- _ __._ 2.' _ _.___. - - --- z_

SE!JIUARIO DE !'.~TOLOGIA QUIRURGICA GENERA

ORGANIZA:OO POR EL DDPJ\RT!.J.!O:H'I\J DE Al7A'l"O>!IA P.~TOIOGIC.il DE L.'l crLIDAD S.tiNITAl1IA DE 111 f:'EGURD>AD SOCIAL (JEFE Dr. ;y. !>1, Loizaga)

I . .:

:t·IVITADO ESPECIAL D!l , JUAlT ROSAI

l'ro:f'aaor da Patolog:ta y :!l::.:~uotor del De!)3r tamento o.e l.natomi a Pat ol6giua de lo. Uni ve rsidad de l"innesota ·-

--:.:/"' ..

·-

Sevi lla , 14-15 Enero 1977

; .

Paciente de se%0 mascul,no, de 47 anos de edad, de profesi6n la­

brador. Bebc>dor discrete, s ei s mesas antes del ingreso nota dol or en hipo­

oondrio dereoho continuo y no colioo que i rradiaba a epigaotrio y espaldn.

El dol.or es de i~stauraci6n proe;resiva y dura dos horae, se acompaiia de -

nl1useas y 'se Calm9. con el v61lli to, este es de caracter alimontioio o bilio­

B() • El O.olor sa alivla con el deotlbito lateral izquierd.o. Coincidiendo con

~e. prl!Jlera crisis de dolor tuvo tambi~ icterioia l ave. Por ollo s e le di~

nostic6 de hepati tl s . Sin embargo, una biopsia hop4tioa demostr6 BOla:nente

eateat oais con f i brosis po;-tal y prolifer acill.t?- de oonductillos biliarea.

La ictericio. fue de apax:ioi6n 'iJrusoa y cedio doe mesas deapu~a. No ho. ten.!,

do f i ebre, astenia, W'l~rexia y p~rdida de 2a Kg. de pebO e.'l aeis mesas. No

disnea ni toe ni e:r.pectoraci6n.

' La exploraoi6n f !sica d emuestra espooialmente quo a nivel de op!

gastrip a hipooondrio derecho se palpa una masa muy bien delillli teda, de -

oonsistenoia media y superfic'.e lisa, de hordes netos no dolorosa ni m6vil.

No hay osplenomegalia.

La explorao1on de labor a·torio es poco expresivas VSG nor mal o li

gera.mente elevaea, mu;y discrete l euoooi tosis co!'l di.soreta desviaoi6n a la

izquierda, antliais de orina con urocultivos normales.

Se practica endoscopia que demuest r a una hernia de hi ato, gas -

t ri t is or<Snica y una al teraoion macro!'tc6pica duodenal que los induce a1

diagn6etioo de adettoma velloeo difuso.

La lapa.roacopin demuestra una vea! oula lllll,Y" il.umentada de tamru1o

con adher encias de epiplon y alteraciones bep4tioas que consideran de tipo

reto,;:tivo sir ir:nganes turoo~les ni signos do oolestasia. Con mctivo de la

endosoo;:>ia se praoUc6 biopsia g:tst.rioa que deroostr6 gastritis cr6nioa a -

tr6:fl'ca y mucosa de intestine delgado :::in al teraoiones.

El est:.dio ~:~diol&gico con contrasts demostr6 una hernia de

hiato oon r eflujo, con ~st6mago normot6nioo y el bulbo duodenal altorado

mey distendido y acompa!iado de una gran irri wbilidad de todo el intestj.

no delgado. En duodooo se visualiza varies .defectos de replecci6n post -

: bulbares que ~reen los radiologos es compatible con l a existencia de u­

na ·tumoraci6n, aunc:.ue 'desoor tan el ampuloma y una t umoraci6n prooedsnte

de la vea!cuia . bilia.r.

na muy 1 I.

Entre los da tos de laboratorio destaca una fosfatasa Qlcali-,.

