Case 167

Surgical Pathology Case
 

CLINICAL INFORMATION

 

A 74 year-old gentleman had a significant history of hypertension and coronary artery disease status post coronary artery bypass graft (CABG) 15 years ago (no detail history available). Recently, he presented to urgent care with a six week history of shortness of breath, fevers, chills, night sweats, and productive cough.  Image studies of the lung revealed bilateral diffuse extensive interstitial patchy opacities with no evidence of pulmonary embolism. A interstitial pneumonia or vascular disease was suspected. However, microbiology tests and immunologic markers were negative, including ANA, cANCA, pANCA, Anti-GBM and HIV. There was no improvement despite various treatment for two weeks. He was then transferred to ICU for worsening respiratory conditions with increasing oxygen requirements. His conditions became progressively worsening and was intubated through tracheostomy with very high oxygen and PEEP requirements. During the hospitalization, he also had several episodes of tachycardia with heart rate of 180s to 200s. He was also fined to have significantly elevated PSA level (63.4ng/mL, normal range 0-4ng/ml). The patient eventually expired due to cardiorespiratory arrest.

GROSS DESCRIPTION

 

The pleural surface and the cut surface of the lung consist of numerous gray-pink, poorly demarcated nodules from 0.4 to 1.8 cm in diameter, and the majority of left lower lobe is infiltrated by the tumor. The serosal surface and the cut surface of the liver reveal scattered well-demarcated, white-pale nodules from 0.3 to 0.7 cm.

   
  Chest X-Ray  
 
 

Lung

Lung

 
 

Lung, left lower lobe

Lung, hilar lymphadenopathies

   
 

Liver

 
 

 

 

 
 

Lung lesion. HE, 10

Lung lesion. HE, 20

 
 

Lung lesion. HE, 40

Lung lesion. HE, 40

 

 

Lung, hilar lymph node. HE, 10

Periaortic lymph node. HE, 10

 

 

Adrenal gland. HE, 2

Adrenal gland. HE, 20

 

 

Thyroid gland. HE, 10

Thyroid gland. HE, 20

 

 

 

Esophagus. HE, 2

 

 

GROSS DESCRIPTION

 

The prostate measures 4.5 4.5 3.5 cm and the cut surface reveals multiple gray, yellow nodules (largest one 1.6 cm in diameter) with focal necrosis and hemorrhage.

 
 

Prostate lesion. HE, 10

Prostate lesion. HE, 20

 
 

Prostate lesion. HE, 40

Prostate lesion. HE, 20

     
 

Click here for diagnosis and case discussion.

 

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

Photo: Zenggang Pan

Discussion: Zenggang Pan