Difference between revisions of "Cytologically Yours: CoW: 20131209"
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== Clinical Summary == | == Clinical Summary == | ||
− | The patient is an | + | The patient is an 64 year old white male who presented with left sided back pain. Imaging showed a left perinephric retroperitoneal hematoma and a left renal lower pole cystic lesion with hemorrhage. Additional imaging showed numerous pulmonary lesions. An endobronchial ultrasound guided fine needle aspiration was scheduled. |
=== Past Medical History === | === Past Medical History === | ||
− | * | + | * Congestive heart failure |
− | * | + | * Ventricular tachycardia |
− | * | + | * Ischemic heart disease |
=== Past Surgical History === | === Past Surgical History === | ||
− | * | + | * Coronary stent placement |
− | * | + | * Implant of AICD |
− | |||
===Clinical Plan=== | ===Clinical Plan=== | ||
− | The | + | The concern is a primary renal malignancy with metastatic disease to lungs. An endobronchial ultrasound guided FNA is scheduled. An onsite rapid diagnosis by cytology was scheduled. |
==Radiology== | ==Radiology== | ||
− | * | + | * CT Abdomen shows a large perinephric hematoma and large low anterior structure in left lower pole suspicious for a hemorrhagic renal cell carcinoma. |
− | * CT | + | * CT Chest shows multiple small lung lesions measuring up to 13x12 mm in greatest dimension. |
+ | ==Pathology== | ||
+ | ===Cytology=== | ||
+ | <gallery heights="250px" widths="250px"> | ||
+ | CytologicallyYoursCoW20131209Cytology1.jpg|4x magnification of a 4R lymph node. Groups of cohesive epithelial appearing cells can be seen on low power. Lymphoid tissue is not easily identified. | ||
+ | CytologicallyYoursCoW20131209Cytology2.jpg|20x magnification of a 4R lymph node. This is a cellular specimen with groups of cells along what appear to be a papillary or papillary-like structure. Single cells are also dispersed in the background. The cells are haphazardly arranged. | ||
+ | CytologicallyYoursCoW20131209Cytology3.jpg|40x magnification of a 4R lymph node. On higher power, the nuclei appear mildly atypical and the cytoplasm is delicate and finely vacuolated. The nuclear contours are somewhat irregular. | ||
+ | CytologicallyYoursCoW20131209Cytology4.jpg|Cell block of 4R lymph node. The cytoplasm does not appear as vacuolated on alcohol fixed cell block material, but the nuclei are relatively uniform, but somewhat atypical. | ||
− | + | </gallery> | |
− | === | + | ===Immunohistochemistry=== |
<gallery heights="250px" widths="250px"> | <gallery heights="250px" widths="250px"> | ||
− | + | CytologicallyYoursCoW20131209Cytology5.jpg|PAX8 on 4R lymph node shows positive nuclear staining. | |
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</gallery> | </gallery> | ||
====Resident Questions==== | ====Resident Questions==== | ||
− | * <spoiler text="What | + | * <spoiler text="What are other immunohistochemical stains that would be applicable in this case?"> |
− | * | + | * RCC |
− | * | + | *CD10 |
+ | *PAX2 | ||
+ | *Kidney specific antigen | ||
+ | </spoiler> | ||
+ | |||
− | <div class="usermessage mw-customtoggle-diagnosis" style="cursor:pointer">Click here to toggle the diagnosis | + | <div class="usermessage mw-customtoggle-diagnosis" style="cursor:pointer">Click here to toggle the diagnosis.</div> |
<div class="mw-collapsible mw-collapsed" id="mw-customcollapsible-diagnosis"> | <div class="mw-collapsible mw-collapsed" id="mw-customcollapsible-diagnosis"> | ||
<div class="mw-collapsible-content"> | <div class="mw-collapsible-content"> | ||
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==Final Diagnosis== | ==Final Diagnosis== | ||
===Cytology=== | ===Cytology=== | ||
− | * | + | * Rapid diagnosis: Non-small cell carcinoma. |
+ | * Final diagnosis: Renal cell carcinoma. | ||
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{{Cytologically Yours}} | {{Cytologically Yours}} | ||
[[Category:Case Reports]] | [[Category:Case Reports]] |
Latest revision as of 22:01, 15 January 2014
Contents
Clinical Summary
The patient is an 64 year old white male who presented with left sided back pain. Imaging showed a left perinephric retroperitoneal hematoma and a left renal lower pole cystic lesion with hemorrhage. Additional imaging showed numerous pulmonary lesions. An endobronchial ultrasound guided fine needle aspiration was scheduled.
Past Medical History
- Congestive heart failure
- Ventricular tachycardia
- Ischemic heart disease
Past Surgical History
- Coronary stent placement
- Implant of AICD
Clinical Plan
The concern is a primary renal malignancy with metastatic disease to lungs. An endobronchial ultrasound guided FNA is scheduled. An onsite rapid diagnosis by cytology was scheduled.
Radiology
- CT Abdomen shows a large perinephric hematoma and large low anterior structure in left lower pole suspicious for a hemorrhagic renal cell carcinoma.
- CT Chest shows multiple small lung lesions measuring up to 13x12 mm in greatest dimension.
Pathology
Cytology
Immunohistochemistry
Resident Questions
Final Diagnosis
Cytology
- Rapid diagnosis: Non-small cell carcinoma.
- Final diagnosis: Renal cell carcinoma.
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