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Asteroids in the blood
  1. Ingrid Böhm
  1. Department of Radiology, Philipps University of Marburg, Marburg, Germany
  1. Correspondence to Dr Ingrid Böhm, Department of Radiology, Philipps University of Marburg, Baldingerstrasse, Marburg 35039, Germany; i.boehm{at}uni-bonn.de

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Clinical presentation

During transarterial embolisation of a patient with hepatocellular carcinoma (HCC), a medical student learnt during his bedside teaching lesson that haematogenous metastasis may occur in cases with HCC. After this interventional procedure the medical student saw the catheter that had been used. This prompted him to use microscopy to analyse a drop of blood that adhered to the tip of the catheter. The microphotograph (figure 1) shows the discovery made by the medical student which he called ‘asteroids—a special form of metastatic HCC cells’.

Figure 1

The ‘asteroids’ detected by the medical student.

Question

What is the diagnosis?

See page 25 for the answer

Answer

From the question on page 9

The so-called ‘asteroids’ were detected microscopically by a medical student who analysed a drop of blood that had adhered to the tip of a catheter after transarterial embolisation (TAE) for the treatment of unresectable hepatocellular carcinoma (HCC). The student's idea arose because he was told that HCC is able to metastasise via blood flow. The ‘asteroids’ detected are neither a ‘special form of metastasis’ nor cells. These impressive microbodies are lipid droplets derived from the bland embolisation emulsion lipiodol that was used during TAE for the treatment of HCC.

Although this case has no clinical relevance it highlights the impressive initiative of a medical student. The ‘take home’ message of this case could be for all teaching physicians to encourage students/trainees, and to enhance their eagerness to learn, possibly by telling them of the case presented here.

Footnotes

  • Competing interests None.

  • Provenance and peer review Not commissioned; not externally peer reviewed.