|
|
 |
  |
 |
|
|
|
|
|
 |
21st European Congress of Pathology
Istanbul, Turkey, September 08-13, 2007
http://www.ecp2007istanbul.org/
Slide Seminar 6, September 13th
Once in a Pathologist Lifetime:
Rare Entities of the GIT
Chairpersons: J. Offerhaus, G. Gedikoglu |
|
|
|
Case 1
Presented by: F. J. W. ten Kate, Netherlands
Clinical History
The patient is a white male, 39 years old, who presented with abdominal discomfort and pain, jaundice and weight loss. The clinical history is remarkable for a previous hospitalization for pancreatitis due to alcohol abusus. The family history is remarkable for a p16 Leiden mutation in the germline and the occurrence of multiple melanomas and an occasional pancreatic cancer. Patient has refused genetic testing.
Imaging through CT and MRI shows a double duct sign and calcifications consistent with chronic pancreatitis. On endoscopy a polypoid green brownish soft lesion protruding through the ampulla is seen suspicious for melanoma and a biopsy is taken
|
|
Diagnosis & discussion |
|
|
|
|
Case 2
Presented by: K. Deraedt, K. Geboes, Belgium
Clinical History
A 32-year-old male presented with fatigue, watery diarrhoea and diffuse sweating. The complaints started after a journey to the Philippines. Nausea and melaena were absent. Further questioning revealed that the patient had suffered from the same kind of diarrhoea during the previous 5 years. Except for a painful inguinal lymph node, there were no abnormalities on clinical examination. Stool examination was negative. Colonoscopy showed numerous white, smooth mucosal nodules in the colon and the rectum.
|
|
Diagnosis & discussion |
|
|
|
|
Case 3
Presented by: Jean-François Fléjou, Laurent Michot, France
Clinical History
A 47-year-old woman without any previous significant medical history was admitted for abdominal pain. Physical examination was normal. Endoscopy revealed an obstructive and ulcerated tumour of the transverse colon. Biopsy of the tumour showed a spindle cell tumour. Abdominal ultrasound CT scan showed one nodule in the liver, 3 cm in diameter, suggestive of metastasis. A right colectomy was performed. On laparotomy, a subcapsular hepatic nodule was removed. On macroscopy, the colectomy specimen showed an ulcerated and infiltrative circumferential tumour. The subcapsular hepatic nodule was also removed. The slide that is submitted is taken from the colonic tumour.
|
|
Diagnosis & discussion |
|
|
|
|
Case 4
Presented by: Fátima Carneiro, Portugal
Clinical History
Male, 11 years-old, with iron-deficiency anaemia and occult gastrointestinal tract blood loss. Clinical history was irrelevant. The use of nonsteroidal anti-inflammatory drugs (NSAIDs) was denied. Microbiologic study of stools was negative. The patient was submitted to video capsule endoscopy which was inconclusive due to the retention of the capsule in the small bowel, necessitating operative extraction. At laparotomy for the removal of the video capsule, intraoperative enteroscopy was performed. This procedure disclosed the presence of several pink-tan mucosal diaphragm-like folds (circumferential ridges) with focal haemorrhage, oedema and ulceration at the luminal orifices. The segment of small bowel displaying the diaphragm-like structures was removed and submitted to histopathological examination
|
|
Diagnosis & discussion |
|
|
|
|
Case 5
Presented by: Fred Bosman, Switzerland
Clinical History
Female, 57 years, upper difestive tract bleeding due to duodenal ulcer, requiring surgical intervention. At laparotomy, a duodeno-jejunal segment is resected. Multiple small nodules are found in the wall of the small bowel. In addition a small nodule is found in the proximal duodenum, which is biopsied.
|
|
Diagnosis & discussion |
|
|
|
|
Case 6
Presented by: Arzu Ensari, Turkey
Clinical History
70 year old male suffering from dyspepsia and nausea for 6 months. Epigastric tenderness on physical examination. Laboratory tests revealed iron deficiency anemia. Upper GI endoscopy suggestive of pangastritis. Multiple biopsies were taken.
|
|
Diagnosis & discussion |
|
|
|
|
Case 7
Presented by: Janina Orlowska, Poland
Clinical History
A 44-year-old woman with longstanding, of about 10 years duration, chronic ulcerative colitis (CUC), treated successfully with sulfasalazine, was invited to controlled colonoscopy. The patient was well, without any symptoms at presentation. Clinical and laboratory findings were not remarkable; she has not suffered either from abdominal pain and diarrhea, nor has observed the blood in the stools. There were no nodular lesions in the skin or palpable lymph nodes. She denied skin lesions in the family, as well.
In controlled colonoscopy, however, despite endoscopical features typical for CUC, consisting of poorly visible vascular pattern of the rectal mucosa, a pedunculated, round polyp of 10mm diameter was identified in the sigmoid colon, 35 cm from the anal verge. Diathermy polypectomy was performed
|
|
Diagnosis & discussion |
|
|
|
|
Case 8
Presented by: Ari Ristimäki, Finland
Clinical History
Female, 70 year old. Two years ago colonoscopy was performed. Multiple polyps were
identified of which five showed hyperplastic morphology and one was tubular adenoma
with mild dysplasia. Four weeks ago a control colonoscopy was performed in which
adenocarcinoma of the transverse colon was diagnosed along with multiple polyps
throughout the colon. Enclosed is the colectomy specimen.
Macroscopy: A flat tumor was found in the transverse colon, diameter 3.5 cm. In
addition, there were 52 polyps throughout the colon of which six were over 5 mm in
diameter (largest 13 mm).
|
|
Diagnosis & discussion |
|
|
|
|
Case 9
Presented by: Gokhan Gedikoglu, Turkey
Clinical History
• 41-year-old woman
• No prior medical history
• Abdominal distention and pain
• Ascites, pleural effusion, thrombosis in portal vein and superior mesenteric vein, diffuse thickening of the small intestine wall in CT examination
• Preliminary Diagnosis: Mesenteric vascular occlusion
• Laparotomy: Segmentary small intestinal resection . No mass lesion was noted on the resection specimen. The serosa and mucosa was brown, fragile and edematous. The mucosa was randomly sampled and mesenteric lymph nodes measuring upto 1 cm were dissected from the mesocolon. The patient deteriorated and died two weeks after the operation
|
|
Diagnosis & discussion |
|
|
|
|
|
 |
 |
 |
|
