Cytologically Yours: CoW: 20131209

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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



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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.