Digital necrosis with squamous cell carcinoma of the tonsil

Figures & data

Figure 1 Gangrenous digits of the patient.

Figure 2 Ulcerated jugulodigastric node.

Figure 3 Diagnostic flowchart for Raynaud’s Phenomenon.

Notes: * Refers to polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and Skin changes. It is a rare multisystemic disease that occurs in the setting of a plasma cell dyscrasia.

Table 1 Routine blood investigations

Test	Result (normal range)
Complete blood count
Hemoglobin	14.6 g/dL (13.5–17.5 g/dL)
Total white blood cell count	18,600 cells/µL (3,500–10,500 cells/µL)
Differential count	Neutrophils 77% (40%–80%)
Platelets	Lymphocytes 19% (20%–40%)
Erythrocyte sedimentation rate	Eosinophils 4% (1%–6%) 230,000 µL (150,000–450,000/µL) 80 mm/h (<20 mm/h)
Liver function test	Within normal range
Renal function test	Within normal range

Table 2 Immunology screening

Test	Result
Antinuclear antibody	Negative
Rheumatoid factor	Negative
P-ANCA	Negative
C-ANCA	Negative
Antiphospholipid antibodies
Anticardiolipin antibodies	Negative
Anti-β2 glycoprotein	Negative
Lupus anticoagulant	Negative
Complements
C3	Normal
C4	Normal

Abbreviations: P-ANCA, perinuclear anti-neutrophil cytoplasmic antibody; C-ANCA, cytoplasmic anti-neutrophil cytoplasmic antibody.

Table 3 Immunoglobulin screening

Test	Result
Immunoglobulin A, G	Normal
Cryoglobulin	Negative

Table 4 Virology screening

Test	Result
HBsAg	Negative
Anti-HCV antibodies	Negative
HIV	Negative

Abbreviations: HbsAg, hepatitis b surface antigen; HCV, hepatitis C virus; HIV, human immunodeficiency virus.

Table 5 Other tests

Test	Result
Thyroid profile	Normal
Mantoux test	Negative

Table 6 Imaging studies

Imaging modality	Result
Chest X-ray	Right lower zone consolidation
Doppler study of the upper limb	Normal

Figure 4 Histological specimen of jugulodigastric lymph node

Notes: (A) Biopsy from the ulcerated jugulodigastric node showing spindle cell carcinoma. (B) Cytology smear from the ulcerated jugulodigastric node showing spindle cell carcinoma.

Figure 5 Lymphangitis carcinomatosis involving the right lobe and mediastinal adenopathy.