Interesting Case of the Month - (IGHP, ICOM) - March
march
Clinical History-
22-year-malepresented with backache for 1.5 months, weight loss approx. 2-3 kgs within a month. CEA-2.62 , CA19.9 <3.00 U/ml, CRP 19 mg/L (<5.0), CBC Hb -16.5, TLC-6270, DLC-67/25/04. LFT -Bilirubin 0.4, SGOT-19, SGPT-27, SAP -74, LDH was elevated-793 (135-225 U/L)
Radiology-
CECT Abdomen -
Multiple enlarged pre, paraaortic and aortocaval lymph nodes forming a conglomerate nodal mass measuring 93 x 40 x 37mm, showing heterogenous post contrast enhancement causing anterior deviation of left renal vessels and complete encasement of abdominal aorta.
Liver is mildly enlarged with poorly defined hypodense hypo enhancing lesions seen in both liver lobes, largest measuring 39.6 x 27mm. hepatosplenomegaly with few poorly defined hepatic lesions.
Microscopic Images-
Biopsy from liver and retroperitoneal lymph node showed deposits of a malignant neoplasm with vague glandular and nesting pattern –
Special Stains-
MT and Orcein stain showing no significant increase in fibrosis in adjacent liver
Immunohistochemistry –
IHC showed the large atypical cells are weak variably positive for PanCK and negative for LCA and S100. The neoplastic cells are diffusely positive for CD30 and SALL4 and are negative for AFP, HepPar1 andCD117.
