2022 Case Studies

Case History / 01

Laura Lamps / Gastrointestinal Pathology

Clinical History:
A 45 year old man had a one week history of bright red blood per rectum. Flexible sigmoidoscopy was performed, and showed distal left-sided proctocolitis involving the rectum and lower sigmoid. The gastroenterology team thought it was ulcerative colitis based on the colonoscopy, and planned to start immunosuppressive therapy as soon as the biopsy results came back.

Case History / 02

David Chapel / Gynecologic Pathology

Clinical History:
A 57-year-old woman presented with bloating, weight gain, urinary frequency, gastric reflux, dyspnea on exertion, and orthopnea. Ultrasound revealed a 28 cm solid-cystic pelvic mass. Serum CA-125 was 16 (normal). An exploratory laparotomy showed a left ovarian mass, with no evidence of extraovarian spread. The mass was sent for frozen section. 

Case History / 03

Kyle Conway / Neuropathology

Clinical History:
The patient is a 64-year old man who presented with seizures and was found to have a multifocal, nonenhancing FLAIR abnormality in the left mesial temporal lobe. 

Case History / 04

Joel Greenson / Gastrointestinal Pathology 

Clinical History:
In early 2012, a 75-year-old man presented with severe diarrhea which began while on a trip to China.  Several courses of antibiotics were not effective and he was finally admitted to the hospital several months later with dehydration. He was having 20-25 bowel movements per day and had lost 35 pounds.  Past medical history was significant for Gout and gastro-esophageal reflux.

While hospitalized the patient’s work up included negative stool cultures and O and P exams, and negative celiac serologies.  Anti-enterocyte antibodies were weakly positive. A CT scan showed thickening of the terminal ileum and right colon which prompted upper and lower endoscopy. At endoscopy, the jejunum and duodenum showed “mild villous flattening” while the stomach showed speckled erythema. The terminal ileum showed “subtle abnormalities”. The ascending colon had an ulcerated edematous lesion while the remaining colon appeared unremarkable.

Case History / 05

Douglas Rottman / Gynecologic Pathology

Clinical History:
A 41-year-old patient with a history of type 2 diabetes mellitus and resultant chronic kidney disease presented for an ultrasound for evaluation of her kidneys. The renal ultrasound revealed a pelvic mass, which prompted further imaging that identified bilateral ovarian masses and an endometrial polypoid mass. Her CA125 was normal. In an attempt to spare future fertility, the patient underwent conservative bilateral cystectomies and an endometrial curettage.

Case History / 06

Elle Chapel / Breast Pathology

Clinical History:
46-year-old female with a 0.9 cm span of grouped calcifications in the right lower outer quadrant, identified on screening mammography. She now presents for stereotactic core biopsy. Specimen radiograph confirms calcifications are present within the tissue cores, and post-procedure imaging shows the biopsy clip in appropriate position with residual calcifications spanning up to 0.6 cm.  

Case History / 07

Julia Dahl, MD / Placental Pathology

Case History / 08

Sara Abbott, MD / Breast Pathology

Case History / 09

Vipulkumar Dadhania / Genitourinary Pathology

Clinical History:
A 75-year-old woman with history of incidental 4.2 cm right kidney mass detected on MRI scan, who underwent partial nephrectomy. 

Case History / 10

Madelyn Lew / Cytology

Clinical History:
75-year-old male with a history of prostatic adenocarcinoma and high-grade urothelial carcinoma presents with ascites. Subsequent imaging shows diffuse peritoneal disease. Ascitic fluid is collected for cytology evaluation.

Case History / 11

Eman Abdulfatah / Genitourinary Pathology

Clinical History:
A 62-year-old female with no significant past medical history, presented with gross hematuria and was found to have a polypoid mass in the urinary bladder neck on cystoscopy. Other imaging studies were negative. The patient subsequently underwent transurethral resection of the bladder tumor.

