Difference between revisions of "Cytologically Yours: CoW: 20131202"

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(Biopsy)
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* <spoiler text="What immunohistochemical stains would you do?">CD15, CD30, and PAX5 would stain tumor cells in Hodkin lymphoma. Mart1, HMB45, and S100 could be used to rule out melanoma. Other additional stain in a lymphoma versus melanoma workup might include CD3, CD20, and keratin.</spoiler>
 
* <spoiler text="What immunohistochemical stains would you do?">CD15, CD30, and PAX5 would stain tumor cells in Hodkin lymphoma. Mart1, HMB45, and S100 could be used to rule out melanoma. Other additional stain in a lymphoma versus melanoma workup might include CD3, CD20, and keratin.</spoiler>
  
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====Surgical Pathology====
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*spoiler text=<gallery heights="250px" widths="250px">
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CytologicallyYoursCoW20131202Biopsy1.jpg|20x magnification of lymph node core biopsy.
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CytologicallyYoursCoW20131202Biopsy2.jpg|40x magnification of lymph node core biopsy.
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CytologicallyYoursCoW20131202Biopsy3.jpg|CD 15 with membranous staining.
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CytologicallyYoursCoW20131202Biopsy4.jpg|CD 30 with membranous staining.
  
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</gallery>
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</spoiler>
  
 
<div class="usermessage mw-customtoggle-diagnosis" style="cursor:pointer">Click here to toggle the diagnosis.</div>
 
<div class="usermessage mw-customtoggle-diagnosis" style="cursor:pointer">Click here to toggle the diagnosis.</div>

Revision as of 21:26, 15 January 2014

Clinical Summary

The patient is an 60 year old male with a remote history of an abdominal melanoma that was excised with negative margins. The patient has been experiencing lower back pain for the past several months and has received epidural injections. As a part of the workup, the patient had a CT which revealed retroperitoneal lymphadenopathy. A CT guided fine needle aspiration and biopsy of a paracaval lymph node was performed.

Past Medical History

  • 2003 Melanoma
  • Diabetes
  • Hypertension

Past Surgical History

  • 2013 Arthroscopic knee surgery
  • 2003 Excision of melanoma
  • 2002 Discectomy


Clinical Plan

The differential diagnosis for otherwise asymptomatic lymphadenopathy in this patient is melanoma, lymphoma, or occult malignancy.

Radiology

  • PET CT showed hypermetabolic activity with an SUV of 12.7.
  • CT of abdomen and pelvis showed adenopathy adjacent to the aorta and inferior to the vena cava at the level of the right kidney. The largest node measured 4 cm in greatest dimension.


Pathology

Cytology

Biopsy

Resident Questions


Surgical Pathology

  • spoiler text=
  • 20x magnification of lymph node core biopsy.

  • 40x magnification of lymph node core biopsy.

  • CD 15 with membranous staining.

  • CD 30 with membranous staining.

</spoiler>

Click here to toggle the diagnosis.

Final Diagnosis

Cytology

  • Positive for malignancy, the differential diagnosis includes melanoma and Hodgkin lymphoma.

Biopsy

  • Classical Hodgkin lymphoma, favor mixed type.