Miliary Metastases

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Dx: Metastatic poorly differentiated carcinoma, consistent with
Mullerian origin.

Path Comment: Immunohistochemical stains show the tumor cells are positive for
PAX-8, Cytokeratin 7 with focal positivity for GATA3 and negative
staining for Cytokeratin 20, ER, and TTF-1.

miliary metastases versus miliary infection, pneumoconiosis less likely.

  • Mets
    • thyroid carcinoma
    • renal cell carcinoma
    • breast carcinoma
    • malignant melanoma
    • pancreatic neoplasms
    • osteosarcoma
    • trophoblastic disease

 

  • infection
    • tuberculosis (often febrile but may be afebrile)
      • miliary tuberculosis
    • fungal (often febrile) immunocompromised or elderly patients may be afebrile
    • healed varicella pneumonia

 

  • Others: Sarcoidosis, etc.

 

 

 

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Condensing Impressions on Reports

Purely a style point, but Clinicians appreciate brevity and concise impressions/conclusions.  Try to eliminate verbal diarrhea.

In the impression, you want a quick “thumbnail” of the body of report.


Rather than:

Interval placement of a left IJ approach vascular catheter in anticipated position. Otherwise unchanged support apparatus.

AND

No pneumothorax is discernible by AP supine technique.


Try:

Uncomplicated interval left IJ Vas-Cath placement with other support apparatus unchanged.