Case History / 12

Caroline (Libby) Simon / Pediatric Pathology

Clinical History:
The patient initially presented with a gluteal mass at approximately 2 years of age and underwent resection. Histologic examination was consistent with lipoblastoma. The patient remained disease free for 17 years when she developed her first recurrence. Since her first recurrence she has had multiple recurrences of disease in the pelvis and retroperitoneum despite surgical resection, cryoablation and radiotherapy. The provided slide is from one of her recurrences.  

Case History / 13

Rajiv Patel / Dermatopathology

Clinical History:
A 68-year-old female with a history of multiple invasive squamous cell carcinomas (SCC) on her lower extremities treated with surgical excision and anti-PD-1 immunotherapy pembrolizumab presented for evaluation of new erythematous plaques with thickened scale on her bilateral feet. Shave biopsy was performed. 

Case History / 14

Tao Huang / Thoracic Pathology

Clinical History:
23 years old woman presented with chronic pelvic pain and underwent low anterior resection. Postoperatively, she had persistent pain and underwent diagnostic laparoscopy 10 months after the initial operation.

Case History / 15

Scott Bresler / Dermatopathology

Clinical History:
A 41-year-old white man presented with a 6mm pink papule on the abdomen that had been slowly growing for approximately six months.

Case History / 16

Kristine Konopka / Thoracic Pathology

Clinical History:
48-year-old female with progressive dyspnea.

Case History / 17

Lauren Smith / Hematopathology

Clinical History:
33-year-old man with enlarged right inguinal lymph node that has been growing for several years.

Case History / 18

Alexandra Hristov / Hematopathology

Clinical History:
84-year-old man with an erythematous tender papule with hyperkeratotic scale on the left scapha.  Clinical impression: Squamous cell carcinoma versus chondrodermatitis nodularis helicis.

Case History / 19

Charles W. Ross / Hematopathology

Clinical History:
A 10-year-old girl with no significant past medical history presented with abdominal pain, ascites, jaundice, and hepatosplenomegaly (liver 17 cm and spleen 19 cm by ultrasound).  There was no lymphadenopathy.  Laboratory abnormalities at presentation:  serum LDH 886 IU/L; direct bilirubin 5.3 mg/dL; ferritin 209 ng/mL; prothrombin time 16.6 seconds; partial thromboplastin time 42.3 seconds; fibrinogen 97 mg/dL.  CBC:  WBC 5600/uL; Hb 8.3 g/dL; MCV 102.2 fL; platelets 16,000/uL.  The peripheral blood smear had leukoerythroblastic features with the following leukocyte differential count:  13% segmented neutrophils and bands; 2% metamyelocytes; 2% myelocytes; 3% blastic/blastoid cells; 68% normal lymphocytes; 10% monocytes; 2% eosinophils; and 5 nucleated red cells per 100 leukocytes. Diagnostic bone marrow biopsy and aspiration were performed.  

Case History / 20

Anamarija Perry, MD / Hematopathology

Break Out Case History / 01

Karen Choi & Scott Owens / Pathology of the Tubular Gut

Case 1 / Clinical History: Esophagus / Odynophagia
Case 2 / Clinical History: Esophagus / Odynophagia
Case 3 / Clinical History: Stomach / Sleeve gastrectomy, bariatric surgery
Case 4 / Clinical History: Stomach / Sleeve gastrectomy, bariatric surgery
Case 5 / Clinical History: Stomach / Gastric mass
Case 6 / Clinical History: Stomach / Sleeve gastrectomy, bariatric surgery
Case 7 / Clinical History: Duodenum / Right lower quadrant pain, abdominal crampling, diarrhea
Case 8 / Clinical History: Duodenum / Nodular mucosa
Case 9 / Clinical History: Appendix / Right lower quadrant pain
Case 10 / Clinical History: Appendix / Appendectomy
Case 11 / Clinical History: Colon / Colon polyp found on screening endoscopy
Case 12 / Clinical History: Colon / Colon polyp
Case 13 / Clinical History: Rectum / Rectal prolapse and fecal incontinence
Case 14 / Clinical History: Rectum, sigmoid / Inflammation in rectum and sigmoid
Case 15 / Clinical History: Colon / Change in bowel habits
Case 16 / Clinical History: Anus / Perianal lesions
Case 17 / Clinical History: Anus / Transanal excision of distal rectal polyp
Case 18 / Clinical History: Stomach / Erythematous mucosa
Case 19 / Clinical History: Stomach / Gastric polyp found incidentally on CT scan
Case 20 / Clinical History: Rectum, sigmoid / Workup for GVHD. Biopsy of nodular mucosa

