Hematology Case 55
Hematology Case 55
Embedded Files
Presented By Dr Mohammad Moharram - Dr Galal Bashanfer
Released on 7-5-2021Patient Data
Patient Data
51 year old male.
Clinical Data
Clinical Data
History: A known case of ischemic heart disease (Inferior MI since 2012)
Complain: Dyspnea and abdominal distention.
Examination: Massive unilateral Rt. side pleural effusion. Diminished air entry on both sides markedly on right. Moderate ascites.
Radiological: CT abdomen is highly suggestive of peritoneal metastasis. ?? Omental cake and cecal mass.
Related Laboratory Results
Related Laboratory Results
CBC: - WBC: 6.2x103 /uL - HGB: 8.2 g/dL - MCV: 95fL -MCH: 27.5 pG - Platelet: 65x103 /uL
AST: 60 u/L (R.R.: 15-41) - ALT: 23 u/L (R.R.: 17-63) - ALP: 44 u/L (R.R.:30-91) - ALB: 34 g/L (R.R.: 35-50).
BUN: 29.4 mmol/L (R.R.: 2.5-6.4) - Creatinine: 186 umol/L (R.R.: 55-113).
Na: 164 mmol/L (R.R.: 135-144) - K: 3.6 mmol/L (R.R.: 3.5-5.1) - Ca: 3.1mmol/L (R.R.: 2.2-2.5).
Pleural Fluid aspirate was sent to the lab for cytological count , differential count and cytopathological evaluation (See below)
Provisional Diagnosis
Provisional Diagnosis
Malignant secondaries of unknown primary
Case Picture(s) / Photo(s)
Case Picture(s) / Photo(s)
Pleural Fluid - Giemsa Stain
Pleural Fluid - Giemsa Stain
Pleural Fluid - H & E
Pleural Fluid - Immunocytochemistry
Images Comment / Findings
Images Comment / Findings
Cytological count and morphology:
Total cell count: 7.5xx103 /uL
Mononuclear cells are the predominant cells. The mononuclear cells are moderate to large sized cells with Basophilic and Vacuolated cytoplasm. Their nuclei are mostly of fine chromatin with 1 to 3 nucleoli commonly seen.
Immunophenotyping for pleural fluid is recommended.
Cytopathological Examination : (H.&E. and immunocytochemistry):
Smear show numerous atypical large non-cohesive cells.
These cells are positive for : LCA, PAX5, CD79a, BCL2
& are negative for BER-EP4, CD138, CD10, C-kit.
Remnant T lymphocytes are positive for CD3.
Final Diagnosis
Final Diagnosis
Pleural fluid features are consistent with non-Hodgkin lymphoma , B-cell type.
Lymph node biopsy or primary mass biopsy is recommended for definite diagnosis.
Additional Note
Additional Note
Patient died 5 days later. Final diagnosis was not reached.
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