MEETING No. 20, HELD ON MAY 17th, 2000 AT HUMANITAS CLINICAL INSTITUTE, ROZZANO (MILANO)

Case 1
Case 2
Case 3
Case 4
Case 5

Case 6

"ABDOMINAL MASS"
EMANUELA BOVERI - S. Matteo Policlinico H, Pavia
(Pictures by dr. Boveri)

Clinical history: 26y.o. man with a one-month history of 10 kg. weight loss, after-meal vomiting, left flank ache and feeling of heaviness in the lower abdomen.
Clinical examination shows a palpable mass in all the abdominal quadrants.
A TC scan shows a 30 cm., lobulated abdominal mass with necrotic areas, which displaces but does not infiltrate the portal space, the left kidney and the bowel and extends to the anterior abdominal wall, the diaphragm and the right lung base. An exploratory laparoscopy is performed.
Frozen section examination: poorly differentiated neoplasia with necrosis; a lympho-proliferative disease is excluded. A partial excision of the abdominal mass, of the pleural and diaphragmatic mass for a 4500 grams total weight, and an ileum-colectomy are performed.
Microscopic description: sections show large groups of small and medium sized, round neoplastic cells, with hyperchromatic nuclei and scanty cytoplasm, surrounded and separated by a dense, desmoplastic fibrous stroma ( pict. 1) - ( pict. 2) - ( pict. 3).
At the periphery of some of the nests, larger, round-oval cells with clear nuclei and more abundant, eosinophilic cytoplasm are present.
There are also rare and isolated rhabdoid-type cells. There are small, focal or large areas of necrosis; mitosis are numerous and there are abundant apoptotic cells.
Immunohistochemical staining results: pictures 4 - 5 - 6 and 7 and noticeable results with CAM 5.2 ( pict. 8), Actin ( pict. 9) and NSE ( pict. 10).

Diagnosis

pict. 1	pict. 2
pict. 3	pict. 4
pict. 5	pict. 6
pict. 7	pict. 8
pict. 9	pict. 10

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