Break Out Case History / 02

Maria Westerhoff & Nora Joseph / Hepatobiliary Pathology

Case 1 / Clinical History: 40M with ulcerative colitis. BMI 31, AST is 32, ALT 67, Alk Phos 79; biopsied because liver chemistries high.

Case 2 / Clinical History: 34 F; BMI 47. AST 57, ALT 76, Alk phos 96; Fibroscan showed probable cirrhosis.

Case 3 / Clinical History: 67 year old female taking losartan, amiodarone. Alkaline phosphatase of 75, AST 170, ALT 121. BMI is 28.

Case 4 / Clinical History: 39 year old female with ETOH, presenting with worsening jaundice and elevated liver chemistries. AST 152, ALT 32, ALP 182, Total bilirubin 7.2, albumin 3.2. Positive ANA (1:80), AMA negative.

Case 5 / Clinical History: 77 year old female with positive ANA, alkaline phosphatase is 380, AST 60, ALT 72.

Case 6 / Clinical History: 50 year old female with jaundice. ANA is positive, AMA is negative. AST 882, ALT 886, ALP 224, and total bilirubin 11.3.

Case 7 / Clinical History: 81 year old male with history of cholecystitis with bile duct injury during surgery a year ago. Recent laboratory studies show alkaline phosphatase 773, AST 159, ALT 128 and imaging showed non-visualization of the junction of the right and left hepatic ducts at the liver hilum, or proximal common hepatic duct.

Case 8 / Clinical History: 31 year old male with AST 202 ALT 633 ALP 398

Case 9 / Clinical History: 70 year old male with iron overload.

Case 10 / Clinical History: 67 yo female with persistent fever and leukocytosis. 3.7 cm complex mass in the liver identified.

Case 11 / Clinical History: 27 year old female with multiple liver masses

Case 12 / Clinical History: 57 year old female with a history of breast cancer and liver lesions, rule out metastasis.

Case 13 / Clinical History: 62 year old female with liver mass

Case 14 / Clinical History: 44 year old female with history of melanoma and liver mass

Case 15 / Clinical History: 74 year old male with liver mass

Case 16 / Clinical History: 78 year old male with cirrhosis and liver masses

Case 17 / Clinical History: 50 year old male with liver mass

Case 18 / Clinical History: 54 year old female getting a liver transplant

Case 19 / Clinical History: 68 year old male with 3.5 cm mass

Case 20 / Clinical History: 59 year old female with liver mass

Case 21 / Clinical History: 46 year old female with liver mass

Case 22 / Clinical History: 53 year old female with 7.8 cm liver mass

Case 23 / Clinical History: 75 year old female with irregular area measuring 3.0 cm near hilum

Case 24 / Clinical History: 39 year old female with gallbladder polyp

Case 25 / Clinical History: 62 year old female with cholelithiasis

Case 26 / Clinical History: 63 year old female with 4 cm liver mass

Break Out Case History / 03

Stephanie Skala & Douglas Rottman / Gynecologic Pathology

Case 1 / Clinical History: A 62-year-old patient with history of endometrial cancer underwent hysterectomy.

Case 2 / Clinical History: A 41-year-old with history of cervical dysplasia underwent endometrial curettage.

Case 3 / Clinical History: An 85-year-old with history of endometrial carcinoma underwent hysterectomy.

Case 4 / Clinical History: A 33-year-old with abnormal uterine bleeding underwent endometrial curettage.

