ACADEMIA DE PATOLOGIA PUERTO RICOA slide Seminar

April 18, 2015

Miguel A. Sanchez MD

EHMC and Mt. Sinai School of Medicine

A day in the life of a community hospital Pathologist

(More or less)

Case #1:A 43 year old nun was referred to

the Cytodiagnosis and Breast Care Center because of a

palpable mass in the left breast. After immediate examination of the aspirate, a laboratory test was performed followed by a

radiologic examination.

Case 1 Diagnosis

• Lactational Hyperplasia associated with a Prolactinoma

• Case #2:• A 62 year old woman, mother of one of our physicians,

was transferred to our hospital with a history of a skin rash for a few weeks, arthritis, mediastinal lymphadenopathy and an increase in size of both parotids. During her hospitalization, the patient’s arthritis worsened and she is now incapable of moving any part of her arms. The mediastinal lymphadenopathy has rapidly increased, and on the way to the operating room for a mediastinal biopsy, she was taken to the Cytodiagnosis and Breast Care Center for a fine needle aspiration of the parotid.

Case 2 Diagnosis

• Lofgren’s Syndrome (benign form of sarcoidosis, association of erythema nodosum and bilateral hilar lymphadenopathy )

• Sven Halvar Löfgren was the second of six children born to August Löfgren, a landowner, and Hilma Elasson. He distinguished himself in school and graduated from the gymnasium with outstanding marks. He studied medicine at the Karolinska institute in Stockholm, becoming a medical licentiate in 1935. He defended his doctoral dissertation at the Karolinska institutet on May 18, 1946 and subsequently became a docent - lecturer - of internal medicine. In 1971 the title of professor, an unusual honour in Sweden for a physician practising outside a university department.

Löfgren spent his entire clinical career at St. Görans sjukhus in Stockholm. At first he was deputy head physician, later he succeeded professor Alf Westergren (1891-1968). However, his medical role model was docent Folke Lindstedt, physician-in-chief at the department of internal medicine at St. Göran. He was also influenced by Jörgen Nilsen Schaumann (1879-1953). In 1963 he hosted a highly successful international congress on sarcoidosis in Stockholm.

Löfgren was a shy, reserved man who loved his family and St. Göran's Hospital. His wife was also a physician and the couple had four children.

• Case #3:• A 51 year old Hispanic man was admitted to the hospital

because of a diagnosis made in Brooklyn of a large kidney mass. He was taken to the operating room for a laparoscopic nephrectomy. During the procedure, the anatomy was rather distorted and the surgeon clipped the renal artery which feeds the normal kidney for approximately five minutes. When this was noted, the clip was removed and blood flow was re-established. The patient underwent a nephrectomy which revealed a large tumor extending outside the renal capsule. The patient was borderline anuric and needed dialysis in the post-operative period.

• Mexico 106,535,000• Spain 45,200,737• Colombia 44,075,701• Argentina 41,000,000• United States 34,000,000*• Peru 28,674,757• Venezuela 28,199,822• Chile 16,598,074• Guatemala 13,354,000• Ecuador 13,341,000• Cuba 11,268,000• Dominican Republic9,760,000

• * 34 million people, 12.2 per cent, of the population older than 5 years speak Spanish at home

• ** Significant numbers of the populations of these countries speak Spanish

• Bolivia 9,525,000• Honduras 7,106,000• El Salvador 6,857,000• Paraguay 6,127,000• Nicaragua 5,603,000• Costa Rica 4,468,000• Puerto Rico 3,991,000• Panama 3,343,000• Uruguay 3,340,000• Jamaica 2,651,000**• Trinidad and Tobago

1,305,000**• Equatorial Guinea 507,000• Western Sahara 382,617**• Belize 314,275**• Andorra 71,822• Gibraltar 28,875

Case 3 Diagnosis

• Collecting duct carcinoma in a patient with sickle cell trait and intravascular sickling do to hypoxia

• Case #4:• A 48 year old woman was referred to the

Cytodiagnosis and Breast Care Center because of a slightly tender, enlarged thyroid. Ultrasound revealed a diffusely, large thyroid without clear-cut nodules. She was otherwise asymptomatic. A fine needle aspiration of the thyroid was performed.

Case 4 Diagnosis

• Anaplastic Rhabdoid tumor of the Thyroid

J.L. Borges Celestial Emporium of Benevolent Knowledge, in which it is written that animals are divided into

1. those that belong to the Emperor,2. embalmed ones, 3. those that are trained,4. suckling pigs, 5. mermaids, 6. fabulous ones, 7. stray dogs, 8. those included in the present classification,9. those that tremble as if they were mad,10. innumerable ones, 11. those drawn with a very fine camelhair brush,12. others, 13. those that have just broken a flower vase,14. those that from a long way off look like flies.

• Case #5:• A 5 year old boy was seen in the laboratory for

blood typing. The boy is the son of a 32 year old nurse from the hospital, and developed severe hematuria for the past few months. A cystoscopy failed to show any signs of bleeding in the bladder and the boy is scheduled for a kidney biopsy. After being seen in the laboratory, a second laboratory test was performed and a consultation obtained. The submitted slide is a direct smear from the boy’s urine.

Karl Friedrich Hieronymus, Freiherr von Münchhausen

Case 5 Diagnosis

• Munchausen by proxy syndrome