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Cytologically Yours: CoW: 20131216: Difference between revisions

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Created page with "== 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..."
 
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== Clinical Summary ==  
== 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. A endobronchial ultrasound guided fine needle aspiration was scheduled.  
The patient is an 66 year old white male with a history of smoking, COPD, and diabetes. The patient presented with increased shortness of breath.  


=== Past Medical History ===
=== Past Medical History ===
* Congestive heart failure
* Diabetes
* Ventricular tachycardia
* COPD
* Ischemic heart disease
* Squamous cell carcinoma of skin


=== Past Surgical History ===
=== Past Surgical History ===
* Coronary stent placement
* Excision of squamous cell carcinoma
* Implant of AICD
* Removal of adenomatous polyp of sigmoid colon




===Clinical Plan===
===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.
The differential diagnosis includes worsening of COPD. CT imaging of chest is performed.


==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 Chest shows hilar lung mass and multiple mediastinal lymph nodes showing increased uptake on PET scan.
* CT Chest shows multiple small lung lesions measuring up to 13x12 mm in greatest dimension.
 
==Pathology==
==Pathology==


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===Immunohistochemistry===
===Immunohistochemistry===
<gallery heights="250px" widths="250px">
<gallery heights="250px" widths="250px">
CytologicallyYoursCoW20131216Cytology6.jpg|PAX8 on 4R lymph node shows positive nuclear staining.
CytologicallyYoursCoW20131216Cytology6.jpg|CD56 on pleural fluid shows positive cytoplasmic staining.
CytologicallyYoursCoW20131216Cytology7.jpg|PAX8 on 4R lymph node shows positive nuclear staining.
CytologicallyYoursCoW20131216Cytology7.jpg|Synaptophysin on pleural fluid shows positive cytoplasmic staining.


</gallery>
</gallery>
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