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Created page with "== Clinical Summary == The patient is a 66yo old male presenting with jaundice. === Past Medical History === * History of prostate cancer 5 years ago. * Hyperlipidemia * Chr..."
== Clinical Summary ==
The patient is a 66yo old male presenting with jaundice.
=== Past Medical History ===
* History of prostate cancer 5 years ago.
* Hyperlipidemia
* Chronic back pain
=== Past Surgical History ===
* Prostatectomy (2009)
* Thyroidectomy (2004)
==Ultrasound==
* Ultrasound of head of pancreas shows a 43mm x 23mm ill defined mass.
===Clinical Plan===
The differential diagnosis included pancreatic adenocarcinoma and metastatic prostate cancer.
==Pathology==
===Cytology===
<gallery heights="250px" widths="250px">
CytologicallyYoursCoW20140213Cytology1.jpg|10x magnification of large cohesive groups of cells.
CytologicallyYoursCoW20140213Cytology2.jpg|40x magnification showing atypical cells with large irregular nuclei.
CytologicallyYoursCoW20140213Cytology3.jpg|20x magnification showing atypical cells with large irregular nuclei.
CytologicallyYoursCoW20140213Cytology4.jpg|40x magnification showing large, markedly pleomorphic cells.
CytologicallyYoursCoW20140213Cytology5.jpg|40x magnification of malignant cell groups.
CytologicallyYoursCoW20140213Cytology6.jpg|60x magnification of malignant cells. Macronucleoli are easily identified.
</gallery>
====Resident Questions====
* <spoiler text="The radiologic differential diagnosis was between osteosarcoma and Ewing sarcma. What would be a possible diagnostic pitfall?"> The confusion between osteosarcoma and Ewing may occur with the small cell variant of osteosarcoma. </spoiler>
<div class="usermessage mw-customtoggle-diagnosis" style="cursor:pointer">Click here to toggle the diagnosis and discussion.</div>
<div class="mw-collapsible mw-collapsed" id="mw-customcollapsible-diagnosis">
<div class="mw-collapsible-content">
==Final Diagnosis==
===Cytology===
* '''High grade sarcoma, favor osteosarcoma'''.
===Biopsy===
<gallery heights="250px" widths="250px">
CytologicallyYoursCoW20140206Biopsy1.jpg|20x magnification of bone biopsy showing sclerotic bone.
</gallery>
===Biopsy Diagnosis===
* '''Conventional high grade sarcoma, sclerotic type'''.
===Discussion===
The experience of FNA of osteosarcoma is mainly with conventional high-grade intramedullary sarcoma and to the rare high-grade surface osteosarcoma. Smears usually contain dissociated neoplastic cells and cell clusters.
</div></div>
{{Cytologically Yours}}
[[Category:Case Reports]]
The patient is a 66yo old male presenting with jaundice.
=== Past Medical History ===
* History of prostate cancer 5 years ago.
* Hyperlipidemia
* Chronic back pain
=== Past Surgical History ===
* Prostatectomy (2009)
* Thyroidectomy (2004)
==Ultrasound==
* Ultrasound of head of pancreas shows a 43mm x 23mm ill defined mass.
===Clinical Plan===
The differential diagnosis included pancreatic adenocarcinoma and metastatic prostate cancer.
==Pathology==
===Cytology===
<gallery heights="250px" widths="250px">
CytologicallyYoursCoW20140213Cytology1.jpg|10x magnification of large cohesive groups of cells.
CytologicallyYoursCoW20140213Cytology2.jpg|40x magnification showing atypical cells with large irregular nuclei.
CytologicallyYoursCoW20140213Cytology3.jpg|20x magnification showing atypical cells with large irregular nuclei.
CytologicallyYoursCoW20140213Cytology4.jpg|40x magnification showing large, markedly pleomorphic cells.
CytologicallyYoursCoW20140213Cytology5.jpg|40x magnification of malignant cell groups.
CytologicallyYoursCoW20140213Cytology6.jpg|60x magnification of malignant cells. Macronucleoli are easily identified.
</gallery>
====Resident Questions====
* <spoiler text="The radiologic differential diagnosis was between osteosarcoma and Ewing sarcma. What would be a possible diagnostic pitfall?"> The confusion between osteosarcoma and Ewing may occur with the small cell variant of osteosarcoma. </spoiler>
<div class="usermessage mw-customtoggle-diagnosis" style="cursor:pointer">Click here to toggle the diagnosis and discussion.</div>
<div class="mw-collapsible mw-collapsed" id="mw-customcollapsible-diagnosis">
<div class="mw-collapsible-content">
==Final Diagnosis==
===Cytology===
* '''High grade sarcoma, favor osteosarcoma'''.
===Biopsy===
<gallery heights="250px" widths="250px">
CytologicallyYoursCoW20140206Biopsy1.jpg|20x magnification of bone biopsy showing sclerotic bone.
</gallery>
===Biopsy Diagnosis===
* '''Conventional high grade sarcoma, sclerotic type'''.
===Discussion===
The experience of FNA of osteosarcoma is mainly with conventional high-grade intramedullary sarcoma and to the rare high-grade surface osteosarcoma. Smears usually contain dissociated neoplastic cells and cell clusters.
</div></div>
{{Cytologically Yours}}
[[Category:Case Reports]]
