View source for Cytologically Yours: CoW: 20140120


== Clinical Summary == 
The patient is a 46 year old female with a new pleural effusion, pelvic mass, and ascites. She presented to the ED with increasing abdominal distension and discomfort.
She also has nausea and has been unable to tolerate anything by mouth. She has shortness of breath and has had a recent >20lb weight loss in the last two months.

=== Past Medical History ===
* Hyperlipidemia
* Coronary artery disease
* Hepatitis C

=== Past Surgical History ===
* Cardiac stent (2011)
* Exploratory pelvic surgery

== CT ==
* Ascites
* Left hydronephrosis
* enlarged uterus 12 x 7 x 7 cm.
* 13 cm pelvic mass 
* Right sided pleural effusion

===Clinical Plan===
Therapeutic paracentesis.

==Pathology==

===Cytology===
<gallery heights="250px" widths="250px">
CytologicallyYoursCoW20140120Cytology1.JPG|20x magnification of cohesive pleomorphic cells with abundant cytoplasm.(DQ)
CytologicallyYoursCoW20140120Cytology2.JPG|40x magnification showing large atypical cells with abundant cytoplasm. (DQ)
CytologicallyYoursCoW20140120Cytology3.JPG|40x magnification showing large groups of cohesive cells that are pleomorphic. (DQ)
CytologicallyYoursCoW20140120Cytology4.JPG|40x magnification showing cells that are large and pleomorphic and in groups.(DQ)
CytologicallyYoursCoW20140120Cytology5.JPG|40x magnification of large atypical cells one nucleus appears to have an inclusion.(DQ)
CytologicallyYoursCoW20140120Cytology6.JPG|40x magnification of atypical cells. Some of the cells appear to have material in their cytoplasm .(DQ)
</gallery>


====Resident Questions====
* <spoiler text="What could the material in the cytoplasm of the cells represent?"> Mucin or hyaluronic acid. Mucin can be tested for using mucicarmine and hyaluronic acid can be tested by Alcian blue   </spoiler>


====Cell Block====
<gallery heights="250px" widths="250px">
CytologicallyYoursCoW20140120Cytology7.JPG|40x magnification cell block
CytologicallyYoursCoW20140120Cytology8.JPG|20x magnification cell block
</gallery>

* <spoiler text="What stains would you order?"> CK7, CK20, CDx2, CA125, Calretinin  </spoiler>

<div class="usermessage mw-customtoggle-diagnosis" style="cursor:pointer">Click here to toggle the diagnosis and discussion.</div>
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==Final Diagnosis==

===Cytology===
* '''Adenocarcinoma'''.

<gallery heights="250px" widths="250px">
CytologicallyYoursCoW20140120Cytology9.JPG|10x magnification of CK7
CytologicallyYoursCoW20140120Cytology10.JPG|10x magnification of CK20
CytologicallyYoursCoW20140120Cytology11.JPG|10x magnification of CDX2
CytologicallyYoursCoW20140120Cytology12.JPG|10x magnification of CA125
CytologicallyYoursCoW20140120Cytology13.JPG|10x magnification of Calretinin
</gallery>

===Surgical Pathology===
* '''Metastatic adenocarcinoma, consistent tiwht papillary serous carcinoma'''.
<gallery heights="250px" widths="250px">
CytologicallyYoursCoW20140120Cytology14.JPG|10x magnification of pleural biopsy specimen
CytologicallyYoursCoW20140120Cytology15.JPG|40x magnification of pleural biopsy specimen. Notice the psammoma bodies present.
</gallery>

===Discussion===
Serous adenocarcinoma commoly presents with widespread peritoneal metastases. Microscopically the tumor can be papillary, solid or nested. Psammoma bodies may be present. 
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{{Cytologically Yours}}

[[Category:Case Reports]]