PatientVignettes TriStateCombined.pptx...

5/8/2017

1

{Thymoma

Meagan BodinMayo Clinic School of Health Sciences3rd, May 2017

Discuss the location and purpose of the thymus gland

Describe thymoma and its relationship to myasthenia gravis

Demonstrate an understanding of the staging and categories of

thymoma

Explain the histology of normal thymus compared to thymoma

Discuss special stains that can be utilized to demonstrate

thymoma

Objectives

Lymphatic gland in upper

chest behind sternum

Produces mature

lymphocytes and helps

with immunity

Larger in adolescents

than adults

The Thymus

https://www.cancer.gov/types/thymoma/patient/thymoma-treatment-pdq

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The Thymus

H&E, 4x

Fibrous Capsule

Trabecule

MedullaCortex

The Thymus

H&E, 40x

http://histology-world.com/photoalbum/displayimage.php?album=46&pid=809#top_display_media

Hassal’sCorpuscle

Malignant cancer of thymus gland

Forms on surface of thymus

Local seeding

Linked to myasthenia gravis

Rare, slow-growing

Different from thymic carcinoma

Defining Thymoma

https://radiopaedia.org/cases/thymoma-1

http://www.humpath.com/spip.php?article19029

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Immune system forms antibodies blocking signals that

stimulate muscle movement

Autoimmune disease

Symptoms include

muscle weakness

double vision

difficulty swallowing

slurred speech

Myasthenia Gravis

Thymoma Risk Factors Smoking

Secondhand smoke

Asbestos exposure

Commonly recur and increased risk for other cancers

Normal CT Thymoma

http://www.nigeriamedj.com/article.asp?issn=0300‐1652;year=2013;volume=54;issue=1;spage=68;epage=71;aulast=Gaude

http://learningradiology.com/notes/ginotes/achalasiapage.htm

A: Spindle cell thymoma

AB: Mixed thymoma

B1: Lymphocyte-rich thymoma

B2: Cortical thymoma

Categories of Thymoma

B3: Epithelial thymoma

C: Thymic Carcinoma

Low-grade

High-grade

Developed by World Health Organization

Based on microscopic evaluation

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Used to determine if cancer has spread from thymus

gland

Fine needle aspiration biopsy for pathologist

Stage 1-4B

Masakoa Staging

https://www.endocrineweb.com/professional/research-updates/thyroid-disorders/

46-year-old female

Smoked one pack of cigarettes/day from age 16-46

Family history of lung cancer

Clinical History

Summer 2010: Diagnosed with myasthenia gravis

April 2011: Mass in the anterior mediastinum

June 2011: Thymectomy surgery and radiation therapy

Mid-2012: Presented with metastatic thymoma

Nov 2014: Right upper quadrant pain and CT scan reveals bile

stone and lung mass

January 2015: Right lower lobectomy, mediastinal

lymphadenectomy, and resection of right hemidiaphragm

Clinical Diagnosis

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Histology

H&E, 4x

Lung Tissue

Pleural Membrane

Histology

H&E, 40x

Histology

H&E, 4x

Muscle Tissue

Local Seeding

Necrotic Mass

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AE1/AE3: keratin

positive epithelial cells

CD3: Positive T cells

CD20: B cells

Histology: Special Stains

AE1/AE3, 4x

CD20, 4xCD3, 4x

Fix immediately to preserve exact

morphology

Embed flat using pins

IHC Staining

No background staining

No erroneous staining

Histological Quality

Has been declining additional radiation

Battling myasthenia gravis

February 2017: Stable

Patient Follow up

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Questions?

