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Case 100

Hematopathology Case
 

CLINICAL INFORMATION

  A 75-year-old male with significant past medical history of chronic obstructive pulmonary disease, coronary artery disease, benign prostatic hypertrophy, hyperlipidemia, splenomegaly, lymphadenopathies, anemia, and exposure to asbestos. Recently he developed symptoms of worsening sharp abdominal pain, right-sided and severe. CMPs, amylase-lipase, and electrolytes were all normal. CT scan revealed bilateral pulmonary masses, diffuse bilateral nodular pleural thickening, mediastinal hilar lymphadenopathy, mass lesions in the liver,  possible T11 vertebral body involvement, and splenomegaly. A liver biopsy showed prominent necrosis with histiocytic reaction. Few atypical cells were noted, but immunostains failed to prove the natures of these cells. Therefore, a systemic metastatic tumor is highly suspicious, but an infectious process cannot totally be ruled out.
 

 

GROSS DESCRIPTION

 
 

Extensive mesenteric lymphadenopathies and diffuse milliary nodules on the serosal surface of the small intestine.

Milliary nodules on the serosal surface of the small intestine.
 
  Plaques on the inner anterior chest wall. Plaques on the inner anterior chest wall.
 
  Plaques on the inner posteroir chest wall. Multiple nodules are seen and better palpated on pleural surface.
 
  Plaques on the diaphragm surface. Multiple nodules are seen and better palpated.
 
  Spleen, outer surface Spleen, section surface
   
  Liver with multiple nodules.  
 

 

Liver. HE, 2

Liver. HE, 10

 
 

Liver. HE, 20

Liver. HE, 40

 
 

Liver. HE, 20

Liver. HE, 40

   
 

Liver. HE, 40

 

 
 

Lymph node. HE, 10

Lymph node. HE, 20

 
 

Lymph node. HE, 40

Lymph node. HE, 40

 
 

Lung. HE, 4

Lung. HE, 20

   
 

Lung. HE, 40

 

 
 

Spleen. HE, 10

Spleen. HE, 40

   
 

Spleen. HE, 40

 

 
 

Small intestine. HE, 2

Small intestine. HE, 4

   
 

Small intestine. HE, 10

 

 
 

Pleural plague. HE, 40

Pleural plague. HE, 40

     
 

Click here for diagnosis and discussion.

 

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

Photo: Zenggang Pan

Discussion: Zenggang Pan