body, pedicle, transverse process, and the lamina with an epidural component producing cord compression.


Postgadolinium injection axial and sagittal T1-weighted images (c and d) show intense enhancement of the tumor. Note the enhancing component in the paraspinal thoracic region.


Radiological monitoring of the patient before and after treatment with sintilimab plus anlotinib. (A) Magnetic resonance imaging (MRI) was performed on the recurrence before treatment (Baseline), on May 16, 2019.


Computed tomography scan of the chest showing the right lateralized mass (asterisk), beginning in the antero-superior pericardium up to the right atrium (white narrow) and right ventricle (dotted arrow).


Magnetic resonance imaging in T2 showing the intrapericardial mass with hypersignal (asterisk) surrounding the wall of the right atrium (white narrow) and ventricle (dotted narrow) with apparent cleavage plan. (A) Sagittal section.


Magnetic resonance imaging in T2 showing the intrapericardial mass with hypersignal (asterisk) surrounding the wall of the right atrium (white narrow) and ventricle (dotted narrow) with apparent cleavage plan. (B) Axial section.


Tumor (asterisk) covering the surface of the right ventricle and right atrium. Aorta (black narrow).


Macroscopic view of the biopsy taken from the tumor.


A; Hematoxylin and eosin staining showed that the liver tumor was composed of spindle cells with pleomorphic nuclei arranged into short fascicles.


B; The immunohistochemical staining for c-Kit was positive.


C; The immunohistochemical staining for DOG1 was positive.


D; The immunohistochemical staining for control was negative. Original magnification, x200.


Computed tomography scan of thorax demonstrating a right hilar mass (red arrow).


Morphological features of yolk sac tumor (A).


Tumor with reticular pattern adjacent the gastric foveolar epithelium (B). Tumor cells, with pale eosinophilic cytoplasm and vesicular nuclei, appear to be arranged into microcystic and papillary or pseudopapillary structures.


The tumor cells show immunoreactivity for cytokeratin.


For AFP.


The adenocarcinomatous component of the tumor shows atypical tubular glands with luminal necrotic material (A).


Focal AFP immunostaining in the adenocarcinoma component (B).


Inspection reveals an ulcerated tumor in the left lower gingiva.


Immunohistochemical examinations for adenocarcinoma are positive for CK20.


But negative for CK7.


Timeline of drug administrations and CEA levels. Top panel represents the different drug combinations - including both chemotherapy, bevacizumab and metformin - received by the patient in 2012-2013. Bottom panel shows serum CEA levels in the same time window.


Timeline of morphologic changes in lung and liver metastasis by CT. Representative CT scans of lung (top panels) and liver metastasis (bottom panels) showing marked attenuation of radiologic density following combined administration of bevacizumab plus metformin in a patient with metastatic endometrial cancer.


Fluorescence in situ immuno-hybridization signals of ALK. . Note: Split red and green signals indicate broken-apart ALK gene.


Magnetic resonance imaging scans depicting the response of intracranial metastases and change in meningeal thickness after crizotinib rechallenge treatment. . Notes:. Cerebral metastatic foci, and ,meningeal thickness.


Magnetic resonance imaging scans depicting the response of intracranial metastases and change in meningeal thickness after crizotinib rechallenge treatment. (C, F) Progression of hepatic metastasis. Arrow indicates brain metastasis, and the arrowhead indicates leptomeningeal metastasis.


Magnetic resonance imaging scans depicting the response of intracranial metastases and change in meningeal thickness after crizotinib rechallenge treatment. Positive response to the second administration of crizotinib after 1 week.


Intraoperative findings at secondary laparoscopic exploration surgery. . Notes:. A 3-cm diameter bleeding tumor nodule was observed on the anterior abdominal wall.


Intraoperative findings at secondary laparoscopic exploration surgery. Multiple grayish white tumor nodules on the liver surface.


Pathology revealed that the metastatic tumor of the liver surface was SMs (sarcoma) derived from YST. . Notes:. Variably sized tumor cells with severe nuclear atypia, and ,edematous stroma with multifocal hemorrhage (H&E, 100x).


Pathology revealed that the metastatic tumor of the liver surface was SMs (sarcoma) derived from YST. Scattered pleomorphic tumor giant cells (H&E, 400x).


Pathology revealed that the metastatic tumor of the liver surface was SMs (sarcoma) derived from YST. Focal positivity for AE1/AE3 immunostaining in tumor cells, AE1/AE3 immunostaining was positive in YSTs, and ,some sarcomatous tumors (IHC staining, 200x).


Pathology revealed that the metastatic tumor of the liver surface was SMs (sarcoma) derived from YST. Immunonegativity for GPC3, and ,SALL4 in tumor cells.


Pathology revealed that the metastatic tumor of the liver surface was SMs (sarcoma) derived from YST. Ki-67-positive expression found in approximately 10% of tumor cells (IHC staining, 400x). . Abbreviations: IHC, immunohistochemistry; SMs, somatic-type malignancies; YST, yolk sac tumor.


Pathology revealed that the vaginal tumor was SMs (sarcoma) derived from YST. . Notes:. Fusiform tumor cells with moderate to severe nuclear atypia (H&E, 400x).


Pathology revealed that the vaginal tumor was SMs (sarcoma) derived from YST. Immunonegativity for AE1/AE3, GPC3, and SALL4 in tumor cells (IHC staining, 400x). . Abbreviations: IHC, immunohistochemistry; SMs, somatic-type malignancies; YST, yolk sac tumor.


Histology revealed pure gonadal dysgenesis in the right gonad. . Notes:. The gonad is entirely composed of fibrous tissue, and ,devoid of germ cells (H&E, 200x).


