DZI20-199: VDE GI

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Topic VDE GI

Presenter VD019 (user needs to log in to Learn Pathology)

Toggle columns: Diagnosis

Case	Clinical history	Requester	Diagnosis
Case	Clinical history	Requester	Diagnosis
Case 1	Whipple - pancreatic transection margin.	Mjf79	Small neuroendocrine tumorlet (<0.5 cm) at margin. Discussed with surgeon. (not present on permanents)
Case 2	Whipple FX1: Duodenal peritoneal nodule (1st slide) FX3: Cyst wall (2nd slide) FX3A: Mass to uncinate margin (3rd slide)	Mjf79	FX1: Fibroadipose tissue with hyalinization • no carcinoma seen. (permanent same) FX3 (cyst wall): Fibrotic cyst wall with chronic inflammation • negative for carcinoma. (Psuedocyst) FX3A (mass to uncinate margin): High-grade carcinoma • uncinate margin negative • but comes to within 0.2 cm. (Recurrent undifferentiated carcinoma with osteoclastic giant cells • uncinate ngative)
Case 3	Pancreatic mass - whipple FX1: pancreas transection margin FX2: Bile duct margin FX3: Bile duct margin	Mjf79	FX1 (pancreas transection margin): TINEM FX2: (bile duct margin): single highly atypical gland. Discussed with surgeon (permanent: eroded bile duct with rare atypical glands. The atypical glands are best seen on frozen section). FX3 (bile duct margin): TINEM
Case 4	Pancreas tumor - whipple FX1: pancreatic transection margin FX1A: mass	Mjf79	FX1 (pancreatic transection margin): TINEM FX2 (mass): neuroendocrine tumor (permanent: neuroendocrine neoplasm • low grade (G1)
Case 5	pancreas mass - middle segment resection FX2: Distal margin (radial) FX2A: Tumor	Mjf79	FX2 (distal margin): Margin negative for high-grade dysplasia and malignancy. FX2A (tumor): At least intermediate grade dysplasia • negative for carcinoma (permanent: IPMN with high-grade dysplasia • branch duct type)
Case 6	pancreas mass - whipple FX2: common bile duct margin FX3: pancreatic transection margin FX4: Mass to uncinate	Mjf79	FX2 (common bile duct margin): TINEM FX3 (pancreatic transection margin): TINEM (permanent: chronic pancreatitis) FX4 (Mass to uncinate): adenocarcinoma • viable cells are present. Uncinate margin • negative for tumor (permanent: ductal adenocarcinoma)
Case 7	pancreas mass - whipple FX1: bile duct margin FX2 + level: pancreatic transection margin (2nd and 3rd slides) FX2A: mass (4th slide)	Mjf79	FX1 (bile duct margin): TINEM FX2 (pancreatic transection margin): positive for carcinoma FX2A (mass): Positive for carcinoma Permanent for part 2: Invasive adenocarcinoma with involved pancreatic transection margin
Case 8	pancreas mass - whipple FX2: bile duct margin FX4 + level: Pancreas transection margin FX5: thickened common bile duct	Mjf79	FX2 (bile duct margin): TINEM FX4 (pancreatic transection margin): Small ducts with involvement by intramucosal malignancy • at least high-grade dysplasia (permanent: invasive adenocarcinoma • moderately differentiated) FX5 (thickened common bile duct): Invasive adenocarcinoma (permanent: invasive adenocarcinoma • moderately differentiated - pancreatic head origin • possibility of bile duct considered by favored against)
Case 9	pancreas mass - whipple FX3+level: Bile duct margin FX4: Bile duct margin	Mjf79	FX3: Positive for adenocarcinoma FX4: Positive for adenocarcinoma
Case 10	pancreas mass - whipple FX1: Liver wedge biopsy FX3: Pancreas transection margin FX4: Mass	Mjf79	FX1 (Liver wedge biopsy): Biliary proliferation (permanent: bile duct adenoma) FX3: Pancreas transection margin: TINEM FX4: Mass: Adenocarcinoma • partially necrotic • greater than 2 cm away from transection margin (permanent: adenocarcinoma of the pancreas)
Case 11	pancreas mass - whipple FX1: gallbladder FX2: pancreatic transection margin	Mjf79	FX1 (gallbladder): Chronic cholecystitis and cholelithiasis and adenomyosis FX2 (pancreatic transection margin): Adenocarcinoma
Case 12	pancreas mass - whipple FX1: pancreatic transection margin (2nd slide is permanent)	Mjf79	FX1 (pancreatic transection margin): Positive for carcinoma (permanent: Invasive adenocarcinoma)