Electron Microscopy of Needle Biopsies
of a Retroperitoneal Mass

Clinical History:

A 28-year-old woman was in relatively good health until 6 weeks prior to her admission when she developed crampy left lower quadrant pain thought to be related to an ovarian cyst. This was removed by laparoscopic cystectomy and was found to be a benign follicular cyst. The abdominal pain persisted and the patient developed increasing abdominal girth, bilateral groin pain, anorexia and early satiety. There was also unspecified weight loss. Physical examination at the time of admission revealed no jaundice, but her abdomen was significantly distended with evidence of ascites. There was tenderness in the left flank region, but no palpable masses. Bilateral leg swelling was present.

On ultrasound and CT of the abdomen, there appeared to be the presence of a very large right retroperitoneal mass, likely of adrenal origin, invading into the liver and inferior vena cava associated with extensive clot in the inferior vena cava and hepatic veins.

Both fine-needle aspiration and core-needle percutaneous biopsies of the retroperitoneal mass were carried out on the same day a few days after admission. Based on the diagnosis obtained from the biopsies, she was immediately transferred to the Medical Oncology Service for chemotherapy and was also anticoagulated.

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