—  SPECIALTY CONFERENCE  — Gastrointestinal Pathology Tuesday, March 23, 7:30 PM Salon 3 and Balconies Moderator: LAURA LAMPS University of Arkansas for Medical Sciences, Little Rock, AR 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: DHANPAT JAIN, Yale University School of Medicine, New Haven, CT SCOTT OWENS, University of Pittsburgh School of Medicine, Pittsburgh, PA WENDY L. FRANKEL, The Ohio State University School of Medicine, Columbus, OH DAVID A. OWEN, University of British Columbia, Vancouver, British Columbia, Canada WADE S. SAMOWITZ, University of Utah Medical Center, Salt Lake City, UT 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: Dhanpat Jain - Yale University School of Medicine, New Haven, CT Clinical Summary: Patient is a 47 year old asymptomatic Portuguese lady who presented to the gastroenterologist for screening endoscopy for strong family history of stomach cancer. Endoscopy revealed a 1cm ulcer in the gastric cardia that appeared benign, however, biopsies were performed and she subsequently underwent gastric resection. Grossly the ulcer was shallow without any thickening of the mucosal folds around it or thickening of the wall. Representative photomicrographs of the lesion are given. 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 2 Submitted by: Scott Owens - University of Pittsburgh School of Medicine, Pittsburgh, PA Clinical Summary: A 50 year-old man presented three days after an umbilical hernia repair with rapidly-progressive left axillary and lower anterior chest pain, accompanied by jaundice and dark urine.  His amylase and bilirubin were elevated and he was presumptively diagnosed with biliary pancreatitis.  A subsequent CT scan showed a large (8.8 cm) enhancing mass in the second portion of the duodenum, which an endoscopic ultrasound found to be a submucosal/intramural mass with cystic areas, located adjacent to the papilla of Vater.  Clinically, it was felt most likely to be a gastrointestinal stromal tumor.  The mass was locally excised approximately two months after the patient's initial presentation. 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 synaptophysin Case 2 - Figure 9 cam5 2 Case 3 Submitted by: Wendy L. Frankel - The Ohio State University School of Medicine, Columbus, OH Clinical History: 58 year old man with no personal history of malignancy or other significant medical history was noted to have two tumors at colonoscopy. The tumors were located in his transverse colon and rectosigmoid. Case 3 - Slide 1 Click to view with ImageScope Click to view with a Web-Based Viewer Case 3 - Figure 1 Case 3 - Figure 2 Case 3 - Figure 3 Case 3 - Figure 4 Case 4 Submitted by: David A. Owen - University of British Columbia, Vancouver, British Columbia, Canada Clinical Summary: The patient is a man aged 62 who presented with a one year history of intermittant dysphagia with occasional episodes of choking. An upper GI endoscopic examination was planned but before the endoscope was fully inserted the patient "burped" and then inhaled deeply. The endoscopist observed that a "large" polyp had refluxed from the upper esophagus and entered the trachea. The patient's airway was partly obstructed and he became cyanosed. Emergency help was summoned and with difficulty the polyp was removed from the airway and returned to the esophagus. A CT scan of the neck was performed which showed a lobulated fatty lesion present in the hypopharynx. This measured 61 X 46 X 19 mm. No lymphadenopathy was identified. It was possible to remove the polyp using an operating laryngoscope. The base of the polyp was in the upper esophagus. The tip was located 12cm distally in the mid- esophagus. It was excised in two pieces. The laboratory received two polypoid masses each of which measured 45 X 40 X 40mm. They were described as consisting of "fluctuant fatty material". The surface mucosa was smooth and intact with no obvious ulceration. Pertinent Laboratory Data: This patient was known to be a type 1 diabetic with elevated blood glucose levels. All other laboratory tests were normal. Case 4 - Slide 1 Click to view with ImageScope Click to view with a Web-Based Viewer Case 4 - Figure 1 Case 4 - Figure 2 Case 4 - Figure 3 Case 4 - Figure 4 Case 4 - Figure 5 Case 4 - Figure 6 Case 4 - Figure 7 Case 5 Submitted by: Wade S. Samowitz - University of Utah Medical Center, Salt Lake City, UT Clinical Summary: A 57 year old insulin-dependent diabetic man presented at an outside institution with lower abdominal pain, anorexia, fatigue, low grade fevers and constipation. The WBC count was 16,400/µl with 8% eosinophils. CT showed an 18 cm mass involving the transverse colon and stomach. Left colon biopsy showed “active colitis with epithelioid granulomas.” The presumptive diagnosis was Crohn's disease and treatment with mesalamine was begun. Subsequent enlargement of the mass prompted surgical resection of a segment of colon and part of the greater curvature of the stomach. Histologic interpretation was “diverticular disease with perforation and foreign body reaction.” The patient was discharged but was then admitted to our institution because of an enlarging mass now involving the pancreatic tail and left kidney. Slides from the initial operation were reviewed at our institution. Case 5 - Figure 1 Case 5 - Figure 2 Case 5 - Figure 3 Case 5 - Figure 4 Case 5 - Figure 5 Case 5 - Figure 6 Case 5 - Figure 7 Case 5 - Figure 8 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.