Clinical Problem Solving: Pathology |

Pathology Quiz Case 1

Kathryn M. Van Abel, MD; Jurij R. Bilyk, MD; Scott E. Bourne, MD; Waleed H. Ezzat, MD; Steven G. Finden, MD, DDS; Edmund A. Pribitkin, MD
Arch Otolaryngol Head Neck Surg. 2010;136(10):1037. doi:10.1001/archoto.2010.163-a.
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A 63-year-old woman presented with a 1-year history of left-sided epiphora. Her medical history included chronic sinusitis and hypertension. She also had a remote history of a peripheral leukocytosis, for which she saw an oncologist, who recommended no therapy. On ophthalmic examination, her vision was 20/25 OD and 20/40 OS. There was no afferent pupillary defect, and extraocular motility was full. The tear lake was increased on the left, with poor dye disappearance. Probing and irrigation on the left showed complete reflux with some mucous discharge. Nasal endoscopy revealed a left septal spur and bilateral ostiomeatal complex crowding. Computed tomography (CT) demonstrated scattered sinus disease, a minimal soft-tissue prominence in the left medial canthus (Figure 1), and multiple enlarged lymph nodes throughout the neck.The preoperative laboratory test results included a white blood cell count (WBC) of 21 900/μL (to convert to ×109/L, multiply by 0.001), a hematocrit of 40.1%, and a platelet count of 168×103/μL (to convert to ×109/L, multiply by 1.0).

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