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Short Course 04 - Early and Precursor Lesions in Endocrine Pathology
Monday, September 18, 2006 08:00 - 12:00
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Moderators:
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Thomas Giordano
University of Michigan Medical Center
Ann Arbor, MI
Paul Komminoth
Institute of Pathology, Konionsspital Baden
Baden, Switzerland
Martin Anlauf
University of Schleswig-Holstein, Campus Kiel
Kiel, Germany
William D. Travis
Memorial Sloan Kettering Cancer Center
New York, NY
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Disclosure:
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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 Short Course) must disclose this to attendees. The Academy also requires that speakers disclose any products that are not labeled for the use under discussion. Faculty members for this Short Course have indicated they have no disclosures to make.
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Clinical histories are displayed below.
Click on the case numbers to display the text and references for each section.
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Early and Precursor Lesions of the Adrenal Gland
Submitted by: Thomas J. Giordano
The patient is a 42 old female who was found to have a 2 cm adrenal mass by CT. She was otherwise in reasonably good general health and was lost to followup. About 4 years later, she developed excessive hair growth on her face, abdomen, and legs. She also complained of a 25 lb weight gain over the past 2 years. Ultrasound of the abdomen uncovered a left adrenal mass. Laboratory evaluation revealed an elevated testosterone. The patient underwent left adrenal resection. The resection specimen consisted of an adrenal yellow-tan encapsulated mass with up to 20% areas of necrosis and weighed 180 with a maximum diameter of 6 cm. A somewhat distinct appearing 1.5 cm area was also noted grossly.
Case 1 - Figure 1
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Adrenal cortical carcinoma, low-grade but mitotic activity, with capsular and vascular invasion.
The patient is a 38 year-old female who is in good overall health. A family member was recently discovered to have multiple endocrine neoplasia, type IIA. Genetic testing of the patient showed a RET mutation. The patient underwent serum calcitonin testing which revealed elevated levels. 24 hour urinary catecholamines were also elevated. A nuclear medicine scan with I131- iodine-131-meta-iodobenzylguanidine (MIBG) revealed bilateral adrenal uptake that was interpreted as abnormal. The patient underwent bilateral adrenalectomy. Subsequently, the patient underwent total thyroidectomy.
Case 2 - Figure 2a
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Case 2 - Figure 2b
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Medullary hyperplasia and pheochromocytoma.
Precursor Lesions of the Duodenum and Pancreas (No slides submitted)
Submitted by: Martin Anlauf
Neuroendocrine Lung Tumors
Submitted by: William D. Travis
A 57 year old woman with a 30 pack year history of smoking presented with productive cough and fever for one month. Her symptoms were not responsive to antibiotics. A chest x-ray showed a right lung mass. A CT scan showed a right upper lobe 2.0 X 1.3 cm mass. A PET scan showed intense FDG uptake with an SUV of 11.2.
Case 4 - Figure 1
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Lung, Right Upper Lobe, Wedge Resection and Lobectomy: Large Cell Neuroendocrine Carcinoma
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