dr.radhika srnivasan, pgimer, chandigarh 26th nov 2010 fernandes slide seminar case preview...

Dr.Radhika Srnivasan,

PGIMER, Chandigarh

26th Nov 2010

Case 1: Clinical history A 45-year-old male presented with a lump in right

breast of 3 months

Lump: 4x4 cms diameter, firm, mobile, non-tender, 2.5 cms above and lateral to the areola.

No lymph nodes palpable in the axilla

Clinical diagnosis: Carcinoma breast.

Clinical History A 46-year-old lady complained of awareness of breast

mass. The mass was present for around 12 years and she was taking homeopathic medicines on and off for the same. There was history of waxing and waning in the size of the mass.

The surgeon referred the patient for a mammogram and FNA

On examination, a 3.5 cms lump was palpable in the lower outer quadrant; was firm with restricted mobility

Mammogram: Dense mass lesion, BIRADS 4

Clinical History A 9-year-old female child presented with abdominal

distension and awareness of mass abdomen of 2-3 weeks duration which was not associated with any pain.

No h/o fever, weight loss, vomiting, diarrhoea or constipation.

H/o retention of urine relieved by micturition present.

No h/o swelling at any other site.

Past and family history: Nothing significant.

Serum AFP and HCG levels were normal

Case presentation A 35-year-old woman presented with

vague pain in the right flank since 4-5 months and

history of hematuria for 2days.

On physical examination,

right level I cervical lymph node, measuring 1.5x1 cms.

Computed tomography (CT) of the abdomen discloses a well defined heterogeneous mass measuring 11.2x10x7.8 cms arising from the right kidney with extension into the right renal vein and thrombus in the inferior vena cava

FNA was performed with ultrasound guidance from the renal mass and also from the lymph node

Brief history A 45-year-old male , a known case of Alcoholic Liver

Disease with Portal hypertension

c/o Difficulty in swallowing of a few weeks duration

Endoscopy carried out

Oesophagus: No growth identified, small ulcer seen.

Brush smears made and sent for cytological examination

Clinical history A 23-year-old male presented

with complaints of pain and abdominal distension of 2-3 weeks duration associated with fever. There was no history of loss of weight but there was some loss of appetite.

An ultrasound examination was carried out followed by CT scan

FNA carried out from LIVER SOL under US guidanceAspirate was 10ml hemorrhagic fluid; repeat FNA yielded particulate material

Ist FNA IInd FNA

Clinical History 52, F, post menopausal for 1 year complains of

occasional bleeding per vaginum.

Routine Pap smear taken

Case History A 15-year-old male

was referred to PGI with a solitary lytic lesion in the skull. There were no other complaints.

FNA performed And subjected to electron microscopy as requested

Case History A 9-yr-old boy presented to the otorhinolaryngologist

with an enlarged thyroid of a 2-3 months duration.

On examination, there was a swelling in the left side of the neck measuring approximately 4 cms diameter and which moved with deglutition indicating a thyroid origin.

Ultrasonography revealed a well defined hypoechoicnodule measuring 5x4x2.8 cm in the left lobe of the thyroid. The cervical lymph nodes were not enlarged.

FNA of thyroid mass lesion was performed as first-line investigation

Case History 45, female, referred to PGI with a clinical diagnosis of

mediastinal abscess of 3 weeks duration, infiltrating the soft tissue and forming a chest wall abscess from which an incision & drainage was attempted; pus was aspirated, however the abscess could not be drained completely.

H/o fever present, no h/o loss of appetite or weight loss. On examination, the patient was well preserved; there was

one palpable left axillary lymph node. No hepatosplenomegaly or any other lymph node was palpable.

FNA was performed from the anterior chest wall / mediastinal lesion which yielded frank pus. The pus was sent for bacteriological / mycobacterial cultures.

Clinical History 36-year-old male patient with vague pain in right thigh

for 3-4 weeks duration

An X-ray pelvis was ordered by the orthopedic surgeon followed by CT scan and MRI

FNA was done from the soft tissue lesion under CT guidance

Radiology

X-ray: Bone not involved

Clinical History A 50-year-old postmenopausal lady complained of

postmenopausal bleeding for 6 months 1-3 pads/day/ ass. with clots

with foul smelling unhealthy vaginal discharge +

h/o post coital bleeding +

Abdominal distension for 1 month Gradually progressive with difficulty in breathing

h/o loss of appetite/loss of weight/fever/fatiguability present

h/o of swelling over feet present

No h/o chest pain/hemoptysis/decreased urine output

No h/o of awareness of mass abdomen

No c/o bladder and bowel abnormalities

Examination and Radiology O/E,

bilateral pleural effusion and ascites which was moderate

Ascitic Fluid Biochemistry:

Protein-5.8 g,

sugar-98mg,

TLC-110 cells/mm3

C/S-sterile

ADA-11 u/L(N=upto 40 u/L)

Per vaginal examination revealed a right adnexal mass

USG and CT Scan-Bulky uterus

-complex pelvic mass 13x11x9 cm arising from Rt adnexa? malignant ovarian tumor

- Lt adnexa-normal limits

- mild ascites; No pelvic nodes seen

-bilateral pleural effusion with basal lung collapse on left side

Clinical Diagnosis: Malignant ovarian tumor, stage IV

Pleural Fluid for cytological examination

FNA adnexal mass [Rt. Ovary]

FNA adnexal mass[Rt. Ovary]

Case History A 2-year-old child presented with history of fever for 3

months with recent onset history of gum bleeds and neck swelling of 15 days duration. Fever was not associated with chills or rigors and showed a rise at night-time.

On examination Malnourished Tonsils – enlarged and congested Bilateral cervical lymphadenopathy, multiple, discrete

ranging in size from 1-2 cms; largest were submandibularlymph nodes.

Gum hypertrophy was present Pallor+, No cyanosis, no raised JVP and no clubbing No hepatosplenomegaly

Investigations Hemogram

Hb: 5.5 g/dl Platelets – 17,000/cu.mm TLC-2200/cu.mm; Neutrophils: 33%, lymphocytes 65%,

monocytes 1% and eosinophil 1% RBC morphology: Micro and macrocytes with occasional

nucleated RBC

Biochemistry: all within normal limits HIV: Non-reactive Throat swab: sterile CECT neck: Tonsillar enlargement with cervical

lymphadenopathy s/o lymphoma

Case Summary 2 year old child with fever, pancytopenia, with gum

bleeds and significant cervical lymphadenopathy

FNA performed from bilateral cervical lymph nodes

Urine Cytology Smear

Patient is a renal transplant recipient on follow up with mildly abnormal Renal Function tests

Urine sent for cytological examination