Previous Cases of the Month

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Updated: Apr 09, 2018

Case of The Month uses a virtual microscope whole slide image (WSI) of a surgical specimen to diagnose diseases from the archives of the CAP PIP.

Updated: Mar 23, 2018

Case of The Month uses a virtual microscope whole slide image (WSI) of a surgical specimen to diagnose diseases from the archives of the CAP PIP.

Updated: Mar 11, 2018

Case of The Month uses a virtual microscope whole slide image (WSI) of a surgical specimen to diagnose diseases from the archives of the CAP PIP.

Updated: Feb 26, 2018

Case of The Month uses a virtual microscope whole slide image (WSI) of a surgical specimen to diagnose diseases from the archives of the CAP PIP.

Updated: Feb 12, 2018

A 54-year-old woman presents with abnormal perimenopausal bleeding and is found to have a 10.0 cm polypoid gray-white hemorrhagic uterine mass filling her uterine cavity.

Updated: Jan 29, 2018

A 4-year-old girl is being evaluated for a two-month history of back pain unresponsive to conservative therapy. Although routine abdominal X-rays are negative, a CT scan of the abdomen demonstrates the presence of an 8.0 cm right paravertebral mass focally extending into the spinal canal. Surgical resection reveals a 76 gm lobulated tan mass measuring 7.5 × 6.5 × 3.0 cm in greatest dimension and surrounded by a thin layer of connective tissue. The cut surface is soft, tan and uniform, with small areas of hemorrhage. A section of fresh tissue is submitted for an N-myc (MYCN) amplification study. The specimen undergoes extensive sampling.

Updated: Jan 19, 2018

A 62-year-old woman presents to the emergency department complaining of three days of subjective fevers and chills. Her initial evaluation was notable for both a fever of 100.4°F (38°C) and an 8 cm-wide warm, erythematous, indurated rash on the right calf. The borders of this lesion were ill-defined. On palpation, the rash was tender and without any notable crepitus. The rest of the physical exam was unrevealing. Notably, her white blood cell count (WBC) was elevated to 17,900/µL (normal: 4,000-11,000/µL) with a differential of 86.8% neutrophils (normal: 50-70%) and 8.1% lymphocytes (normal: 18-42%). All other laboratory parameters were within normal limits. Following her emergency department evaluation, the patient is admitted to the hospital in stable condition.

Parotid Gland
Updated: Jan 08, 2018

A 79-year-old woman initially presents with facial twitching and is otherwise asymptomatic. Imaging studies performed to rule out the possibility of a stroke reveal a 2.4 cm right parotid gland mass with central calcification and enlarged level II and III lymph nodes. The patient presents again 8 months later with interval increase of her right parotid mass, which now involves the entire parotid gland and measures 7 cm. Additionally, the overlying skin is thickened suggestive of cutaneous involvement, and one of the right level II lymph nodes is now enlarged to 2.0 cm. The resection specimen includes the right parotid gland, levels Ib through IV neck dissection, and a partial auriculectomy. The earlobe, submandibular gland, and jugular vein are unremarkable. The 7.2 × 5.5 × 3.2 cm parotid mass shows gross extension to skin and to the cartilaginous portion of the external auditory canal.

Right Ovary
Updated: Dec 04, 2017

A 9-year-old girl presents with a three-week history of lower abdominal discomfort. Upon physical examination a right adnexal mass is palpated, subsequently confirmed by radiologic evaluation. There is no evidence of abnormal secondary sexual characteristics. Surgical resection of the right adnexal structures reveals an intact cystic ovarian tumor with a smooth outer surface, measuring 12.0 cm in greatest dimension. Upon sectioning, close to 30% of the cut surface is cystic and 70% solid. The cystic, smooth-walled, tan areas are filled with serosanguinous fluid; the largest cyst measures 4.5 cm in greatest dimension. The solid component is tan and soft, without gross evidence of necrosis or hemorrhage. A grossly unremarkable fallopian tube is also present. No evidence of metastatic disease or ascites is noted.

