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Created page with "== 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..."
== 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===
<gallery heights="250px" widths="250px">
CytologicallyYoursCoW20131216Cytology1.jpg|4x magnification of a 4R lymph node. Groups of cohesive epithelial appearing cells can be seen on low power. Lymphoid tissue is not easily identified.
CytologicallyYoursCoW20131216Cytology2.jpg|20x magnification of a 4R lymph node. This is a cellular specimen with groups of cells along what appear to be a papillary or papillary-like structure. Single cells are also dispersed in the background. The cells are haphazardly arranged.
CytologicallyYoursCoW20131216Cytology3.jpg|40x magnification of a 4R lymph node. On higher power, the nuclei appear mildly atypical and the cytoplasm is delicate and finely vacuolated. The nuclear contours are somewhat irregular.
CytologicallyYoursCoW20131216Cytology4.jpg|Cell block of 4R lymph node. The cytoplasm does not appear as vacuolated on alcohol fixed cell block material, but the nuclei are relatively uniform, but somewhat atypical.
CytologicallyYoursCoW20131216Cytology5.jpg|Cell block of 4R lymph node. The cytoplasm does not appear as vacuolated on alcohol fixed cell block material, but the nuclei are relatively uniform, but somewhat atypical.
</gallery>
===Immunohistochemistry===
<gallery heights="250px" widths="250px">
CytologicallyYoursCoW20131216Cytology6.jpg|PAX8 on 4R lymph node shows positive nuclear staining.
CytologicallyYoursCoW20131216Cytology7.jpg|PAX8 on 4R lymph node shows positive nuclear staining.
</gallery>
====Resident Questions====
* <spoiler text="What are other immunohistochemical stains that would be applicable in this case?">
* RCC
*CD10
*PAX2
*Kidney specific antigen
</spoiler>
<div class="usermessage mw-customtoggle-diagnosis" style="cursor:pointer">Click here to toggle the diagnosis and case discussion.</div>
<div class="mw-collapsible mw-collapsed" id="mw-customcollapsible-diagnosis">
<div class="mw-collapsible-content">
==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.
</div></div>
{{Cytologically Yours}}
[[Category:Case Reports]]
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===
<gallery heights="250px" widths="250px">
CytologicallyYoursCoW20131216Cytology1.jpg|4x magnification of a 4R lymph node. Groups of cohesive epithelial appearing cells can be seen on low power. Lymphoid tissue is not easily identified.
CytologicallyYoursCoW20131216Cytology2.jpg|20x magnification of a 4R lymph node. This is a cellular specimen with groups of cells along what appear to be a papillary or papillary-like structure. Single cells are also dispersed in the background. The cells are haphazardly arranged.
CytologicallyYoursCoW20131216Cytology3.jpg|40x magnification of a 4R lymph node. On higher power, the nuclei appear mildly atypical and the cytoplasm is delicate and finely vacuolated. The nuclear contours are somewhat irregular.
CytologicallyYoursCoW20131216Cytology4.jpg|Cell block of 4R lymph node. The cytoplasm does not appear as vacuolated on alcohol fixed cell block material, but the nuclei are relatively uniform, but somewhat atypical.
CytologicallyYoursCoW20131216Cytology5.jpg|Cell block of 4R lymph node. The cytoplasm does not appear as vacuolated on alcohol fixed cell block material, but the nuclei are relatively uniform, but somewhat atypical.
</gallery>
===Immunohistochemistry===
<gallery heights="250px" widths="250px">
CytologicallyYoursCoW20131216Cytology6.jpg|PAX8 on 4R lymph node shows positive nuclear staining.
CytologicallyYoursCoW20131216Cytology7.jpg|PAX8 on 4R lymph node shows positive nuclear staining.
</gallery>
====Resident Questions====
* <spoiler text="What are other immunohistochemical stains that would be applicable in this case?">
* RCC
*CD10
*PAX2
*Kidney specific antigen
</spoiler>
<div class="usermessage mw-customtoggle-diagnosis" style="cursor:pointer">Click here to toggle the diagnosis and case discussion.</div>
<div class="mw-collapsible mw-collapsed" id="mw-customcollapsible-diagnosis">
<div class="mw-collapsible-content">
==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.
</div></div>
{{Cytologically Yours}}
[[Category:Case Reports]]