ReferencesAmerican Society of Clinical Oncology. (2015-2017). Thymoma:

Stages. Retrieved from http://www.cancer.net/cancer-types/thymoma/stages

National Cancer Institution. (August 9, 2016). Thymoma and Thymic Carcinoma Treatment. Retrieved from https://www.cancer.gov/types/thymoma/patient/thymoma-treatment-pdq

Stanford Health Care. (2017). Types of Thymoma and Thymic Cancer. Retrieved from https://stanfordhealthcare.org/medical-conditions/cancertypes.html

Taylor, Tim. (1999-2017). Thymus Gland. Retrieved from http://www.innerbody.com/image_endoov/lymp04-new.html

Michelle Nelsen

Dr. Herrera

Dr. Roden

Thank You

5/8/2017

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BASAL CELL CARCINOMAPenny Dahlen

Mayo Clinic School of Health Sciences

05/03/2017

22

OBJECTIVES

Define basal cell carcinoma

Identify risk factors

Determine diagnosis

Categorize treatment options

Indicate factors of quality histology

Discuss a patient case study

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BASAL CELL CARCINOMA (BCC) Skin cancer

Mutation of basal cells

Most common cancer

2500 BC

24

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RISK FACTORS

Chronic sun exposure

Radiation therapy

Fair skin, sex, age

History of skin cancer

Sun picture from: http://www.clipartkid.com/decorative-sun-clip-art-at-clker-com-vector-clip-art-online-royalty-4ByTiK-clipart/Couple picture from:http://clipart-work.net/single/2087482.html

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RISK FACTORS

Immune-suppressing drugs

Arsenic

Basal cell nevus syndrome

Medication bottles

Picture from Global Healing Center website:http://www.globalhealingcenter.com/natural-health/wp-content/uploads/2015/04/arsenic.jpg

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DIAGNOSIS

Macroscopic Clinical appearance

Microscopic Microscopic morphology

Subtype Nodular

Pigmented

Superficial

Morpheaform

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NODULAR BCC

Pearly white, skin-colored, or pink papule with a rolled border28

PIGMENTED BCC

Brown, black, or blue lesion

Picture from: Cleveland Clinic Center for Continuing Educationhttp://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/dermatology/nonmelanoma-skin-cancer/

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SUPERFICIAL BCC

Flat, scaly, reddish, well-circumscribed patch

Picture from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC214105/

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MORPHEAFORM

BCC

White, waxy, scar-like lesion without a clearly defined border

Picture from: Cleveland Clinic Center for Continuing Educationhttp://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/dermatology/nonmelanoma-skin-cancer/

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HISTOLOGIC QUALITY

Orientation must be correct

Must clearly show epithelium

H&E must contrast nuclei, background

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Basal Cell Layer

Courtesy of: Dr. Shashidhar Venkatesh Murthy, James Cook University, Australiahttps://www.slideshare.net/vmshashi/pathology-of-skin-common-disorders

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Picture from: http://missinglink.ucsf.edu/lm/dermatologyglossary/basal_cell_carcinoma.html

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TREATMENT OPTIONS

Medicated creams

Surgical excision

Electrodesiccation and curettage (ED&C)

Cryosurgery

Radiation

Mohs surgery

35

MOHS SURGERY

Picture from: http://www.uchospitals.edu/specialties/cancer/skin/mohs.html

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INTERESTING FACT

Frederick E. Mohs

Most effective technique

Picture from: Wisconsin State Journalhttp://host.madison.com/wsj/news/opinion/editorial/pardon-our-pride-over-huge-story----state/article_20b71789-9ec9-

5032-93fb-f9510579a56e.html

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PATIENT CASE

83 year-old female

History of basal cell and squamous cell carcinoma

Nodular basal cell carcinoma

38

NODULAR BCC

Pearly white, skin-colored, or pink papule with a rolled border39

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PATIENT CASE

Mohs surgery

Cleared in 3 stages

40

BCC - H&E - 40x

Palisading nuclei

41

QUESTIONS?

42

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REFERENCES Basal cell carcinoma. (n.d.). Retrieved April 23, 2017, from http://missinglink.ucsf.edu/lm/dermatologyglossary/basal_cell_carcinoma.html

Basal cell carcinoma. (n.d.). Retrieved April 23, 2017, from https://www.aad.org/public/diseases/skin-cancer/basal-cell-carcinoma

Brown, R. W. (2009). Histologic preparations: Common problems and their solutions. Northfield, IL: College of American Pathologists.

