MEETING No. 45 - SEPTEMBER 11th, 2002 - NIGUARDA HOSPITAL, MILAN

Case 1
Case 2
Case 3
Case 4
Case 5

Caso 2


“RETROPERITONEAL MASSES”
G. GAZZANO– S. Paolo Hospital - Milano
(pict. by dr. Gazzano)

Clinical history: a 69y.o. woman undergoes excision of two large left and right retroperitoneal masses (A and B) and of the gall bladder (C).
Macroscopical description: A), B) well defined and apparently capsulated, round masses measuring A) 34x25x9cm and B) 38x25x9 and weighing A) 3812gr and B) 4658gr; both appear yellowish and soft (pict. 1) with focal hemorrhagic areas on cut surface.
C) 8cm long gall bladder with thickened walls and focally elevated mucosa.
Microscopical description: A&B) There is a proliferation of spindled, atypical cells (pict. 2) admixed to a very vascular fibrous stroma (pict. 3); there are also some vacuolated cells (pict. 4) and areas with bizarre cells (pict. 5) with hyperchromatic nuclei and eosinophilic, finely vacuolated cytoplasm (pict. 6).
In only one of the sections there is a group of epithelial cells (pict. 7) with intra-cytoplasmic mucin (pict. 8), which are positive for Cytokeratin AE1/AE3 (pict. 9, left mass).
C) trans-parietal infiltration by glandular cells (pict. 10 - pict. 11) with PAS positive, intra-cytoplasmic mucin (pict. 12); these cells extend beyond the muscle layer (pict. 13) to the adipose tissue which surrounds the gall bladder; there is neoplastic lymphangitis.

Diagnosis

pict. 1	pict. 2
pict. 3	pict. 4
pict. 5	pict. 6
pict. 7	pict. 8
pict. 9	pict. 10
pict. 11	pict. 12
pict. 13

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