Pathology Case Study 6

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A 50-year old male teacher notices the sudden onset of “chest tightness” when he walks across the parking lot to and from the school. The pain, which is localized over the sternum, goes away when he sits down. He does not experience any pain or discomfort at other times. He has mild hypertension for which he is on dietary therapy. His cholesterol level is elevated. He does not smoke.

  1. Give the differential diagnosis and discuss each condition.
  2. What is the most likely diagnosis?
  3. Discuss the clinicopathologic correlation of the following:
  • What are the risk factors?
  • What are the clinical manifestations and most likely mechanism for these symptoms?
  • What are the diagnostic work-ups to be done on this patient and possible results?
  • What are the morphologic (gross and microscopic) findings in this case?
  • What are the complications and prognosis?
  • Discuss its management and treatment?

Pathology Case Study 5

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A 40-year old male presented with increasing fatigue and weight loss of six months duration. He also reported low grade fever and night sweats for the past four weeks. On examination, multiple enlarged lymph nodes were palpable on both sides of the neck. They varied from 2-3 cms in size and were discrete and non-tender. Abdominal palpation revealed a slight splenic enlargement, but the liver could not be palpated. His temperature was 99.6 degrees Fahrenheit; other vital signs were within normal limits. Examination of peripheral blood revealed total WBC 7000 per cubic millimeter, Hb 9.5 grams per deciliter and platelets of 150,000 per cubic millimeter. WBC differential count was within normal limits. A lymph node biopsy was done. Following the biopsy report, x-rays and CT examination revealed bilateral lymph node enlargements in the mediastinum and the mesenteric regions. The splenic enlargement was confirmed. No lesions could be detected in any visceral organs. He was treated with chemotherapy. The lymph nodes regressed, and he has remained free of symptoms for three years.

  1. Discuss the clinicopathologic correlation of this case.
  2. Give your differential diagnosis.
  3.  What is the most likely diagnosis?


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Pathology Case Study 4

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A 64-year-old male factory worker presented with a history of chest pain and hemoptysis. He had lost more than 3 kg in weight in the last four weeks and complained of feeling “run down and having no energy”. He had smoked heavily since adolescence. The only relevant past history was a squamous cell carcinoma of the larynx three years previously, which had been treated with surgery and radiation. Physical examination revealed a cachectic, nervous man with decreased breath sounds on the right side of the chest. An x-ray demonstrated a large right upper lobe mass with central cavitation. CT scans indicated that the mediastinal nodes were enlarged. Sputum cytology revealed a moderate number of metaplastic and dysplastic squamous cells, and rare malignant cells. Laryngoscopy indicated no evidence of recurrence of his original tumor. Bronchoscopy revealed several thickened white areas, which were biopsied and a large polypoid mass obstructing the right upper lobe bronchus. Examination of the mediastinum, using a special instrument, was performed and an enlarged node was biopsied. He received radiation therapy to the chest, but his condition deteriorated and he died four months later. An autopsy was performed.

  1. Discuss the clinicopathologic correlation of this case.
  2. Give your differential diagnosis
  3. What is the most likely diagnosis?