Case of the Month: January 2024
Clinical history
A 63 year-old male presents with nasal obstructive symptoms (blockage, nasal discharge and epistaxis) for 2 months. He has also noticed blurry vision in the right eye for the last 3 weeks. In addition, he endorses unintended weight loss, but no fever or night sweats.
His past medical history is significant for hypertension and hyperlipidemia. His medications include atorvastatin and ramipril. He has no known allergies. He works as a data analyst and lives with his wife and two children. He is a social drinker and non-smoker. Family history is non-contributory.
He was seen by a ENT surgeon who performed some investigations (imaging). CT shows a 5 cm, locally destructive mass arising in the left nasal passage. It involves nasopharynx, hard palate and the inferior aspect of the left orbit. There is also extensive adjacent soft tissue involvement.
A biopsy of the nasal cavity mass was performed.
Questions:
- What is the differential diagnosis for the “starry sky” pattern on histology?
- Based on the imaging and histologic findings, what are your differential diagnoses?
- What lymphoproliferative disorders occur in immunocompromised individuals and what virus is commonly associated with them?
How to participate
Take a look at the H&E images.
Anyone is welcome to try to solve the puzzle by commenting on the related post on our Instagram.
If you are a medical student at the University of Toronto, you can also:
If you do, you are in for a chance to win a $100 gift card! (UofT Med students only).
If you are a current medical student at U of T, you can register to join the December case of the month lecture online or in person and have a chance to win a $100 gift card!
You can also join the Special Interest Group in Laboratory Medicine to learn more about Laboratory Medicine.
Laboratory Medicine and the study of disease for medical students
