|
|
Slide Seminar 20 - Lesions of the Lower Intestinal Tract
Thursday, September 21, 2006 08:00 - 12:00
|
|
Moderators:
|
Dr. Henry Appelman and Dr. Joel K. Greenson
|
|
|
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 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. Faculty members for this Slide Seminar have indicated they have no disclosures to make.
|
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.
|
Windows users with administrator privileges may download and install a free version of Aperio ImageScope to view USCAP Virtual Slides. Click the icon on the right to get your free copy: | 
|
- Poorly Differentiated Colon Adenocarcinoma in a Patient with Hereditary Nonpolyposis Colorectal Carcinoma
Submitted by: Dr. Wendy Frankel
A 58 year old man was found at routine colonoscopy to have 2 colonic tumors, one in his transverse colon and the other in his rectum. He was healthy and had no previous medical illnesses. Multiple family members had tumors including colon and endometrial carcinoma and ureter, kidney, skin, thyroid and brain tumors. Biopsies were performed followed by colectomy.
Case 1 - Slide 1
|
- Adult Hirschprung's Disease
Submitted by: Dr. Wendy Frankel
A 26 year old woman had many years of constipation. She was first evaluated at age 8 but the studies were normal. Since then, she was evaluated with colonoscopy, barium enema and anal manometry, with all studies being reported as normal. There was no history of delayed passage of meconium. Similar constipation occurred in her mother and aunt. Upon admission, she was emaciated with significant abdominal distension and tympani to palpation. Her abdominal skin had changes of chronic distension. She had an iron deficiency anemia. Endocrine function tests were normal. Abdominal X-rays and CT scan revealed extensive fecal retention throughout the severely dilated colon, and thee was generalized colonic wall thickening. The rectum was markedly dilated. No obstructing lesion was found. Bowel rest, nasogastric tube decompression and daily enemas were effective over several days. Flexible sigmoidoscopy revealed a markedly distended colon. A small bowel follow-through showed delayed transit time. Anal manometry and rectal biopsy were then performed followed by proctocolectomy.
Case 2 - Slide 1
|
- Sporadic Adenoma and 'pseudo-dysplasia' Due to IV Cyclosporin Therapy
Submitted by: Dr. Neil A. Shepherd
This 73 year old man had ulcerative colitis that failed to respond to medical therapy. A total colectomy was performed.
Case 3 - Slide 1
|
- Juvenile Polyposis with 'atypical Juvenile Polyps' and Focal Dysplasia
Submitted by: Dr. Neil A. Shepherd
This 40 year old man had multiple polyps in his colon and rectum. These three polyps were snare resected from the sigmoid colon.
Case 4 - Slide 1
|
- Ileocolonic Tuberculosis Following Infliximab Therapy for Presumed Crohn's Disease
Submitted by: Dr. Barbara J. McKenna
This 32 year old man has carried a diagnosis of Crohn's disease for over a year, based on the presence of a perianal fistula, CT findings of thickened terminal ileum and righ colon, and colonoscopy with biopsies performed at another institution. He was initially treated with Asacol. Imuran was added later, and he had recently received several doses of Remicage for refractory flares of disease. The flares were characterized by high fevers, myalgias, and abdominal pain. Because of persistent symptoms despite therapy, ileocolectomy was performed. The ileum and right colon had several large geographic, circumferential ulcers and nodular mucosa.
Case 5 - Slide 1
|
- Cronkhite-canada Syndrome
Submitted by: Dr. Barbara J. McKenna
This 77 year old man developed diarrhea following a flu shot, then was diagnosed with ulcerative colitis based on a colonoscopy performed at another institution. He also reported having lost allof his fingernails and much of his hair, and he developed some hyperpigmentation. Upper endoscopy, was also performed at another hospital after the patient had significant weight loss. Enlarged antral folds were biopsied and reported and foveolar hyperplasia. Small bowel biopsies were read as possible common variable immune deficiency based on villous blunting and decreased plasma cells. Repeat upper and lower endoscopies were performed at our institution, and numerous polyps and areas of nodular mucosa were seen everywhere. The patient ultimately underwent colectomy, from which these sections were taken.
Case 6 - Slide 1
|
- Caecal Goblet Cell Carcinoid with Multiple Ileal Nodules and Metastases
Submitted by: Dr. Claude Cuvelier
This 50 year old man had a 4 cm in diameter polypoid non-ulcerated tumor in his cecum. The terminal ileum was granular. The sections are from the terminal ileum.
Case 7 - Slide 1
|
- Diffuse Ganglioneuromatosis with Plexiform Neurofibromas
Submitted by: Dr. Claude Cuvelier
This 30 year old man had diffuse thickening of his mesocolon, malrottion of small intestinal loop. The small intestinal loop was 53 cm long, 44 cm of which had a diffusely thickened wall. On opening this loop, multiple firm swollen polyps caused narrowing of the lumen. The question to be answered was if this was malignant.
Case 8 - Slide 1
|
- Inflammatory Polyp in a Pelvic Ileal Reservoir
Submitted by: Dr. Bryan Warren
This 59 year old man had a longstanding J-pouch for ulcerative colitis. A polyp was found in the blind limb. The concern: was it neoplastic?
Case 9 - Slide 1
|
Case 9 - Slide 2
|
- Cytomegalovirus in Ulcerative Colitis
Submitted by: Dr. Bryan Warren
This 32 year old man had ulcerative colitis for 4 years. Recently he developed very severe diarrhea.
Case 10 - Slide 1
|
- Depressed Type Submucosal Carcinoma
Submitted by: Dr. Yoichi Ajioka
This 66 Year old womn was symptom-free and requested a colonoscopic examination for cancer screening. A depressed type lesion was found in the rectum. This was biopsied, and was subsequently resected.
Case 11 - Slide 1
|
- Depressed Type Adenoma (Low-grade Dysplasia)
Submitted by: Dr. Yoichi Ajioka
This 54 year old man complained of anal prolapse. A rectal carcinoma was found which was resected. The lesion was actually in the sigmoid colon. It measured 2 x 1 mm.
Case 12 - Slide 1
|
|
|
|
|
Click to view with ImageScope
Click to view with a Web-Based Viewer