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GI EQA circulation S 2011

S 01

Male 78 years

Large intestine. Polyp diagnosed at colonsocopy on caecum (not possible to remove endoscopically).

Macro: right hemicolectomy - there is a protruding lesion at the ileocaecal valve.


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S 02

Male 20 years


Macro: appendix 76 x 10mm containing faecolith.

Specials: Positive CAM 5.2, CK20, synaptophysin CD56 weak specific staining in a few cells. Chromogranin equivocal, likely negative.


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S 03

Male 74 years

Oesophagus. Mass lesion in wall at 30cm.

Macro: transhiatal oesophagectomy specimen, maximum diameter 19mm.

Specials: positive - Ckit, CD34, vimentin; negative - CD31, desmin, SMA, CAM5.2


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S 04

Female 77 years

Large intestine. Presented with right iliac fossa mass with obstruction. Previous breast carcinoma in 2008.

Macro: Appendix from right hemicolectomy. A complex specimen including small bowel, a 7cm markedly thickened appendix and loop of colon. Massive tumour 12cm diameter involving terminal ileum, appendix and colon. Tumour pale white on sectioning.

Specials: CD20 positive with co-expression of CD10, BCL6, MUM1 and BCL2. Ki67 index 80-100%. EBV, CD5, CD23 and cyclin D1 all negative.


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S 05

Female 74 years

Stomach. Iron deficiency anaemia, gastric erosion, probably benign.

Macro: Two biopsies, 3mm each.

Specials: perls positive.


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S 06

Female 73 years

Appendix. C diff colitis following Whipples. Re-laparotomy for raised CRP.

Macro: appendix - 80mm in length, No exudate.


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S 07

Female 46 years

Large intestine. Known endometriosis, previous TAH and BSO. Extrarectal mass obstructing ureters - endometriosis? cancer?

Macro: anterior resection - a 50mm fibrotic ragged area involving mainly the left mesorectal fat. Focal mucosal ulceration and bulge. The fibrotic lesion extends inwards up to the bowel mucosa. The section includes CRM.

Specials: glands are vimentin and CK7 positive, stroma is CD10 positive. CK20 and CDX2 are negative.


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S 08

Male 48 years

Appendicular mass.

Macro: cystically dilated appendix 60 x 50 x 40mm. The base of the appendix appeared normal. The external surface was intact and smooth. The lumen was filled with tenacious mucin. The wall was fibrotic and calcified in places. The entire lesion showed similar features.


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S 09

Female 59 years

Peritoneum. Gastric cancer. Peritoneal nodule on frozen section.

Macro: 12 x 9 x 5mm fat with 5mm white firm nodule (the submitted slides are the frozen section after paraffin embedding).


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S 10

Female 35 years

Stomach. GOJ hot spot on PET. Previous CRT for SCC hypopharynx. PEG. Gastric cardia ?malignancy.

Macro: gastric biopsies - six pieces of tissue up to 0.4cm in maximum dimension.

Specials: Positive AE1/AE3, p63, CK5/6.


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S 11

Female 58 years

Pancreas. Incidental distal pancreatic mass seen on CT. Cytology: necrotic material.

Macro: distal pancreatectomy with splenectomy. Multiloculated cystic lesion 35mm maximum diameter filled with ?necrotic material.


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S 12

Female 54 years

Pancreas. CT scan for abdominal pain, anorexia and weight loss. Large cystic tumour in head of pancreas.

Macro: Whipples resection specimen. Multicystic lesion consisting of a central 4cm cavity surrounded by several smaller cystic areas. Cavities filled with haemorrhagic fluid and surrounded by thin rim of ?tumour tissue.

Specials: pleomorphic cells: proportion is BerEP4, MDF116, CK7 positive, all CD68 negative.


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S 13

Male 60 years

Pancreas. Recent surgery for rectal adenocarcinoma. Abnormal LFTs. US scan showed a dilated common bile duct. Six weeks later itching and malaise. Imaging: ?biliary cancer ?metastatic rectal cancer.

Macro: left hepatectomy with en bloc resection of gall bladder and hepatic duct. Common bile duct, hepatic duct and cystic duct dilated (4cm maximum diameter) and filled with mucus and friable tumour tissue. Extension of lesion into intrahepatic ducts.


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S 14

Male 60 years

Pancreas. CT abdomen for altered bowel habit: lesion in body of pancreas with dilated pancreatic duct.

Macro: distal pancreatectomy with splenectomy. 29mm tumour protruding from the inferior border of the pancreas. On slicing well circumscribed, partially cystic partially solid tumour: cystic part filled with mucus. Probable connection to branch duct. Main pancreatic duct minimally dilated (4mm).

Specials: alcian blue / PAS staining positive in part of tumour. Negative for endocrine markers, alpha-1-antitrypsin, trypsin.


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