Cytologically Yours: CoW: 20131111
The patient is an 80 year old male who presented to the Emergency Department with a chief complaint of right flank pain. He described the pain as a 10/10 pain in his right flank. He denied any associated symptoms with this pain. He denied constipation, cough, shortness of breath, fever, dysuria, hematuria, nausea, or diarrhea. He could not identify anything that made the pain worse or better. He did take 5mg of acetaminophen-hydrocodone and did not have any relief. He had just taken his evening medications when the pain began, and he can not identify any activity that may have caused the pain.
Past Medical History
- Chronic obstructive pulmonary disease
- Allergic rhinitis
- Coronary artery disease
- Diabetes mellitus type 2
Past Surgical History
- 1993 Disk arthroplasty
- 2002 Coronary artery bypass with grafting
- 2009 arthroplasty
- Cholecystectomy year unknown
Differential diagnosis for flank pain includes: kidney stone, vertebral compression fracture,and infection. The suspicion for kidney stone was highest on the list. A urine culture, abdominal CT, and POC urine were ordered.
CT scan revealed multiple lytic and sclerotic lesions within the thoracolumbar spine and sacrum. These were thought to be suspicious of metastatic disease. Wall thickening in the descending colon was seen and was thought to possibly represent a primary colon cancer. The prostate was enlarged.
The clinicians decided to perform a CT guided biopsy and a touch prep was made for rapid interpretation by the Cytology team.
These groups of cohesive cells are larger than the normal elements we would expect to find in a touch prep from a spinal biopsy. This, along with the patient's history, should make you think that there is a malignant process involving the spine.
This is a male patient with no previous history of malignancy. Our differential diagnosis can include many entities. However, these are cohesive cells so lymphoma should be at the bottom of our list. We would need more information to classify these cells, but a diagnosis of positive for malignancy (with no further specificity) can be rendered.
This is a male patient with a new spinal mass. The spinal mass has glands made of cells with prominent nucleoli. In a case like this you should consider prostate as the source of the malignancy. A PSA stain would help highlight cells of prostatic origin.
- Positive for malignancy.
- Metastatic prostatic adenocarcinoma.
This is a classic case of prostatic adenocarcinoma, metastatic to the spine.