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 WISCONSIN SOCIETY OF PATHOLOGISTS 2007 ANNUAL MEETING Gastrointestinal Pathology Henry D. Appelman, M.D. Virtual Slides for Download and install ImageScope to view the virtual slide scans ImageScope Users Guide Virtual Slide Scans
Case Histories CASE 1: CASE 2: CASE 3: CASE 4: CASE 5: Long term immobilized with severe rheumatoid arthritis, Admitted to Emergency Department with acute renal failure. Bloody diarrhea led to colonoscopy with the finding of extensive severe inflammation/ulceration. Random biopsies of the ulcerated colon were taken. The endoscopist’s concerns were whether this was infectious, ischemic, pseudomembranous or ulcerative colitis. CASE 6: 2 months of diarrhea. Leukocytes on stool exam, Colonoscopy: mild diffuse inflammation. The patient had been on multiple medications including CASE 7: RLQ pain. The specimen was an appendix with a 1 cm transmural defect in the middle which was thought by the prosector to be due to surgical manipulation, rather than a true rupture. The mid to distal part was covered by exudates. CASE 8: CASE HISTORY 1 Stomach wall bump in an adult woman. The specimen was a 1.8 cm piece of stomach with a 0.6 cm pink-purple irregular raised lesion, which was later referred to as a nodule.
Have I driven you crazy yet?
CASE HISTORY 2 Random colon biopsies in a 52 yo man with a four month history of diarrhea. How many diseases can you find?
CASE HISTORY 3 No information other than the patient has dysphagia and a history of H pylori. I want everyone to count eosinophils in the 2 high power fields on the slides with the questions.
CASE HISTORY 4 No information other than “colon polyps”. The specimen was multiple fragments that when made into a pile measured 1 x 0.6 x 0.3 cm. The pile was not weighed.
Do the polyps in this case fit into a specific category or group,
CASE HISTORY 5 48 yo M Long term immobilized with severe rheumatoid arthritis, treated with prednisone. Admitted to Emergency Department with acute renal failure. Bloody diarrhea led to colonoscopy with the finding of extensive severe inflammation/ulceration. Random biopsies of the ulcerated colon were taken. The endoscopist’s concerns were whether this was infectious, ischemic, pseudomembranous or ulcerative colitis.
So, which is it:
CASE HISTORY 6 64 yo F. 2 months of diarrhea. Leukocytes on stool exam, but stool cultures negative. Colonoscopy: mild diffuse inflammation. The patient had been on multiple medications including Trazodone, Ativan, Depakote, 5 day course of Ciprofloxacin. Trazodone: used for the treatment of depression, panic attacks, agoraphobia, cocaine withdrawal, and aggressive behavior. Ativan: an antianxiety drug used for the management of anxiety disorders and anxiety associated with depression. Depakote: for the treatment of bipolar disorder, epilepsy, and migraine headaches. Ciprofloxacin: used to treat infections of the skin, lungs, airways, bones, and joints caused by susceptible bacteria.; effective in treating infectious diarrheas caused by E. coli, campylobacter jejuni, and shigella bacteria. Did she get this because of the diarrhea or because she had an infection somewhere? The tissue had about 6 pieces. Although we were not told the biopsy sites, I suspect that these were random biopsies from throughout the colon So, if that supposition is correct, then any of the biopsies are typical of the disease.
What would you like to do to prove your diagnosis? What are you going to do with the superficial giant cells?
CASE HISTORY 7 51 yo F. RLQ pain. The specimen was an appendix with a 1 cm transmural defect in the middle which was thought by the prosector to be due to surgical manipulation, rather than a true rupture. The mid to distal part was covered by exudates. Multiple choice question: 1. A goblet cell carcinoid tumor
CASE HISTORY 8 No information except for the history of rectal bleeding. The specimen was submitted as an anal papilla.
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