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Slide Seminar 15 - Rodger C. Haggitt Slide Seminar: Lesions of Esophagus, Stomach, and Duodenum
Wednesday, September 20, 2006 08:00 - 12:00
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Moderators:
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Dr. Cecilia Fenoglio-Preiser and Dr. Wendy Frankel
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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 Slide Seminar) must disclose this to attendees. The Academy also requires that speakers disclose any products that are not labeled for the use under discussion. Dr. Robert Petras indicated is an employee at AmeriPath,Inc. All other faculty members for this Slide Seminar 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 case.
Click on each slide thumbnail image to view each slide in a Web-based slide viewer.
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- Lymphocytic Gastritis
Submitted by: Drs. Jean-François Flejou, Adriana Handra-Luca
74 yr old man. Recent anorexia and weight loss, with upper abdominal pain. Moderate arterial hypertension, no other past medical history. Under NSAIDs for vague rheumatismal pain. On upper digestive endoscopy, large eroded folds in the gastric body.
Two slides of gastric biopsies are submitted: (slide 1) body; (slide 2) antrum.
Case 1 - Slide 1
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Case 1 - Slide 2
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- Adenomyoma of the Ampulla of Vater
Submitted by: Drs. Jean-François Flejou, Adriana Handra-Luca
48 yr old woman. No remarkable past medical history. For 5 years, several attacks of right upper abdominal pain with transient and mild increase in gamma-glutamyltransferase. Normal abdominal US and CT scan, with normal intra- and extrahepatic biliary tract. On repeated upper digestive endoscopies, polypoid lesion of the major papilla, increasing in size on the last examination (from 15 to 20 mm). Two series of biopsies show reactive and inflammatory changes, with no evidence of neoplasia. On echoendoscopy, the nodule measures 26mm in its greater dimension and is limited to the ampulla of Vater. Due to strong clinical suspicion of an ampulloma, duodenopancreatectomy is performed. The slide (3) that is submitted is from the major papilla.
Case 2 - Slide 1
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- Barrett's Esophagus: Dysplasia and Carcinoma
Submitted by: Robert E. Petras, M.D., FASCP, FACG
67 year-old woman with Barrett's esophagus. R/O dysplasia.
Case 3 - Slide 1
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- Radiation and Chemotherapy-associated Gastric Ulcers vs. Gastric Carcinoma/dysplasia
Submitted by: Robert E. Petras, M.D., FASCP, FACG
The patient, a 46 year-old man, presents with marked epigastric pain. Upper endoscopy reveals a very large gastric ulcer involving most of the anterior wall of the body and antrum of the stomach. The ulcer is described as a clean-based with smooth edges.
Case 4 - Slide 1
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- Signet Ring Cell/diffuse Carcinoma in the Setting of Hereditary Diffuse Gastric Cancer (HDGC)
Submitted by: Professor Fatima Carneiro
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.
Case 5 - Slide 1
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- Gastric Syphilis
Submitted by: Professor Fatima Carneiro
Male, 35-year-old, with long lasting dyspepsia. In January 2005 the patient was submitted to gastric endoscopies on two occasions. The diagnosis of "suspicion of malignancy" was reported and the patient was submitted to distal gastrectomy.
Brief description of the surgical specimen:
Distal stomach (GC-24cm; LC-12-cm; duodenal segment- 1.5cm).
The antral mucosa was hyperemic and displayed irregular erosions. Body mucosa had a normal appearance. Lymph nodes (n=26) were isolated in both curvatures (the largest with 1.5cm in diameter).
Case 6 - Slide 1
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- "Iron Pill Esophagitis"
Submitted by: Elizabeth Montgomery, MD
Female, 70-year-old, This biopsy was obtained from an area of "esophagitis" with scleroderma.
Case 7 - Slide 1
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- Gastric Stromal Tumors
Submitted by: Elizabeth Montgomery, MD
Female, 61-year-old, This slide was prepares from a 7 cm mass excised from the stomach.
Case 8 - Slide 1
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- Early Esophageal Squamous Cell Carcinoma, Endoscopic Mucosal Resection
Submitted by: Professor Kaiyo Takubo, Miwako Arima, MD
A 72-year-old man underwent endoscopic examination during mass screening for upper GI tract cancer. He had been asymptomatic up to the time of the endoscopic examination. He had drunk an equivalent of 30 mg of ethanol per day for 50 years, and his Smoking Index was 800. His medical history included arteriosclerosis obliterans of both lower extremities. At endoscopy, a slightly depressed lesion was observed in the esophageal mucosa, and a biopsy specimen from the lesion was diagnosed as a carcinoma. One month after the lesion was detected, the patient underwent endoscopic mucosal resection (EMR) of the esophageal carcinoma. Since the EMR, the patient has been well for the last 2 years. The histologic slides used for this presentation were prepared from the EMR specimen.
Case 9 - Slide 1
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Case 9 - Slide 2
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- Superficial Basaloid Squamous Carcinoma, Endoscopic Mucosal Resection
Submitted by: Professor Kaiyo Takubo, Miwako Arima, MD
A 66-year-old man with recurrent invasive squamous cell carcinoma of the mid-pharynx was hospitalized for radical surgery. He had previously received radiation therapy for mid-pharyngeal carcinoma. He had drunk an equivalent of 36 mg of ethanol per day for 45 years, and his Smoking Index was 920. Before the radical operation, he underwent endoscopic examination of the esophagus and stomach for cancer screening, and was found to have a slightly elevated lesion in the esophagus. A biopsy specimen from the lesion was diagnosed as a carcinoma. After radical surgery for the mid-pharyngeal carcinoma, endoscopic mucosal resection (EMR) was performed twice for the esophageal carcinoma. The patient has been well with no evidence of recurrence of the pharyngeal or esophageal carcinoma for 3 years after the last EMR. The histologic slides used for this presentation were prepared from the last EMR specimen.
Case 10 - Slide 1
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- Infiltrative Granular Cell Tumor of the Esophagus
Submitted by: Gregory Y. Lauwers, M.D.
A 22-year-old woman, with no significant past medical history, presented to her general practitioner complaining of dysphagia. She was treated symptomatically but maintained her complaints and eventually consulted a gastroenterologist who performed an upper endoscopy. The examination was unremarkable, and biopsies of the distal esophagus revealed a normal squamous epithelium. She was then sent to an ear, nose, and throat specialist who did not notice evidence of nasopharyngeal regurgitation, hoarseness, or aspiration. Given the persistence of symptoms she finally had a CT scan which revealed a poorly defined, circumferential thickening of the esophageal wall. A second set of biopsies was performed that again came back negative. She eventually underwent a partial esophagectomy.
Case 11 - Slide 1
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- Gastric Hyperplastic Polyp with Malignant Transformation
Submitted by: Gregory Y. Lauwers, M.D.
A 75-year-old woman, previously healthy, presented to her family doctor for general fatigue. Routine tests demonstrated an iron deficiency anemia. A full colonoscopy had been performed in the recent past, and had demonstrated 2 hyperplastic polyps. She was again referred to a gastroenterologist, who this time performed an upper endoscopy. The examination demonstrated an atrophic antral mucosa. In addition, a large 2 cm polyp was identified. Of note, the polyp appeared friable when touched by the tip of the endoscope and bled easily. A polypectomy was attempted.
Case 12 - Slide 1
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