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{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
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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
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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
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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
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BCC - H&E - 40x
Palisading nuclei
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QUESTIONS?
42
5/8/2017
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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
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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
5/8/2017
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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
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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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©2012 MFMER | slide-88
Objectives
1. Introduce esophageal adenocarcinoma
2. Compare normal and pathological tissue cells
3. Analyze a patient case
Monday, May 08,
2017
©2012 MFMER | slide-89
Normal Esophagus
Monday, May 08,
2017http://www.sts.org/node/2268
©2012 MFMER | slide-90
Normal Esophagus
Monday, May 08,
2017
http://www.siumed.edu/~dking2/erg/GI005b.htm
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©2012 MFMER | slide-91
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
©2012 MFMER | slide-92
Adenocarcinoma Symptoms
•Dysphagia
•Weight loss without trying
•Chest pain, pressure, burning
•Worsening in digestion or heartburn
•Coughing or hoarseness
Monday, May 08,
2017
©2012 MFMER | slide-93
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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©2012 MFMER | slide-94
Gastro-esophageal Reflux Disease (GERD)
Monday, May 08,
2017
https://www.liverdoctor.com/natural-solutions-gerd-gastro-esophageal-reflux-disease/
©2012 MFMER | slide-95
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
©2012 MFMER | slide-96
Diagnosis and Treatments
• Diagnosis• Endoscopy• Biopsy• PET/CT
• Treatments• Surgery• Chemotherapy• Radiation therapy• Chemotherapy + Radiation
Monday, May 08,
2017
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©2012 MFMER | slide-97
Cancer Staging
Monday, May 08,
2017
www.roshdypharmacies.com
©2012 MFMER | slide-98
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
©2012 MFMER | slide-99
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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©2012 MFMER | slide-100
Treatments and Tests
• Prednisone
• Advair puff
• Methacholinechallenge
• Expired nitric oxide
• pH probe
Monday, May 08,
2017
https://www.slideshare.net/nroucher/restech-presentation
©2012 MFMER | slide-101
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
©2012 MFMER | slide-102
Esophageal Carcinoma Histology
Monday, May 08,
2017
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©2012 MFMER | slide-103
Esophageal Carcinoma Histology
Monday, May 08,
2017
©2012 MFMER | slide-104
Esophageal Carcinoma Histology
Monday, May 08,
2017
©2012 MFMER | slide-105
Esophageal Carcinoma Histology
Monday, May 08,
2017
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©2012 MFMER | slide-106
Esophageal Carcinoma Histology
Monday, May 08,
2017
©2012 MFMER | slide-107
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
©2012 MFMER | slide-108
Questions ?
Monday, May 08,
2017
5/8/2017
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©2012 MFMER | slide-109
Monday, May 08,
2017
Thank You
Special thanks to:Loren P. Herrera Hernandez, M.D.
Michelle Nelsen, M.S., HTL(ASCP)cm
©2012 MFMER | slide-110
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.
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Monday, May 08,
2017
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