Female 40 y.o. Complaints of weakness, dizziness, ecchymoses of lower extremities. 06.07.15 — tick bite. From 12.08.15 signs of renal bleeding, marked ecchymoses of lower extremities. Bruising, bleeding and the decrease in hemoglobin noted since childhood. In September takes high dose prednisolone for acquired hemorrhagic diathesis. At scintigraphy of the skull, thorax, shoulder girdle, spine and pelvis no preparation hyperfixation centers are seen except some minor accumulation of the radioisotope in the bones of the cranial vault. At CT in December 2015, a structurally homogeneous pathologic mutifocal lesion with blurry distinguishable contours affecting the whole left humerus (except for a small epiphyseal portion) is determined. The material was submitted to our laboratory for second opinion. The primary diagnosis of Hodgkin lymphoma on the background of the use of prednisolone. The material was sent for second opinion before starting the treatment of Hodgkin’s lymphoma.
Female 32 y.o. Clinical diagnosis: Atypical hyperplasia of the endometrium. At the moment the patient was using hormone therapy by herself (using the intrauterine device “Mirena” for three month). Control hysteroscopy showed greyish and loose polypoid growths of the endometrium. Histological slides from the initial curetage aren’t provided. The patient further underwent a separate diagnostic curettage. Macro: 1. endocervical curettage – scanty material consisting of blood clots and tiny greyish elements. 2. Generous amount of material consisting of blood clots and grayish polypoid fragments up to 0.6 cm in diameter.
The patient was born in 1996. The tumor was removed from the area behind the right ear. The size of the mass was 6x5x3 cm. At cut surface the tumor is whitish, soft and elastic with some hemorrhages.
A girl born in 2002, is ill since May 2015 with headache, weakness, drowsiness. In September 2015 addressed to local neurosurgeon. At MRI of brain a tumor sized 25x20x20 mm is seen in the projection of the hypothalamus, with possible penetration into the area of the 3rd ventricle’s bottom. It has heterogeneous structure and rather sharp but irregular contours. For further examination the patient directed to the endocrinologist. At the thyroid ultrasound investigation, a hypoechoic inhomogeneous solid structure sized 23x43x24 mm which occupies the entire thyroid’s right lobe with transition into isthmus is found. Structurally similar lesions are found in the left lobe of the thyroid gland, with the size of 14×13, 16×8 and 6×6 mm. In the proximity to the lower pole of the thyroid gland multiple lymph nodes are visualized, with the largest size of 13×6 mm. In the early October 2015 thyroidectomy with lymph node dissection on both sides was performed. More
The patient was born in 1995. A long-term mass in the soft tissues of the right thigh’s medial upper part. During 1,5 months was followed up treated with traditional (folk) medicine and physiotherapy in a private clinic. At the admission the patient had a large tumor node in the above-mentioned location with deep growth, compression surrounding tissues and skin necrosis. Metastases in regional lymph nodes were revealed. Lymph node excision biopsy is available for discussion.
In 2012 the patient underwent prostate biopsy (patient’s complaints at that time are unknown). The picture was estimated as a benign prostatic hyperplasia with low grade PIN. Approximately three months ago the patient (himself) revealed enlarged tender lymph node in the left inguinal area. FNA cytology showed atypical cells. The patient was thereon hospitalized into urology department with PSA at 11.7 ng/ml and prostatic gland’s volume of 90 cm3 at admission. Histopathology report: glandular-stromal hyperplasia with low grade PIN and basal cell hyperplasia. In one of the slides is seen a focus of atypical small acinar proliferation (ASAP). Lymph node biopsy is available for discussion. More
Pathology Puzzles Project gives an opportunity to all the specialists to study interesting morphological cases. It is not only a good educational opportunity but also a chance to discuss the cases within the pathologists’ community. Every month three cases will be uploaded into the Digital Pathology system. Before uploading the cases minimum two specialists will validate them.