DZI20-200

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Subspecialty Gastrointestinal

Set Frozen Conference

Topic VDE Liver

Presenter Vd019 (user needs to log in to Learn Pathology)

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Case	Clinical history	Requester	Diagnosis
Case	Clinical history	Requester	Diagnosis
Case 1	72 yo M with ileal mass - 3.1 cm encapsulated tan-white submucosal mass extruding.	Mjf79	FX1 • 1A(RS mass): spindle cell neoplasm. Do not favor metastatic melanoma. Permanent: GIST • low-grade • spindle cell type
Case 2	74 Yo M with pancreatic tumor • presenting for whipple. You receive "liver lesion." Partial hepatectomy • inked black and sectioned. EF as FX1 • 1A.	Mjf79	FX1 • 1A: hemangioma • negative for malignancy Permanent: hemangioma
Case 3	58 yo with h/o metastatic CRC. Appendix sent - sectioned to reveal 2.5 cm gray-white firm mass in the attached mesoappendix. RS-->FX1 • 1A. Proximal uninvolved appendix-->FX1B	Mjf79	FX1 • 1A (RS mass): Adenocarcinoma involving periappendiceal soft tissue and appendiceal wall. Appendiceal mucosa is benign. No evidence of appendiceal primary. Permanent: metastatic adenocarcinoma c/w colon primary
Case 4	"Cholangiocarcinoma. (Slides 1-3): ""Right • left and common hepatic duct"" - oriented Y-shaped tubular portion of ST. Left hepatic duct shaved --> FX1 (1st slide) • Right hepatic duct shaved --> FX1A (2nd slide) • common hepatic duct shaved --> FX1B (3rd slide). Specimen opened to reveal a thickened fibrotic wall (up to 0.6 cm). 4th slide: ""jejunal margin of hepatojejunostomy"" - tubular ST • EF-->FX2 (4th slide). 5th slide: ""new proximal left duct margin"" - tubular ST • EF-->FX3 (5th slide)"	Mjf79	"FX1(left hepatic duct margin): Positive for malignancy. FX1A(Right hepatic duct margin): high-grade dysplasia with concern for cancerization of duct. FX#1B(common hepatic duct margin): Adenocarcinoma. FX#2(jejunal margin of hepaticojejunostomy): c/w reactive atypia FX#3(new proximal duct margin): Positive for adenocarcinoma" "Permanent: FX1 (left and common hepatic duct margin): Invasive adenocarcinoma FX1A(Right hepatic duct margin): High-grade dysplasia FX1B(common hepatic duct margin): invasive adenocarcinom FX2(jejunal margin of hepaticojejunostomy): Small intestine with marked reactive atypia and acute and chronic inflammation. TINEM. FX3(New proximal left duct margin): invasvie adenocarcinoma • best seen on FX slides."
Case 5	46 yo M with "carcinoid tumor of intestine." Portion of small bowel - 4.5 cm tan-white firm lesion with irregular borders within mesentery. Abundant tan-white fibrous tissue extending through mesenteric tissue surrounding mass. Mucosa is uninvolved. RS mass--> FX1 and FX3 (both slides)	Mjf79	FX1 • A1: Spindle cell lesion. Lymph node. Discussed with surgeon. Defer to permanents. Permanent: Desmoid type fibromatosis involving the wall of the small intestine and mesenteric adipose tissue.
Case 6	30 yo M with Crohns. "Pelvic nodule" - 0.9 cm cyst with attached fat filled with tan-yellow fluid.	Mjf79	FX1(pelvic nodule): nodular fat necrosis • TINEM Permanent: fibroadipose tissue with fat necrosis • FBGCR to suture and CI. TINEM.
Case 7	32 yo F 11.5 cm hepatic mass. RS mass to uninvovled hepatic parenchyma FX1	Mjf79	FX1(mass): Hepatocellular neoplasm • favor hepatocellular adenoma permanent: hepatocellular adenoma
Case 8	62 yo F with retroperitoneal mass. "Small bowel mesenteric mass" 8cm pink-tan smooth walled cystic ST with scant milky white fluid. RS-->FX1	Mjf79	FX1: consistent with lymphangioma Permanent: lymphangioma
Case 9	64 yo with h/o gastric cancer • poorly differentiated with signet ring cell features. "Omental biopsy #1" ST EF	Mjf79	FX1: Favor carcinoma Permanent: Adenocarcinoma • poorly differentiated • invasive • consistent with gastric primary.
Case 10	60 yo with gallbladder mass - 1.5 cm cystic area at fundus of gallbladder. RS cystic lesion	Mjf79	FX1: Benign appearing adenomatous proliferation Permanent: Gallbladder with adenomyoma of fundus and chronic cholecystitis.
Case 11	68 yo F -- gallbladder mass • 0.6 cm ill-defined mass within fundus -->RS FX3	Mjf79	FX3(gallbladde mass): adenocarcinoma • consistent with gallbladder primary Permanent: Invasive adenocarcinoma
Case 12	70 yo M - small bowel resection • 2.2 cm tan-yellow fibrotic appearing subserosal mass. RS-->FX1	Mjf79	FX1(mass): well-differentiated neuroendocrine tumor Permanent: Neuroendocrine tumor • grade 1