Monday, February 28, 2005 - 7:30 PM
Rivercenter Salon H,K,L
Celeste N. Powers Medical College of Virginia Richmond, VA
Click on each slide thumbnail image for an enlarged view
Submitted by: Martha Bishop Pitman
A 52-year-old female presents with a 1-month history of a deep cyst in the left cheek. The cyst was
anterior to the parotid gland and not associated with the salivary duct. The clinical impression was
a sebaceous cyst. An FNAB was performed.
A 62 year-old woman from Sierra Leone presented with a left-sided mass of her face that has been
progressively enlarging over the last 2 years. The patient complained of occasional pain, but no
dysphagia or mastication problems and no systemic symptoms. On physical examination, a firm 10 cm
mass extended from the left temporal area over the temporomandibular joint and covered the parotid and
jaw area. Her medical history was significant for a left mandibular mass excision with mandibular
reconstruction 25 years prior to presentation. The FNA of the mass is illustrated.
This 51-year-old woman presents with pneumonia. She had undergone a bone marrow transplant within the
recent past. Radiologic studies show bilateral diffuse pulmonary infiltrates. A bronchoalveolar
lavage was performed and Diff-Quik, Pap and GMS stains were prepared from cytospin preparations.
The patient is a 24-year-old female with no significant past medical history. She presented with
sudden onset of upper abdominal pain, which was constant and severe but not associated with nausea or
vomiting. A CT scan of her abdomen showed multiple large low-density lesions scattered throughout the
liver. The patient had no history of prior liver disease and was not jaundiced. An initial fine
needle aspiration under ultrasound guidance was inconclusive due to low cellularity. A subsequent MRI
exam again revealed multiple liver lesions as well as a large mass between the liver and the anterior
wall of the stomach impinging upon the gastric orifice. A fine needle aspiration was performed of an
enlarged celiac lymph node under endoscopic ultrasound (EUS) guidance.
A 75-year-old alcoholic woman presented with abdominal pain. Ultrasound revealed a 4 cm
multiloculated cystic mass in the head of the pancreas connected with a dilated pancreatic duct. The
cyst had thick septations and there was no apparent wall mass. An endoscopic ultrasound guided biopsy
was performed. 30cc of viscous mucoid fluid was aspirated and sent for cytological evaluation and cyst
fluid analysis. A cytospin slide was prepared and stained with a Papanicolaou stain.
A 56 year-old man presented with a history of intermittent fever, flushing, nausea, vomiting, and
abdominal pain and distention. A colonoscopic exam performed in the past year was reportedly normal.
An abdominal CT scan was performed and revealed a 12.0x5.0x 13.0 cm intra-abdominal mass involving the
small bowel. A core biopsy was obtained with ultrasound guidance but did not provide adequate tissue
for diagnosis. A PET scan confirmed the presence of a hypermetabolic, ill-defined soft tissue mass in
the lower abdomen arising from small bowel or mesenteric wall. Additional small coalescent masses or
adenopathy were also noted as well as increased marrow activity. An open biopsy with intraoperative
consultation was performed. Diff-Quik and H&E-stained smears were prepared.
This 41-year-old para 0, gravida 0 woman presented with a history of vaginal bleeding. She has no
history of cervical disease or malignancy. On exam she is an obese Caucasian female in no evident
distress. Pelvic examination shows an enlarged friable cervix. A SurePath cervical sample was taken
as well as a biopsy.
The patient is a 55-year-old female with a several year history of recurrent urinary tract infections
and recurrent gross hematuria. Her past medical history is remarkable for a TAH/BSO five years
previously. Physical exam revealed a 2-3 cm smooth mass palpable at the mid urethra consistent with a
diverticulum. There was no palpable mass or stone in diverticulum and no urethral discharge on
palpation. The remainder of the exam was unremarkable. A catheterized urine cytology was collected.
MRI revealed a large (3.7 x 2.1 x 2.1 cm) complex left periurethral diverticulum with thick nodular
enhancing walls, (radiologic differential diagnosis includes malignancy in the diverticulum and an
infected diverticulum). Cystoscopy revealed no mucosal lesion and no discernable diverticular opening
associated with the previously noted submucosal mass lesion.