Surgical intervention can increase the risk of comorbidities and complications in elderly patients. This case study highlights how timely and accurate pathology diagnostics helped the 71-year-old patient to be diagnosed with Chronic lymphocytic leukemia. A benign kidney cyst was identified through a non-invasive fine needle aspiration biopsy (FNAB). The case shows the critical role of pathology in guiding clinical decision-making and enhancing patient outcomes.
The patient underwent a routine ultrasonography (USG) that revealed a 7 cm cyst in the left kidney. It was further confirmed in the CT scan. Both the USD and CT scans showed that it was possibly a benign cyst, but cancer could not be ruled out. Now, here was the challenge.
Traditional diagnostic methods, such as surgical biopsy, can increase patients' risks. Therefore, an alternative diagnostic approach was required to minimize procedural risks while ensuring diagnostic accuracy.
In this blog, we will explore a real-life example highlighting pathology's significance in preventing unnecessary surgeries and improving patient outcomes. The initial screening showed that it was a case of a benign cyst or CLL, but imaging tests could not be ruled out, and this raised the challenge of identifying what it was. Check out this case study to understand how Pathology Saved a 71-year-old Man from surgery and unnecessary risks.
What is Chronic lymphocytic leukemia (CLL?
Chronic lymphocytic leukemia (CLL) is a type of blood cancer. It's one of the most common types of cancer in adults. It happens when bone marrow white blood cells (lymphocytes) mutate or become cancerous. These cells then multiply and start reducing healthy blood cells and platelets.
CLL typically affects people aged 65 or older, but it can affect people of age 30 as well. However, chronic lymphocytic leukemia can be asymptomatic. Most people know about CLL after having blood tests and routine physical examinations.
Risk Factors of Chronic Lymphocytic Leukemia (CLL)
CLL occurs when there is a change in genetic material (DNA) in bone marrow cells. The cause of these changes is unknown. There are a few factors that might increase your risk of developing CLL.
While anyone can get CLL. There are a few risk factors that may increase the chances of developing CLL, including-
- Age: CLL is most commonly diagnosed in individuals over 60 years old.
- Family history: Having a close relative with CLL or other blood cancers increases the risk.
- Ethnicity: CLL is more common in whites than in people of other nationalities.
- Chemical exposure: Certain herbicides, pesticides, and industrial chemicals may increase risk.
Symptoms of Chronic Lymphocytic Leukemia (CLL)
In the early stages, CLL may not cause symptoms. As the disease progresses, common symptoms may include:
- Swollen lymph nodes (around the neck, armpits, or groin)
- Fatigue and weakness
- Sudden weight loss
- Frequent infections due to weakened immunity
- Night sweats
- Fever
- Easy bruising or bleeding
- Enlarged spleen or liver
How is Chronic Lymphocytic Leukemia (CLL) Diagnosed?
CLL is often detected during routine blood tests before symptoms appear. Diagnostic tests include:
- Blood tests- CBC, kidney function tests, a basic metabolic panel (BMP), a comprehensive metabolic panel (CMP), liver function tests, and an electrolyte panel.
- Flow Cytometry- This identifies CLL cells based on surface markers.
- Bone Marrow Biopsy- Biopsy confirms the presence of leukemia cells in the bone marrow.
- Imaging Tests (CT Scan, Ultrasound)- Detects enlarged lymph nodes, liver, or spleen.
How does Pathology help in Diagnosis?
To obtain cytological samples from the cyst, a minimally invasive, ultrasound-guided fine-needle aspiration biopsy (FNAB) was performed. The microscopic examination revealed a benign squamous cell characteristic of an epidermoid cyst. Within an hour, the test results confirmed that it was a benign cyst, allowing clinicians to recommend surveillance instead of surgery.
Result and Follow-Up
The patient was placed under a monitoring protocol to track cyst size or morphology changes—a repeat CT scan after 13 months was done to evaluate whether everything was normal. There was no increase in cyst size, which further confirmed that it is non-cancerous in nature. This is how pathology avoids the unnecessary surgical risks associated with nephrectomy and ensures a quality patient's life.
This case shows the importance of pathology in modern healthcare, particularly in elderly patient management. Key aspects highlighted include:
- Risk Reduction in Elderly Patients—Advanced age is associated with a high risk of complications. The FNAB approach minimized procedural morbidity and enabled an accurate diagnosis without compromising patient safety.
- Precision in Diagnosis—Although the imaging test showed benign cysts, only a pathological procedure could confirm the absence of CLL, preventing unnecessary surgical procedures.
The Final Words
Pathology is a cornerstone of modern medicine, crucially involved in diagnosing and guiding treatment decisions for some of the most complex medical cases. The above case study highlights its significance in preventing unnecessary surgeries and improving patient quality of life.
This case highlights the essential role of pathology in accurate diagnostics, reducing surgical risks, and ensuring the best possible patient care. However, with the help of timely and precise insights, pathology continues to shape the future of healthcare and save lives.