Thymoma Meagan Bodin Mayo Clinic School of Health Sciences { 3Rd, May 2017

Home , Thymoma

5/8/2017

Thymoma Meagan Bodin Mayo Clinic School of Health Sciences { 3rd, May 2017

Objectives

 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

The Thymus

 Lymphatic gland in upper chest behind sternum

 Produces mature lymphocytes and helps with immunity

 Larger in adolescents than adults

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

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The Thymus

Fibrous Capsule

Medulla Cortex Trabecule

H&E, 4x

The Thymus

Hassal’s Corpuscle

H&E, 40x http://histology-world.com/photoalbum/displayimage.php?album=46&pid=809#top_display_media

Defining Thymoma

 Malignant cancer of thymus gland

 Forms on surface of thymus

 Local seeding

 Linked to myasthenia gravis

 Rare, slow-growing

 Different from thymic carcinoma

https://radiopaedia.org/cases/thymo ma-1

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

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Myasthenia Gravis

 Immune system forms antibodies blocking signals that stimulate muscle movement

 Autoimmune disease

 Symptoms include

 muscle weakness

 double vision

 difficulty swallowing

 slurred speech

Thymoma Risk Factors

 Smoking  Secondhand smoke  Asbestos exposure  Commonly recur and increased risk for other cancers

http://www.nigeriamedj.com/article.asp?issn=0300‐ http://learningradiology.com/notes/ginotes/achalasiapage.htm 1652;year=2013;volume=54;issue=1;spage=68;epage=71;aulast=Gaude Normal CT Thymoma

Categories of Thymoma

 Developed by World Health Organization

 Based on microscopic evaluation

 B3: Epithelial thymoma  A: Spindle cell thymoma

 C: Thymic Carcinoma  AB: Mixed thymoma

 Low-grade  B1: Lymphocyte-rich thymoma

 High-grade  B2: Cortical thymoma

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Masakoa Staging

 Used to determine if cancer has spread from thymus gland

 Fine needle aspiration biopsy for pathologist

 Stage 1-4B

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

Clinical History

 46-year-old female

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

 Family history of lung cancer

Clinical Diagnosis

 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

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Histology

Pleural Membrane

Lung Tissue

H&E, 4x

Histology

H&E, 40x

Histology

Muscle Tissue

Local Seeding

Necrotic Mass

H&E, 4x

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Histology: Special Stains

 AE1/AE3: keratin positive epithelial cells

 CD3: Positive T cells

 CD20: B cells AE1/AE3, 4x

CD3, 4x CD20, 4x

Histological Quality

 Fix immediately to preserve exact morphology

 Embed flat using pins

 IHC Staining

 No background staining

 No erroneous staining

Patient Follow up

 Has been declining additional radiation

 Battling myasthenia gravis

 February 2017: Stable

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Questions?

References

American Society of Clinical Oncology. (2015-2017). Thymoma: Stages. Retrieved from http://www.cancer.net/cancertypes/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

Thank You

 Michelle Nelsen

 Dr. Herrera

 Dr. Roden

7 5/8/2017

BASAL CELL CARCINOMA 22 Penny Dahlen Mayo Clinic School of Health Sciences 05/03/2017

OBJECTIVES

 Define basal cell carcinoma  Identify risk factors  Determine diagnosis  Categorize treatment options  Indicate factors of quality histology  Discuss a patient case study

BASAL CELL CARCINOMA (BCC)

 Skin cancer  Mutation of basal cells  Most common cancer  2500 BC

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RISK FACTORS

 Chronic sun exposure  Radiation therapy  Fair skin, sex, age  History of skin cancer

Sun picture from: 25 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

RISK FACTORS

 Immune-suppressing drugs  Arsenic

 Basal cell nevus Medication bottles syndrome

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

DIAGNOSIS

 Macroscopic  Clinical appearance  Microscopic  Microscopic morphology  Subtype  Nodular  Pigmented  Superficial  Morpheaform

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NODULAR BCC

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

PIGMENTED BCC

Brown, black, or blue lesion

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

SUPERFICIAL BCC

Flat, scaly, reddish, well-circumscribed patch 30

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 Education http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/dermatology/nonmelanoma-skin-cancer/

HISTOLOGIC QUALITY

 Orientation must be correct  Must clearly show epithelium  H&E must contrast nuclei, background

Basal Cell Layer

33 Courtesy of: Dr. Shashidhar Venkatesh Murthy, James Cook University, Australia https://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

TREATMENT OPTIONS

 Medicated creams  Surgical excision  Electrodesiccation and curettage (ED&C)  Cryosurgery  Radiation  Mohs surgery

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 Journal 37 http://host.madison.com/wsj/news/opinion/editorial/pardon- our-pride-over-huge-story----state/article_20b71789-9ec9- 5032-93fb-f9510579a56e.html

PATIENT CASE

 83 year-old female  History of basal cell and squamous cell carcinoma  Nodular basal cell carcinoma

NODULAR BCC

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

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PATIENT CASE

 Mohs surgery  Cleared in 3 stages

Palisading nuclei

41 BCC - H&E - 40x

QUESTIONS?

