Residency Program - Case of the Month

Clinical history:

A 63 yr old female presents with worsening abdominal pain, distention, nausea and progressively fewer and smaller bowel movements. Abdominal imaging showed dilated transverse colon. Colonoscopy was inconclusive due to inability to pass the scope past a stenosis at 60 cm. CT abdomen/pelvis showed fat stranding and wall thickening from the splenic flexure to the sigmoid colon, as well as destructive lesion of the right ilium. CT chest revealed a left lung mass with encasement of the left superior lobe artery, scattered opacities within the lung parenchyma, and T3, T12 and rib lesions. The patient subsequently underwent a left hemicolectomy.

Imaging:

 

Gross description:

 Received in formalin is a segment of colon measuring 28 x 9 x 7 cm. The serosal surface is dark red-black and dusky with areas of desquamation and possible ischemic necrosis. There is an area of fibrous stricture measuring 3.2 x 2.5 x 1.8 cm that is located 8 cm from the distal end of the specimen and 18 cm from the proximal end. The colon is opened longitudinally, revealing complete luminal occlusion at the strictured area. The mucosa overlying the stricture is dark red and hemorrhagic without ulceration or exophitic lesions. Sectioning reveals effacement of the muscularis propria by an ill-defined tan-white firm lesion.

The following stains were performed:

Microscopic images

 

TTF1, +	CK19, +	CK7, +
Mucicarmine, +	10x, involving muscularis	10x, serosa

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