Inguinal Lymph Node
Updated: Nov 16, 2017

A 28-year-old man presents with generalized adenopathy and weight loss. The patient is otherwise asymptomatic. Peripheral blood examination is normal. A firm mobile inguinal mass that developed over the last six months is removed. Gross examination reveals two fragments of soft tissue (30 and 20 grams), measuring up to 5.0 cm, with a lobulated tan cut surface. Immunophenotypic flow cytometry analysis reveals no clonal proliferation.

Updated: Nov 03, 2017

A 67-year-old man presents with complaints of hematuria and flank pain. A computerized tomography (CT) scan shows a 10.5 cm mass in the upper pole of the right kidney and retroperitoneum. The patient undergoes a right radical nephrectomy. Grossly, the tumor is yellow-tan and centered in the renal cortex. Tumor penetrates the renal capsule and extends into perinephric adipose tissue. Immunohistochemical evaluation demonstrates tumor cells expressing pan-cytokeratin (AE1/AE3), vimentin, and epithelial membrane antigen (EMA).

Updated: Oct 25, 2017

A 9-month-old boy presents with a painless abdominal mass. Imaging reveals a left renal mass and a left total nephrectomy is performed subsequently. Gross examination reveals a 6.5 cm lower pole tumor with a lobulated, bulging, rubbery tan cut surface.

Right Ovary
Updated: Oct 16, 2017

A 60-year-old woman presents with abdominal pain. Physical examination reveals a large abdominal mass. A CT scan of the abdomen and pelvis shows a large cystic right ovarian mass extending from the pelvis to the abdominal cavity. She undergoes total abdominal hysterectomy with bilateral salpingo-oophorectomy, and bilateral pelvic and para-aortic lymph node dissections. Gross examination shows a markedly dilated unilocular ovarian cystic mass that measures 10.0 cm in greatest dimension, filled with thick brown, slightly mucinous fluid. The cyst contains a solid 6.0 x 3.5 cm area; scattered, variably thickened, coarsely nodular and broad-based papillary excrescences line the interior wall.

Updated: Sep 25, 2017

An 80-year-old woman presents with fatigue. Physical examination reveals splenomegaly, and laboratory studies show anemia and thrombocytopenia.

Updated: Sep 11, 2017

A 66-year-old man presents to his primary care physician with complaints of abdominal discomfort, fullness, nausea and vomiting, especially, after a meal. Physical examination reveals non-tender splenomegaly, which is 7.0 cm below the left costal margin. Complete blood count is normal. A CT scan reveals an enlarged spleen with multiple lesions interspersed within normal appearing parenchyma.

Updated: Aug 22, 2017

A 48-year-old woman presents with a deep, 7.0 cm mass in the vulvar region. The lesion is surgically excised revealing a gelatinous tan-purple mass with grossly indistinct boundaries.

Updated: Aug 08, 2017

A 56-year-old woman presents with abnormal uterine bleeding. An endometrial biopsy is performed and the diagnosis leads to a decision to perform a hysterectomy.

A 48-year-old woman presents with a 12.5 cm intrathoracic, mediastinal, well-circumscribed mass that is adherent to the left upper lobe of the lung and near the 6th intercostal foramen. Radiologic heterogeneity is noted on chest CT with contrast.

Right Testicle
Updated: Jul 14, 2017

A 42-year-old man presents with a right testicular mass. Laboratory studies reveal normal serum AFP and HCG. Orchiectomy demonstrates a 5.0 cm homogeneous white-gray mass confined to the testicle, with minimal hemorrhage and necrosis.

Updated: Jun 23, 2017

A 21-year-old male presents with intermittent rectal bleeding. A Hemoccult® test is positive. Colonoscopy demonstrates over 100 polyps throughout the colon. Further questioning reveals that both his father and grandfather died at an early age from colon cancer. Mutational testing for the APC gene is positive and a restorative proctocolectomy is performed.

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