Hematology Case 51
Hematology Case 51
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Presented By Dr Ghada M Balah
Released on 17-02-2021Patient Data
Patient Data
52 year-old male pt , non-smoker
Clinical Data
Clinical Data
Known case of DM, came to ER complaining of neck mass and vomiting of blood and back pain for 5 days .
The pt was well till the last 2 months he start to feel cervical and back pain on axial skeleton associated with weight loss.
In the last 10 days, he had bilateral neck swelling , increasing gradually , associated with vomiting food particles and he vomited one time fresh blood.
Patient had difficulty in swallow of the fluids but no for the solid and food particles since the swelling appear .
Enlarged cervical, mediastinal and axillary LNs
CHEST X RAY : Bilateral mild effusion
Related Laboratory Results
Related Laboratory Results
CBC: - WBC: 5.5x103 /uL - HGB: 8 g/dL - Platelet: 203 x103 /uL
D-Dimer: 6616 ng/mL (R.R.: 0-500)
Amylase: 133 u/L (R.R.: 25-115) - Lipase : 640 u/L (73-393).
TSH: 6.4 µIU/mL (R.R.: 0.27-4.2) - FT3: 3.1 pmol/L (R.R.: 2.8-7.1) - FT4: 12 pmol/L (R.R.: 12-22)
BUN: 6 mmol/L (R.R.: 2.5-6.4) - Creatinine: 85 umol/L (R.R.: 55-113).
Na: 133 mmol/L (R.R.: 135-144) - K: 4.3 mmol/L (R.R.: 3.5-5.1)
Pleural fluid sample was taken and sent to the lab; See images and comment below
Case Picture(s) / Photo(s)
Case Picture(s) / Photo(s)
Comment / Findings
Comment / Findings
Pleura fluid cell count : 7.325 10^3/ul polymorph count 36.80 % mononuclear cells 63.20%
Large cells with round to irrigular nucleus and prominent neucleuli and abundant cytoplasm frequently seen. please for cytological examontion , cd19, cd20, cd38, cd79a, cd138, cd30.
Provisional Diagnosis
Provisional Diagnosis
Pleural fluid lymphoma/Leukemia cells
Additional Note
Additional Note
Cytopathological examination:
The smears show mixed predominantly mononuclear inflammatory cells including large numbers of atypical large lymphocytes, plasma cells and reactive mesothelial cells. The large lymphoid cells show atypical nuclear features: macro-nucleoli and irregular chromatin pattern.
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