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Department of Pathology and Laboratory Medicine

Department of Pathology and Laboratory Medicine

Residency Program - Case of the Month

The Department of Pathology and Laboratory Medicine is highlighting a new case every month, to be called the Case of the Month. Normally, these are cases of greater than normal clinical interest, cases with unusual symptoms and/or microscopic and gross characteristics, or cases involving rare diseases or conditions. Below is a link to the current Department of Pathology and Laboratory Medicine Case of the Month.

Disclaimer: Review of the Case of the Month is intended for educational purposes ONLY, NOT for research.

Current Case of the Month - October 2015

Previous cases

  • September 2015 - A 20-year-old female with history of Systemic Lupus Erythematosus (SLE) and lupus nephritis causing renal failure for which she is on hemodialysis. She was on chronic immunosuppression and subsequently developed a left thigh nodule and numerous lung nodules. Incisional biopsy of the left anterior thigh mass showed suppurative granulomatous dermatitis containing fungi consistent with chromomycosis and the patient was started on Itraconazole.
  • August 2015 - A 74-year-old woman underwent living donor kidney transplantation for chronic kidney disease on 5/15/2012. The patient developed fatigue, fever, cough, diarrhea and small bowel obstruction 30 months after the transplantation and was found to have bilateral pleural effusion.
  • July 2015 - The patient is a 64-year-old female with an unremarkable past medical history who presented for evaluation of a slow growing swelling on the floor of her mouth. Physical examination revealed a firm mass (2.7 x 1.1 cm) that appeared confined to the right side with normal overlying mucosa.
  • June 2015 - An 82-year-old man who presented with fever, diaphoresis, fatigue, and dysphagia. On exam, he was noted to have prominent lymphadenopathy including enlarged tonsils as well as splenomegaly.
  • May 2015 - A 17-year-old female with past medical history of Anomalous Pulmonary Venus Connection (Left to right shunt) and Biphasic thoracolumbar Scoliosis with Restrictive Lung Disease. She present with proximal muscle weakness since last year.
  • April 2015 - A 66-year-old female with a past medical history of peptic ulcer disease presents to the Emergency Department with 5 weeks of vague epigastric abdominal pain with non-bloody non-bilious emesis.  She does not report any weight loss, fever, chills or lymphadenopathy.
  • March 2015 - A 53-year-old male with history of neurofibromatosis type 1 (NF-1) presented to the ED with a 3-week history of abdominal pain. On physical examination, multiple plexiform neurofibromas and cafe-au-lait spots were noted.
  • February 2015 - A 30-year-old male with a history of Hodgkin lymphoma which was diagnosed 5 years ago.  He received chemotherapy followed by an allogenic stem cell transplant in 2013.  He subsequently developed poikiloderma, keratoconjunctivitis sicca, chronic diarrhea and lost 20% of his weight over a period of 4 months.
  • January 2015 - The patient is a 43-year-old woman and navy veteran who was brought to the attention of the Mather Veterans Affairs otolaryngology service after a CT scan conducted as part of a routine trauma survey following a motor vehicle accident revealed a nodular thyroid.
  • October 2014 - The decedent is a 55-year-old Caucasian male with a past medical history of diffusely metastatic carcinoma, severe chronic obstructive pulmonary disease (on 4 L home oxygen therapy), extensive smoking history, and asbestos exposure history.  He had symptomatic lesions and pathologic fractures at the lumbosacral spine, the left pelvis, the left femur and the left upper extremity. He was not a candidate for systemic treatment or surgery but was considering possible radiation therapy.
  • September 2014 - The patient is a 24-year-old O RhD positive G2P1 female at full term in her pregnancy.  Her history includes HbSC disease and she has had sickle cell pain crises episodically requiring transfusions.  Fetal monitoring has been stable.
  • August 2014 - The patient is a 57-year-old male with a history of atrial fibrillation on coumadin, chronic obstructive pulmonary disease, hypertension, gout, and alcohol abuse who presented with a three day history of melena. His INR was 7.
  • July 2014 - The patient is a 35-year-old female with a medical history significant for hypothyroidism, depression, and asthma.  She presented to her primary care physician in January 2014 with four days of fever and cough after having returned from a trip to Egypt and Israel for which she was placed on antibiotics. 
