Dr.Radhika Srnivasan, PGIMER, Chandigarh 26 th Nov 2010
Dr.Radhika Srnivasan,
PGIMER, Chandigarh
26th Nov 2010
Case 1: Clinical history A 45-year-old male presented with a lump in right
breast of 3 months
Lump: 4x4 cms diameter, firm, mobile, non-tender, 2.5 cms above and lateral to the areola.
No lymph nodes palpable in the axilla
Clinical diagnosis: Carcinoma breast.
Clinical History A 46-year-old lady complained of awareness of breast
mass. The mass was present for around 12 years and she was taking homeopathic medicines on and off for the same. There was history of waxing and waning in the size of the mass.
The surgeon referred the patient for a mammogram and FNA
On examination, a 3.5 cms lump was palpable in the lower outer quadrant; was firm with restricted mobility
Mammogram: Dense mass lesion, BIRADS 4
Clinical History A 9-year-old female child presented with abdominal
distension and awareness of mass abdomen of 2-3 weeks duration which was not associated with any pain.
No h/o fever, weight loss, vomiting, diarrhoea or constipation.
H/o retention of urine relieved by micturition present.
No h/o swelling at any other site.
Past and family history: Nothing significant.
Serum AFP and HCG levels were normal
Case presentation A 35-year-old woman presented with
vague pain in the right flank since 4-5 months and
history of hematuria for 2days.
On physical examination,
right level I cervical lymph node, measuring 1.5x1 cms.
Computed tomography (CT) of the abdomen discloses a well defined heterogeneous mass measuring 11.2x10x7.8 cms arising from the right kidney with extension into the right renal vein and thrombus in the inferior vena cava
FNA was performed with ultrasound guidance from the renal mass and also from the lymph node
Brief history A 45-year-old male , a known case of Alcoholic Liver
Disease with Portal hypertension
c/o Difficulty in swallowing of a few weeks duration
Endoscopy carried out
Oesophagus: No growth identified, small ulcer seen.
Brush smears made and sent for cytological examination
Clinical history A 23-year-old male presented
with complaints of pain and abdominal distension of 2-3 weeks duration associated with fever. There was no history of loss of weight but there was some loss of appetite.
An ultrasound examination was carried out followed by CT scan
FNA carried out from LIVER SOL under US guidanceAspirate was 10ml hemorrhagic fluid; repeat FNA yielded particulate material
Ist FNA IInd FNA
Clinical History 52, F, post menopausal for 1 year complains of
occasional bleeding per vaginum.
Routine Pap smear taken
Case History A 15-year-old male
was referred to PGI with a solitary lytic lesion in the skull. There were no other complaints.
FNA performed And subjected to electron microscopy as requested
Case History A 9-yr-old boy presented to the otorhinolaryngologist
with an enlarged thyroid of a 2-3 months duration.
On examination, there was a swelling in the left side of the neck measuring approximately 4 cms diameter and which moved with deglutition indicating a thyroid origin.
Ultrasonography revealed a well defined hypoechoicnodule measuring 5x4x2.8 cm in the left lobe of the thyroid. The cervical lymph nodes were not enlarged.
FNA of thyroid mass lesion was performed as first-line investigation
Case History 45, female, referred to PGI with a clinical diagnosis of
mediastinal abscess of 3 weeks duration, infiltrating the soft tissue and forming a chest wall abscess from which an incision & drainage was attempted; pus was aspirated, however the abscess could not be drained completely.
H/o fever present, no h/o loss of appetite or weight loss. On examination, the patient was well preserved; there was
one palpable left axillary lymph node. No hepatosplenomegaly or any other lymph node was palpable.
FNA was performed from the anterior chest wall / mediastinal lesion which yielded frank pus. The pus was sent for bacteriological / mycobacterial cultures.
Clinical History 36-year-old male patient with vague pain in right thigh
for 3-4 weeks duration
An X-ray pelvis was ordered by the orthopedic surgeon followed by CT scan and MRI
FNA was done from the soft tissue lesion under CT guidance
Radiology
X-ray: Bone not involved
Clinical History A 50-year-old postmenopausal lady complained of
postmenopausal bleeding for 6 months 1-3 pads/day/ ass. with clots
with foul smelling unhealthy vaginal discharge +
h/o post coital bleeding +
Abdominal distension for 1 month Gradually progressive with difficulty in breathing
h/o loss of appetite/loss of weight/fever/fatiguability present
h/o of swelling over feet present
No h/o chest pain/hemoptysis/decreased urine output
No h/o of awareness of mass abdomen
No c/o bladder and bowel abnormalities
Examination and Radiology O/E,
bilateral pleural effusion and ascites which was moderate
Ascitic Fluid Biochemistry:
Protein-5.8 g,
sugar-98mg,
TLC-110 cells/mm3
C/S-sterile
ADA-11 u/L(N=upto 40 u/L)
Per vaginal examination revealed a right adnexal mass
USG and CT Scan-Bulky uterus
-complex pelvic mass 13x11x9 cm arising from Rt adnexa? malignant ovarian tumor
- Lt adnexa-normal limits
- mild ascites; No pelvic nodes seen
-bilateral pleural effusion with basal lung collapse on left side
Clinical Diagnosis: Malignant ovarian tumor, stage IV
Pleural Fluid for cytological examination
FNA adnexal mass [Rt. Ovary]
FNA adnexal mass[Rt. Ovary]
Case History A 2-year-old child presented with history of fever for 3
months with recent onset history of gum bleeds and neck swelling of 15 days duration. Fever was not associated with chills or rigors and showed a rise at night-time.
On examination Malnourished Tonsils – enlarged and congested Bilateral cervical lymphadenopathy, multiple, discrete
ranging in size from 1-2 cms; largest were submandibularlymph nodes.
Gum hypertrophy was present Pallor+, No cyanosis, no raised JVP and no clubbing No hepatosplenomegaly
Investigations Hemogram
Hb: 5.5 g/dl Platelets – 17,000/cu.mm TLC-2200/cu.mm; Neutrophils: 33%, lymphocytes 65%,
monocytes 1% and eosinophil 1% RBC morphology: Micro and macrocytes with occasional
nucleated RBC
Biochemistry: all within normal limits HIV: Non-reactive Throat swab: sterile CECT neck: Tonsillar enlargement with cervical
lymphadenopathy s/o lymphoma
Case Summary 2 year old child with fever, pancytopenia, with gum
bleeds and significant cervical lymphadenopathy
FNA performed from bilateral cervical lymph nodes
Urine Cytology Smear
Patient is a renal transplant recipient on follow up with mildly abnormal Renal Function tests
Urine sent for cytological examination