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2015 Annual Meeting
Evening Specialty Conference - Gastrointestinal Pathology
Sunday, March 22, 2015 - 7:30pm to 9:30pm
CC Auditorium
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Case title: 62 year old man with diarrhea and rectal pain
Clinical Summary:

A 62 year old male patient presents for an elective outpatient Lower Endoscopic Ultrasound.

Indications: Diarrhea and rectal pain.


Case title: An unusual neoplasm of the stomach
Clinical Summary:

A 63 year-old Korean man, former smoker with history of heavy alcohol use, presented with mild, intermittent epigastric pain for the past 3 weeks.  There was no significant personal or family history.  Physical exam was unremarkable.  Esophagogastroduodenoscopy revealed an infiltrating, ulcerated lesion at the lesser curvature of the gastric antrum.  The biopsy obtained was read as “poorly differentiated adenocarcinoma, diffuse signet ring cell type, in a background of H. pylori-associated gastritis.”  A CT scan showed minimal lymphadenopathy in the region of the left gastric artery, but no distant disease.  The patient underwent subtotal (distal) gastrectomy with regional lymphadenectomy.

Case title: Mismatch Repair Deficiency in Colorectal Carcinoma: Lynch Syndrome or Lynch-Like?
Clinical Summary:

A 69 year old man presented for a colonoscopy for unexplained iron deficiency anemia.  Nine years prior he had surveillance colonoscopy showing 6 tubular adenomas ranging in size from 3 mm to 9 mm and six years prior he had a surveillance colonoscopy showing only 1 hyperplastic polyp in the rectum.  His current colonoscopy demonstrated two tumors in the ascending colon:  tumor #1 was a 3.0 cm fungating non-obstructing mass and tumor #2 was a 1.5 cm polypoid mass.  A right hemicolectomy was performed (see image of resected colon).  Screening for Lynch syndrome using immunohistochemistry for DNA mismatch repair proteins demonstrated the following abnormal staining patterns for tumor #1 and tumor #2 (virtual slides below).  Tumor #1 demonstrated preserved PMS2 expression within the tumor (not shown).  Tumor #2 demonstrated preserved MSH6 expression within the tumor (not shown).

Gross image of resected colon
Gross image of resected colon
Case title: 36-year-old man with ulcerative colitis and worsening bloody diarrhea
Clinical Summary:

The patient is a 36-year man with a two-year history of left sided ulcerative colitis with activity limited to the rectum and distal sigmoid colon.  Two weeks prior to the current presentation, the patient presented with a flare of colitis symptoms and underwent flexible sigmoidoscopy, where severe proctitis to 15cm was noted.   Prednisone and 5-ASA enemas were administered without significant relief (continued urgent non-bloody stools).   Therefore, steroids were tapered and a dose of IV Remicade (infliximab) was administered 6 days prior to the admission.

 

Three days later the patient experienced abdominal pain, bloody diarrhea, BRBPR, urgency and fatigue without fever, chills, nausea or vomiting.   The white count was mildly elevated with a mild left shift.  A CT of the abdomen revealed circumferential inflammation from the cecum to the hepatic flexure as well as thickening of the rectum.   Colonoscopy revealed moderate proctitis to 14cm and severe colitis with ulceration from the cecum to the mid transvers colon.  The terminal ileum was normal.  The intervening colon appeared normal.  Biopsies were taken.  

 

Following pathology interpretation, Remicade was stopped and patient was treated supportively with steroids.  Symptoms slowly improved and the patient was discharged 5 days after admission on 40mg of prednisone. 

Case title: A small bowel tumor
Clinical Summary:

83-year old female presented with lower abdominal pain and vomiting. She was given course of antibiotics.  Two days later,she re-presented with abdominal obstruction and a CT scan showed a small bowel mass.  She had a laparotomy and a 17.5 cm segment of small bowel containing a 6.0 x 4.5 x 2.5 cm tumour was resected.