  • May 2014 - An 83-year-old female G2P2 with a past medical history of hypertension, hyperlipidemia, hypothyroidism and enterococcus endocarditis in 2013 presented in February 2014 with mid-abdominal pains. She was primarily diagnosed with gallstones.  In March 2014, she returned to the hospital with abdominal pains. A CT scan showed a large cystic pelvic mass.
  • April 2014 - A 2-year-old female with no significant past medical history presented to her primary care physician six months prior with complaint of dysuria, she was placed on empiric antibiotics, urine cultures were found to be negative and she was sent home with resolution. She had two more distinct episodes of dysuria with negative urine cultures which resolved after one week. She presented again five months later with similar complaints in addition to a rash and a fever.
  • March 2014 - The patient is a 47-year-old male with no significant past medical history who presented with a palpable mass of several years in the anterior and lateral aspects of the left lower leg.  The mass was first attributed to a musculoskeletal injury and no further evaluation was obtained.  However, the lesion continued to progress in size with severe pain.
  • February 2014 - The patient, a 91 year old female, presented with a 6 month history of vaginal bleeding and mild abdominal discomfort.
  • January 2014 - The decedent is a 57-year-old female with a history of papillary serous ovarian cancer (stage IIIc) who underwent a radical hysterectomy and debulking of her primary tumor followed by six cycles of intraperitoneal chemotherapy.
  • December 2013 - A 50-year-old female with a past medical history of fibromyalgia, chronic pain, and 25 pack year smoking history, who presented to the ED at an outside hospital one year ago with severe left upper quadrant pain without fever, chills, anorexia, nausea, vomiting, diarrhea, constipation, or back pain.  She additionally had a 40 lb weight loss (unintentional) over the prior 8 months.
  • November 2013 - A 70-year-old woman with malaise, hot flashes, and 5-10 pound weight loss was found to have an elevated hematocrit of 46.  She was referred to UC Davis Urology for further evaluation.
  • October 2013 - A 28-year-old woman with no significant past medical history presented with a palpable left neck mass which had been slowly increasing in size for approximately one year and was not associated with pain or other symptoms.
  • September 2013 - The patient is a healthy 80-year-old male with a large, right, painless scrotal swelling that has progressed in size slowly for many years.
  • August 2013 - A 22-year-old G1P0 female with an uncomplicated pregnancy history was at 31 weeks 6/7 days gestational age by last menstrual cycle when she presented to her OB clinic for routine screening. There was imaging concern for congenital anomalies, so she was transferred to our institution for management.
  • July 2013 - A 3-year-old boy presented with an enlarging mass in front of his ear. There was no bleeding or bruising, change in visual acuity, fever, pain, or drainage from the ear.
  • June 2013 - The patient is a 55 year old male with a past medical history significant for hypertension and osteoarthritis who presented with a 3 to 4 month history of alternating diarrhea with steatorrhea and constipation. He also noted fevers and an unintentional 40 lbs weight loss.
  • April 2013 - The decedent was a 33 year old male with a prior history of illicit drug use who complained of vague abdominal pain 1 week prior to death.
  • March 2013 - 75 year old male who presented with dysphagia and epigastric discomfort.
  • February 2013 - A newborn female infant born at 37 weeks gestation with a left –sided multicystic lung mass discovered at 25 weeks on ultrasound.
  • January 2013 - 63-year-old female with a past medical history of gastrointestinal bleeding from a gastric ulcer and H. pylori infection presented with new complaints of melena, progressive weakness, fatigue and shortness of breath.
  • December 2012 - 55-year-old para 1 female who presented with abdominal pain and a palpable mass.
  • November 2012 - 27 year-old male with a recent history of recurrent pneumonia (5 times over the past two years).
  • September 2012 - 37 year-old nulligravida female with a history of abnormal menstruation and more recently, episodes of severe lower abdominal cramping and copious vaginal bleeding.
  • August 2012 - 44 year-old pravida 2, para 2 woman with a seven-year history of a pedunculated vulvar mass.
  • July 2012 - 11-year-old girl with no significant past medical history who presented with a headache located behind the right eye, with radiation to bilateral temples.
  • June 2012 - 64 year-old female with a past medical history of cervical cancer s/p vaginal hysterectomy, hemorrhagic cyst s/p right oopherectomy, hypertension, and recurrent pulmonary emboli. She presented with abdominal pain for two weeks. Computed tomography (CT) showed a multi-cystic pelvic mass.