Carson, F. L., & Cappellano, C. H. (2015). Histotechnology: A self instructional text (4th ed.). Chicago: ASCP.

Crouch, H. E. (1983, April). History of basal cell carcinoma and its treatment. Retrieved April 9, 2017, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1438987/?page=4

Decorative sun clip art at clker com vector clip art [Cartoon]. (n.d.). Retrieved April 22, 2017, from http://www.clipartkid.com/decorative-sun-clip-art-at-clker-com-vector-clip-art-online-royalty-4ByTiK-clipart/

Eroschenko, V. P., & DiFiore, M. S. (2013). Integumentary system. In DiFiore's atlas of histology with functional correlations (12th ed., pp. 264-283). Baltimore: Wolters Kluwer / Lippincott Williams & Wilkins.

Group, E., DC. (2016, February 29). 4 sources of arsenic you'd never expect. Retrieved April 22, 2017, from http://www.globalhealingcenter.com/natural-health/4-sources-of-arsenic-youd-never-expect/

Leonardi, G., Vahter, M., Clemens, F., Goessler, W., Gurzau, E., Hemminki, K., . . . Fletcher, T. (2012). Inorganic arsenic and basal cell carcinoma in areas of Hungary, Romania, and Slovakia: A case-control study. Environmental Health Perspectives, 120(5), 721-726. doi:10.1289/ehp.1103534

Marzuka, A. G., & Book, S. E. (2015, June). Basal cell carcinoma: Pathogenesis, epidemiology, clinical features, diagnosis, histopathology, and management. Retrieved April 23, 2017, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4445438/#R23

Mayo Clinic Staff. (2015, September 17). Mohs surgery. Retrieved April 2, 2017, from http://www.mayoclinic.org/tests-procedures/mohs-surgery/basics/definition/prc-20014261

Mayo Clinic Staff. (2016, October 05). Basal Cell Carcinoma. Retrieved April 2, 2017, from http://www.mayoclinic.org/diseases-conditions/basal-cell-carcinoma/home/ovc-20251803

McConnell, T. H., Paulson, V. A., & Valasek, M. A. (2014). Disorders of the skin. In The nature of disease: Pathology for the health professions (Second ed., pp. 671-703). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

Mohs micrographic surgery. (n.d.). Retrieved April 23, 2017, from http://www.uchospitals.edu/specialties/cancer/skin/mohs.html

Murthy, S. V., MD. (2010, August 30). Pathology of skin - Common disorders. Retrieved April 9, 2017, from https://www.slideshare.net/vmshashi/pathology-of-skin-common-disorders

Old people cartoons clipart #2087482. (n.d.). Retrieved April 22, 2017, from http://clipart-work.net/single/2087482.html

Tung, R., & Vidimos, A. (2009, January). Nonmelanoma skin cancer. Retrieved April 23, 2017, from http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/dermatology/nonmelanoma-skin-cancer/

Wong, C. S. (2003). Basal cell carcinoma. Bmj, 327(7418), 794-798. doi:10.1136/bmj.327.7418.79443

THANK YOU

Special thanks to:

Loren P. Herrera Hernandez, M.D.

Michelle Nelsen, M.S., HTL (ASCP)cm

44

A Case PresentationBy Valerie La DueMay 3, 2017

5/8/2017

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• Learn physiology of PSC

• Distinguish PSC from other conditions

• Review severity of the condition

• Identify histology techniques

• Evaluate associated case study

• Discuss diagnosis and prognosis

• Stratum functionalis• Uterine glands encased

in connective tissue

• Ciliated columnar epithelium

• Stratum basalis• Functional layer

formation

• Myometrium• Vascular, smooth muscle

layer

“Endometrial Cycle and Infertility”

https://www.slideshare.net/DrRahulJaipur/endometrial-cycle-and-infertility-drrahulphysiologysms-mc-jaipur

