A 70 year old female with eye pain and periorbital swelling


DIFFERENTIAL DIAGNOSIS

The clinical differential included an inflammatory lesion or lymphoma. The patient was sent to the operating room for a biopsy of the lesion which is photographed below. The sections demonstrate infiltrative, single-file rows of medium sized cells with vacuolated to eosinophilic cytoplasm, irregular nuclear contours and small nucleoli (See Figures 3, 4, and 5).

At the time of biopsy, the patient developed abdominal pain. A CT scan of the abdomen showed diffuse anasarca and a 3.3 cm cystic lesion in the region of the left ovary. Diagnostic paracentesis was done and the cytology of the fluid is shown below (Figures 6, 7, 8, 9 and 10 Selected Images of Peritoneal Fluid stained with Diff Quick; Figure 11 Selected Image of Peritoneal Fluid stained with Papanicolaou stain; Figure 12 Selected Image of Cell Block).

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