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Department of Pathology and Laboratory Medicine

Department of Pathology and Laboratory Medicine

Residency Program - Case of the Month

January 2012 - Presented by Sarah Barnhard, M.D.

Clinical history:

The patient was a 53 year old Caucasian male with a past medical history significant for hypertension. In July of 2009 he visited his care provider with complaints of episodic right eye pain for 9 months with concurrent blind spots. Fundus photography revealed a 9DD (horizontal) by 10DD (vertical) pigmented lesion that was 2mm temporal to the fovea. Fluorescein angiography revealed mottled staining with a rim of block fluorescence extending 1DD temporal to the fovea, and a B-scan showed a temporal choroidal lesion measuring 14.65 x 13.37 x 4.65mm with no extra-scleral extension. An MRI-brain was performed (see below). Further work-up was negative for metastatic disease, and an intensive course of treatment was pursued. However, the patient returned in May 2010 with abdominal pain concerning for metastatic disease. An MRI-abdomen was performed followed by liver biopsy. Despite further treatment, the patient’s clinical course deteriorated and the patient expired in November 2010. An autopsy was performed.



2009, Brain MRI

2010, Abdominal MRI

2010, PET scan

Image 1 (Click to enlarge) Image 2 (Click to enlarge) Image 3 (Click to enlarge)


Gross images:

Autopsy - Right eye

Autopsy - Liver in situ

Gross image - Autopsy image, right eye (Click to enlarge) Gross image - Autopsy image, liver in situ (Click to enlarge)


Microscopic photographs:

Right eye, H&E low power

Right eye, H&E high power

Liver core biopsy, H&E

Microscopic image 1- Right eye, H&E low power (Click to enlarge) Microscopic image 2 - Right eye, H&E high power(Click to enlarge) Microscopic image 3 - Liver core biopsy, H&E (Click to enlarge)

Liver core biopsy, CD117

Liver core biopsy, S100

Liver core biopsy, HMB45

Microscopic image 4 - Liver core biopsy, CD117 (Click to enlarge) Microscopic image 5 - Liver core biopsy, S100 (Click to enlarge) Microscopic image 6 - Liver core biopsy, HMB45 (Click to enlarge)