台灣病理學會一○六年切片討論會(秋季年會)

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History Finding Macro
ScanID: Case-01:台中榮民總醫院      Magnification: X40
A 62-year-old female complained of dyspnea on exertion for 1 year. Shortness of breath even when talking was noted in the recent 2 weeks. The patient is a non-smoker and has no history of systemic disease and cancer. The clinical survey revealed an endobronchial mass lesion, 1.5 cm in size, over left main bronchus with lumen obstruction. She received twice of bronchoscopic biopsies and subsequently underwent thoracoscopic sleeve lobectomy of left upper lobe on 2017/04/21.
ScanID: Case-02:成大醫院      Magnification: X40
A 45-year-old female is a victim of rheumatoid arthritis under medical control with independent daily activity. She suffered from fever up to 38.5 ℃ for about 5 days, accompanied with upper airway symptoms, including dry cough and dyspnea on exertion. Also, intermittent headache was noted without vomiting. No other symptoms were complained and there was no travel or insect bite history. The laboratory data showed thrombocytopenia (54,000/uL) and lymphopenia (2.7%). A chest CT scan showed fibronodular lesions and linear atelectasis, probably due to an infection. Empirical antibiotics failed, and interstitial lung disease or atypical infection was suspected. A wedge biopsy was performed two weeks after admission
ScanID: Case-03:台北榮民總醫院      Magnification: X40
A 47-year-old woman presented to the emergency department with sudden-onset right side chest pain. Physical examination revealed diminished breathing sound in the right chest. Chest radiograph showed a small amount of right side pneumothorax. Her vital signs were stable, and no respiratory distress was noted. The patient was discharged after conservative oxygen therapy. However, the symptoms did not resolve. Chest CT performed five days after symptom onset showed persistent right side pneumothorax. In addition, consolidations and reticular opacities involving the pleural and subpleural regions indicating fibrosis at bilateral upper and middle lung zones were noted. She was admitted to our hospital for surgical intervention. Eleven days after symptom onset, she received video-assisted thoracoscopic surgery (VATS). During the surgery, multiple blebs and consolidated areas in right upper, middle and lower lobes were noted. The lesions were wedge-biopsied, and mechanical pleurodesis was performed. The patient recovered well after the surgery.
ScanID: Case-04:台北榮民總醫院      Magnification: X40
The patient is a 78-year-old female with underlying ascending colon adenocarcinoma with peritoneal seeding status post right hemicolectomy on 2014/12 and chemotherapy on 2015/1- 2015/10. This time she experienced productive cough for months and visited OPD for help. Chest CT scan was arranged and revealed a 9mm nodule with spiculated margin in left upper lobe and another 5mm solid nodule in left lower lobe. Wedge resections for both lesions were performed. The pathological diagnosis for the left upper lobe nodule is acinar predominant adenocarcinoma (pT2aNxMx). The pathological slide for the left lower lobe nodule is submitted for preview (S105-17070).
ScanID: Case-05:花蓮慈濟醫院      Magnification: X40
A 65-year-old female patient with HTN was admitted due to lower abdominal distension and left leg swelling for 2 week. No black stool or bowel habit change was noted. She also had decreased urine output and frequency, weight gain about 5-6kg, decreased stool amount, and abdominal distension. No appetite change was noted recently. She mentioned left leg swelling in recent one week. She also had pain, redness and heat over left leg. She had no fever nor chills. At ED, D-dimer: 988.14ng/ml, left lower limb veins color doppler sonar showed loss of flow and compressibility of the left lower extremity veins. She was admitted to CV ward with initial impression of left leg DVT and abdominal distension. Heparin pump was given after admission, which keep aPTT within 40-60. GYN Dr. Pang was consulted for lower abdominal mass. And uterine mass and left pelvic tumor, R/O uterine sarcoma, was impressed via gyn sonar. Pap smear and biopsy were done. Tumor markers showed: SCC:1.3ng/ml, CA-125:28.2 IU/ml, CA199:8.51 IU/ml. Stool OB:(-). Abdomen to pelvis CT showed a 8.4x13.2x14.0 cm lobulated soft tissue density mass with heterogeneous enhancement in uterine body and minimal ascites in lower abdomen and pelvic cavity. Dilatation of bilateral ureters was also noted. After discussing with families, they decided to have surgery in our hospital. Hence she was transfered to our GYN ward for pre-operative evaluation. Debulking surgery on 08/10 was performed and DC heparin on 08/09 and consult GU doctor for bilateral double J tube insertion.
