Pathology Case Collection

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Pathology Case Collection

• Dr. Venkatesh M. Shashidhar.
• Fiji School of Medicine.

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Case 1

• Female patient, 49y, Hodgkin's disease. On
  treatment.

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Clinical details

• Presented severe diarrhea and abdominal pain.
• Gastroduodenal and ileocolonic endoscopic
  examination revealed severe lesions, with
  multiple ulcerations, widespread oedema and
  hyperaemia.

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Course

• In spite of a prompt antiviral treatment, the
  course of the disease worsened and in two weeks
  after the patient presented multiples intestinal
  perforations, peritonitis and finally she died.

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Colonoscopy - well delimitated ulcerations
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CMV - Giant Nuclear Inclusions
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Duodenal mucosa with blunted vili, moderate
inflammatory infiltrate in the lamina propria and
cytomegalic inclusions in epithelial cells of
Brunner glands (arrows).
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Colonic mucosa with cytomegalic inclusion
demonstrated by in situ hybridisation, DIG
method 400x
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Discussion

• Disseminated infection of GIT by CMV.
• The CMV is a herpes virus that causes a latent,
  asymptomatic infection.
• Reactivated when cellular immunity is depressed.
• CMV infection with symptoms are seen in normal.
• Frequent in immunosuppressed patients - AIDS,
  graft organs and, rarely, Hodgkins disease.

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Disseminated infection of the digestive tract
caused by cytomegalic virus in a patient with
Hodgkin's disease G. Becheanu a, R. Stoia b, C.
Gheorghe c, B. Stamm d a Department of
Pathology, "Carol Davila" University of Medicine,
Bucharest, Romania b Clinic of Haematology,
Fundeni Clinical Institute, Bucharest, Romania c
Clinic of Gastroenterology, Fundeni Clinical
Institute, Bucharest, Romania d Institute of
Pathology, Kantonsspital Aarau,
Switzerland Correspondence to Dr. G. BECHEANU,
M.D.Department of Pathology, "Carol Davila"
University ofMedicine and Pharmacy,P.O. Box
1-349, Bucharest 70700, Romania.Download Pdf of
caseDisseminated infection of the digestive
tract caused by cytomegalic virus in a patient
with Hodgkin's disease 744 KB
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Case-2

• Female patient 72 years old
• Nodule of 3 cm in upper outer quadrant of right
  breast.
• Radiological features of malignancy.
• A fine needle aspiration cytology is performed.

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Discussion

• Telepath case On General Path site.
• http//pat.uninet.edu/zope/pat/casos/C135/index.ht
  ml
• Final Diagnosis Papillary carcinoma.
• Participants diagnosis varied from reactive
  papillary hyperplasia to Pap carcinoma.
• I called it low grade duct carcinoma.

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Case 3

• 23 y/o man, with cystic tumor in the
  upper-anterior mediastine.

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Discussion

• Thymic cyst.
• Benign cystic teratoma.

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Case 4

• massive bilateral parotid swelling in 70 yr male
  for 1 yr.
• FNAC specimen.

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Differential Diagnosis

• Benign Lymphoepithelial lesion (autoimmune).
• Bilateral MALT lymphoma.
• Low grade NHL / CLL infiltration?
• ? Mikulicz disease ? Sjogren Sy

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Benign Lymphoepithelial lesion

• Autoimmune, females, adult gt50years.
• Majority will have features of sjogrens syndrome
  either clinically or immunologic.
• Progressive replacement of acini by lymphoid
  follicles.

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Case 5

• 25 year old drug addict with jaundice 9 months
  duration.
• (IAPM-Kerala chapter)

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Discussion

• Raynaud's phenomena peripheral digit gangrene.
• Focal arterial spasms arterogram.
• Histology focal angiitis.
• Kidney inflammation of Glomeruli.
• ? Thromboangiitis obliterans. Buergers diseas.

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Case 6

• Acute Eosinophilic Pneumonia
• (AFIP online seminar)

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Clinical

• Pneumonias with eosinophilic lung infiltration.
• Parasite, fungal, immune, drug, toxic, unknown.
• Infiltrates on chest radiographs combined with
  peripheral blood eosinophilia. (not always..!)
• Bronchoalveolar lavage (BAL) or lung biopsy is
  diagnostic.

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Clinical

• acute respiratory illness of 1 to 7 days.
• Fever, dyspnea, cough, pleuritic chest pain,
  myalgias
• Crackles on chest auscultation.
• hypoxemic respiratory insufficiency.
• many patients with AEP meet the criteria for
  acute lung injury ALI, ARDS) SARS.
• Excellent prognosis - rapid response to
  corticosteroids.

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bilateral reticular opacities Kerley B (septal)
lines.
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CT- bilateral ground-glass attenuation,
interlobular septal thickening, parenchymal
consolidation
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Features of diffuse alveolar damage with
interstitial and alveolar infiltrates of
eosinophils
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Case 7

• 46 Year Female severe Menorrhagia

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Normal Ovarian Stroma
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Normal Infiltration by pale round
cells
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Infiltration by pale round cells
Capsule intact
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peripheral nucleus (signet ring)
Blood vessels
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Note pleomorphism of nuclei (malignant)
Mucous production
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Malignant signet ring cells.
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Subcapsular infiltration by signet ring cells.
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Mucin production and malignant signet ring cells.
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Dermatopathology Case

• From Telederm group
• Cessare Massone. University Grez,

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Clinical details

• 72 year female.
• Since 6 months erythematous, ulcerated nodule.
  (boil)
• Side not specified.

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Case Breast Lump

• Schin Kale Patho India

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Clinical Details

• 42 years, Female. 2x3 cm lump in breast  hard, 
  non-tender. Free from skin and underlying
  structures.

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Discussion

• Marked epithelial proliferation, mitotic figures,
  cribriform appearance.
• Although infiltration out of duct is not seen,
  cannot be ruled out without more study.
• Intraductal carcinoma in-situ.
• Comedo carcinoma.