PathWays Case Study: March 7

By Rene Revier • March 7, 2017

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A 75-year-old man with valvular heart disease develops increasing peripheral edema and worsening lower extremity wounds (also see February 28, 2017, PathWays case). Laboratory testing revealed elevated liver function tests (AST, ALT, bilirubin) and hypoalbuminemia. CT imaging showed innumerable lesions throughout his liver without other overt sites of disease. An antemortem CT-guided biopsy revealed malignancy with neoplastic cells positive for high molecular weight cytokeratin, chromogranin, synaptophysin, and TTF-1 and negative for CDX2 and PAX8 (Figure 1). He underwent a single round of chemotherapy but succumbed to his disease. Autopsy revealed his liver was diffusely involved by this malignancy with marked hepatic cholestasis (Figure 2). The only other site of involvement by this malignancy was his adrenal glands (microscopic involvement only).

Justin Juskewitch, M.D., Ph.D.
Resident, Division of Anatomic and Clinical Pathology
Mayo Clinic

Michael Roh, M.D., Ph.D.
Associate Professor of Laboratory Medicine and Pathology,
Mayo Clinic College of Medicine

Marie Christine Aubry, M.D.
Consultant, Division of Anatomic Pathology
Mayo Clinic
Professor of Laboratory Medicine and Pathology,
Mayo Clinic College of Medicine

Rene Revier

Rene Revier is an Editorial Assistant at Mayo Medical Laboratories. She supports Mayo Clinic PathWays and other corporate communications activities.