Case 5 / Clinical History: A 70-year-old with a history of endometrial carcinoma underwent hysterectomy.

Case 6 / Clinical History: A 78-year-old with no provided clinical history underwent endometrial curettage.

Break Out Case History / 04

May Chan & Paul Harms / Dermatopathology

Case 1 / Clinical History: 67-year-old man developed redness on the tip of his nose.  It has gradually changed over 4 months. Shave biopsy is performed.

Case 2 / Clinical History: 84-year-old man, with a history of Merkel cell carcinoma on the left forehead, presents for Mohs surgery on a biopsy-proven squamous cell carcinoma of the left zygoma.

Case 3 / Clinical History: 57-year-old woman, with a recent history of choroidal melanoma of her right eye, now presents with a new nodule clinically resembling a cyst on her left scalp.

Case 4 / Clinical History: 39-year-old woman presents with a 4 mm black gray lesion on the back. Rule out blue nevus versus atypia.

Case 5 / Clinical History: 51-year-old woman with a left buccal mass.

Case 6 / Clinical History: 54-year-old woman presents with a lesion on the chin. Rule out BCC.

Case 7 / Clinical History: A 55-year-old woman with no significant past medical history reports 7-month history of draining “cyst” on the anterior left shoulder. Physical examination reveals a 10 cm, necrotic lobulated mass. An incisional biopsy is performed, and submitted in consultation to Michigan Medicine.

Case 8 / Clinical History: A 32-year-old man presents with a mass on the right forehead. Shave biopsy is performed, and submitted in consultation to Michigan Medicine.

Case 9 / Clinical History: 11-year-old boy with a lesion on the right leg.

Case 10 / Clinical History: 44-year-old woman with a recurrent left ear canal lesion causing conductive hearing loss. Previous outside biopsy diagnosed as chondroid syringoma several years ago.

Case 11 / Clinical History: 47-year-old women with an ulcerated rash. Biopsy of the right upper back.

Break Out Case History / 05

Angela Wu, MD & Priya Kunju, MD / Genitourinary Pathology

Break Out Case History / 06

Celina Kleer & Sara Abbott / Breast Pathology

Case 1 / Clinical history: 44-year-old-female with a history of recurrent “breast infections” presents to ED with right breast periareolar swelling, pain, and spontaneous brown nipple discharge; 2.5 cm complex, oval mass with possible fluid by ultrasound; microbial cultures showed no growth. Excision specimen

Case 2 / Clinical history: 60-year-old female with right breast mass; case received as external consultation citing concern for lymphoma. Excision specimen.

Case 3 / Clinical history: 52-year-old female with right breast calcifications. Stereotactic core biopsy.

Case 4 / Clinical history: 46-year-old female with a 2.9 cm partially cystic mass in the right breast.

Case 5 / Clinical history: 64-year-old woman with an abnormal mammogram demonstrating a 1.0 cm breast mass.

Case 6 / Clinical history: 46-year-old woman with a 1.6 cm right breast mass located approximately 10 o'clock, 10 cm from nipple. A previous core biopsy revealed a spindle cell proliferation. These slides are from the excision specimen.

Case 7 / Clinical history: 41-year-old female with macromastia. Bilateral breast reduction.

Case 8 / Clinical history: 29-year-old with 2.5 cm right breast mass. Excision specimen.

Case 9 / Clinical history: 64-year-old female with a suspicious 2.9 cm right breast mass corresponding to a palpable abnormality. Excision specimen.

Case 10 / Clinical history: 55-year-old female with 2.6 cm right breast mass. Excision specimen.

Case 11 / Clinical history: 59-year-old female with a 2 cm left breast mass, who underwent a core biopsy.

Case 12 / Clinical history: 50-year-old with a low suspicion echogenic circumscribed mass in the upper right breast. Differential clinical/radiological diagnosis: PASH, fat necrosis, fibroadenoma.

Case 13 / Clinical history: 67-year-old female with a suspicious 4.5 cm right breast mass. Ultrasound-guided core biopsy.