submitted by:
Peter McEvoy
Armed Forces Institute of Pathology
Washington, DC
Marine, 21 years old with right testicular mass for several months. No laboratory abnormalities or
pertinent travel history. Orchiectomy performed for possible neoplasm.
submitted by:
Jeannette Guarner
Center for Disease Control
Atlanta, Georgia
A 21 year-old woman presented to the emergency room with sudden onset of fever, chills, and abdominal
pain. The patient died shortly after arriving. The person accompanying the patient commented that she
had had diarrhea the day before. The patient had been living in Oklahoma but had immigrated from Mexico
6 months earlier. During the autopsy, no macroscopic abnormalities were observed except for fine
petechia in the conjunctiva. Microscopic exam of the heart showed focal areas of inflammation and the
pathologist sent the case to CDC for Chagas' disease testing.
submitted by:
Robert Hackman
Fred Hutchinson Cancer Center
Seattle, Washington
This colon biopsy was obtained from a 25 year-old male patient with abdominal pain and intermittent
guaiac positive diarrhea on day 46 after marrow allograft transplantation for acute myelomonocytic
leukemia (AMML). The acute leukemia had developed following autologous marrow transplantation for
metastatic embryonal cell carcinoma diagnosed at age 20. Although engraftment had been prompt after
infusion of marrow from his HLA mismatched mother, graft-versus-host disease (GVHD) of skin and liver had
developed despite prophylaxis with humanized anti-CD3 antibody and methyl-prednisolone. The GVHD
resolved following the addition of cyclosporin and methotrexate therapy, but the gastrointestinal
symptoms continued and led to endoscopy and biopsy.
submitted by:
Andre Moriera
New York University
New York, New York
The patient is a 34 year-old woman from Central America, who presented to the hospital with mental
alterations. The clinical history was collected from her husband who accompanied her to the hospital.
He says that the patient had recently immigrated to New York City area and was previously in good health.
Two weeks before, the patient complained of mild headaches. The husband noted that the patient was
becoming increasingly forgetful and that she started to sleep more than usual. The day he decided to
bring her to the hospital she could not be awaken easily. He denies fever or convulsions. He says the
patient has been losing weight slowly but does not know how much. He also says that he is not aware of
any significant family history for carcinoma or other diseases. He denies alcohol and tobacco abuse.
Laboratories tests were non-contributory. She had normochromic-normocytic anemia and slight
leukocytosis. A computerized tomography (CT) scan of the head showed intracranial masses suggestive of
metastasis (Figure A). Subsequent CT scan of the abdomen and pelvis showed a 12 cm cystic septate mass
in the pelvis, posterolateral to the uterus (Figure B), suggestive of a cystic adnexal neoplasm. There
was no associated lymphadenopathy and intra-abdominal organs were within normal limits. A chest X-ray
showed two nodules in the lung.
A transvaginal aspiration biopsy of the pelvic mass was performed.
submitted by:
Ronald Neafie
Armed Forces Institute of Pathology
Washington, DC
A five-year-old Zairian boy was transferred from a neighboring hospital to a rural mission hospital with
a possible diagnosis of malignant soft tissue tumor. The lesion was of three months duration.
On physical examination, the patient was a healthy well-nourished appearing child with marked swelling of
the left lower extremity. A well-defined woody hard area of induration and cutaneous thickening extended
from mid thigh to mid calf. The area was non tender, warm to palpation, hyperpigmented and desquamating
in some areas. X-ray of the limb was unremarkable.
