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

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== Clinical Summary ==  
 
== 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.
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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 ===
 
=== Past Medical History ===
* 2003 Melanoma
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* Congestive heart failure
* Diabetes
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* Ventricular tachycardia
* Hypertension
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* Ischemic heart disease
  
 
=== Past Surgical History ===
 
=== Past Surgical History ===
* 2013 Arthroscopic knee surgery
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* Coronary stent placement
* 2003 Excision of melanoma
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* Implant of AICD
* 2002 Discectomy
 
  
  
 
===Clinical Plan===
 
===Clinical Plan===
The differential diagnosis for otherwise asymptomatic lymphadenopathy in this patient is melanoma, lymphoma, or occult malignancy.
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The concern is a primary renal malignancy with metastatic disease to lungs. An endobronchial ultrasound guided FNA is scheduled.
  
 
==Radiology==
 
==Radiology==
* PET CT showed hypermetabolic activity with an SUV of 12.7.  
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* CT Abdomen shows a large perinephric hematoma and large low anterior structure in left lower pole suspicious for a hemorrhagic renal cell carcinoma.
* 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.
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* CT Chest shows multiple small lung lesions measuring up to 13x12 mm in greatest dimension.
 
 
 
 
 
==Pathology==
 
==Pathology==
  
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==Case Discussion==
 
==Case Discussion==
This is a classic case of Hodgkin lymphoma.
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This is a classic case of metastatic renal cell carcinoma.
 
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Revision as of 20:53, 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.

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

Resident Questions



Click here to toggle the diagnosis and case discussion.

Final Diagnosis

Cytology

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

Biopsy

  • Classical Hodgkin lymphoma, favor mixed type.

Case Discussion

This is a classic case of metastatic renal cell carcinoma.