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British Division of the International Academy of Pathology
 
 SYMPOSIUM ON UPPER GI & PANCREATOBILIARY PATHOLOGY
 
Prof Ian Roberts
Case 1

H Grabsch

56 year old woman suffering from dysphagia for several months. Upper gastrointestinal endoscopy found in the mid oesophagus a 4cm tumour protruding into the lumen with intact overlying mucosa. CT: well-demarcated, homogenous mass. The tumour was surgically enucleated from the oesophageal wall and had a firm, elastic consistency. The cut surface showed vague lobulation and a homogenous yellow-white colour. No haemorrhage, no necrosis.  
Case 1
Diagnosis & discussion [0]
Case 2

H Grabsch

71 year old man presenting with dysphagia and anaemia. Upper gastrointestinal endoscopy showed a partly nodular lesion in the mid oesophagus approximately 25cm from the incisors, length of the lesion approx. 21mm. After biopsy diagnosis, an oesophagectomy with lymph node dissection was performed.
 
 
Case 2
Diagnosis & discussion [0]
Case 3

N Shepherd

Male 71 years. Iron deficiency anaemia. Gastritis and duodenitis at endoscopy. Duodenal biopsies. 
Case 3
Diagnosis & discussion [0]
Case 4

N Shepherd

Female 51 years. Multinodular tumour mass 96mm in diameter involving jejunum but centred on small bowel mesentery.

 
Case 4
Diagnosis & discussion [0]
Case 5

C Verbeke

63 year old female, who presented with obstructive jaundice. CT scan showed an 18 mm long stricture of the common bile duct.

Macroscopy: Pylorus-preserving pancreatoduodenectomy specimen showing on axial slicing a 28 x 21 x 18 mm tumour in and around the distal common bile duct (both the extra- and intrapancreatic part).

Figure 1: overview of axial specimen slices (top left = most cranial slice, bottom right = most caudal slice).

Figures 2, 3 & 4 show axial specimen slices through the extrapancreatic bile duct from which slides 8, 10 and 12 were sampled.
Case 5a
Case 5b
Case 5c
Case 5 Fig 1.JPG
Case 5 Fig 2.JPG
Case 5 Fig 3.JPG
Case 5 Fig 4.JPG
Diagnosis & discussion [0]
Case 6

C Verbeke

49 year old male with a history of abdominal pain, weight loss, nausea and vomiting. Imaging showed a borderline resectable, 42x36x36 mm tumour in the pancreatic head. The tumour infiltrated the duodenum and superior mesenteric vein (SMV) over a length of 30 mm, and extended around the superior mesenteric artery (less than 30° of circumference). After treatment with 8 cycles Abraxane-Gemzar, the size of the tumour size was reduced to max 22 mm. There was no evidence of distant metastasis.

Macroscopy: Extended pancreatoduodenectomy specimen with resection of a 30 mm long segment of SMV, which is surrounded and occluded by abnormal tissue. Further resected en-bloc a 75 mm long small bowel segment, which is adherent to the anterior surface of the pancreatic head in a 15 x 15 mm large area.

Axial slicing shows a 27 x 26 x 25 mm area of tumour-suspicious tissue, which is located in the superior-anterior part of the pancreatic head and seems to infiltrate the duodenum and SMV. Possible focal infiltration of the attached small bowel.

Figure 1: axial specimen slice at the level of the adherent small bowel (slide 6c).

Figure 2: axial specimen slice at the level of SMV involvement (slides 6a & b).
Case 6a
Case 6b
Case 6c
Case 6 Fig 1.JPG
Case 6 Fig 2.JPG
Diagnosis & discussion [0]
Case 7

N Mapstone

Male 74 years. 3 year history of dysphagia. Multiple previous biopsies (in another hospital) showed fungal infection or normal squamous mucosa. Unhealthy looking “fungal” oesophagus with mobile lesion at 30cm ?keratinising tumour.

Case 7a
Case 7b
Diagnosis & discussion [0]
Case 8

N Mapstone

Male 31 years. “Hypertrophic” folds throughout stomach.

8a = fundus, 8b = lesser curve, 8c = greater curve, 8d = antrum

Case 8a
Case 8b
Case 8c
Case 8d
Diagnosis & discussion [0]
Case 9

M Rodriguez-Justo

HIV+ve 39 year-old male, treatment naïve, presented with a two months history of jaundice and problems with weight loss and abdominal pain. OGD and ERCP showed oesophageal Candidiasis and 4 healed ulcers in the stomach. In the duodenum there were similar ulcerated lesions as in the stomach.

Case 9
Case 9 CD10
Case 9 EBER
Diagnosis & discussion [0]
Case 10

M Rodriguez-Justo

63 year old male referred by his GP with a history of 3 stone weight loss in a year and epigastric pain. His first endoscopy showed extensive Candida and nodular GO junction, confirmed low-grade dysplasia on biopsy. CT abdomen and pelvis showed no significant abnormalities.

One month later repeat gastroscopy confirmed short tongue of Barrett’s (37-38cm) with low-grade dysplasia. Referred for EMR.

Since then progressive weight loss and diagnosis of HIV. Repeat OGD shows an exophytic oesophageal tumour, from 37 to 40 cm from teeth.

Case 10
Case 10 CD20
Case 10 CD3
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Case 11

T Andrews

57 year old male. At OGD Barrett’s Oesophagus and ?odd looking squamous epithelium but no focal lesion seen. Biopsies from 24cm.

Case 11
Diagnosis & discussion [0]
Case 12

T Andrews

70 year old woman with previous diagnosis of ‘dysplasia’ in the oesophagus, referred for advance imaging and endoscopic assessment. Patchy abnormalities in oesophagus on iodine and NBI. Biopsies from 24cm.

Case 12
Diagnosis & discussion [0]
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