“Endometrium” H&E 40x

http://www.proteinatlas.org/learn/dictionary/normal/endometrium/detail+1/magnification+1

“Dating of the Endometrium” H&E, 10x

http://www.pathologyoutlines.com/topic/uterusdating.html

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• Poorly differentiated cells• Dark hyperchromatic cells

• Mitotic figures

• Abnormal papillary glandular structure• Neoplastic cellular structures

• Necrosis with protrusion of myometrium

“Papillary Serous Carcinoma of Endothelium” H&E, 40x

http://www.webpathology.com/image.asp?case=569&n=21

• Endometroid carcinoma are well-differentiated• Resemble proliferative endometrium

• Delayed metastasis

• Stimulated with unopposed estrogen

• PSC structure containing poor differentiation.• Endometrial atrophy

• Without unopposed estrogen

• Aggressive metastasis

“Papillary Serous Carcinoma Endothelium” H&E, 40x

“Endometrial carcinoma, endometroid type” H&E, 10x

http://www.webpathology.com/image.asp?case=569&n=21

http://www.pathpedia.com/education/eatlas/histopathology/uterus_and_cervix/endometrial_carcinoma,_endometrioid_type.aspx

• Common metastasis• Pelvic cavity

• Lymph nodes

• Appendix

• Mass formations• Ovarian

• Peritoneal

• Uterine

http://www.ultrasoundregistryreview.com/OBTrial4.html

“Female Pelvic Anatomy and Sonographic Evaluation”

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• Specimen oriented as instructed• Representation of endometrial layers

• Other areas routine unless specified

• Sectioned variable to desired stain• Routinely H&E slides

• Quality H&E stain distinguish to components

• 61 year old healthy female• 2000, cyst in cul-de-sac

• Hormone replacement for osteopenia

• Post-menopausal bleeding

• PSC with confined ovarian mass• Grade ¾ carcinoma

• 9x8.5x5cm, confined to ovary

• PSC positive cells in cul-de-sac

H&E, 60x

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• Fallopian tube and ovary, right salpingo-oopherectomy• Unremarkable

• Endometrial hysterectomy• Atrophic tissue

• Adnexal region, left excision• Adenosalpingosis

H&E, 60x

H&E, 60x

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• Cytology for alternative evidence• Cervical pap smear

• Tumor cells clump together

• Glandular appearance

• Dark malignant cells

• Mitotic figures

PAP, 40x

PAP, 60x

• Additional biopsies unremarkable

• Hormonal therapy rejected

• Chemotherapy plan for carcinoma

• Patient lived without problems

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• Bloomer, David and Paula. Prof. Arulkumaran, Sabaratnam. “The Endometrial Cycle.” The Global Library of Women’s Medicine, July. 2008. Web. http://www.glowm.com/section_view/heading/The%20Endometrial%20Cycle/item/292 Accessed 31 Apr. 2017.

• Boyraz, Gokhan MD. Salman, Mehmet Coskun MD….* “Extrauterine Spread, Adjuvant Treatment, and Prognosis in Noninvasive Uterine Papillary Serous Carcinoma of the Endometrium: A Reproductive Multicenter Study.” IntrnationalJournal of Gynecological Cancer. 15 Aug. 2016.

• Cham, Stephanie. Huang, Yongmei. Tergas, Ana I. Hou, June Y. Burke, William M. Deutsch, Israel. Ananth. Cande V. Neugut, Alfred I. Hershman, Dawn L. “Utility of radiation therapy for early-stage uterine papillary serous carcinoma.” Gynecologic Onocology. 23 Mar. 2017.

• Dr. Ramnani, Dharam. “Papillary Serous Carcinoma of Endothelium.” WebPathology, 2 Apr. 2017. Web. http://www.webpathology.com/image.asp?case=569&n=21 Accessed 31 Apr. 2017.

• “Endometrial carcinoma, endometriod type.” PathPedia. Web. http://www.pathpedia.com/education/eatlas/histopathology/uterus_and_cervix/endometrial_carcinoma,_endometrioid_type.aspx Accessed 1 Mar. 2017.

