Case 122

Surgical Pathology Case
 

CLINICAL INFORMATION

 

An autopsy was performed on a 72-year-old white male with multiple medical problems, which included congestive heart failure, hypertension and chronic obstructive airway disease.  Chronic lymphocytic leukemia (CLL) was diagnosed nine years prior to death. One year ago, the patient developed relapse of CLL and a gingival lesion; flow cytometric analysis of the bone marrow and immunohistochemical staining of the gingival lesion revealed neoplastic lymphocytes with reactions to CD5, CD19, CD20, CD23 and CD79a.

Several weeks prior to death, the patient developed neutropenia, recurrent fever as high as 104 F, hypotension, and right upper quadrant abdominal pain. Sepsis was suspected and cholelithiasis was diagnosed radiographically. Eventually the patient succumbed to his illness and an autopsy was performed. Important autopsy findings included cholelithiasis with acute cholecystitis and perforation and diverticulitis of the sigmoid colon with perforation and acute serositis. The bone marrow and lymph nodes at multiple sites were diffusely involved with leukemic infiltrates. In addition, a well-circumscribed, solid nodule was found within the right adrenal gland, which measured 1.8 cm in greatest dimension.  The nodule showed a variegated yellow and dark red cut surface with small admixed gray-white foci.  

 

 

 

 

 
     
 
 

HE, 2

HE, 4

 
 

HE, 20

HE, 20

 
 

HE, 40

HE, 40

 
 

Gingival biopsy. HE, 40

Gingival biopsy. HE, 40

 
 

Gingival biopsy. HE, 40

Gingival biopsy. HE, 40

     
 

Click here for diagnosis and case discussion.

 

Source: Department of Pathology, Creighton University Medical Center, Omaha, NE

Photo: Zenggang Pan

Discussion: Zenggang Pan