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CASE NUMBER 1 (UMich slide 84) Clinical History: A 53-year-old man presents to his primary care physician. He reports that he has had “heartburn” for the last ten years that he has been treating with an over-the-counter proton pump inhibitor that has offered partial relief. He has no other symptoms. An endoscopy is performed and is notable for the presence of reddish patches among the more normal pale-appearing mucosa (compare image on the left from the patient to the image on the right from a healthy esophagus). A biopsy is performed. Following biopsy analysis, an endoscopic mucosal resection is performed yielding the specimen shown in the slide. 1-1. What type of tissue should normally be found in the lining of the esophagus (for comparison, here is a slide of normal esophagus: Slide UMich 153 20x [DigitalScope])
1-2. What type of tissue (i.e. CLASSIFY the tissue) is present in the lining of the esophagus specimen from this patient?
1-3. Which of the following BEST describes the general process that appears to be happening in the patient's esophagus? (hint: the aberrant tissue is remarkably similar that which is normally found in the intestine as shown in this slide: Slide UMich 29 40x [DigitalScope])
CASE NUMBER 1 (continued) UIowa_aacr_1831fb The patient is referred to yearly follow-up with a gastroenterologist. 5 years later, the patient presents with mild epigastric pain and reports occasional difficulty swallowing. The patient also reports having lost approximately 10 pounds in the last two months and decreased appetite. Bowel habits have been regular, although the patient reports having occasional black, tarry stools. CT imaging shows an esophageal mass, which is confirmed by endoscopy. A biopsy of the mucosal surface yields the specimen shown in slide UIowa_aacr_1831fb above. 1-4. Which of the following BEST describes the general process that appears to be happening NOW in the patient's esophagus? (hint: compare the aberrant tissue to that which is normally found in the intestine as shown in Slide UMich 29 40x [DigitalScope]. Does it appear less differentiated or show signs of invasion?)
1-5. If you think this is a neoplastic process, is it most likely benign or malignant? How would you name the tumor (i.e. squamous cell carcinoma, adenocarcinoma, leiomyosarcoma, etc.)? HINT – a tumor is named for the type of cell from which it directly arose; e.g. a squamous cell carcinoma if it arose from a squamous cell, an adenocarcinoma if it came from a glandular epithelium, etc.)
CASE NUMBER 2 (UMich slide 48575nl) A 34-year-old man presents to his primary care physician with a lump he noticed in his groin area over the last couple of months. At first, he thought maybe it was a tick bite as he recalled having removed ticks in that area. However, the lump did not go away and has enlarged. He is referred to a dermatologist who conducts a biopsy yielding the specimen shown in slide 48575nl above. 2-1. Observe the surface of the skin seen on the right side of the slide. Classify the tissue that comprises the skin.
2-2. Note the tissue beneath the skin. Classify this tissue.
2-3. Note the expanded area of tissue that makes up much (the left 3/4 of the slide) showing marked hypercellularity. Which of the following BEST describes the general process that appears to be happening in this aberrant tissue?
2-4. If you think this is a neoplastic process, is it most likely benign or malignant? How would you name the tumor (i.e. squamous cell carcinoma, adenocarcinoma, leiomyosarcoma, etc.)?
CASE NUMBER 2 (continued) Slide UMich 26 The lump is successfully resected with clear margins. Groin lymph nodes are negative. Approximately 6 months post-surgery the patient notes that the scar seems to have gotten larger and has started to raise the skin. A biopsy is performed yielding the specimen shown in slide 26 above. 2-5. Note the expanded area of tissue under the skin showing slight hypercellularity as shown in this area (click here to open). Identify these cells.
2-6. Which of the following BEST describes the general process that appears to be happening in this aberrant tissue?
2-7. If you think this is a neoplastic process, is it most likely benign or malignant? How would you name the tumor (i.e. squamous cell carcinoma, adenocarcinoma, leiomyosarcoma, etc.)?
CASE NUMBER 3 (UMich smear 100x03S) A 55-year-old female presents with increasing fatigue, night sweats, weight loss, and abdominal "fullness." The patient has marked splenomegaly, 10 cm below the left costal margin, without lymphadenopathy. The CBC showed: WBC = 105,000 cells/mm3, Hb = 10.5 gm/dl, and platelets = 85,000/mm3. A peripheral blood smear shows numerous immature cells ("blast" cells) and other abnormalities (compare this to a normal blood smear: [DigitalScope]) 3-1. Based on the abnormalities seen in the peripheral smear, which of the following is the MOST likely diagnosis?
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