~~da: \ -

Se 1~ practica gastrodeudeno .panorea';ectom:!a cefall.ca. En -

'· ;tre loa datos macroso6picos destacan estenosis segmentaria de duod€mo y

f!stulas numsrosas con exudado fibrinoso en serosa. . I

cr.so NO 2: .. ' •

Paoientc de ocxo l:UI$0Ulino , de 35 anos db edad , de p:rofesi6n

adninistr.:ttivo. Ent:ro los antecedenteo refiere que padecia hemorragiia . . cu·taneao nl menor tra~w.a y que cur.!'ba rapidrunonte y bien, aetas aHcr,!

clones l us paoiece c1e8de nino. A loa 8 enos do edad se le p1•ac t ic6 Ull'\ ·

loboctomia inferior derecha con di:--nostico anatomo-patol6S).co 6.e "B!!

gioma". Du:tWl'tl. los Ill tiaios 5 anv: <' • ha presentado episodios de dolor

abdominal · r;p:ave y variable localizac1.6n , gene1•almante dos boras despues . . de las· cOmidas . ·Se asocinron primoro a diarroas y hcces con·teniendo n:.2,

co "' s'anc:re roja. Mas recier>..tel!lente ostos e::>isodios i brul soguirdos de

distension abdooinal y paralisis intestinal, alsunos dias despues del e­

pisodic de dolor abdominal. !a r adiologia de' abdor.:en despu~s de dos e­

pieodios como loa relatados mostraban gre.n di~:rtens1.6n del in·testino

dalgado con nivelas l~quidos .

El ezamon fisico mostr6 numerosas cicatrices en piol e~eoia1

m'e·r,te en areas no cubiertas, en pun·tos de presi6n, en la zona del Ci,!!·

turon o del cuello y tambi~n en plie~s de la pial .

El fone.o de ojo cost:-6 pequenas bemorragias recientes y anti

guas. El astado de nutrioi6n era deficienta. El oxarnen radiologioo ~

:testinal con contrasts de baric mostr6 dilataoion de asas , p(mlidas

de las arru(Sas y sclaca de :pared. El oranan hernato16gico mostr6 lnooci

tosis cc:1 neutrofilia, siendo noma las las pruobas de coagulaci6n.

Sa pracUc6 l~arotomia y mostr6 1;odo el :intestine delgado,

grueao y el mese~tcrio edernatosos , friabl cs y con areas de hemorragias

r.:;oientes y cmtigua <, con bOI!lorragias el manor oontaoto y JUterial con

aspecto cicatricial y hernorragico neorotico diaem:inado por serosa.

El hieado y ol bazo no mostraba.~ alteraciones. Sa hicieron -

reee9ciones ~e aquellos segmentos intest:inales que pareoian. on peores

condiciones.

Despu6s del tratamionto quir(~gioo el paoiento se reoupor6

baatante !lien y meses dospu~s oie;ue bien.

En el laborato· . .i.o eo reoibieroll doe seemontos de intestine

delgodo el mayor d_e los cu"lles media 14 em. y el ~:~enor 4 om. Er ambos

la serosa mostraba ~eas irregulcres de color entre rojo y marr6n y

blanco. Hab:fen 1!.1-ee.s da aopooto qufstico subsorosas que median 1 om. -

de d;i.dmetro la mayor y conterunn mateJ:ial homurr~oo oscuro. Se enoc>n

tr~~.ron' t wnbi6n var:i.as (u-eas lineales de 1 em. do longi tud :irregulare,;

· que ~~ootaban la mucosa y 1legaban a producir una l ove estenosis. En -

' general 1a Glucosa est<> '.>a l'Ospeteda y nor;r.a1.

..

Faoiento de sexo mnsoulino, de 56 anos de ·edad, caaado. ~1atro

al'fo::~ ant es de la p1•eaen1;e histori a l e f'ue extil·pada una pequona tumca·; ,­

oi6n en glande y doc . a.iios despu~s otra en coroto y en otra parte de la_­

pial. En el moc:ento t&l dltino eotudio le ban extirpado otra poquefia. t=.2.

raoi6n ~ .. bra'.O Cloz:echo "semejan~e a las anteriorcs Con el diagn6stioo de

Jti.stioci torna. EJ. resto de l a hiotoria clfnica oru.:aoe de inter~o .

En el labor atorio ~ reoibi6 un f'ragmonto fusif'orme de piel de

2.5 x 1,7 x 1 oms. Ados n1lfmetros de uno de los bardes de resooci6n­

se ob1Jervo. = f'ornaci6n li&-er nmente excrecente. AJ. corte se apreoia si­

tuada en dormis superficial y sobre la misme sa observa epidermis oonse~·

va.da. Ic. tumoraoi6n mide o. 3 em. 0n :m dimensi6n meyor y tiene un color

amarillo <nbarino.

