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AMERICAN TESTING & DIAGNOSTICS
792 TREMONT DRIVE • HAMLIN, FL 32744 • 407-555-9764

PATIENT: WALKEN, SERITA
ACCOUNT/EHR #: WALKSE001
DATE: 10/15/18

Ordering Dr: Terence Rollin, MD 

HISTORY: This patient is a 25-year-old female, referred by her primary care physician, Dr. Kennison, due to complaints of abdominal discomfort and distension, which she has had for about four weeks. The patient reported constipation but denied nausea, vomiting, sharp abdominal pain, and rectal bleeding. Physical examination demonstrated diffuse abdominal tenderness and firmness without guarding. A transvaginal ultrasound revealed a large, complex, cystic and solid soft tissue mass within the pelvis,  extending to 2.0 cm above the umbilicus. A CT scan of the abdomen and pelvisshowed involvement of the right adnexa. The patient underwent a right salpingo-oophorectomy. 

LABORATORY DATA: Alpha-Fetoprotein (AFP) 11023 ng/mL, CA 125 93 U/mL, CA 19-9

GROSS DESCRIPTION: The right salpingo-oophorectomy specimen consisted of an unremarkable fallopian tube and a 19 3 18 3 6 cm solid and cystic ovarian mass. The serosa was intact and smooth. Serial section of the mass demonstrated multiloculated cysts containing yellow, seromucinous fluid. The interior of the cyst wall was red-tan and smooth, with focal edema and intramural hemorrhage. The solid component was fleshy and tan-pink with yellow, rubbery-to-firm stellate areas. Separate from the main solid and cystic mass was a 6.5-cm area containing hair and friable, yellow material. 

MICROSCOPIC DESCRIPTION: Histologic sections of the smaller yellow, friable area showed epidermis with adnexal structures.

Sections of the larger cystic and solid mass demonstrated branching papillary structures containing thick basement membrane material and covered with cuboidal to low columnar cells. This arrangement was best seen in a cross section of an individual papilla. In addition to this pattern, microcystic spaces were prominent in other areas. Eosinophilic globules were present in a few sections and were found to be PAS-positive, diastase-resistant.

IMMUNOHISTOCHEMICAL STAINS: Stains for human chorionic gonadotropin (hCG), placental alkaline phosphatase (PLAP), and epithelial membrane antigen (EMA) were negative.

FINAL DX: Yolk sac tumor arising in association with mature cystic teratoma (dermoid cyst).

Lewis Strumm, MD
Pathologist

LS/fa D: 10/15/18 09:50:16 T: 10/16/18 12:55:01

Expert Solution Preview

Based on the provided content, the patient in question is a 25-year-old female who presented with complaints of abdominal discomfort and distension. She reported constipation but denied nausea, vomiting, sharp abdominal pain, and rectal bleeding. Physical examination revealed diffuse abdominal tenderness and firmness without guarding. Imaging studies, including a transvaginal ultrasound and CT scan of the abdomen and pelvis, identified a large, complex, cystic and solid soft tissue mass within the pelvis, extending to 2.0 cm above the umbilicus and involving the right adnexa. The patient subsequently underwent a right salpingo-oophorectomy. Laboratory data indicated elevated levels of Alpha-Fetoprotein (AFP) and CA 125.

The gross description of the right salpingo-oophorectomy specimen revealed an unremarkable fallopian tube and a 19 x 18 x 6 cm solid and cystic ovarian mass. The mass exhibited multiloculated cysts with yellow, seromucinous fluid and a red-tan and smooth cyst wall containing focal edema and intramural hemorrhage. There was also a fleshy and tan-pink solid component with yellow, rubbery-to-firm stellate areas. Additionally, a separate 6.5-cm area containing hair and friable, yellow material was observed.

Microscopic examination of the smaller yellow, friable area showed epidermis with adnexal structures. Sections of the larger cystic and solid mass demonstrated branching papillary structures with thick basement membrane material covered by cuboidal to low columnar cells. Microcystic spaces were also observed in other areas. Eosinophilic globules, which were PAS-positive and diastase-resistant, were present in some sections.

Immunohistochemical stains for human chorionic gonadotropin (hCG), placental alkaline phosphatase (PLAP), and epithelial membrane antigen (EMA) were negative.

The final diagnosis for the patient’s condition is a yolk sac tumor arising in association with a mature cystic teratoma (dermoid cyst).

This case presentation highlights an interesting and rare pathological finding in a young female patient. The combination of presentation, imaging findings, and histopathological examination contributed to a definitive diagnosis. Further discussions and studies in gynecological pathology would be valuable to broaden students’ understanding and diagnostic skills in similar cases.

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