ScanID: Case-06:台北馬偕紀念醫院      Magnification: X40
This 70-year-old female had skin rash, including wheals, erythematous nodules on right forearm and erythematous patches on the trunk for three or four months. It attacked several times a week. She visited our Dermatology clinic this February. Hypersensitivity reaction or chronic eczema was the first clinical impression. Local steroid cream was prescribed. But, the lesions didn’t improve much. One month later, the lesion persisted and skin biopsy was done to clarify the diagnosis. She didn’t have any relevant past history.
ScanID: Case-07:成大醫院      Magnification: X40
This 36 year-old man has the following history: 1. Human immunodeficiency virus infection, under regular medication; 2. Thalassemia; 3. Carrier of hepatitis B virus under regular medication. This time, he visited an outpatient clinic due to anal bleeding and bloody stool for months. The colonoscopic examination showed an annular ulcerative mass in the rectum, 3-5 cm above the anal verge. Computed tomography scan revealed an ill-defined rectal mass (5.8 x 6.4 cm) involving mesorectum and prostate. A rectal cancer is favored, but submucosal tumor or lymphoma cannot be excluded. Transrectal colonic polypectomy was performed.
ScanID: Case-08:彰化基督教醫院      Magnification: X40
The 55- year-old female presented with shortness of breath since 12 hours before admission. According to the patient's statement, she had ever experienced similar symptom about one week ago. Then she was brought to emergency room of Taichung Veterans General Hospital where systemic corticosteroid and bronchodilator were given and she was discharged after symptoms were relieved. This time, shortness of breath suddenly attacked again, and she was brought to emergency room of Changhua Christian Hospital for help. Image examination was arranged and revealed a marked enhancing and heterogeneous mass at gastrohepatic/hepatoduodenal region. The tumor displaced left hepatic lobe and pancreas head, and compressed portal vein without dilatation of pancreatic duct or common bile duct. Then she was admitted for further evaluation and management. After admission, echo-guided biopsy was done on 2017-07-28. Besides, intra-abdominal tumor excision was performed on 2017-8-8.
ScanID: Case-09:亞東醫院      Magnification: X40
This is a 33 year-old man with history of right distal femur open fracture 7-8 years ago, status post surgical treatment. Repeated infection over the wound developed, and debridement were done for several times. He had heroin abuse since junior high school. Right knee wound discharge with soft tissue bulging was noted for a month, and the mass progressed gradually. He came to our ER in 2017/8 for wound treatment. Chronic osteomyelitis or soft tissue malignancy were suspected. Right thigh MRI showed distal femoral shaft old fracture with malunion, and the lesion was compatible with osteomyelitis. He was admitted for surgical treatment. A cauliflower-like soft tissue mass, around 10*5*5 cm in size at lateral side of right knee, was noted intraoperatively. It extends from bone to skin, easy touch bleeding and fragile, with bone destruction and pus accumulation. Debridement was performed.
ScanID: Case-10_1:台大醫院      Magnification: X40
A 48-year-old male complained right epistaxis and frequent nasal obstruction for one month. He denied other nasal symptoms, palpable neck mass, aural symptoms, or body weight loss. He went to Cardinal Tien Hospital, Yonghe District for help, where local finding showed right nasal cavity tumor. Computed tomography of head showed right nasal cavity tumor with maxillary sinus involvement, without orbital or intracranial invasion, the following chest X-ray film and whole body scan were free of metastasis of tumor. Multiple endoscopic sinus surgeries were performed and the surgical specimens are listed as 17P-479 (NTUH-B1) and 17P-496, supplied for pathological diagnosis.
