—  SPECIALTY CONFERENCE  —

Hematopathology
7:30 PM, Thursday, March 27
Washington Rooms 1-3


Diagnoses Too Easy to Miss



Moderator:

Steven H. Swerdlow
UPMC Presbyterian Hospital
Pittsburgh, Pennsylvania


Clinical histories are printed below.
Click on the case numbers for text and references of each case.
Click on each slide thumbnail image for an enlarged view

Case 1

submitted by:
Jonathan W. Said
UCLA Center for Health Sciences
Los Angeles, California

Clinical Summary:

The patient is a 15-month-old boy with fever, upper respiratory tract infection, leukocytosis and a localized lesion on the right cheek, which was biopsied. Stains for organisms (AFB, GMS, PAS, GRAM) were negative.



Case 1 - Figure 1

Case 1 - Figure 2

Case 1 - Figure 3


Case 1 - Figure 4

Case 1 - Figure 5




Case 2

submitted by:
Marsha Kinney
University of Texas Health Sciences Center
San Antonio, Texas

Clinical Summary:

This 63 year old male presented with progressive dyspnea over 4 months, dry cough, low grade fever and chills, and 19 pound weight loss. Past medical history was significant for single vessel atherosclerotic cardiovascular disease, hyperlipidemia, hypertension, and peptic ulcer disease. Chest x-ray revealed a retrocardiac infiltrate. Patient had recent exposure to birds and puppies at a neighbor's house. Patient was treated with antibiotics for two weeks without response.

Patient was admitted to the hospital. CT examination revealed an alveolar infiltrate more pronounced in the bases than in the apices. There was no adenopathy by physical examination or CT. Pulmonary function tests revealed airflow obstruction. CBC was normal except for anemia (HCT = 30.3%). LDH was 1825 IU/L with a mildly elevated AST (124 IU/L) and a normal total bilirubin and ALT. Haptoglobin was normal and reticulocyte count was 3.3%. Bronchoscopy with transbronchial biopsy was performed.



Case 2 - Figure 1

Case 2 - Figure 2

Case 2 - Figure 3


Case 2 - Figure 4

Case 2 - Figure 5




Case 3

submitted by:
Amy Chadburn
New York Presbyterian Hospital
New York, New York

Clinical Summary:

A 40-year homosexual man presented with shortness of breath. Chest X-ray showed bilateral pleural effusions. A diagnostic procedure was performed. Giesma stained cytospin; H and E stained section of the cell block.



Case 3 - Figure 1

Case 3 - Figure 2

Case 3 - Figure 3 - LANA




Case 4

submitted by:
Harald Stein
University Hospital Benjamin Franklin
Berlin, Germany

Clinical Summary:

A 66-year-old patient presented with an ulcerated swelling of the maxillary gingiva and with enlarged cervical lymph nodes. An excision biopsy was taken from the lesion. Two paraffin blocks with representative slides were sent to our Lymphoma Reference Center in Berlin for consultation.



Case 4 - Figure 1

Case 4 - Figure 2


Case 4 - Figure 3

Case 4 - Figure 4




Case 5

submitted by:
Kathryn Foucar
University of New Mexico Health Sciences Center
Albuquerque, New Mexico

Clinical Summary:

68-year-old female with severe pancytopenia, hepatosplenomegaly, and recent onset of weakness, fever, weight loss, and confusion. The patient has a past history of a cerebrovascular accident, multi-infarct dementia, hypertension, and congestive heart failure.



Case 5 - Figure 1

Case 5 - Figure 2

Case 5 - Figure 3