Cases Flashcards
Female patient 30 year old, diabetic, came to the emergency department with acute onset of loin pain. Her temperature was 39 degrees, her blood pressure was 110/70. On asking about any previous complaints she admitted having prolonged catheterization following urinary bladder injury during caesarean section.
What is your possible diagnosis?
Mention the predisposing factors in this case that led to her complaint.
acute pyelonephritis
female, diabetic, catheterization
A 67-year-old man complains of increased urgency to void. He could not completely empty his bladder and felt “distended” and “irritated” all the time. Rectal digital examination reveals an enlarged nodular
prostate. A biopsy discloses hyperplastic prostatic glands.” If this patient’s prostate continues to enlarge, what are the possible
complications?
Acute Urinary Retention, Hydronephrosis, Hematuria and kidney stones
” A 5 year old child, presented to the pediatric clinic with generalized edema. Upon examination his cardiac condition was normal. Liver functions were normal. Urine analysis revealed proteinuria > 3.5gm/day & lipiduria.
” What is the most common cause of this condition in this age group?
” What are the expected morphologic changes by light microscopic examination?
Minimal Change Disease
Podocyte Foot Processes
A 57-year-old woman presents to her gynecologist with lower abdominal pain.
During her workup, a CT scan of her abdomen shows bilateral large ovarian cysts. Removal of these cysts were done. The both cysts were unilocular with smooth outer surface , filled with serous fluid and showed small papillae on the inner surface.
a) What’s your diagnosis?
b) Mention the types of this lesion and describe their microscopic pictures?
The diagnosis for the described ovarian cysts is likely to be serous cystadenoma
Simple Serous Cystadenoma
Papillary Serous Cystadenoma
Cyst has smooth outer surface with small papillae on the inside
A 58-year-old female came to the outpatient clinic, complaining of a breast mass and itchy nipple. She told history that she first noticed this mass since 3 months with rapid increase in size. On examination, the mass was hard fixed and measured 5 cm in diameter. The nipple was red, scaly and ulcerated. The axillary
lymph nodes on the same side were enlarged.
a) What’s your diagnosis of breast lump?
b) Mention three common microscopic types of such lesion?
c) What’s the likely cause of the scaly ulcerated nipple and what is the expected microscopic picture of the nipple in such case.
a) breast cancer
b) Invasive Ductal Carcinoma, Inflammatory Breast Cancer,
c) Paget’s disease of the breast; paget cell, epidermal involvement, ductal carcinoma
A 25 year old female patient presented to the emergency department by pelvic pain and tenderness with offensive vaginal discharge. Her temperature was 39.6°C. She gave history of abortion 8 days ago.
What’s your diagnosis?
Mention one predisposing factor and two possible micro-organisms associated with such condition.
What are the possible complications of such condition?
pelvic inflammatory disease
recent history of abortion; gonorrhae and chlamydia
Infertility and peritonitis
A 54 years old female presented to her gynecologist with a five months history of postmenopausal bleeding. Ultrasonography revealed thickened endometrial lining and a left sided ovarian mass 7 cm in diameter. Total hysterectomy and bilateral salpingo-0ophrectomy were performed. On gross examination, the endometrium showed a fungating polypoid mass infiltrating into the
myometrium. The ovarian mass was partially cystic and partially solid. Microscopic examination confirmed the endometrial mass as carcinoma. The ovarian mass showed oval cells arranged in micro-follicles.
” What’s the expected type of such endometrial carcinoma? Describe its microscopic picture.
” What’s your diagnosis of the ovarian mass.
” What other effects may be caused by such mass in the different age groups.
” Mention one other ovarian neoplasm that may lead to similar effects on the endometrium.
endometrioid carcinoma; Infiltration into Myometrium, Nuclear Atypia, Glandular differentiate
ovarian granulosa cell tumor
Postmenopausal Women and Premenopausal Women
Thecoma
A 25 year old female patient came to the out-patient clinic complaining of primary infertility. She gave history of dysmenorrhea. Ultrasound showed an ovarian cyst measured 5 cm in diameter. Laparoscopic exploration also
showed dense fibrous adhesions around the fallopian tube. Laparoscopic cystectomy was performed and the cyst was sent to the pathology department. On gross examination, the cyst was filled with brownish thick
material.
” What’s your provisional diagnosis of such ovarian cyst.
” Mention the microscopic requirements needed to confirm your diagnosis.
” Mention two sites other that may be involved by such lesion.
” Mention other complication that may be caused by such peri-tubal adhesions.
Endometrioma
Presence of Endometrial-Like Tissue
Pelvic Peritoneum and Uterine Ligaments
Fallopian Tube Obstruction and inflammation
A 50-year-old woman presents to her doctor with large firm fixed left breast mass
with axillary lymph nodes. The nipple was retracted and the skin showed Peau
d’orange. Her mammography showed microcalcifications
.
a) What’s your diagnosis?
b) Describe the microscopic picture of this lesion?
a) Breast cancer
b) Invasive Ductal Carcinoma , micro-calcifications, Lymphatic Invasion and inflammatory changes
A 68-year-old heavy smoker man presents with a 4-week history of painless hematuria. Cytoscopy reveals a large exophytic tumor near the neck of the bladder.
In addition to cigarette smoking, what are other risk factor for the development of this patient’s malignant neoplasm?
What are the possible routes of spread of this neoplasm?
Occupational exposure, sex, family history
Local invasion, blood invasion, lymphatic invasion
