PathWays Case Study: Feb. 28
A 75-year-old man with a history of an aortic valve replacement, pacemaker placement, and severe mitral valve calcification develops a high-grade malignancy involving his liver. He completes a single round of chemotherapy, but continues to develop worsening liver failure. He succumbs to his underlying malignancy several days later. At autopsy, he has a moderately enlarged heart with an intact mechanical aortic valve, appropriate pacemaker lead placements, and severe mitral annular calcification. The myocardium is without any gross abnormality (focal greenish-yellow areas are due to bilirubinemia) (Figure 1). Microscopy, though, reveals multiple focal lesions throughout the myocardium in no particular distribution (Figure 2).
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Justin Juskewitch, M.D., Ph.D.
Resident, Division of Anatomic and Clinical Pathology
Mayo Clinic
Marie Christine Aubry, M.D.
Consultant, Division of Anatomic Pathology
Mayo Clinic
Professor of Laboratory Medicine and Pathology,
Mayo Clinic College of Medicine
William Edwards, M.D.
Consultant, Division of Anatomic Pathology
Mayo Clinic
Professor of Laboratory Medicine and Pathology,
Mayo Clinic College of Medicine