Presentation
Patient with chronic myeloid leukemia, abdominal swelling for seven months, lower limbs swelling for two months, difficulty in breathing. Splenomegaly approximately 18 cm.
Patient Data
Unilateral 5,000ml left pleural effusion with homogenous low level echoes, containing multiple echogenic curvilinear, undulating membranes.
The liver span of 18.51 cm and the splenic length of 19.56 cm (current splenic index = 186.60 cm2) indicate hepatosplenomegaly.
Histology:
Gross:
Very singy fragments, 2mm diameter. All processed at multiple levels (in 1 cassette).
Microscopy:
Fibrous connective tissue with congested vessels and a foci of necrosis. No tumor is identified.
Diagnosis:
Reactive stroma, likely in the visinity of lesion.
Case Discussion
Encysted, unilocular left pleural effusion with wavy echogenic linear membranes (serpent sign) are typical of detached membranes or ruptured daughter cysts within an echinococcal cyst. Serology is not always positive 1-4 and histological findings may not be diagnostic.
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