9 August 2006 Case of the Week #55

 

These cases can also be accessed by clicking on the Case of the Week button on the left hand side of our Home Page at www.PathologyOutlines.com. This email is sent only to those who subscribe in writing or by email. To view the images or references, you must click on the links in blue.

 

To subscribe or unsubscribe, email info@PathologyOutlines.com, indicating subscribe or unsubscribe to Case of the Week. We do not sell, share or use your email address for any other purpose. We also maintain two other email lists: to receive a biweekly update of new jobs added to our Jobs page, and to receive a monthly update of changes made to the website. You must subscribe or unsubscribe separately to these email lists.

 

Are you planning on buying any new pathology books? Check out our Books page (from the Home page, click on the Books button on the left hand side). We list over 900 books of interest to pathologists sorted by subspecialty (liver pathology, cytopathology, etc.), and add new books weekly. Lippincott offers our visitors a 10% discount, and Amazon.com offers discounts that change daily. Click on the Discounts button on the Books pages for more details.

 

We thank Dr. Jamie Shutter, George Washington University Medical Center, Washington, D.C. (USA) for contributing this case. This case was reviewed in May 2020 by Dr. Jennifer Bennett, University of Chicago and Dr. Carlos Parra-Herran, University of Toronto.

 

Case of the Week #55

 

Clinical history

 

The patient is an asymptomatic 50 year old woman with a radiographic submucosal mass at the ileocecal junction suspicious for carcinoma. An ileocolectomy was performed.

 

Microscopic images: low power #1, low power #2, medium power

 

What is your diagnosis?

 

(scroll down to continue)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Diagnosis:

 

Endometriosis

 

Discussion

 

Endometriosis may present clinically with pain or obstruction, as a mass lesion, or be an incidental finding. In the bowel, it is rarely associated with neoplasms or premalignant change (AJSP 2000;24:513, Hum Path 2000;31:456, AJCP 1982;78:555)

 

Grossly, endometriosis typically presents as serosal or subserosal nodules 5 cm or less in size. The cut surface is gray with small areas of hemorrhage. Microscopically, there are typical endometrial glands and stroma with hemosiderin in deeper layers. The lesion is often surrounded by smooth muscle. The overlying bowel epithelium may have inflammation and ulcers simulating inflammatory bowel disease or solitary rectal ulcer syndrome, but is otherwise normal. There may also be fibrosis of the bowel wall or neuronal hypertrophy.

 

The clinical differential diagnoses included diverticulitis, appendicitis, inflammatory bowel disease, irritable bowel syndrome, tuboovarian abscess and malignancy (AJSP 2001;25:445). The histologic diagnosis is usually not difficult as long as one thinks of the diagnosis. If necessary, the endometrial stroma tests immunoreactive for CD10, and the endometrial glands are negative for CEA.

 

 

Nat Pernick, M.D.
PathologyOutlines.com, LLC
30100 Telegraph Road, Suite 404
Bingham Farms, Michigan (USA) 48025
Telephone: 248/646-0325
Fax: 248/646-1736
Email: NPernick@PathologyOutlines.com