1. Mastocytosis

2. History
67 y/o male with CAD, s/p CABG, evaluated for recurrent ascites requiring frequent LVP
Past medical history:
Coronary artery disease s/p CABG 2007
Type 2 diabetes
Hypertension
Medications:
Lisinopril
Insulin 70/30
ASA 81mg

3. History Social history: Family history: No Etoh, tobacco, drug use
Negative for gastrointestinal malignancy or liver disease

4. Exam Well nourished, well developed Clear lung and cardiac exam
Soft, non-tender, distended, +fluid wave, easily palpable liver below CM, +spleen
Erythematous lesions predominantly on back

5. Intensely pruritic lesions upon slight rubbing

6. Laboratory Testing Total protein: 6.8 Alb: 2.9 Tbil: 0.7 AST 14 ALT 24
AlkPhos: 324
GGTP: 75
INR: 1.2
WBC: 4.3
Hgb: 10.6
HCT 31.3
Plat: 190
Cr: 1.5
Viral hepatitis panel, ANA, AMA, ASMA negative

7. Ascitic fluid 2D echo Total protein: 2.8 SAAG>1.1 LDH 47
WBC 268 (PMN 0%, Mono 100%)
Culture and gram stain: negative
2D echo
Left ventricular ejection fraction: 60%
Normal right ventricular size
Normal tricuspid, mitral, aortic valve

8. Imaging Studies Abdominal US CT scan abdomen Hepatosplenomegaly
Patent portal vein with hepatopetal flow
CT scan abdomen
Nodular liver
Splenomegaly
Ascites
Cholelithiasis
Multiple blastic lesions throughout the thoracic/lumbar spine and pelvic bones consistent with metastasis

13. Laparoscopy

14. Laparoscopy

15. Pathology Portal fibrosis with focal bridging S2-3
Mild to moderate inflammatory infiltrate in portal triad with
eosinophils
mast cells
lymphocytes
Special stains confirmed the diagnosis of mastocytosis

16. Histology

17. Histology

18. Histology