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Case 45

Surgical Pathology Case


Clinical Information


  • 62 YO, M, H/O diabetes; smoking for 16 yrs, 2-3 PPD; Traveled a lot in US last year.

  • For 2 yrs, increasing weakness/fatigue, loss of 80 pounds;

  • Over the past months, fever/night sweats, cough with yellow/green sputum;

  • He was then admitted and found to have:

    • Bilateral apical cystic changes of the lung;

    • TB test positive;

    • distended gallbladder and intrahepatic bile ducts;

    • Marked dilation of the pancreatic duct with possible distal pancreatic necrosis.

    • SAIDH, hyponatremia, hypokalemia and high bicarbonate;

    • Pronounced dead two weeks after admission. Autopsy perform.

  • Examinations of the lung are presented here, and examinations of the pancreas are in case 46.

Gross Examination



Cavities: R-6.0cm, L-2.0cm. Consolidation: RUL. Miliary spreading

Brown Atrophy of the Heart



Cavity and consolidation - RUL

Cavity, consolidation and military spreading - RUL




Microscopic Examination



Caseating Necrosis - RUL. HE, 4

Caseating Necrosis - RUL. HE, 20




AFB, 60






Click here for diagnosis and case discussion.


Source: Department of Pathology, Creighton University Medical Center, Omaha, NE

Photo: Zenggang Pan

Discussion: Zenggang Pan