General and Systemic Histopathology, C601&C602

    Virtual Slide: This 78 year-old man complains of lethargy and back pain.

    This 78 year-old man complains of lethargy, and is known to have a five-year history of prostate cancer. He also gives a history of recent onset back and leg pains. At the time of diagnosis of his prostate malignancy, his PSA was not elevated, although several regional lymph nodes were positive for metastatic malignancy. 

    WBC  6.1 X 103   RBC   2.76 Alk Phos = 430 U/L
              Percent   HGB   10 Calcium = 11.5 mg/dL
    NE      41   HCT     29.8 PSA = None detected
    LY      36   MCV    101  
    MO     12   MCH    36  
    EO       4   MCHC  33  
    BA       2   RDW    17  
    NRBC   5   PLT    68 X 103 Reference values?
    Immature cells seen   MPV    8.2  
    Click the little red + in the smear above to see the slide using the virtual microscope. Describe what you see and then answer the following questions.
    • What can explain the peripheral blood findings?
    • What is the association with the history of prostate cancer?
    • What is the with a non-detectable level of PSA?
    • What can be judged from the bone scan to the right?
    • Is he experiencing a primary malignant transformation of his bone marrow?
    • Where are the NRBCs and immature cells coming from in the peripheral smear? (Here's a hint.)

    The next patient is a 20 year-old student with a sore throat.


    Bone scan and representative example of spine.

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