May 2020 — Renal

39-year-old man who on a routine physical exam was found to have elevated serum creatine at 1.4 mg/dL associated with elevated serum free kappa to lambda ratio at 27. The serum protein electrophoresis (SPEP) test was negative for paraprotein. Urine protein electrophoresis (UPEP) showed a free kappa light chain. Bone marrow biopsy was done and showed 1-2% kappa restricted plasma cells. Additional workup revealed a 24-hour urine protein of 0.5 g, negative fat pad biopsy for amyloid, and negative skeletal survey. A kidney biopsy was performed.

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Sam Albadri, M.B., Ch.B., M.S.
Fellow, Renal Pathology
Mayo Clinic
@sam_albadri
Photo of Samih H. Nasr, M.D.   Samih Nasr, M.D.
Consultant, Anatomic Pathology
Mayo Clinic
Professor of Laboratory Medicine and Pathology
Mayo Clinic College of Medicine and Science

May 2020 — Gynecological

A 13 year old female with no prior medical history presented with worsening chronic right lower quadrant abdominal pain. CT imaging identified a complex 8 cm ovarian mass.

Serum tumor markers were: LDH 1671 U/L, HCG <2 IU/ml, AFP 3.2 ng/mL and CA-125 50 U/mL. The patient underwent right salpingo-oopherectomy.

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Photo of Farah Baban, M.B., Ch.B. Farah Baban, M.B., Ch.B.
Resident, Anatomic and Clinical Pathology
Mayo Clinic
@BabanFarah
Photo of J. Kenneth Schoolmeester, M.D. J. Kenneth Schoolmeester, M.D.
Consultant, Anatomic Pathology
Mayo Clinic
Assistant Professor of Laboratory Medicine and Pathology
Mayo Clinic College of Medicine and Science

May 2020 — Bone and Soft Tissue & Infectious Disease

A mother and her 3 month old son present to their local physician for what the mother believes is decreased arm movement and pain when moving her son’s arms. Initial imaging of the boys arms revealed bilateral radial fractures and associated lytic bony lesions (Figure 1). Clinically child abuse was an initial concern. A follow up skeletal survery, along with an ophthalmology consult, was performed to assess for further child abuse related injuries. Skeletal survery revealed bilateral, medial tibial lytic lesions (Figure 2). Biopsy was performed of the right sided tibial lesion and showed a mixed lymphohistiocytic infiltrate with associated fibrosis (Figure 3).

Figure 1 Figure 2 Figure 3

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Photo of Casey Gleue, M.D. Casey Gleue, M.D.
Resident, Anatomic and Clinical Pathology
Mayo Clinic
Photo of Jorge Torres-Mora, M.D. Jorge Torres-Mora, M.D.
Consultant, Anatomic Pathology
Mayo Clinic
Assistant Professor of Laboratory Medicine and Pathology
Mayo Clinic College of Medicine and Science

May 2020 — Placental

19 year old G1P0 delivered a nonviable male fetus at 31 weeks. Placenta was grossly described as a 2,297g aggregate of disrupted placenta tissue with tan-pink spongy parenchyma admixed with numerous vesicles.

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Photo of Jodi L. Hilderbrand, M.S., PA(ASCP) Jodi Hilderbrand, M.S., PA(ASCP)CM
Pathologists’ Assistant, Pathology
Mayo Clinic

Instructor in Laboratory Medicine and Pathology
Mayo Clinic College of Medicine and Science
Photo of Michael Henry, M.D. Michael Henry, M.D.
Consultant, Anatomic Pathology
Mayo Clinic
Professor of Laboratory Medicine and Pathology
Mayo Clinic College of Medicine and Science
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