submitted by:
Shari Taylor
GI Pathology Partners, PC
Memphis, Tennessee
A 20-year-old man presented to his gastroenterologist with progressive dysphagia. At endoscopy, a short
distal esophageal stricture was noted, which was dilated. In addition, the endoscopist noted an
"atypical" esophagitis in the proximal esophagus, with an endoscopic appearance concerning for candidal
esophagitis. Biopsies were obtained from both proximal and distal esophagus.
submitted by:
Barbara McKenna
University of Michigan
Ann Arbor, Michigan
A 40-year-old woman presented with epigastric pain. CT scan of abdomen showed a small distal gastric
mural nodule, suspicious for neoplasm. The patient underwent a partial gastrectomy. A 1.5 cm tan,
well-circumscribed subserosal nodule was present on the distal gastric wall.
submitted by:
Susan Abraham
Mayo Clinic
Rochester, Minnesota
A 54-year-old Caucasian woman was referred for upper endoscopic examination because of early satiety and
midepigastric pain. Endoscopic examination revealed thickened gastric folds and multiple polypoid
lesions in the gastric body and fundus, which were biopsied. Serologic workup showed markedly elevated
serum levels of chromogranin A (1500 pg/mL; normal <14 pg/mL) and gastrin (1400 pg/mL; normal <75 pg/mL).
Based on this endoscopic appearance, laboratory work-up, and the biopsy results, she underwent subtotal
gastrectomy with antrectomy. Slides from the thickened folds and nodules in the gastric body are shown.
submitted by:
Laura Lamps
University of Arkansas for Medical Sciences
Little Rock, Arkansas
A 53-year-old man presented with a several month history of fatigue and vague abdominal pain. Laboratory
evaluation revealed mild anemia but no other abnormalities in his complete blood count or electrolyte
studies. The patient subsequently presented with massive upper gastrointestinal bleeding. Endoscopy
revealed bleeding from multiple ulcerated sites in the gastric mucosa. No masses were seen. An emergent
subtotal gastrectomy was performed to control the bleeding. Images submitted are from the subtotal
gastrectomy specimen.
submitted by:
Henry Appelman
University of Michigan
Ann Arbor, Michigan
4 years ago, this teenager had a terminal ileal and right colonic resection with an ileostomy for a
traumatic perforation. Except for the acute perforation, the resected colon and ileum were normal. The
rest of the colon from the hepatic flexure through the rectum was left in place as a diverted segment.
About 3 ½ years later, occasional stool drainage from the rectum began, and this lasted for about 6
months up to the present. Recently, there has been some blood spotting superimposed on the drainage. A
colonoscopic exam was performed, but the endoscopist did not see any abnormalities. The whole colon and
rectum were resected about 6 weeks after the colonoscopy. The reason for this resection is not important
for this presentation. In the resected specimen, there were numerous small mucosal nodules scattered
throughout. In addition, there were several small partial strictures due to mural thickening and some of
these had small ulcers which tended to be situated over the points where the vessels penetrate the wall.
In this slide, there are 2 sections of the colon. Figure 1 contains several of the small gross mucosal
nodules. The other three figures are from one of the strictures.
