—  SPECIALTY CONFERENCE  — Gastrointestinal Pathology Sunday, February 27, 2011, 7:30 PM CC BRA Moderator: GREGORY Y. LAUWERS Massachusetts General Hospital Boston, MA Disclosure: In accordance with ACCME guidelines regarding disclosure, the USCAP policy requires that faculty members who have a significant financial or other relationship with a commercial company, entity, or service (which will be discussed in this Symposium) must disclose this to attendees. The Academy also requires that speakers disclose any products that are not labeled for the use under discussion. The speakers listed below have indicated they have nothing to disclose. Panelists: Amitabh Srivastava, Dartmouth Hitchcock Medical Center, Lebanon, NH David Driman, London Health Sciences Centre, London, Ontario, Canada Priyanthi Kumarasinghe, PathWest, Queen Elizabeth II Medical Centre, Perth, Australia Noam Harpaz, The Mount Sinai Medical Center, New York, NY Robert D. Odze, Brigham and Women Hospital, Boston, MA Clinical Histories and Still Images are displayed below. Click on slide thumbnail images for an enlarged view. If you have any difficulties viewing these slides, email or call George Clay at +1.724.449.1137. Case 1 Submitted by: Amitabh Srivastava - Clinical Summary: A 65 year old man presented with abdominal pain, anemia and an unintentional 15 lb weight loss over the past six months. Colonoscopy revealed two small polyps but no evidence of malignancy. Upper GI endoscopy showed an ulcer with heaped up margins in the distal stomach. Biopsies from the lesion showed high-grade dysplasia and intramucosal adenocarcinoma. However, endoscopic ultrasound examination was consistent with a T2 lesion and a distal gastrectomy was performed. Case 1 - Figure 1 Case 1 - Figure 2 Case 1 - Figure 3 Case 1 - Figure 4 Case 1 - Figure 5 Case 1 - Figure 6 Case 1 - Figure 7 Case 1 - Figure 8 Case 1 - Figure 9 Case 1 - Figure 10 D2-40 immunostain Case 2 Submitted by: David Kevin Driman - Clinical Summary: This 31 year old male presented with a one month history of profuse watery diarrhea and vomiting. He had had a heart transplant 2 years previously for familial dilated cardiomyopathy. Routine blood work was normal and his stools contained no ova or parasites. He was taking the following medication: tacrolimus, mycophenolate mofetil, aspirin, lansoprazole, atorvastatin and buproprion. Colonoscopy showed patchy erythema but there were no ulcers or other striking abnormalities. Several biopsies were taken. Case 2 - Slide 1 Click to view with ImageScope Click to view with a Web-Based Viewer Case 2 - Figure 1 Case 2 - Figure 2 Case 2 - Figure 3 Case 2 - Figure 4 Case 2 - Figure 5 Case 2 - Figure 6 Case 2 - Figure 7 Case 2 - Figure 8 Case 3 Submitted by: Priyanthi Kumarasinghe - Clinical History: A 65 year old male underwent a total gastrectomy. A previous endoscopic biopsy showed a poorly differentiated adenocarcinoma. Her-2 status was assessed. Case 3 - Figure 1 Case 3 - Figure 2 Case 3 - Figure 3 Case 3 - Figure 4 Case 3 - Figure 5 IHC Case 3 - Figure 6 HER-2 IHC Case 3 - Figure 7 HER-2 IHC Case 3 - Figure 8 HER-2 IHC Case 3 - Figure 9 HER-2 IHC Case 3 - Figure 10 HER-2 SISH Case 4 Submitted by: Noam Harpaz - Clinical Summary: The patient was a 50-year-old male who presented with pain of the left upper extremity. He had been diagnosed with a rectal tumor 5 years earlier at another facility and treated with chemotherapy and local radiation. Radiological examination now revealed a large lytic tumor in the left humerus and further work-up revaled hepatic, pulmonary and intracranial lesions. A biopsy of the humeral tumor was performed and a slide of the original rectal biopsy was retrieved for comparison. Case 4 - Figure 1 Case 4 - Figure 2 Case 4 - Figure 3 DPAS Case 4 - Figure 4 LCA Case 4 - Figure 5 HMB45 Case 4 - Figure 6 lambda Case 4 - Figure 7 CD1a Case 4 - Figure 8 CAM5_2 Case 4 - Figure 9 SYN Case 4 - Figure 10 CD56 Case 4 - Figure 11 Rectal bx Case 4 - Figure 12 Rectal bx Case 5 Submitted by: Robert D. Odze - Clinical Summary: The case represents a 56 year old male with an 8 year history of Barrett's esophagus (BE). At initial diagnosis, the patient had long segment BE extending to 5 cm above the gastroesophageal junction (GEJ). At the time of the patient's most recent endoscopic surveillance, the length of esophageal columnar mucosa was 3.5 cm, and there were multiple foci of squamous islands. Four quadrant biopsies were obtained from every 2 cm of columnar-lined esophagus. No other endoscopic abnormalities were detected. The biopsy of interest represents mucosa obtained from 2 cm proximal to the GEJ. The patient has no family history of esophageal or colon cancer, and other biopsies from the upper GI tract (stomach and duodenum) were within normal limits. Case 5 - Figure 1 Case 5 - Figure 2 Handouts for all Specialty Conferences will be accessible via the "Educational Materials" section on the homepage the morning after each respective conference. Printed copies of the handout will not be available at the meeting.