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21st European Congress of Pathology
Istanbul, Turkey, September 08-13, 2007
http://www.ecp2007istanbul.org/
Slide Seminar 5, September 10th
New and Controversial Entities of the New WHO Classification of Endocrine Tumors
Chairpersons: P. Komminoth (Switzerland), G. Rindi (Italy) |
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Case 1
Presented by: Prof. Manuel Sobrinho-Simoes, Portugal
Clinical History
Thyroid tumor in a euthyroid 56 year-old-woman. The surgical specimen had an encapsulated whitish tumor measuring 5x4x4cm and several small nodules dispersed in the “normal” thyroid parenchyma.
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Diagnosis & discussion |
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Case 2
Presented by: Prof. Günter Klöppel, Germany
Clinical History
62 year old woman who developed anemia due to gastrointestinal bleeding. Endoscopically, a polyp was found in the duodenum close to the papilla of Vater. The polyp was eroded. A laparotomy with duodenotomy and excision of the polypous tumor was performed. The patient showed no hormonal or hereditary syndrome. The excised lesion consisted of a 2.2 cm tumor that lay in the submucosa
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Diagnosis & discussion |
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Case 3
Presented by: Prof. George Kontogeorgos, Greece
Clinical History
A 43 year old female with long-standing history of acromegaly was presented complaining of headaches and visual disturbances during the last 2 years. GH serum levels were slightly elevated. Ophthalmologic examination revealed bilateral temporal hemianopsia. MRI revealed a large clepsydra-like pituitary mass of 6.5 cm with enlargement and distortion of the sella turcica. The tumor showed upward extension occupying the 3rd ventricle and protruding into the sphenoid sinus. The patient underwent three consecutive operations, initially a transsphenoidal surgery, and then with a cranial frontal approach.
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Diagnosis & discussion |
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Case 4
Presented by: Prof. Sylvia Asa, Canada
Clinical History
This 36 year old woman had a thyroid nodule detected on her annual physical examination. She was asymptomatic and had no clinical features of hypo- or hyperthyroidism. Thyroid function tests were within the normal range and no anti-thyroid antibodies were identified. Ultrasound examination identified a 3 cm isoechoic nodule in the right lobe and needle aspiration biopsy was read as “thyroid follicular cells present”. The patient was sent for right thyroid lobectomy.
The specimen consisted of a lobe of thyroid that measured 5cm SI x 4 cm ML x 3.2 cm AP. On section the mid-lobe contained a homogeneous tan to brown well-defined nodule that measured 3.2 cm SI x 3 cm ML x 2.5 cm AP. There was central cystic change and hemorrhage. The surrounding thyroid was grossly unremarkable.
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Diagnosis & discussion |
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Case 5
Presented by: Prof. Paul Komminoth, Switzerland
Clinical History
This 84 year old female patient presented with a 4.5 cm nodule of the right thyroid lobe. A previously performed fine needle examination revealed degenerative changes consistent with a cyst. The macroscopic examination revealed a polycyclic non-encapsulated ill-defined firm mass with yellow parts (necroses) until the resection boarder (the lesion reached into the surrounding connective tissue).
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Diagnosis & discussion |
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Case 6
Presented by: Prof. C. Sokmensuer, Turkey
Clinical History
A 36 year old woman presented with a complaint of a defect in her palate that occurred after surgical excision of a mass localized on the right lateral side of the hard palate at another clinic. Otorhinolaryngological examination confirmed a 2x2 cm defect of the hard palate connecting the nasal cavity with the oral cavity and a 3x3 cm palpable thyroid nodule on the right side was incidentally detected at that time.
The computerized tomographic (CT) scan showed a huge nodule (42x30x27 mm) which was compressing the trachea on the right thyroid lobe, and a soft tissue lesion in the right mandibular canal. Tc-99m Sestamibi scintigraphy demonstrated diffuse radiopharmaceutical uptake, which correlated with a thyroid nodule, within the thyroid region. It was reported as a thyroid nodule, with an additional note saying that a parathyroid adenoma could not be excluded. Before further surgery, the slides of the previous biopsy were sent for review to our pathology department and reported as a giant cell granuloma. On the other hand, the fine needle aspiration of the thyroid nodule revealed highly atypical, hyperchromatic cells. It was reported as a malignant neoplastic process.
In further laboratory investigations serum alkaline phosphatase was elevated (329 U/l), serum total calcium was markedly elevated at 13.8 mg/dl and intact PTH was 13 times above the normal range. Decalcification of the bones was observed in the densitometries and in the direct bone images. Fifteen days later her serum calcium level dropped to 10.5 mg/dl. Based on the above clinical findings, the patient underwent surgical exploration. During surgery, a firm, 3x3 cm mass partially infiltrating the thyroid capsule on the right pole of the thyroid gland was noticed. En bloc resection of the mass was performed, along with the entire thyroid gland and the surrounding connective tissue, both of which were apparently involved by the tumor.
Macroscopic findings: Bilateral total thyroidectomy of 66 g had normal cut sections. But an irregular solid grayish mass of 4x3,5x2,3 cm in size was seen at the inferior pole of the right thyroid lobe.
Follow up: The patient had severe postoperative hypocalcemia, necessitating calcium and vitamin D replacement. She also received postoperative radiotherapy. She ıs free of symptoms since one year.
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Diagnosis & discussion |
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Case 7
Presented by: Prof. Guido Rindi, Italy
Clinical History
84 year old female suffering from dyspepsia and megaloblastic anemia. An upper GI endoscopy revealed a small irregularity of the corpus-fundus mucosa. Sampling of antrum, angulus, corpus-fundus and fundus.
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Diagnosis & discussion |
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Case 8
Presented by: Prof. Ronald de Krijger, Netherlands
Clinical History
21 year old male with severe hypertension. Adrenal mass detected by MRI. Lesion positive in a MIBG scan. The sample is taken from the center of the lesion
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Diagnosis & discussion |
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Case 9
Presented by: Prof. Anne-Marie McNicoll, UK
Clinical History
27 year old man with abdominal pain. Non-functioning right adrenal tumor.
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Diagnosis & discussion |
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