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Case 2
“Ileal mass”
Antonio Scapinello – Castelfranco Veneto Hospital
(Pict. by Dr. Scapinello)
Clinical history
39 y.o. man with a subocclusive crisis. The CT scan evidenced an ileal mass and an hepatic lesion ( probably of neoplastic nature).
Macroscopical description
Ileum tract including a neoplasia of the wall that ulcerated the mucous membrane and extended into the mesenteric fatty tissue and with diameter greater than 5cm. Neoplastic nodules were evidenced on the serous membrane of the intestine and some lymph nodes with a substituted appearance were isolated. Intraoperative biopsy of the hepatic lesion was performed.
Microscopical description
The neoplasia was composed of a proliferation of relatively monomorphic ovoid-spindle, at times epitheloid, cells arranged in solid nests and in honeycomb-like structures (Pict. 1 - Pict. 2). Amongst these cells were osteoclast-like giant cells which were most evident in the lymph node metastasis (Pict. 3
Pict. 4). The neoplastic cells were of medium size with an eosinophilic cytoplasm, a round hyperchromatic nucleus and central nucleoli (Pict. 5
Pict. 6). With immunohistochemistry stains cells were strongly positive for S100 (nuclear and cytoplasmic) (Pict. 7
Pict. 8) and vimentin and negative for c-Kit (Pict. 9), CD34 (Pict. 10), actin ML (Pict. 11), actin MS, desmin, HMB45, Melan-A, pancytocheratin (AE1-AE3) (Pict. 12), cytocheratin 5D3 (8,18,19) cytocheratin 7 e cytocheratin 20, EMA, chromogranin, synaptophisin, CD56 and NSE.
The hepatic lesion was confirmed as a metastasis of the lesion described above.
Diagnosis
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