ScanID: Case-10_2:台大醫院      Magnification: X40

ScanID: Case-11:高醫附設醫院      Magnification: X40
This 38 year-old female patient had left nasal obstruction for about one month. She visited our out-patient clinic for help. Fiberscope exam showed bilateral bulging nasal mucosa and a left middle meatus mass extending to choana and nasal septum. She denied epistaxis, blood-tinged rhinorrnea, foul odor, facial pain, cough, epiphora, or headache. The computed tomography of head revealed an enhanced polypoid lesions arising from left middle nasal meatus with extension to nasal choana. Under the impression of left nasal tumor, the patient was admitted for tumor excision.
ScanID: Case-12:三軍總醫院      Magnification: X40
A 50-year-old man presented to our ER with progressively increasing pain over the left lower chest wall and left upper quadrant of the abdomen. There was no history of anorexia, weight loss, nausea, and vomiting. On examination, he had a blood pressure of 120/82 mmHg with no postural drop, a pulse rate of 126 beats/minute, and no fever. His physical examination was otherwise unremarkable, except abdominal tenderness. His past medical history was significant for hypertension for 5 years, for which he received antihypertension therapy. A laboratory workup and computed tomography (CT) of the abdomen with contrast enhancement were done. Patient’s hematological test and kidney function test were within normal limit. The liver function test showed mild increase of the AST (54 U/L, normal <40 U/L) and ALT (45 U/L, normal <41 U/L). The coagulative test is within normal limit, except increase of the D-dimer (4.05 mg/L, cut off: 0.5 mg/L). Computed tomography revealed a well-defined heterogeneous enhancing soft tissue density mass in the left adrenal gland. It measured 6.8 × 5.3 × 6 cm. It associated with adjacent retroperitoneal hematoma, which might be spontaneous bleeding of the left adrenal gland. Further laboratory workup revealed the following levels: catecholamines (dopamine: 578 ug/day, 138-540 ug/day; norepinephrine: 223 ug/day, 10-80 ug/day), sodium 144 mEq/L, potassium 3.2 mEq/L, lactate dehydrogenase 214 IU/L, P.R.A 1.39 ng/ml, aldosterone 95.1 pg/ml, urinary vanillylmandelic acid 3.9mg/24 hours. The patient underwent left adrenalectomy. Histopathological test results showed a Castleman disease. Immunohistochemical stains were positive for CD3, CD20 and CD10 for centroblasts, and Bcl-2 highlight the mantle zone. After surgical resection of the tumor, he was routinely followed at our urology and cardiovascular medicine department. The patient is currently doing well.
ScanID: Case-13: 高雄榮民總醫院      Magnification: X40
This 44 y/o female presented with episodes of painless gross hematuria off and on since 2016/05/08. She denied flank pain, dysuria, or trauma. She came to urology outpatient department and the abdominal computed tomography scan revealed a 6 cm solid mass in the inferior pole of the right kidney. A laparoscopic right radical nephrectomy was performed.
ScanID: Case-14:中國附設醫院      Magnification: X40
A 25-year-old man presented headache for two weeks was admitted to our hospital. The patient was diagnosed with subarachnoid hemorrhage (SAH) and hydrocephalus by image study, and ever received V-P shunt insertion two years ago.This time, he complaint about severe headache recurrence. The computer tomography shows diffuse SAH over supertentorium and infratententorium. No aneurysm or arteriovenous malformation in seen under CTA or angiography. The MRI discloses diffuse leptomeningeal enhancement at T1WI serious. The tentative diagnosis including vasculitis,vasculopathy and neoplasm. Thus, biopsy surgery is indicated.
ScanID: Case-15:高雄長庚醫院      Magnification: X40
Without relevant systemic diseases, the 56-year-old man suffered from abdominal pain, nausea and loss of body weight (5 kg within 3 months). Abdominal CT revealed a huge encapsulated, lobulated retroperitoneal mass, measuring 26.0 x 20.0 x 13.0 cm and featuring heterogeneous densities, which was speculated to invade the left kidney and descending colon. Preoperative biopsy presumptively indicated an adipocytic tumor with necrosis, for which en-block tumor resection was performed together with left nephrectomy and hemicolectomy.
