Module # 3
Neoplastic/Immunologic Diseases
Case Studies & Answers
CASE STUDY # 1:
CC: A 3-year-old male is brought to his pediatrician for evaluation of an abdominal mass
that his parents noticed. (Look at the picture below)
HPI: The child has been well all his life
PE: Slight pallor; weight and height right for age; nontender, large, firm, and smooth
intra-abdominal mass to right of midline; right Cryptorchidism and his eyes are shown in
the picture (below).
Labs UA: microscopic hematuria.
• What is the diagnosis?
CASE STUDY # 2:
ID/CC A 6 year old white female is brought to the emergency room by her mother
because of severe itching, joint pain, and generalized skin eruption.
HPI She had had an injection of penicillin six days before for streptococcal tonsillitis.
Her mother denies any relevant history in the child, including allergies. Once in the
hospital, the child develops fever, edema of the ankles and knees, hematuria, and
lethargy.
PE: Generalized urticarial skin rash; axillary and inguinal lymphadenopathy;
splenomegaly; redness and swelling of knees and ankles. Her BP is within normal limits
Labs UA: proteinuria, hematuria. No other abnormality found
A pic of the rash is shown (on a younger patient).
• What is the diagnosis?
CASE STUDY # 3:
A 70-year-old man complains of bone pain, extreme fatigue, numbness and weakness in
the lower extremities, headaches. Physical examination is remarkable for tenderness over
the vertebrae, pallor, waxy nodules on the lip and a slightly enlarged tongue.
Lab: platelets 85,000/mm3, serum calcium 13.1 mg/dL
X-ray to the skull is show below.
1. What is the diagnosis?
2. Name the pathology that has caused the lip nodule and the large tongue.
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CASE STUDY # 4:
ID/CC A 45 year old male with refractory acute myeloid leukemia is brought to the
emergency room with fever, a generalized rash, jaundice, right upper quadrant pain,
severe diarrhea, and dyspnea; two months ago, he underwent an apparently
uncomplicated bone marrow transplantation.
HPI Prior to the transplant, he received radiotherapy and chemotherapy as well as
broad-spectrum antibiotics
PE VS: normal blood pressure; cachexia; moderate dehydration; 2+ jaundice;
violaceous and erythematous macules as well as papules and bullae with scale formation
over extremities
Labs Elevated IgE level. CBC/PBS: falling blood counts; relative eosinophilia.
Elevated direct serum bilirubin and transaminases, no infectious agents on stool exam.
• What is the diagnosis?
CASE STUDY # 5:
The patient has 30-year-history of cigar smoking.
• What is the diagnosis?
CASE STUDY # 6:
A 37-year-old woman comes to clinic complaining of persistent dry cough for the last
couple of months. History reveals irregular menses and post-coital bleeding. A CXR is
shown with multiple round lesions.
• What is the diagnosis of lesions in the lungs?
• What is the other concurrent most likely diagnosis?

Solution:

Module #  3

Neoplastic/Immunologic Diseases – Case Studies & Answers

CASE STUDY # 1:

CC: A 3 year old male is brought to his pediatrician for evaluation of an abdominal mass that his parents noticed. (Look at the picture below)

HPI: The child has been well all his life
PE: Slight pallor; weight and height right for age; nontender, large, firm, and smooth intra-abdominal mass to right of midline; right Cryptorchidism and his eyes are shown in the picture (below).

Labs   UA:  microscopic hematuria.

What is the Diagnosis?

ANSWER

Wilm’s tumor

Associated with WAGR syndrome: Wilm’s tumor, Aniridia (eye pics), Genitourinary malformation (the cryptoorchidism), and retardation.