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CASE 1CASE 1
CASE 1 Diagnosis: CoccidioidomycosisCASE 1 Diagnosis: Coccidioidomycosis
CoccidioidomycosisCoccidioidomycosis
Diagnosis CoccidioidomycosisDiagnosis Coccidioidomycosis
- Endemic fungal infection of the desert- Endemic fungal infection of the desertsouthwestern United Statessouthwestern United States
- Generally a self-limited illness in healthy persons.- Generally a self-limited illness in healthy persons.
- Immunosuppressed persons who contract it- Immunosuppressed persons who contract itare at increased risk for disseminated infectionare at increased risk for disseminated infection
Janis E. Blair, MD; Jerry D. Smilack, MD; Sean M. Caples, DO. Janis E. Blair, MD; Jerry D. Smilack, MD; Sean M. Caples, DO. Coccidioidomycosis in Patients With Hematologic MalignanciesCoccidioidomycosis in Patients With Hematologic MalignanciesArch Intern Med. 2005;165:113-117Arch Intern Med. 2005;165:113-117
HistoplasmosisHistoplasmosis
CryptococcosisCryptococcosis
CASE 2CASE 2
Case 2 Diagnosis: LeiomyomaCase 2 Diagnosis: Leiomyoma
Mesenchymal tumors of the gastrointestinal tract are less Mesenchymal tumors of the gastrointestinal tract are less frequent than epithelial neoplasms but they are by no frequent than epithelial neoplasms but they are by no means rare.means rare.
Gastrointestinal stromal tumors (GISTs):Gastrointestinal stromal tumors (GISTs):-Most common mesenchymal tumor of the GI tractMost common mesenchymal tumor of the GI tract- Histopathology: Histopathology:
- cellular spindledcellular spindled- epithelioidepithelioid- pleomorphic lesionspleomorphic lesions- express KIT (CD117) and CD34 proteinsexpress KIT (CD117) and CD34 proteins
True leiomyomas of the muscularis propria:True leiomyomas of the muscularis propria:
-Common in the esophagus and rare in the gastric body Common in the esophagus and rare in the gastric body and antrumand antrum
-Most frequent mesenchymal tumor of the esophagus:Most frequent mesenchymal tumor of the esophagus:- Leiomyomas outnumber GIST by a ratio of 3 to 1Leiomyomas outnumber GIST by a ratio of 3 to 1
CASE 3CASE 3
Case 3 Diagnosis: Thymoma ABCase 3 Diagnosis: Thymoma AB
Thymoma Type B1Thymoma Type B1
CLASSIFICATION OF THYMOMAS
HISTOLOGICAL TYPES CHARACTERIZATION
WHO Classification of Thymic Epithelial Tumors (1999)
This system is based upon the morphology of the epithelial cells as well as the lymphocyte to epithelial cell ratio
TYPE AHomogeneous population of neoplastic epithelial cells having spindle/oval shape, lacking nuclear atypia, and accompanied by few or no non-neoplastic lymphocytes
TYPE ABFoci having the features of type A admixed with foci rich in lymphocytes; the segregation of the two patterns can be sharp and distinct
TYPE B1Resembles the normal functional thymus by combining large expanses with an appearance practically indistinguishable from normal thymic cortex with areas resembling thymic medulla
TYPE B2Neoplastic epithelial component appears as scattered plump cells with vesicular nuclei and distinct nucleoli among a heavy population of lymphocytes; perivascular spaces are common
TYPE B3
Predominately composed of epithelial cells having round or polygonal shape and exhibiting mild atypia admixed with a minor component of lymphocytes, foci of squamous metaplasia and perivascular spaces are common
TYPE C Thymic carcinoma
CASE 4CASE 4
Case 4 Diagnosis: Giant Cell Tumor of Tendon SheetCase 4 Diagnosis: Giant Cell Tumor of Tendon Sheet
CASE 5CASE 5
Case 5 Diagnosis: Fibrous DysplasiaCase 5 Diagnosis: Fibrous Dysplasia
Fibrous dysplasia, benignt tumor (developmental arrest)Fibrous dysplasia, benignt tumor (developmental arrest)Components of normal bone are present, but they fail toComponents of normal bone are present, but they fail todifferentiate into mature structures. differentiate into mature structures.
Occurs as one of three clinical patterns:Occurs as one of three clinical patterns:1. involvement of a single bone (monostotic)1. involvement of a single bone (monostotic)
2. involvement of multiple bones( polyostotic)2. involvement of multiple bones( polyostotic)
3. Polyostotic disease, associated with cafe au lait skin 3. Polyostotic disease, associated with cafe au lait skin pigmentations and endocrine abnormalities, precocious pigmentations and endocrine abnormalities, precocious puberty (McCune- Albright syndrome). Somatic, not puberty (McCune- Albright syndrome). Somatic, not hereditary. Skeletal, skin, and endocrine lesions from G hereditary. Skeletal, skin, and endocrine lesions from G protein that constitutively activates adenyl cyclase with protein that constitutively activates adenyl cyclase with resultant cyclic adenosin monophosphate overproduction resultant cyclic adenosin monophosphate overproduction and cellular hyperfunctioning.and cellular hyperfunctioning.
CASE 6CASE 6
Case 5 Diagnosis: Chemical / Reactive GastropathyCase 5 Diagnosis: Chemical / Reactive Gastropathy
CHRONIC, REACTIVE (CHEMICAL) GASTROPATHYCHRONIC, REACTIVE (CHEMICAL) GASTROPATHY
- Very common in current clinical practice.- Very common in current clinical practice.- Changes usually more prominent in the prepyloric regionChanges usually more prominent in the prepyloric region- The usual underlying causes include chronic bile reflux The usual underlying causes include chronic bile reflux and long-term NSAID intake.and long-term NSAID intake.
The histopathologic features:The histopathologic features:-mucosal edemamucosal edema- congestioncongestion- fibromuscular hyperplasia in the lamina propriafibromuscular hyperplasia in the lamina propria- foveolar hyperplasia with a corkscrew appearance in the foveolar hyperplasia with a corkscrew appearance in the most severe formsmost severe forms
The foveolar epithelium characteristically: reactive nuclear The foveolar epithelium characteristically: reactive nuclear features and reduction of mucin.features and reduction of mucin.
The epithelial changes occur with little background The epithelial changes occur with little background chronic inflammation.chronic inflammation.
CHRONIC, REACTIVE (CHEMICAL) GASTROPATHYCHRONIC, REACTIVE (CHEMICAL) GASTROPATHY
Arch Pathol Lab Med—Vol 132, October 2008