ScanID: Case-16:台大醫院      Magnification: X40
A 15-year-old boy had a progressively enlarged mass over right 5th proximal toe with tenderness for more than three months. The plain film roentgenography showed mixed osteolytic and osteoblastic change of the middle to distal portion of the right 5th metatarsal bone with cortical erosion. A bone scan showed increased tracer uptake over the right metatarsal bone region, which could be due to osteomyelitis, traumatic changes, or neoplasm. Wide excision was then performed, which revealed a 5 cm, ill-defined soft tissue and bone tumor.
ScanID: Case-17:台北馬偕紀念醫院      Magnification: X40
This patient is a 15-year-old boy without any medical history. He was brought to 天成 hospital outpatient department due to non-productive cough for a long time. Chest X-ray revealed a tumor over left lower lung with haziness. He was then transferred to our hospital for further evaluation and treatment. Chest CT revealed a lower lobe bronchial nodule with left lower lobe pneumonia. He had no fever, rhinorrhea, abdominal pain, vomiting, diarrhea or skin rash and had no TOCC history. Bronchoscopic biopsy was performed first, and then left lower lobe lobectomy with lymph node dissection was performed.
ScanID: Case-18:林口長庚醫院      Magnification: X40
A 53-year-old man with type 2 diabetes mellitus suffered from a 13-cm mass at left ankle for one year, which increased in size and caused skin ulceration and bleeding. The imaging studies revealed a lobulated and heterogeneous soft tissue mass at left lateral ankle with multiple lung nodules.
ScanID: Case-A:台中榮民總醫院      Magnification: X40
This 65 year-old male has history of: 1. LLL wedge resection for malignancy (diagnosed at other hospital) 2. Fungal pneumonia, s/p Vfend (2017/02/22-) 3. Chronic kidney disease, stage III-IV 4. Hypertension He worked in mechanical field for more than 30 years. Chest CT on 2016/09/07 showed slightly nodular pleural thickening of left posterior lung and left pleural effusion.
ScanID: Case-B:汐止國泰醫院      Magnification: X40
This 39-year-old male patient suffered from nasal obstruction with foul-smelling discharge in recent one month. In addition, he complained of headache, poor appetite, and bilateral neck masses. On physical examination, firm and non-tender lymph nodes were found over bilateral level II regions. Fiberoptic endoscopy of the left nasal cavity showed mucosal erosion with whitish exudates coating on the surface. Laboratory examination revealed mild anemia and high LDH level. The result of HIV test was negative. Computed tomography (CT) of head and neck demonstrated iso-enhancing masses at the left nasal cavity, nasopharynx and paranasal sinuses, associated with destruction of adjacent bony structures. Multiple enlarged and enhancing lymph nodes were observed at bilateral levels IB, II, III, IV and V. Ultrasound-guided fine-needle aspiration cytology (FNAC) for the left neck lymphadenopathy was performed.
ScanID: Case-C:嘉義基督教醫院      Magnification: X40
A 52 year-old gentleman has history of ventricular septal deficiency repair post surgery 30 years and hyperlipidemia with regular medication control. He had a palpable left neck mass for two years. Owing to its progressive enlargement, he went to our general surgery outpatient department for help. Thyroid function tests revealed euthyroid status. Neck ultrasonography revealed many small goiter-like masses and a left lobe hypoechoic mass (size 6.18 x 3.24 cm) with unclear margin and heterogeneous echogenicity. Multinodular cystic goiter was clinically suspected. Fine needle aspiration was performed, and the cytology examination reported a non-diagnostic result. One month later, he received a left thyroid lobectomy for the left thyroid mass. Because Hurthle cell carcinoma was confirmed by pathologists, he received total thyroidectomy and central neck lymph node dissection, one month after 1st operation. I-131 whole body scan showed functioning thyroid remnants in anterior neck and further 100mCi I-131 therapy was administered. Eleven months after 1st operation, he currently has no evidence of tumor recurrence.