• “Endometrium.” The Human Protein Atlas. Web. http://www.proteinatlas.org/learn/dictionary/normal/endometrium/detail+1/magnification+1

• Eroschenko, Victor. diFiore’s Atlas of Histology with Functional Correlations. Wolters Kluwer: Lippincott Williams & Wilkins. 2013.

• Jaipur, Rahul. “Endometrial cycle and infertility.” SlideShare. Jan. 2011. Web. https://www.slideshare.net/DrRahulJaipur/endometrial-cycle-and-infertility-drrahulphysiologysms-mc-jaipur

• Kar, Asaranti. Kar, Tushar. Dha, Ipsita, Panda, Sasmita. “Squash cytodiagnosis of synchronous papillary serous carcinoma of ovary and endothelium with demonstration of serous tubal intraepithelial carcinoma as a precursor lesion.” Indian Journal of Pathology and Microbiology. 14 Feb. 2017.

• McConnell, Thomas. The Nature of the Disease. Wolkers Kuwer: Lippencott Williams & Wilkins. 2014.

• Pernick, Nat. “Dating of Endometrium.” PathologyOutlines.com. 16 Jan. 2017. Web. http://www.pathologyoutlines.com/topic/uterusdating.html

• Pierce, Stuart R. Stine, Jessica E. Gehrig, Paola A. Havrilesky, Laura J. Secord, Angeles A. Nakayama, John. Snavely, Anna C. Moore, Dominic T. Kim, Kenneth H. “Prior breast cancer and tamoxifen exposure does not influence outcomes in women with uterine papillary serous carcinoma.” Gynecologic Onocology. 3 Mar. 2017.

5/8/2017

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Presenter: Christine Raymond05/03/17

Define Osteosarcoma Describe normal bone Describe abnormal bone Outline osteosarcoma case information Review the role of the histology technician in

diagnosis

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A malignant tumor of bone, proliferation of osteoblasts

A.k.a osteogenic carcinoma Most common type of cancer that develops in

bone Mostly occur in children and young adults Most occur in metaphysis of long bone

Where in the skeleton osteosarcoma most often occurs. [Photograph]. (2016). Bone cancer research trust, Charitable incorporated organization, Horsforth

Leeds.

Where is Osteosarcoma Found?

If tumor is localized:60%-80%

If tumor has metastasized:15%-30%◦ Spread to lungs 40%

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Boundless. "Cell Types in Bones." Boundless Biology Boundless, 23 Jun. 2016. Retrieved 22 Apr. 2017 from https://www.boundless.com/biology/textbooks/boundless-biology-

textbook/the-musculoskeletal-system-38/bone-216/cell-types-in-bones-816-12058 /

Normal bone tissue

Normal Bone 40x H&E [Personal photograph taken in Mayo Clinic Histology Student Laboratory]. (2017, April 12).

Normal bone

Lacunae with Osteocyte

Bone Matrix

Osteoblast

Bone Marrow

Osteosarcoma forms neoplastic bone◦ Not as strong

Presents as a painful enlarging mass◦ Swelling is also common

Spreads via the bloodstream

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Osteoblastic Chondroblastic Fibroblastic Mixed Small Cell Telangiectatic High-grade surface Pagetoid Extra-skeletal Post-radiation

Osteosarcoma [Photograph]. (2016, February 3). Mayo Foundation for Medical Education and Research, Mayo Clinic, Rochester.

Osteosarcoma Tumor

Wittig, J. C., Dr. (2014). Gross Pathology: Osteosarcoma of Distal Femur [Photograph]. Osteosarcoma, Hackensack University Medical

Center, Hackensack.

Gross Pathology of Osteosarcoma

5/8/2017

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Malignant bone 40x H&E [Personal photograph taken in Mayo Clinic Histology Laboratory]. (2017, April 12).

