pathtalk.org is a weblog about pathology and laboratory medicine.

Case of the Week 57

Here’s a more straight-forward case than our recent ones:

The following object was seen on stool ova and parasite examination and measures approximately 15 micrometers (Modified Trichrome stain, 1000x).

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Answer to Case of the Week 56

Answer: proglottids of the broad fish tapeworm Diphyllobothrium latum.

Congratulations to everyone who got this right! Also in the differential would be proglottids of Taenia spp. and artifacts such as onion skin which may be passed relatively intact and mimic tapeworm segments. However, the diagnosis is easily made by examining the central proglottid structures which form a rosette-structure, or so-called “Chinese character” as shown here:

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Follow-up to “An unfortunate case”

Thanks to the readers who responded with the correct diagnosis to last week’s case!  I’ve also presented this case at our weekly clinical pathology conference and I’ve found it extremely interesting and educational.

This was indeed a case of hepatosplenic T-cell lymphoma (HSTL), gamma-delta type.  Characteristically, lymphadenopathy was absent and there was no peripheral involvement at presentation.  Interestingly, however, the typical intrasinusoidal marrow involvement was a minor feature second to an interstitial process.  Perhaps it was just caught at a progressed stage.  The immunophenotype was fairly typical: CD2+, surface CD3+, CD4-, CD5-, CD7 partial dim, CD8 partial dim, CD16+, and CD56/CD57-.  One reader pointed out that these lymphomas are usually CD4- and CD8-.  This is true; but a solid subset will express partial CD8+ as this case did.  Another interesting feature of this T-cell lymphoma is its predilection for expression of multiple KIR isoforms, for those of you keen on flow cytometry.  Cytogenetic studies also showed the characteristic isochromosome 7q and associated trisomy 8.  The spleen was also removed after diagnosis and representative images are shown below.

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An unfortunate case

It’s been a while since I posted an interesting case, but here’s one that I saw in follow-up during my flow cytometry month.

The patient is a 44 yo M with a history of end-stage renal disease secondary to hypertensive nephropathy who was awaiting transplant > 2 years and undergoing peritoneal dialysis.  Fatigue and anemia and thrombocytopenia developed in late 2009 and because the anemia was attributed to his renal impairment, the thrombocytopenia was felt to be immune thrombocytopenic purpura (ITP) and he was treated with oral prednisone.  As you might expect, his fatigue persisted – as did the anemia and thrombocytopenia.  In addition, on review of systems in January he complained of drenching night sweats, fevers, a 30 pound weight loss and occasional nose bleeds.  Of significance he also had left upper quadrant cramping.  A physical exam at the time showed a palpable spleen and did NOT uncover any lymphadenopathy.

Labs showed the following:

WBC 6900 (normal diff), Hgb 8.6 L, MCV 101 H, Plt 37,000 L

BUN 66 H, Cr 6.35 H, Uric acid 15.9 H, LDH 1767 H (range 100-190), albumin 3.2 L, and slightly increased AST and ALT.  Calcium levels were normal.

A CT abdomen, bone marrow examination, and representative flow plots (with the population of interest painted red) showed the following.  Diagnosis?  Comments?

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Compendium of Online Pathology Resources

Case of the Week 56

The following was ‘passed’ in the stool of an otherwise asymptomatic 50 year old woman. (images courtesy of Dr. Washington Winn, Fletcher Allen Health Care, VT)

Identification?

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