PathWays Case Study: Feb. 14

A 19-year-old man is found deceased in his place of residence (where he lives alone) after not being heard from for several days. When he was last seen, he was experiencing nausea, vomiting, and increasing lethargy. At autopsy, he was found only to have a markedly enlarged liver with a vaguely steatotic appearance (3.5 kg; expected 1.0–1.6 kg; Figure 1). Microscopic evaluation of his liver revealed distended hepatocytes with clear cytoplasm. The material within the cytoplasm was positive by PAS (Periodic acid-Schiff) staining and negative by PAS-D (Periodic acid-Schiff diastase) staining (Figure 2). Furthermore, microscopic evaluation of his kidneys showed diffuse subnuclear vacuolization of his proximal tubular cells. The material within these renal subnuclear vacuoles was negative by both PAS and PAS-D staining (Figure 3).

 

Figure 1. Liver cut section
Figure 2. Liver photomicrograph
Figure 3. Kidney photomicrographs

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Justin Juskewitch, M.D., Ph.D.

Justin Juskewitch, M.D., Ph.D.
Resident, Division of Anatomic and Clinical Pathology
Mayo Clinic

 

 

Mariam (Priya) Alexander, M.D.

Mariam (Priya) Alexander, M.D.
Consultant, Division of Anatomic Pathology
Mayo Clinic
Assistant Professor of Laboratory Medicine and Pathology,
Mayo Clinic College of Medicine

 

Michael Torbenson, M.D.

Michael Torbenson, M.D.
Consultant, Division of Anatomic Pathology
Mayo Clinic
Professor of Laboratory Medicine and Pathology,
Mayo Clinic College of Medicine

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Rene Revier

Rene Revier is an Editorial Assistant at Mayo Medical Laboratories. She supports Mayo Clinic PathWays and other corporate communications activities.

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