History Finding Macro
ScanID: Case-01:台中榮民總醫院      Magnification: X40
A 62-year-old female complained of dyspnea on exertion for 1 year. Shortness of breath even when talking was noted in the recent 2 weeks. The patient is a non-smoker and has no history of systemic disease and cancer. The clinical survey revealed an endobronchial mass lesion, 1.5 cm in size, over left main bronchus with lumen obstruction. She received twice of bronchoscopic biopsies and subsequently underwent thoracoscopic sleeve lobectomy of left upper lobe on 2017/04/21.
ScanID: Case-02:成大醫院      Magnification: X40
A 45-year-old female is a victim of rheumatoid arthritis under medical control with independent daily activity. She suffered from fever up to 38.5 ℃ for about 5 days, accompanied with upper airway symptoms, including dry cough and dyspnea on exertion. Also, intermittent headache was noted without vomiting. No other symptoms were complained and there was no travel or insect bite history. The laboratory data showed thrombocytopenia (54,000/uL) and lymphopenia (2.7%). A chest CT scan showed fibronodular lesions and linear atelectasis, probably due to an infection. Empirical antibiotics failed, and interstitial lung disease or atypical infection was suspected. A wedge biopsy was performed two weeks after admission
ScanID: Case-03:台北榮民總醫院      Magnification: X40
A 47-year-old woman presented to the emergency department with sudden-onset right side chest pain. Physical examination revealed diminished breathing sound in the right chest. Chest radiograph showed a small amount of right side pneumothorax. Her vital signs were stable, and no respiratory distress was noted. The patient was discharged after conservative oxygen therapy. However, the symptoms did not resolve. Chest CT performed five days after symptom onset showed persistent right side pneumothorax. In addition, consolidations and reticular opacities involving the pleural and subpleural regions indicating fibrosis at bilateral upper and middle lung zones were noted. She was admitted to our hospital for surgical intervention. Eleven days after symptom onset, she received video-assisted thoracoscopic surgery (VATS). During the surgery, multiple blebs and consolidated areas in right upper, middle and lower lobes were noted. The lesions were wedge-biopsied, and mechanical pleurodesis was performed. The patient recovered well after the surgery.
ScanID: Case-04:台北榮民總醫院      Magnification: X40
The patient is a 78-year-old female with underlying ascending colon adenocarcinoma with peritoneal seeding status post right hemicolectomy on 2014/12 and chemotherapy on 2015/1- 2015/10. This time she experienced productive cough for months and visited OPD for help. Chest CT scan was arranged and revealed a 9mm nodule with spiculated margin in left upper lobe and another 5mm solid nodule in left lower lobe. Wedge resections for both lesions were performed. The pathological diagnosis for the left upper lobe nodule is acinar predominant adenocarcinoma (pT2aNxMx). The pathological slide for the left lower lobe nodule is submitted for preview (S105-17070).
ScanID: Case-05:花蓮慈濟醫院      Magnification: X40
A 65-year-old female patient with HTN was admitted due to lower abdominal distension and left leg swelling for 2 week. No black stool or bowel habit change was noted. She also had decreased urine output and frequency, weight gain about 5-6kg, decreased stool amount, and abdominal distension. No appetite change was noted recently. She mentioned left leg swelling in recent one week. She also had pain, redness and heat over left leg. She had no fever nor chills. At ED, D-dimer: 988.14ng/ml, left lower limb veins color doppler sonar showed loss of flow and compressibility of the left lower extremity veins. She was admitted to CV ward with initial impression of left leg DVT and abdominal distension. Heparin pump was given after admission, which keep aPTT within 40-60. GYN Dr. Pang was consulted for lower abdominal mass. And uterine mass and left pelvic tumor, R/O uterine sarcoma, was impressed via gyn sonar. Pap smear and biopsy were done. Tumor markers showed: SCC:1.3ng/ml, CA-125:28.2 IU/ml, CA199:8.51 IU/ml. Stool OB:(-). Abdomen to pelvis CT showed a 8.4x13.2x14.0 cm lobulated soft tissue density mass with heterogeneous enhancement in uterine body and minimal ascites in lower abdomen and pelvic cavity. Dilatation of bilateral ureters was also noted. After discussing with families, they decided to have surgery in our hospital. Hence she was transfered to our GYN ward for pre-operative evaluation. Debulking surgery on 08/10 was performed and DC heparin on 08/09 and consult GU doctor for bilateral double J tube insertion.
