Case 44

I would like to share with you another case of mine, that of DU, a 43 year old female who was previously diagnosed with Hodgkin's lymphoma and has undergone chemotherapy for the said condition. A year prior to admission, the patient noted a skin lesion located at the right lateral chest wall. The specimen submitted were 2 elliptical fragments of tissue with overlying skin, measuring 2 x 1.2 x 0.8 cm and 1.8 x 0.9 x 0.7 cm. Cut sections of each reveal a tan white solid surface. On microscopic examination, there are geographical zones of inflammation composed of an admixture of lymphocytes, eosinophils, and histiocytes. Also noted are rather atypical cells that somehow resemble uninucleate and binucleate forms of Reed-Sternberg cells. My initial impression of this case is a Cutaneous Hodgkin's Lymphoma, Lymphocytic Predominant subtype.

The patient is M.C. a 43 year old female diagnosed to have Polycythemia Vera. An hour prior to admission, patient experienced abrupt onset of left-sided weakness. The patient was admitted and worked up for Myeloproliferative Disorder. A bone marrow biopsy was done wherein an elongated fragment of soft to gritty, tan white tissue measuring 0.7 cm long was submitted. Attached are shots taken from her slides.

My initial impression is a Hypercellular Marrow with Erythroid and Megakaryocytic Hyperplasia.

Patient is a 28 years old male. Clinical-Pathology notes: Low grade pyrexia with bleeding gums for last 2-3 months. Peripheral blood showed Magaloblastic Anemia with thrombocytopenia (Platelets- 46 K/ul) and presence of 10-12% atypical immature cells (blasts).

Age: 12 yrs Sex: Male Complaining of: Pyrexia, body aches, joint pains, anorexia and weight loss for the past year. Physical findings: Hepato-splenomegaly and generalized lymphadenopathy with anemia and pedal edema. Clin. Diagnosis: Lymphoid reticular malignancy.

A 16 year old girl presented with gradual onset breathlessness from one year and imaging studies showed diffuse left upper and middle lobe and right middle lobe opacities. A CT scan showed hyper dense, vaguely defined LUL and LML regions of the lungs. No well defined mass was visualized on either lung fields. She subsequently had undergone left upper lobectomy.

This is a 45 yo female with fever & weakness for 3 months, splenomagaly - 2 cm, mild sternal tenderness.

63 y-o male with low grade fever, malaiase, weakness and occasional gum bleeding. Lab: Pancytopenia, accelerated ESR, siginificant roulex formation of RBC and mild hyperglobulinemia are present.

Male aged 36 years, HIV positive status. Was treated for pulomoary tuberculosis earlier. Later developed nodule over the hard palate measuring about 1 cm diameter for which biopsy was done. He received a course of treatment, which he discontinued after the nodule regerssed. The mass recurred soon after and increased in size to the present 3 cm. Another reddish area also developed on the right margin of the tongue. FNAC was done from the hard palate mass.

Female infant presented with symptoms and signs of sub-acute intestinal obstruction. Mass was felt in the right iliac fossa. Cecum was removed along with terminal ileum.

The patient is a 30 yrs female who was found to be HIV positive during her pre-natal checkup. Recently she developed pruritic nodules on the chest wall and the limbs. Clinical diagnosis is Prurigo Nodularis or PPE. The histological images show several low and high magnification areas of the lesion with H&E staining (Figures a to f) and a CD34 immunoperoxidase staining (Figure g). We are unable to provide clinical photographs

A 48-year old female from a rural area of Kashmir (India). Para 4, presented with menorrhagia for last few years along with progressive anemia and generalized weakness. Vaginal examination revealed a bulky uterus with bilateral solid ovarian masses. Ultrasound examination revealed bilateral ovarian masses, 10 cms on the right and 6 cms on the left side with ascitis.

Twenty five year old woman, married for one year, presented in December 2000 to the Ob/Gyn Outpatient department with pain in the abdomen of 3 months duration. She suffered from irregular menstrual cycles lasting for 5-10 days occurring every 15 days to 2 months. Intraoperatively, there was a 25x20 cm mass replacing the left ovary. Uterus appeared normal. Bowel, kidneys, omentum and undersurface of the diaphragm were normal.

46 year-old female patient in whom a mass in the right ovary was excised.