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Specimen_299-303 - A Case of Chronic Myelomonocytic Leukemia and

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									       Specimen#299-303 - A Case of Chronic Myelomonocytic Leukemia and Complications
Specimen # 330 - 333 - A CASE OF METASTATIC MALIGNANT MESOTHELIOMA




CLINICAL HISTORY



        This 52 year old male was found to have a pleural effusion during a work up in preparation for a
hernia repair. Pleurocentesis revealed malignant cells, and subsequently a pleural biopsy was carried out to
classify the exact type of the malignacy, which showed a malignant mesothelioma. Since there is no effective
therapy for this condition, he was followed in the clinic . Nine months later he was admitted once again for
symptoms of superior and inferior vena cava obstruction (arm edema and facial plethora, and leg edema
respectively) and a pleural effusion. No fluid was drawn from the pleural or pericardial spaces, and chest Xray
changes were thought to be due to lymphangitic spread. Two months after this, he was deeply distressed by
dyspnoea, and was admitted essentially for palliative care. He died about one year after his original diagnosis.



       No risk factors, apart from those possibly encountered as an employee of Ontario Hydro, were elicited.



AUTOPSY FINDINGS



        The autopsy showed that his right lung was entirely enclosed by the mesothelioma. This is shown in
specimen 330, which consists of the solidified mediastinal structures, and a slice of the medial portion of the
lung. On one side of the specimen, the depression forming the pericardial space is evident. It is easy to see
why it was thought that he had pericardial tamponade due to an effusion. although the effusion was quite
small, and would not have likely been significant on its own. The superior and inferior vena cavae are buried
in the mediastinal tumour, and again, it is easy to see that both would have been obstructed. Turning to the
other side of the specimen, the tumour has infiltrated deeply into the septal spaces of the lung, as well as the
lymphatics. Specimen 332 is the left lung which also shows lymphangitic spread. Specimen 333 is part of the
colon and the omentum, which is studded with metastases. Specimen 331 is the liver, which also shows
metastatic spread.

         Digestion of the lung showed numerous ferruginous bodies, indicating significant exposure to
asbestos, which may have occurred during his employment as an electrician for Ontario Hydro. Usually
malignat mesothelioma is manifest as a tumour that kills by local encroachment rather than metastatic
spread. Local encroachment was undoubtedly the cause of death here, but the case exemplifies the potential
of this tumour for considerable metastatic disease.

       The finding of ferruginous bodies in this case, indicating significant asbestos exposure is important for
the family, as it opens up the possibility of workman's compensation.




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    Specimen#299-303 - A Case of Chronic Myelomonocytic Leukemia and Complications



DIAGNOSES



    330     MEDIASTINUM AND LUNG - MALIGNAT MESOTHELIOMA

    331     LIVER - METASTASES, MESOTHELIOMA

    332     LUNG - METASTASES, MESOTHELIOMA

    333     COLON AND OMENTUM - METASTASES, MESOTHELIOMA




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