History Finding Macro
ScanID: Case-06:台北馬偕紀念醫院      Magnification: X40
This 70-year-old female had skin rash, including wheals, erythematous nodules on right forearm and erythematous patches on the trunk for three or four months. It attacked several times a week. She visited our Dermatology clinic this February. Hypersensitivity reaction or chronic eczema was the first clinical impression. Local steroid cream was prescribed. But, the lesions didn’t improve much. One month later, the lesion persisted and skin biopsy was done to clarify the diagnosis. She didn’t have any relevant past history.
ScanID: Case-07:成大醫院      Magnification: X40
This 36 year-old man has the following history: 1. Human immunodeficiency virus infection, under regular medication; 2. Thalassemia; 3. Carrier of hepatitis B virus under regular medication. This time, he visited an outpatient clinic due to anal bleeding and bloody stool for months. The colonoscopic examination showed an annular ulcerative mass in the rectum, 3-5 cm above the anal verge. Computed tomography scan revealed an ill-defined rectal mass (5.8 x 6.4 cm) involving mesorectum and prostate. A rectal cancer is favored, but submucosal tumor or lymphoma cannot be excluded. Transrectal colonic polypectomy was performed.
ScanID: Case-08:彰化基督教醫院      Magnification: X40
The 55- year-old female presented with shortness of breath since 12 hours before admission. According to the patient's statement, she had ever experienced similar symptom about one week ago. Then she was brought to emergency room of Taichung Veterans General Hospital where systemic corticosteroid and bronchodilator were given and she was discharged after symptoms were relieved. This time, shortness of breath suddenly attacked again, and she was brought to emergency room of Changhua Christian Hospital for help. Image examination was arranged and revealed a marked enhancing and heterogeneous mass at gastrohepatic/hepatoduodenal region. The tumor displaced left hepatic lobe and pancreas head, and compressed portal vein without dilatation of pancreatic duct or common bile duct. Then she was admitted for further evaluation and management. After admission, echo-guided biopsy was done on 2017-07-28. Besides, intra-abdominal tumor excision was performed on 2017-8-8.
ScanID: Case-09:亞東醫院      Magnification: X40
This is a 33 year-old man with history of right distal femur open fracture 7-8 years ago, status post surgical treatment. Repeated infection over the wound developed, and debridement were done for several times. He had heroin abuse since junior high school. Right knee wound discharge with soft tissue bulging was noted for a month, and the mass progressed gradually. He came to our ER in 2017/8 for wound treatment. Chronic osteomyelitis or soft tissue malignancy were suspected. Right thigh MRI showed distal femoral shaft old fracture with malunion, and the lesion was compatible with osteomyelitis. He was admitted for surgical treatment. A cauliflower-like soft tissue mass, around 10*5*5 cm in size at lateral side of right knee, was noted intraoperatively. It extends from bone to skin, easy touch bleeding and fragile, with bone destruction and pus accumulation. Debridement was performed.
History Finding Macro
ScanID: Case-10_1:台大醫院      Magnification: X40
A 48-year-old male complained right epistaxis and frequent nasal obstruction for one month. He denied other nasal symptoms, palpable neck mass, aural symptoms, or body weight loss. He went to Cardinal Tien Hospital, Yonghe District for help, where local finding showed right nasal cavity tumor. Computed tomography of head showed right nasal cavity tumor with maxillary sinus involvement, without orbital or intracranial invasion, the following chest X-ray film and whole body scan were free of metastasis of tumor. Multiple endoscopic sinus surgeries were performed and the surgical specimens are listed as 17P-479 (NTUH-B1) and 17P-496, supplied for pathological diagnosis.
