1. SPUC December 15, 2008 Francisco.LaRosa@UCDenver.edu

2. CASE 1

3. CASE 1 Diagnosis: Coccidioidomycosis

4. Coccidioidomycosis

5. Diagnosis Coccidioidomycosis - Endemic fungal infection of the desert southwestern United States - Generally a self-limited illness in healthy persons. - Immunosuppressed persons who contract it are at increased risk for disseminated infection Janis E. Blair, MD; Jerry D. Smilack, MD; Sean M. Caples, DO. Coccidioidomycosis in Patients With Hematologic Malignancies Arch Intern Med. 2005;165:113-117

6. Histoplasmosis

7. Cryptococcosis

8. CASE 2

18. Case 2 Diagnosis: Leiomyoma

19. Mesenchymal tumors of the gastrointestinal tract are less frequent than epithelial neoplasms but they are by no means rare. Gastrointestinal stromal tumors (GISTs): -Most common mesenchymal tumor of the GI tract - Histopathology: - cellular spindled - epithelioid - pleomorphic lesions - express KIT (CD117) and CD34 proteins

20. True leiomyomas of the muscularis propria: -Common in the esophagus and rare in the gastric body and antrum -Most frequent mesenchymal tumor of the esophagus: - Leiomyomas outnumber GIST by a ratio of 3 to 1

21. CASE 3

22. Case 3 Diagnosis: Thymoma AB

23. Thymoma Type B1

24. CLASSIFICATION OF THYMOMAS HISTOLOGICAL TYPESCHARACTERIZATION WHO Classification of Thymic Epithelial Tumors (1999) This system is based upon the morphology of the epithelial cells as well as the lymphocyte to epithelial cell ratio TYPE A Homogeneous population of neoplastic epithelial cells having spindle/oval shape, lacking nuclear atypia, and accompanied by few or no non-neoplastic lymphocytes TYPE AB Foci having the features of type A admixed with foci rich in lymphocytes; the segregation of the two patterns can be sharp and distinct TYPE B1 Resembles the normal functional thymus by combining large expanses with an appearance practically indistinguishable from normal thymic cortex with areas resembling thymic medulla TYPE B2 Neoplastic epithelial component appears as scattered plump cells with vesicular nuclei and distinct nucleoli among a heavy population of lymphocytes; perivascular spaces are common TYPE B3 Predominately composed of epithelial cells having round or polygonal shape and exhibiting mild atypia admixed with a minor component of lymphocytes, foci of squamous metaplasia and perivascular spaces are common TYPE CThymic carcinoma

25. CASE 4

26. Case 4 Diagnosis: Giant Cell Tumor of Tendon Sheet

28. CASE 5

29. Case 5 Diagnosis: Fibrous Dysplasia

30. Fibrous dysplasia, benignt tumor (developmental arrest) Components of normal bone are present, but they fail to differentiate into mature structures. Occurs as one of three clinical patterns: 1. involvement of a single bone (monostotic) 2. involvement of multiple bones( polyostotic) 3. Polyostotic disease, associated with cafe au lait skin pigmentations and endocrine abnormalities, precocious puberty (McCune- Albright syndrome). Somatic, not hereditary. Skeletal, skin, and endocrine lesions from G protein that constitutively activates adenyl cyclase with resultant cyclic adenosin monophosphate overproduction and cellular hyperfunctioning.

31. CASE 6

32. Case 5 Diagnosis: Chemical / Reactive Gastropathy

33. CHRONIC, REACTIVE (CHEMICAL) GASTROPATHY - Very common in current clinical practice. - Changes usually more prominent in the prepyloric region - The usual underlying causes include chronic bile reflux and long-term NSAID intake.

34. The histopathologic features: -mucosal edema - congestion - fibromuscular hyperplasia in the lamina propria - foveolar hyperplasia with a corkscrew appearance in the most severe forms The foveolar epithelium characteristically: reactive nuclear features and reduction of mucin. The epithelial changes occur with little background chronic inflammation. CHRONIC, REACTIVE (CHEMICAL) GASTROPATHY Arch Pathol Lab Med—Vol 132, October 2008