MEETING No. 48 HELD ON DECEMBER 11th, 2002 AT THE SAN CARLO HOSPITAL, MILANO

Case 1
Case 2
Case 3
Case 4
Case 5

Case 1


"A NEOPLASIA OF THE ILEAL MESENTERY"
S. GAMBINI – San Carlo Hospital - Milano
(pict. by dr. Gambini)

Clinical history: a 38y.o. man presents to the Hematology Dept. because of a severe anemia of unknown cause.
An abdomen CT scan shows a 10 cm ileal mass with satellite nodules/lymph nodes. The patient undergoes surgical excision of 40 cm small bowel.
Macroscopical description: exophitic lesion, covered by eroded mucosa (pict. 1), and consisting of homogeneous lardaceous tissue (pict. 2) which extends in the bowel wall down to the serosa.
In the ileal mesentery there are satellite nodules the largest of which measures 5 cm in diameter.
Microscopical description: the tumor consists of cells infiltrating the lamina propria of the mucosa (pict. 3), where there are still some glands, and the deeper layer of the bowel wall (pict. 4).
The nodules in the mesentery are lymph nodes with neoplastic infiltration of the sinuses (pict. 5).
The neoplastic cells have a diffuse pattern of growth and are large with abundant eosinophilic cytoplasm and pleomorphic, sometimes vesicular nuclei with semi lunar or kidney shaped, prominent nucleoli, best seen on cytological imprints (pict. 6).
In the lymph nodes aspects of leuco- or erythrophagocytosis could be seen (pict. 7).
Mitoses are frequent and the proliferation index is moderate.
With immunohistochemical staining the neoplastic cells are positive for Vimentin (pict. 8), weakly positive for LCA (pict. 9), negative for S100 and strongly positive for CD68 (pict. 10).
they are also negative for large spectrum Cytokeratin, CD20, CD3, CD43, Smooth Muscle Actin, Desmin, EMA, CD15 and CD23.

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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