ScanID: Case-10_2:台大醫院      Magnification: X40

ScanID: Case-11:高醫附設醫院      Magnification: X40
This 38 year-old female patient had left nasal obstruction for about one month. She visited our out-patient clinic for help. Fiberscope exam showed bilateral bulging nasal mucosa and a left middle meatus mass extending to choana and nasal septum. She denied epistaxis, blood-tinged rhinorrnea, foul odor, facial pain, cough, epiphora, or headache. The computed tomography of head revealed an enhanced polypoid lesions arising from left middle nasal meatus with extension to nasal choana. Under the impression of left nasal tumor, the patient was admitted for tumor excision.
ScanID: Case-12:三軍總醫院      Magnification: X40
A 50-year-old man presented to our ER with progressively increasing pain over the left lower chest wall and left upper quadrant of the abdomen. There was no history of anorexia, weight loss, nausea, and vomiting. On examination, he had a blood pressure of 120/82 mmHg with no postural drop, a pulse rate of 126 beats/minute, and no fever. His physical examination was otherwise unremarkable, except abdominal tenderness. His past medical history was significant for hypertension for 5 years, for which he received antihypertension therapy. A laboratory workup and computed tomography (CT) of the abdomen with contrast enhancement were done. Patient’s hematological test and kidney function test were within normal limit. The liver function test showed mild increase of the AST (54 U/L, normal <40 U/L) and ALT (45 U/L, normal <41 U/L). The coagulative test is within normal limit, except increase of the D-dimer (4.05 mg/L, cut off: 0.5 mg/L). Computed tomography revealed a well-defined heterogeneous enhancing soft tissue density mass in the left adrenal gland. It measured 6.8 × 5.3 × 6 cm. It associated with adjacent retroperitoneal hematoma, which might be spontaneous bleeding of the left adrenal gland. Further laboratory workup revealed the following levels: catecholamines (dopamine: 578 ug/day, 138-540 ug/day; norepinephrine: 223 ug/day, 10-80 ug/day), sodium 144 mEq/L, potassium 3.2 mEq/L, lactate dehydrogenase 214 IU/L, P.R.A 1.39 ng/ml, aldosterone 95.1 pg/ml, urinary vanillylmandelic acid 3.9mg/24 hours. The patient underwent left adrenalectomy. Histopathological test results showed a Castleman disease. Immunohistochemical stains were positive for CD3, CD20 and CD10 for centroblasts, and Bcl-2 highlight the mantle zone. After surgical resection of the tumor, he was routinely followed at our urology and cardiovascular medicine department. The patient is currently doing well.
ScanID: Case-13: 高雄榮民總醫院      Magnification: X40
This 44 y/o female presented with episodes of painless gross hematuria off and on since 2016/05/08. She denied flank pain, dysuria, or trauma. She came to urology outpatient department and the abdominal computed tomography scan revealed a 6 cm solid mass in the inferior pole of the right kidney. A laparoscopic right radical nephrectomy was performed.
History Finding Macro
ScanID: Case-14:中國附設醫院      Magnification: X40
A 25-year-old man presented headache for two weeks was admitted to our hospital. The patient was diagnosed with subarachnoid hemorrhage (SAH) and hydrocephalus by image study, and ever received V-P shunt insertion two years ago.This time, he complaint about severe headache recurrence. The computer tomography shows diffuse SAH over supertentorium and infratententorium. No aneurysm or arteriovenous malformation in seen under CTA or angiography. The MRI discloses diffuse leptomeningeal enhancement at T1WI serious. The tentative diagnosis including vasculitis,vasculopathy and neoplasm. Thus, biopsy surgery is indicated.
ScanID: Case-15:高雄長庚醫院      Magnification: X40
Without relevant systemic diseases, the 56-year-old man suffered from abdominal pain, nausea and loss of body weight (5 kg within 3 months). Abdominal CT revealed a huge encapsulated, lobulated retroperitoneal mass, measuring 26.0 x 20.0 x 13.0 cm and featuring heterogeneous densities, which was speculated to invade the left kidney and descending colon. Preoperative biopsy presumptively indicated an adipocytic tumor with necrosis, for which en-block tumor resection was performed together with left nephrectomy and hemicolectomy.
