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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.

 

Imaging:

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)

 

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