Difference between revisions of "Cytologically Yours: CoW: 20131209"

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====Resident Questions====
 
====Resident Questions====
 
* <spoiler text="What are other immunohistochemical stains that would be applicable in this case?">
 
* <spoiler text="What are other immunohistochemical stains that would be applicable in this case?">
** RCC
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** RCC
** CD10
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** CD10
** PAX2
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** PAX2
** Kidney specific antigen
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** Kidney specific antigen
 
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Revision as of 21:16, 14 January 2014

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.

Past Medical History

  • Congestive heart failure
  • Ventricular tachycardia
  • Ischemic heart disease

Past Surgical History

  • Coronary stent placement
  • Implant of AICD


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.

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 multiple small lung lesions measuring up to 13x12 mm in greatest dimension.

Pathology

Cytology

Immunohistochemistry

Resident Questions



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Final Diagnosis

Cytology

  • Rapid diagnosis: Non-small cell carcinoma.
  • Final diagnosis: Renal cell carcinoma.


Case Discussion

This is a classic case of metastatic renal cell carcinoma.