ScanID: Case-16:台大醫院      Magnification: X40
A 15-year-old boy had a progressively enlarged mass over right 5th proximal toe with tenderness for more than three months. The plain film roentgenography showed mixed osteolytic and osteoblastic change of the middle to distal portion of the right 5th metatarsal bone with cortical erosion. A bone scan showed increased tracer uptake over the right metatarsal bone region, which could be due to osteomyelitis, traumatic changes, or neoplasm. Wide excision was then performed, which revealed a 5 cm, ill-defined soft tissue and bone tumor.
ScanID: Case-17:台北馬偕紀念醫院      Magnification: X40
This patient is a 15-year-old boy without any medical history. He was brought to 天成 hospital outpatient department due to non-productive cough for a long time. Chest X-ray revealed a tumor over left lower lung with haziness. He was then transferred to our hospital for further evaluation and treatment. Chest CT revealed a lower lobe bronchial nodule with left lower lobe pneumonia. He had no fever, rhinorrhea, abdominal pain, vomiting, diarrhea or skin rash and had no TOCC history. Bronchoscopic biopsy was performed first, and then left lower lobe lobectomy with lymph node dissection was performed.
ScanID: Case-18:林口長庚醫院      Magnification: X40
A 53-year-old man with type 2 diabetes mellitus suffered from a 13-cm mass at left ankle for one year, which increased in size and caused skin ulceration and bleeding. The imaging studies revealed a lobulated and heterogeneous soft tissue mass at left lateral ankle with multiple lung nodules.
History Finding Macro
ScanID: Case-A:台中榮民總醫院      Magnification: X40
This 65 year-old male has history of: 1. LLL wedge resection for malignancy (diagnosed at other hospital) 2. Fungal pneumonia, s/p Vfend (2017/02/22-) 3. Chronic kidney disease, stage III-IV 4. Hypertension He worked in mechanical field for more than 30 years. Chest CT on 2016/09/07 showed slightly nodular pleural thickening of left posterior lung and left pleural effusion.
ScanID: Case-B:汐止國泰醫院      Magnification: X40
This 39-year-old male patient suffered from nasal obstruction with foul-smelling discharge in recent one month. In addition, he complained of headache, poor appetite, and bilateral neck masses. On physical examination, firm and non-tender lymph nodes were found over bilateral level II regions. Fiberoptic endoscopy of the left nasal cavity showed mucosal erosion with whitish exudates coating on the surface. Laboratory examination revealed mild anemia and high LDH level. The result of HIV test was negative. Computed tomography (CT) of head and neck demonstrated iso-enhancing masses at the left nasal cavity, nasopharynx and paranasal sinuses, associated with destruction of adjacent bony structures. Multiple enlarged and enhancing lymph nodes were observed at bilateral levels IB, II, III, IV and V. Ultrasound-guided fine-needle aspiration cytology (FNAC) for the left neck lymphadenopathy was performed.
ScanID: Case-C:嘉義基督教醫院      Magnification: X40
A 52 year-old gentleman has history of ventricular septal deficiency repair post surgery 30 years and hyperlipidemia with regular medication control. He had a palpable left neck mass for two years. Owing to its progressive enlargement, he went to our general surgery outpatient department for help. Thyroid function tests revealed euthyroid status. Neck ultrasonography revealed many small goiter-like masses and a left lobe hypoechoic mass (size 6.18 x 3.24 cm) with unclear margin and heterogeneous echogenicity. Multinodular cystic goiter was clinically suspected. Fine needle aspiration was performed, and the cytology examination reported a non-diagnostic result. One month later, he received a left thyroid lobectomy for the left thyroid mass. Because Hurthle cell carcinoma was confirmed by pathologists, he received total thyroidectomy and central neck lymph node dissection, one month after 1st operation. I-131 whole body scan showed functioning thyroid remnants in anterior neck and further 100mCi I-131 therapy was administered. Eleven months after 1st operation, he currently has no evidence of tumor recurrence.