Malignant Bone

Abnormal shape and number of nuclei, varying amount of cytoplasm

Female 12 years of age Right knee and distal thigh pain (10/2011) Referred by her chiropractor

High grade chondroblastic osteosarcoma Diaphysis of right femur 29 weeks of chemotherapy total Resection of tumor (13.5x3.9x3.2) 30% cells viable & 70% necrosis

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Recurrence with left lung metastasis (01/2014)◦ Underwent Chemotherapy

Recurrence with metastasis in: (10/2015)◦ Right tibia◦ Left iliac bone◦ Left femur◦ Enlarging pulmonary metastasis

One of the fastest growing types Does not look like normal bone◦ Makes cartilage

Mitotic figures present

Tumor vs. Malignant bone 40x H&E [Personal photograph taken in Mayo Clinic Histology Student Laboratory]. (2017, April 27).

Tumor vs. Malignant Bone

Tumor

Malignant Bone

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Chondroblastic Osteosarcoma 40x H&E [Personal photograph taken in Mayo Clinic Histology Student Laboratory]. (2017, April 12).

Chondroblastic Osteosarcoma

Mitotic Figures

Embedding◦ At an angle◦ Flat as possible, without breaking

Microtomy◦ May need time in decal

Staining◦ H&E

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American Cancer Society. Cancer Facts & Figures 2014. Atlanta, Ga. American Cancer Society; 2014.

Boundless. "Cell Types in Bones." Boundless Biology Boundless, 23 Jun. 2016. Retrieved 22 Apr. 2017 from https://www.boundless.com/biology/textbooks/boundless-biology-textbook/the-musculoskeletal-system-38/bone-216/cell-types-in-bones-816-12058/

Carson, Freida L. HTmMASP, PhD.”Instrumentation.”Histotechnology A Self Instructional Text.4thed.Singapore:American Society for ClinicalPathology, 2015.60-66.Print.

Chondroblastic Osteosarcoma 40x H&E [Personal photograph taken in Mayo Clinic Histology Student Laboratory]. (2017, April 12).

Malignant bone 40x [Personal photograph taken in Mayo Clinic Histology Laboratory]. (2017, April 12).

McConnell, T. H., Dr. (2014). The Nature of Disease Pathology For the Health Professions (2nd ed., Vol. 1). Baltimore, MD: S4Carlisle Publishing Services.

Normal Bone 40x H&E [Personal photograph taken in Mayo Clinic Histology Student Laboratory]. (2017, April 12).

Osteosarcoma 40x H&E [Photograph]. (2016, February 3). Mayo Foundation for Medical Education and Research, Mayo Clinic, Rochester.

Tumor vs. Malignant bone [Personal photograph taken in Mayo Clinic Histology Student Laboratory]. (2017, April 27).

Where in the skeleton osteosarcoma most often occurs. [Photograph]. (2016). Bone cancer research trust, Charitable incorporated organization, Horsforth Leeds.

Wittig, J. C., Dr. (2014). Gross Pathology: Osteosarcoma of Distal Femur [Photograph]. Osteosarcoma, Hackensack University Medical Center, Hackensack.

Special Thank You To:Loren P. Herrera Hernandez, MD

©2012 MFMER | slide-87

Esophageal Adenocarcinoma

Di Zhou

3 May 2017Monday, May 08,

2017

5/8/2017

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Objectives

1. Introduce esophageal adenocarcinoma

2. Compare normal and pathological tissue cells

3. Analyze a patient case

Monday, May 08,

2017


Normal Esophagus

Monday, May 08,

2017http://www.sts.org/node/2268


Normal Esophagus

Monday, May 08,

2017

http://www.siumed.edu/~dking2/erg/GI005b.htm

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Esophageal Tumors

• Benign tumors • Epithelial tumor

• Squamous papilloma• Non-epithelial tumor

• Leiomyoma

• Malignant tumors• Squamous Cell Carcinoma• Adenocarcinoma

Monday, May 08,

2017

https://www.drugs.com/health-guide/esophageal-cancer.html


Adenocarcinoma Symptoms

•Dysphagia

•Weight loss without trying

•Chest pain, pressure, burning

•Worsening in digestion or heartburn

•Coughing or hoarseness

Monday, May 08,

2017


Esophageal Adenocarcinoma Risk Factors

• Age (usually >50)