  • May 2012 - 86 year old male with a past medical history significant for diabetes mellitus and hypertension who was incidentally found to have a left lung mass discovered on chest radiographs (during work-up for dull chest pain).
  • April 2012 - 40-year-old Asian female status post right ovarian cystectomy and left salpingo-oophorectomy for seromucinous cystadenoma of the right ovary and mixed endometrioid and mucinous tumor of low malignant potential of the left ovary.
  • March 2012 - 63-year-old female presents with worsening abdominal pain, distention, nausea and progressively fewer and smaller bowel movements.
  • February 2012 - 16-year-old girl with no significant past medical history presented with a tender right breast lump.
  • January 2012 - 53-year-old Caucasian male with a past medical history significant for hypertension.
  • December 2011 - 64-year-old female, with a past medical history significant for chronic obstructive pulmonary disease, diabetes mellitus, and hypertension, who was found to have a right adrenal mass on chest CT (during work-up for pneumonia).
  • November 2011 - 62-year-old male, with no significant past medical history, who presented with a chief complaint of a lump in his right testicle causing mild discomfort.
  • October 2011 - 65-year-old female who presented with increasing abdominal distention and pain.
  • September 2011 - 2-year-old boy with a soft tissue mass in the thenar eminence of the hand. MRI showed an amorphous area of enhancing soft tissue in the thenar eminence and a suggestion of increased soft tissue between the radial metacarpals.
  • August 2011 - 39 year-old female with a 5-month history of persistent abdominal pain and cramping. A colonoscopy was performed and found no abnormalities.
  • July 2011 - 54 year-old woman with a history of melanoma of the right leg and a left adnexal mass that was found on CT when the patient presented to the ED with abdominal pain.
  • June 2011 - 38 year-old male, with a past medical history significant only for gastroesophageal reflux disease, who presented with burning epigastric pain.
  • April 2011 - 38 year-old male with a history of a left testicular varicocele and a chief complaint of infertility for four years.
  • March 2011 - 30 year-old female from Sudan with no significant past medical history who presents with an incidental finding of persistent mildly elevated liver function tests and microcytic anemia.
  • February 2011 - 66 year-old female with a past medical history of hypertension, atrial fibrillation and congestive heart failure who underwent a computed tomography (CT) scan of the abdomen to evaluate for an existing abdominal aneurysm.
  • January 2011 - 22 year-old woman with a 10 year history of menorrhagia.
  • December 2010 - 15-month-old female with a 1-week history of fever, fatigue, and maculopapular rash which had recently resolved.
  • October 2010 - 9-year-old boy with no past medical history who had a right flank mass which had been growing over several months.
  • September 2010 - 31-year-old female with a prior history of a myelomeningocele who was noted to have a new cystic structure within the pelvis/sacrum region at the time of a C-section.
  • August 2010 - 68 year-old man who initially presented with pancreatitis and was incidentally found to have hypercalcemia due to hyperparathyroidism.
  • July 2010 - 34-year-old male with no significant past medical history who presented with right painful lump, behind right ear for 2.5 months.
  • June 2010 - 56-year-old female with no significant past medical history who presented to her PMD with on going non-specific microscopic hematuria.
  • May 2010 - 33-year-old Caucasian female with no significant past medical history who presented with a chief complaint of progressive shortness of breath over a course of 3 months.
  • April 2010 - 79-year-old man with a history of Barrett’s esophagus.
  • March 2010 - 37-year-old female with a two to three month history of abdominal pain, burning on urination, occasional fevers, weight loss of 10 lbs. and amenorrhea for a period of 6 months
  • February 2010 - nulligravida 47-year-old female with Turner’s Syndrome who presented with a 10 month history of irregular vaginal bleeding
  • January 2010 - 80 year-old woman who presented with a three month history of multiple urinary tract infections and one day of gross hematuria
  • October 2009 - 51-year-old female with a right upper eyelid swelling present for at least nine months
  • September 2009 - 57-year-old male who noted a “pop” in his right thigh while doing heavy labor activities
  • August 2009 - 63-year-old male who presented to the emergency room because of sharp chest pain radiating to the scapula