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

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===Cytology===
 
===Cytology===
 
<gallery heights="250px" widths="250px">
 
<gallery heights="250px" widths="250px">
CytologicallyYoursCoW20131202Cytology1.jpg|This is a 10x magnification the cytology specimen from the spinal mass. We see red blood cells and a cohesive group of cells in this field.
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CytologicallyYoursCoW20131202Cytology1.jpg|10x magnification of paracaval lymph node. There is a polymorphic lymphoid population with scattered large atypical cells.
CytologicallyYoursCoW20131202Cytology2.jpg|This is a 20x magnification of the cytology specimen from the spinal mass. We can see red blood cells in the background and a cohesive group of cells in this field.
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CytologicallyYoursCoW20131202Cytology2.jpg|20x magnification of paracaval lymph node. There are small lymphocytes with background lymphoglandular bodies. Scattered eosinophils and large atypical cells with prominent nucleoli.
CytologicallyYoursCoW20131202Cytology3.jpg|This is a 60x magnification of the cytology specimen from the spinal mass. We can see this group of cohesive cells have round nuclei, prominent nucleoli, and ample cytoplasm.
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CytologicallyYoursCoW20131202Cytology3.jpg|40x magnification of paracaval lymph node. There are atypical binucleated cells among the large atypical cells.
CytologicallyYoursCoW20131111Cytology4.jpg|This is a 60x magnification of the cytology specimen from the spinal mass. Again we have a cohesive group of cells that have ample cytoplasm, round nuclei, and some prominent nucleoli.
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CytologicallyYoursCoW20131111Cytology5.jpg|This is a 60x  magnification of the cytology of the specimen from the spinal mass.
 
CytologicallyYoursCoW20131111Cytology6.jpg|This is a 40x magnification of single cells in cytology specimen from the spinal mass. These single cells are much larger than the red blood cells, have ample cytoplasm, and are larger than the lymphocytes that are also present in the image.
 
 
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Revision as of 19:42, 14 January 2014

Clinical Summary

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
  • Hypertension
  • Hyperlipidemia
  • Diverticulosis
  • Coronary artery disease
  • Diabetes mellitus type 2

Past Surgical History

  • 1993 Disk arthroplasty
  • 2002 Coronary artery bypass with grafting
  • 2009 arthroplasty
  • Cholecystectomy year unknown

Medications

  • Acetominophen-hydrocodone
  • Acetaminophen-oxycodone
  • Albuterol
  • Aspirin
  • Gabapentin
  • Losartan
  • Meloxicam
  • Metoprolol
  • Nitroglycerin

Clinical Plan

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.

Radiology

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.

CT

Pathology

Cytology

Resident Questions


Biopsy

Immunohistochemistry

Resident Questions
Click here to toggle the diagnosis and case discussion.

Final Diagnosis

Cytology

  • Positive for malignancy.

Biopsy

  • Metastatic prostatic adenocarcinoma.

Case Discussion

This is a classic case of prostatic adenocarcinoma, metastatic to the spine.