• Sex (male:female = 4:1)

• Genetic factor

• Environmental factor

• Gastro-esophageal reflux disease (GERD)

Monday, May 08,

2017

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Gastro-esophageal Reflux Disease (GERD)

Monday, May 08,

2017

https://www.liverdoctor.com/natural-solutions-gerd-gastro-esophageal-reflux-disease/


Barrett Metaplasia

• Precursor condition of esophageal adenocarcinoma

• Esophago-gastro-duodenoscopy (EGD)

Monday, May 08,

2017

http://bme240.eng.uci.edu/students/07s/jpuckett/page_212.htm


Diagnosis and Treatments

• Diagnosis• Endoscopy• Biopsy• PET/CT

• Treatments• Surgery• Chemotherapy• Radiation therapy• Chemotherapy + Radiation

Monday, May 08,

2017

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Cancer Staging

Monday, May 08,

2017

www.roshdypharmacies.com


Histology Technique

• Embedding• Embed on edge• In line

• Microtomy• Chatter artifact• Hydration

Monday, May 08,

2017

https://eduonline.mayo.edu/webapps/blackboard/execute/displayLearningUnit?course_id=_10165_1&content_id=_445260_1

https://eduonline.mayo.edu/webapps/blackboard/execute/displayLearningUnit?course_id=_10165_1&content_id=_445211_1


Patient Information

• 76 year old caucasian male

• Persistent cough (15 month)

• History of smoking

• Automotive service, gasoline

• Newly constructed house

• GERD

Monday, May 08,

2017

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Treatments and Tests

• Prednisone

• Advair puff

• Methacholinechallenge

• Expired nitric oxide

• pH probe

Monday, May 08,

2017

https://www.slideshare.net/nroucher/restech-presentation


Follow-up Information

• Esophago-gastro-duodenoscopy (EGD) • Irregular gastroesophageal junction

• Multiple biopsies• Barrett’s mucosa• Poorly-differentiated adenocarcinoma

• CT/PET• T3, N1 tumor

Monday, May 08,

2017


Esophageal Carcinoma Histology

Monday, May 08,

2017

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Monday, May 08,

2017

• No surgery

• Chemotherapy + radiation

• Protonix

• Peripherally Inserted Central Catheter (PICC)

• Deceased after two years

Follow-up Treatment

https://my.clevelandclinic.org/-/scassets/images/org/health/articles/14983-picc-01.ashx


Questions ?

Monday, May 08,

2017

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Monday, May 08,

2017

Thank You

Special thanks to:Loren P. Herrera Hernandez, M.D.

Michelle Nelsen, M.S., HTL(ASCP)cm


Reference

• Shaheen, Nicholas, and David F. Ransohoff. "Gastroesophageal reflux, barrett esophagus, and esophageal cancer: scientific review." Jama 287.15 (2002): 1972-1981.

• Cook, Megan, et al. "Gastrointestinal biopsies: more action and less ‘chatter’?." Journal of Histotechnology 34.2 (2011): 65-68.

• Park, Kyung Sik. "Benign Esophageal Tumors." Clinical Gastrointestinal Endoscopy. Springer Berlin Heidelberg, 2014. 47-59.

• McConnell, T. H. (2007). The nature of disease: pathology for the health professions. Lippincott Williams & Wilkins.

• Devesa, Susan S., William J. Blot, and Joseph F. Fraumeni. "Changing patterns in the incidence of esophageal and gastric carcinoma in the United States." Cancer 83.10 (1998): 2049-2053

• Lagergren, Jesper, et al. "Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma." New England journal of medicine 340.11 (1999): 825-831.

• Rice, Thomas William. "Esophageal cancer staging." Esophageal Cancer. Springer International Publishing, 2015. 93-103.

Monday, May 08,

2017

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