Case 1 - Click here for Text and References
Submitted by: Michael Vieth
Clinical Summary - Case A:
56 year old male patient, gastrectomy in 1976 due to peptic ulcer disease
Dysphagia in 2011, Endoscopy + Histology showed moniliasis, antimycotic treatment for months, in repeated endoscopy: recurrent moniliasis, end of 2011 endoscopic suspicion for tumor, histology: moniliasis
Due to persistent dysphagia laparascopic inspection of esophagus: no tumor
Feb 2012: admission to our Hospital
Endoscopy with biopsies was repeated
Clinical Summary - Case B:
67 year old male patient, squamous cell carcinoma of the esophagus in Feb 2011.
Endoscopic resection: pT1(m2), L0, V0, R0, G1
Follow-up with biopsies after 3, 6 and 9 months without pathological findings. Now 15 months after endoscopic resection due to focal reddening and surface irregularities. Prior biopsies: no neoplasia.
Case 2 - Click here for Text and References
Submitted by: Elizabeth A. Montgomery
Clinical Summary:
A 65 year old man shown to have high-grade dysplasia in Barrett’s mucosa in 2003. He was offered surgery but preferred to undergo an endoscopic mucosal resection. This sample is from his endoscopic mucosal resection performed in 2003. Image 1 is low magnification and image 2 is high magnification of one of the lateral margins.
Low magnification of the endoscopic mucosal resection. Note the process at the later margin, depicted on the right side of the field.
High-magnification. There is intramucosal adenocarcinoma.
Case 3 - Click here for Text and References
Submitted by: Fatima Carneiro
Clinical Summary:
Male, 40-year-old, asymptomatic, with a family history of gastric cancer. Gastric endoscopies were normal and multiple biopsies were negative for malignancy. After genetic counseling, an elective gastrectomy was performed. Brief description of the surgical specimen: The surgical specimen (total gastrectomy) was grossly normal both in appearance and by palpation. The whole stomach was sectioned, embedded in paraffin, and examined microscopically.
Early intramucosal carcinoma (T1a): neoplastic cells display a pure signet ring cell phenotype.
Foveolar hyperplasia and tufting of surface epithelium (focally with globoid change) in non neoplastic mucosa.
In situ carcinoma: presence of signet ring cells within the basal membrane, with hyperchromatic and depolarized nuclei.
Pagetoid spread of signet ring cells: glands/foveolae display a two-layer structure, an inner layer composed of benign mucous cells and an outer layer of continuous or discontinuous tumour signet ring cells.
Pagetoid spread of signet ring cells and early invasion of the lamina propria.
Immunohistochemical expression of E- cadherin in intramucosal carcinoma (T1a): signet ring cells show absent or reduced E-cadherin expression. E-cadherin is expressed at the cell membrane in non neoplastic epithelium.
Immunohistochemical expression of E- cadherin in intraepithelial lesions: E-cadherin is absent in in situ signet ring cell carcinoma (ellipses; upper panels)and in pagetoid spread of signet ring cells (arrow heads, lower panels).
Case 4 - Click here for Text and References
Submitted by: Christophe Rosty
Clinical Summary:
A 58 year-old asymptomatic woman underwent screening colonoscopy after her 60 year-old brother had been diagnosed with colorectal cancer. Multiple sessile polyps measuring 5 to 23 mm were identified throughout the large bowel, with predominance in the proximal colon. The biopsy of the largest polyp in the proximal transverse colon showed high grade dysplasia, suspicious for adenocarcinoma. An extended right hemicolectomy was performed.
Invasive low grade adenocarcinoma with an adjacent serrated polyp
Loss of MLH1 expression in carcinoma cells
Large sessile polyp of the colonic mucosa showing serrated architecture and abnormal architecture of the crypt bases
Closer view on a serrated polyp highlighting the distorted crypt architecture. The crypts show dilatation and branching; there are goblet cells at the bases of the crypt.
Another medium-power view of a sessile polyp with prominent serration throughout the length of elongated crypts with dilated bases. Mature cells at the base of some crypts are also evident.
Low-power view of another large sessile polyp with abnormal crypt architecture and areas of crowding of crypts
This sessile serrated polyp displays a sharply demarcated area of cytological dysplasia identified at this low-power view by abnormal crowding of proliferating crypts with back-to-back formations
Closer view of the dysplastic component of a sessile serrated adenoma. The nuclei of atypical cells show open vesicular chromatin and prominent nucleoli. The cytoplasm is eosinophilic. Note that the dysplastic cells are more cuboidal in shape that dysplastic cells from conventional adenoma.
Loss of MLH1 expression in the dysplastic components of a sessile serrated adenoma
Case 5 - Click here for Text and References
Submitted by: Kieran Sheahan
Clinical Summary:
76 year old female with a history of non-Hogkin's lymphoma. Endoscopic mucosal resection of a flat rectal polyp.
Case 5 - Slide 1
elastic
Cam 5.2
Cam 5.2
desmin