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May 2018 — Gastroenterology

A 33-year-old woman presented with abdominal cramps and intentional weight loss of 27 pounds. Abdominal CT revealed a right ovarian cyst suspicious for teratoma and a cystic mass posterior to pancreatic head. EUS-guided ultrasound showed a 4 x 3 cm cyst filled with mobile intracystic material. Cystic fluid analysis revealed increased amylase (26, 376 U/L) and increased CEA (5266 ng/mL). A Whipple-procedure was performed. Gross examination revealed a unilocular cystic mass (2.5 x 2.1 x 2.0 cm) along the periphery of pancreas, containing mucinous debris.

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Aishwarya Ravindran, M.B.B.S.
Resident, Anatomic and Clinical Pathology
Mayo Clinic
Thomas Smyrk, M.D.
Consultant, Anatomic Pathology
Mayo Clinic
Professor of Laboratory Medicine and Pathology
Mayo Clinic College of Medicine

May 2018 — Genitourinary

A 60-year-old man presented with flank pain while passing a kidney stone. CT of the abdomen and pelvis showed left and right renal masses in a horseshoe kidney.

He subsequently underwent partial nephrectomy with removal of the left mass. By gross examination, there was a 0.9 x 0.7 x 0.5 cm well circumscribed mass with yellow-tan cut surface, located within 0.3 cm of the parenchymal resection margin.

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7-CAM-5.2
8-CK7
9-Vimentin
10-Chromogranin & Synaptophysin
11-Thyroglobulin TTF-1
12-PAX-8

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Mira Lotfalla, M.B., B.Ch.
Resident, Anatomic Pathology
Mayo Clinic
Loren Herrera Hernandez, M.D.
Consultant, Anatomic Pathology
Mayo Clinic
Assistant Professor of Laboratory Medicine and Pathology
Mayo Clinic College of Medicine

May 2018 — Molecular Diagnostics

A 71-year-old female presented with diplopia, ptosis, and nyctalopia. At 76 years, she had bilateral reduced visual acuity, reduced color vision, central scotomas, ptosis, and ophthalmoplegia. MRI showed thinned extraocular muscles, and a flash electroretinogram showed reduced cone function and borderline rod-function, bilaterally. In addition to ocular findings, the patient also had mild gait ataxia, progressive extremity weakness, and adrenal insufficiency. A quadriceps muscle biopsy showed the presence of a few ragged red fibers, which was nonspecific for her age.

She was suspected to have a mitochondrial disorder, therefore, a blood specimen and then, two months later, muscle tissue were sent for mitochondrial genome analysis.

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Nicole Boczek, Ph.D.
Fellow, Clinical Molecular Genetics
Mayo Clinic
Linda Hasadsri, M.D., Ph.D.
Senior Associate Consultant, Laboratory Genetics and Genomics
Mayo Clinic
Assistant Professor of Laboratory Medicine and Pathology
Mayo Clinic College of Medicine

May 2018 — Anatomic Pathology

A 76-year-old man with a history of resected colonic polyps presented for follow-up colonoscopy. He was otherwise asymptomatic and in overall good health. Colonoscopy was unremarkable. The following pictures are haemotoxylin and eosin (H&E)-stained biopsies from the colonic biopsy and immunohistochemistry against Treponema pallidum.

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  Kyriakos Chatzopoulos, M.D.
Resident, Anatomic and Clinical Pathology
Mayo Clinic
  Audrey Schuetz, M.D.
Senior Associate Consultant, Laboratory Genetics and Genomics
Mayo Clinic
Associate Professor of Laboratory Medicine and Pathology
Mayo Clinic College of Medicine

May 2018 — Gastroenterology 2

A 27-year-old woman with a history of ulcerative colitis and new onset pain and obstructive symptoms underwent ileocolectomy for a mass involving the cecum. Gross examination revealed a circumferential 9.5 cm mass with invasion through the muscularis propria. The tumor exhibited papillary architecture with fibrovascular cores, including sheets of crowded primitive appearing cells. Immunohistochemistry revealed immunoreactivity for CDX2 with rare reactivity for CK7 and CK20, and immunoreactivity for AE1/AE3, Glypican3, and SALL4, with patchy reactivity for AFP and CD30.

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  Sara Cook, M.D., Ph.D.
Resident, Anatomic and Clinical Pathology
Mayo Clinic
  Tsung-Teh Wu, M.D., Ph.D.
Consultant, Laboratory Medicine and Pathology
Mayo Clinic
Professor of Laboratory Medicine and Pathology
Mayo Clinic College of Medicine
Erika Fetterman

Erika Fetterman

Erika Fetterman, Editorial Assistant at Mayo Medical Laboratories, supports internal and client-facing communications.