14 5/8/2017

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/ 43  Wong, C. S. (2003). Basal cell carcinoma. Bmj, 327(7418), 794-798. doi:10.1136/bmj.327.7418.794

THANK YOU

Special thanks to: Loren P. Herrera Hernandez, M.D. Michelle Nelsen, M.S., HTL (ASCP)cm

A Case Presentation By Valerie La Due May 3, 2017

15 5/8/2017

• 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

“Dating of the Endometrium” H&E, 10x http://www.pathologyoutlines.com/topic/uterusdating.html “Endometrium” H&E 40x http://www.proteinatlas.org/learn/dictionary/n ormal/endometrium/detail+1/magnification+1

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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 “Endometrial carcinoma, endometroid type” H&E, 10x http://www.pathpedia.com/education/eatlas/histopathology differentiation. /uterus_and_cervix/endometrial_carcinoma,_endometrioid_t ype.aspx • Endometrial atrophy • Without unopposed estrogen • Aggressive metastasis

“Papillary Serous Carcinoma Endothelium” H&E, 40x http://www.webpathology.com/image.asp?case=569&n=21

• Common metastasis • Pelvic cavity • Lymph nodes • Appendix • Mass formations • Ovarian • Peritoneal • Uterine

“Female Pelvic Anatomy and Sonographic Evaluation”

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

17 5/8/2017

• 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

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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/it em/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.” Intrnational Journal 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_cervi x/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/magnificat ion+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.

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Presenter: Christine Raymond 05/03/17

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

 If tumor is localized:60%-80%

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

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Normal bone tissue 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 /

Osteoblast

Lacunae with Osteocyte

Bone Matrix

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

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

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

25 5/8/2017

Abnormal shape and number of nuclei, varying amount of cytoplasm

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

 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

Malignant Bone

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

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Mitotic Figures

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

 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

Esophageal Adenocarcinoma

Di Zhou

3 May 2017

29 5/8/2017

Objectives

1. Introduce esophageal adenocarcinoma 2. Compare normal and pathological tissue cells 3. Analyze a patient case

Normal Esophagus

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Esophageal Tumors

• Benign tumors • Epithelial tumor • Squamous papilloma • Non-epithelial tumor • Leiomyoma • Malignant tumors • Squamous Cell Carcinoma • Adenocarcinoma

Adenocarcinoma Symptoms

•Dysphagia •Weight loss without trying •Chest pain, pressure, burning •Worsening in digestion or heartburn •Coughing or hoarseness

Esophageal Adenocarcinoma Risk Factors

• Age (usually >50) • Sex (male:female = 4:1) • Genetic factor • Environmental factor • Gastro-esophageal reflux disease (GERD)

31 5/8/2017

Gastro-esophageal Reflux Disease (GERD)

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

Barrett Metaplasia

• Precursor condition of esophageal adenocarcinoma • Esophago-gastro-duodenoscopy (EGD)

Diagnosis and Treatments

• Diagnosis • Endoscopy • Biopsy • PET/CT • Treatments • Surgery • Chemotherapy • Radiation therapy • Chemotherapy + Radiation

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Cancer Staging

Histology Technique

• Embedding • Embed on edge • In line

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

• Microtomy • Chatter artifact • Hydration

https://eduonline.mayo.edu/webapps/blackboard/execute/displa

Patient Information

• 76 year old caucasian male • Persistent cough (15 month) • History of smoking • Automotive service, gasoline • Newly constructed house • GERD

33 5/8/2017

Treatments and Tests • Prednisone • Advair puff • Methacholine challenge • Expired nitric oxide • pH probe

https://www.slideshare.net/nroucher/restec h-presentation

Follow-up Information

• Esophago-gastro-duodenoscopy (EGD) • Irregular gastroesophageal junction • Multiple biopsies • Barrett’s mucosa • Poorly-differentiated adenocarcinoma • CT/PET • T3, N1 tumor

Esophageal Carcinoma Histology

34 5/8/2017

Esophageal Carcinoma Histology

35 5/8/2017

Esophageal Carcinoma Histology

Follow-up Treatment

• No surgery • Chemotherapy + radiation • Protonix • Peripherally Inserted Central Catheter (PICC)

• Deceased after two https://my.clevelandclinic.org/- /scassets/images/org/health/articles/14983- years picc-01.ashx

Questions ?

36 5/8/2017

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.