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Case 321

Surgical Pathology Case
 

CLINICAL INFORMATION

 

A 72-year-old Caucasian male was previously healthy; he hasn't seen any doctor in past 25 years. Recently he felt lower abdominal pain, associated with hematuria for four to five days.  He had generalized fatigue, with decreased energy over the last three to four weeks.  He had increasing pain with urination over the last few days, as well.  No fevers.  The patient denied any back pain at the time of admission.

CLINICAL IMAGE STUDIES

 

CT of chest, abdomen and pelvis without contrast demonstrates numerous pulmonary nodules in the lung bases, consistent with metastatic disease. The largest on the right measures 1.7 cm in the largest on the left measures 2.0 cm. A multilobulated, heterogeneous, and partially calcified mass in the pelvis roughly measuring 25 16 cm. It is difficult to make a clear distinction between the mass and the urinary bladder. Bulky pelvic lymphadenopathy with the largest lymph node on the right measuring 5.3 3.0 cm. There is also periaortic lymphadenopathy. Indeterminate hypodensity seen the liver, the largest is in segment 6 and measures approximately 1.5 cm.

 
     
   
     
     
 

HE, 2

HE, 4

     
 

HE, 10

HE, 20

     
 

HE, 20

HE, 40

     
 

HE, 40

HE, 40

     
 

HE, 40

HE, 40

     
 

Click here for diagnosis and discussion.

 

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

Photo: Zenggang Pan

Discussion: Zenggang Pan