Histology revealed pure gonadal dysgenesis in the right gonad. Immunonegativity for OCT3/4 confirming the absence of germ cells (IHC staining, 200x). . Abbreviation: IHC, immunohistochemistry.


MRI of the patient showing the rt seminal vesicle sandwiched between bladder and rectum.


MRI showing the tumor's relationship to the ureter.


Intraoperative picture showing the tumor.


Enbloc removal of the rt seminal vesicle along with partial cystectomy.


Immunohistochemistry revealed. CK.


Medical image.


Villin(-). . Note: Magnification x200.


Abdominal CT examination showed the occupying lesion of the lesser curvature of gastric antrum (size 3.6x2.8 cm).


Gastroscopy showed chronic superficial gastritis and submucous eminent lesions in the lesser curvature of gastric antrum (size 3.5x2.5 cm).


Gastric metastasis of ovarian serous cystadenocarcinoma x50.


Histological section with haematoxylin and eosin staining, magnification, x200. Primarily round and spindle cells, were identified to contain eccentric nuclei and deeply eosinophilic cytoplasm.


Whole abdomen CT images show abdominal mass prior to treatment.


After 2 cycles of treatment.


After 4 cycles of treatment.


After the whole treatment (8 cycles).


Gross photograph of mastectomy specimen with cut surface revealing a fibrous, grey-white, partially encapsulated tumor.


Photomicrograph showing IDC with marked nuclear pleomorphism and atypical mitotic figures (H&E 400X).


Photomicrograph showing tumor cells scattered singly, in groups and cords within a chondromyxoid matrix with atypical nuclei and eosinophilic cytoplasm (H&E 200X).


Photomicrograph showing invasive ductal carcinoma with an abrupt transition to chondromyxoid matrix without an intervening spindle cell component (H&E 200X).


Immunohistochemical profiling: Matrix-producing tumor cells showing positive immunoexpression for S100 and negative for cytokeratin (IHC 200X).


Immunohistochemical profiling: Infiltrating ductal carcinoma cells showing positive immunoexpression for cytokeratin and negative for S100 (IHC 200X).


Computed tomography and positron emission tomography images of the right lower lobe. . Notes: Mediastinum, upper and lower bilateral clavicle area, left armpit, and lung lymph node metastases at treatment initiation (March 2016; A).


Computed tomography and positron emission tomography images of the right lower lobe. After treatment with crizotinib for 2 months (May 2016.


Computed tomography and positron emission tomography images of the right lower lobe. , the metastatic lymph nodes had disappeared, with the metabolism returning to normal; 11 months later (February 2017;. No new tumor metastases were found in other organs and bones in other parts of the body. The patient's overall recovery was good; the primary lesion was relieved, the lymph node metastasis had disappeared, and the metabolism was normal.


Intraoperative findings and the gross specimens. (A) Endoscopic thyroidectomy shows the trachea deviated to the right and the recurrent laryngeal nerve was involved.


Intraoperative findings and the gross specimens. (B) The gross specimen of the left thyroid mass is well-defined, with an approximate size of 5 x 3 x 2.5 cm and a 3 x 2 x 2 cm yellowish necrotic portion accompanied with calcification in the central portion.


Histopathological findings. (A) Microscopy observed that nesting pattern with cornified pearl, keratin, and intercellular bridge (H&E, x20).


Histopathological findings. (B,C) Immunochemistry shows primary squamous cell carcinoma of the thyroid (PSCCT) cells positive for p63 and p40 (p63 and p40 immunostaining, x20).


Whole body CT shows an enlarged mesenteric mass measuring 5.8x6.9x5.7 cm.


Lung.


Liver.


Bone.


Brain. Metastases before start of nab-paclitaxel/trastuzumab treatment. . Abbreviation: nab, nanoparticle albumin-bound.


Brain. Lesions after four courses of nab-paclitaxel/trastuzumab combination. . Abbreviation: nab, nanoparticle albumin-bound.


Brain. Lesions after nine courses of nab-paclitaxel/trastuzumab combination. . Abbreviation: nab, nanoparticle albumin-bound.


Timeline of patient's diagnosis and treatments. . Abbreviations: BMs, brain metastasis; CHT, chemotherapy; CNS, central nervous system; FEC, fluouracil, epirubicin, and cyclophosphamide; HER, human epidermal growth factor receptor; PD, progressive disease; SRS, stereotactic radiosurgery; nab, nanoparticle albumin-bound; LHRH, luteinizing hormone-releasing hormone; RT, radiotherapy; WBRT, whole-brain radiotherapy.


Computed tomography images: A. Axial slice showing a heterogeneously enhancing left parotid mass with deep lobe involvement B. Coronal reconstruction showing the same enhancing mass.


A) Photomicrograph showing discohesive high grade tumors cells with irregular nuclei and prominent nucleoli. There are no light microscopic features of squamous or glandular differentiation (eg. Intercellular bridges, keratinization or mucin production) but the cells stained positively for broad spectrum keratin, consistent with a carcinoma. There are small mature lymphocytes in the background (H&E 400x).


B) Immunohistochemistry for the p63 antibody, consistent with squamous differentiation (400x).


The pathological images of primary breast cancer and the colonic mass. . Notes: (A) Mastectomy specimen obtained in 2001, showing lobular infiltrating carcinoma, are similar to infiltrating ductal carcinoma (hematoxylin and eosin stain, x100).


The pathological images of primary breast cancer and the colonic mass. (B) Right-colectomy specimen obtained in 2011, showing poorly differentiated ductal adenocarcinoma. Tumor emboli can be found in some lymph vessels (hematoxylin and eosin stain, x100).