May 2014

Author: Jeff Wang, MD, Dept. of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, U.S.A.

Reviewer: Christopher van den Bussche, MD, MIAC, Dept. of Pathology, Johns Hopkins Hospital, Baltimore, MD, U.S.A.

CASE: The patient is a 62 year old man with a newly diagnosed bladder cancer. CT shows multiple ill-defined hypodense lesions in the liver, the most prominent of which is in hepatic segment 5/8, measuring 1.4 x 1.1 cm. Multiple circumscribed hypodense lesions are also found in the spleen, likely secondary to metastatic disease. Ultrasound-guided FNA was performed on the liver lesion.

Fig 1 2014 May
Figure 1: Diff-Qik stain, 10x
Fig 2 2014 May
Figure 2: Diff-Qik stain, 20x
Fig 3 2014 May
Figure 3: Diff-Qik stain, 60x
Fig 4 2014 May
Figure 4: Pap stain, 60x
Fig 5 2014 May
Figure 5: Pap stain, 60x

What is the most likely diagnosis?