Previous Cases of the Month

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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.

Updated: Jun 08, 2017

A 42-year-old woman presents with right upper quadrant pain. Physical examination reveals no abnormalities. Her laboratory evaluation is remarkable for a 2-fold increase in alkaline phosphatase, but otherwise normal liver function tests and a normal complete blood count. Computed tomography (CT) scan shows multiple nodular lesions involving her entire liver. These lesions are hypoechoic on liver ultrasound. Given the imaging findings, serum tumor markers are evaluated including alpha-fetoprotein, carcinoembryonic antigen, CA19-9, CA125 and CA27-29, all of which are normal. She undergoes wedge biopsy of one of the liver nodules and subsequently undergoes orthotopic liver transplantation. The gross examination of the explanted liver shows the entire liver to be involved by multiple grey-white ill-defined nodules ranging from 0.5 cm – 10.0 cm and replacing about half of the liver parenchyma. The slide presented is comprised of a representative nodule from the explanted liver.

Thyroid Gland
Updated: May 22, 2017

A 48-year-old woman presents with hypothyroidism treated with high dose Synthroid® for the past 28 months. Recently, she has developed marked dysphagia and dyspnea. She has a history of classical Hodgkin lymphoma 20 years ago. Physical exam reveals a firm to hard, slightly enlarged asymmetric thyroid gland. There is no lymphadenopathy. Laboratory findings include elevated serum TSH, elevated antithyroglobulin antibody titer of 1:4096, elevated antithyroid peroxidase antibody titer of 1:2048, and mild normocytic, normochromic anemia (Hct-34%). The thyroid is resected revealing a diffusely firm, pale gray, slightly enlarged lobulated segment of tissue with a well-delineated capsule and without extension into surrounding soft tissue. No definitive normal thyroid tissue is visible grossly.

Updated: May 01, 2017

A 50-year-old woman presents with a sudden onset of right flank pain following a 2–3 day history of low-grade fevers. She recalls having urinary tract infections in the distant past. Currently, she does not respond to antibiotic therapy. A computerized tomography (CT scan) shows an irregularly shaped right kidney with dilatation of the pelvis but no evidence of urinary tract calculi. She undergoes a right simple nephrectomy. Gross examination demonstrates a deformed 8.7 x 7.1 x 4.0 cm kidney with a coarsely granular cortical surface. Serial sections reveal blunted renal calyces with firm gray-white areas, interspersed tan-pink parenchyma, a dilated renal pelvis and proximal ureteral thickening.

Right Neck
Updated: Apr 24, 2017

A 48-year-old man complains of a growing tender right neck mass. The patient has no other significant clinical symptoms. At operation, the mass proves to be multiple lymph nodes, the largest of which measures 7.0 cm. Histologic sections show numerous large cells infiltrating lymph nodes. These cells are strongly positive for CD30, variably positive for CD15, dimly positive for PAX5, and negative for CD20 and CD45.

Right Lung and Pleura
Updated: Apr 11, 2017

A 62-year-old woman presents with weight loss, shortness of breath, and chest pain. Chest x-ray shows a pleural effusion. Chest computed tomography (CT scan) shows multiple pleural tumor nodules on the right side. An extrapleural pneumonectomy is performed. Gross examination reveals a diffuse pleural rind on the right lung along with two pleural masses measuring 7.0 x 5.5 x 5.0 cm and 5.5 x 4.0 x 4.0 cm, respectively. Immunoevaluation reveals the tumor cells to express cytokeratin 5/6, calretinin, Wilms tumor 1 protein (WT-1), and negative staining with thyroid transcription factor 1 (TTF-1) and BerEP4.

Left Atrium, Heart
Updated: Mar 21, 2017

A 53-year-old man with clinical history of hypertension and hypercholesterolemia is admitted to the emergency room due to a possible stroke. A transthoracic echocardiogram is unremarkable. On further evaluation, a transesophageal echocardiogram reveals an oval and pedunculated mass, measuring 2.0 cm, adherent to the left atrial wall. The mass is mobile and distensible, protruding to the left atrial appendage during atrial systole. Due to its embolic potential, the mass is removed. The resected mass is soft, polypoid, and pedunculated, with a gelatinous cut surface and focal dark red areas on the periphery.

Stump of Left Below Knee Amputation
Updated: Mar 08, 2017

A 72-year-old man with left leg below knee amputation presents with a large exophytic and fungating mass involving the amputation stump.

Updated: Feb 24, 2017

A 34-year-old G4 P3-0-0-3 presents at 27 weeks’ gestation with complaints of decreased fetal movement for 3 days, fever of 101.3°F, chills, and body aches. White blood count is 19,900/mm3 with increased neutrophils and band forms. Ultrasound examination shows fetal demise. The fetus is delivered with foul-smelling amniotic fluid, and the placenta shows a yellow-green opaque fetal surface with features suggestive of necrotizing funisitis.

Right Ovary
Updated: Feb 14, 2017

A 53-year-old woman presents with a 4-week history of intermittent right lower quadrant pain. Upon pelvic examination, a firm right adnexal mass is palpated. Subsequent radiologic evaluation confirms the presence of a solid ovarian mass. Surgical resection reveals a firm mass with a white-yellow bosselated outer surface measuring 8.0 cm in greatest dimension, located on the upper pole of an otherwise grossly unremarkable ovary. Upon sectioning, the ovarian mass has firm, white-yellow and glistening cut surfaces, without gross evidence of necrosis, hemorrhage, calcification, and/or cystic change.

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