: PACTINTE no 4 :

Paciente sexo .masculine, do 55 anos de edad, Ingresq on

una Cltnica Pr:.vada por · mol estias abdominal'es 'difusas que a.fectali ·a. ­

todo el abdomen y crisis suboclusivas,

Se le i ntervione y se encuont .ra una. masa r etroperi toneal

que enwelve los 6rganos vecinos sin invadirl os. Ante la imposibilidad

de una extirpa~i6n oorrecta ae toma biopsia. , '•

. . . \ .

Nii'la de oinoo mesas de edad, Un :r.e~ antes del ostudio los pa-­

dres advierten ur'\a tumoraci6n ocoipi tal y :>tra en J.a parte dereclia del

torax, !A explorac16n demostr6 oolamente placas de pus en lllllic;dalas, El

estado general era regular, mostraba gr~n hepatooglanomeealia jwlto .oon,

adenopatias en e! ouello de un t~1o m4ximo de 2 oms, y losiones papu­

loeritematoss.s en pial. No reoibido tratacJ.ento. Con el diac..,6stico de

retiouloendiotelosia se tom6 una adenopatia de ouello.

. ..

C.4SO NO 6; •' :.

Paciente de 32 ai'ios, aexo-IM.sculino, oasado. En 1969 fue

intervonido par un cuadro de hipertonsi6n intracraneal lave con h_! mipa.resia dereoha. Se le encont :·6 un tumor _po.rasagi tal parietal' i,i

quierdo. Dioho tumor r ecidiv6 a11 1970 y 1973. En 1970 reoibi6 4000 '

r . Ul tima.menttl presenta cris:'.s convulsivas y ba aum.mtado la beJI!!.

par0s_1_a·: de:r:echa, adel!l1!s tiene afasia. Se le practica oranieotoJ!I!a

pa:-ietal izquierda y se aprecia \lll tumor s61ido7 bastante bien li-

. :.mi tado, parietal, parasagi tal izquiordD. Con cl diagn6stico de re­

. cidivn de ~a neoplasia anterior se extirpa la. neoplasia.

En el laboratorio ~e reoibe una pieza de 6 x 4 x 2,5 oms.

qua muestra superfioie irregular, finamente nodularea de ooloraci6n

parda. ·,a oonsistencia eo eld?tica y la superfroie de corte muest~a

aspeoto abigarrado alternando dreas de ooloraoi6n aoarilla con o -,. traa bla.oqueoinas y otras rojas de aspeoto homorr4gioo~1 t

· ' ; .

C.ASO 110 7: . .

Paoie~<te de 28 affos de adad1• embarozed.e de sai s mosca , De f\>X'!Ila

brusca present6 un ou:tdro de ai:xl.ome.t agudo por lo que sa le prectic6 la -

parotomia, En l a mis.-:m se descubri6 una hemorragia qua llenaba ol fondo -

del saco de Dou~la_s,ce ex~cndia p~r de t ras do t1toro y anoxo3 y a· lo largo

de la pnrca··posterior dol abdomen, Se p:ractio6 oxploraoi6n do la regi6n -. ' , . . adviriti6ndose un gran tooor situado entre la pared abdominal posterior y

·el. t1te~. El t~~or estaba rnuy necrosndo y era hemorr~gico y so decidi6

practicer hietere{tomia con doblo anexedomi a y extil.T.aci6n de lo que se ,-

. pudiera de la mesa, la. intervenci6n fue· muy l aboriosa por la bemorragia 1

la necrosis y adherencias. las preparacicnes .proocclcn del tumor,

CASO no 8 :

lUna de 5 olio.· . Dinenosticada do Scp~-:s oncontraron una hepatomc;l­

enlia 'do 10om. sobxc el r eborde costal , de borde netos y concistencia dura..

Se comp3fiaba de circuleci6n colateral y ascitia. J\de~ ictoricia a oxpen - ·

saa de la bilirrubina. conjueadae las trallS<ll<linO.SP.S y i'o~.d'atMOS C lcaline.s e . -loV<J,das . P.:u-a intentn1• e.clu •ar el diae;n6stico le pr act icaron unn laparot o :..

l!lia e:lqll orador a y _c:m:f'irm« .... on Dclarnento la bepatonecalia y l a !'"lei tis sin -

poder aolurar el proceoo quo equojaba a la nina. Se descubri6 taobi6n una -

discreto. eeplenor.tet>alia. Tomaron bio11sia on curia de higado.

, . . . C,\SO N~ 9:

Paciente clc 27 n!'ios de edad, caco.da, de sexo fet••<mino. H.;,oe· !!i1o ·

y modio comenz6 con nnol:exia y p~Nida de :peso , cuacl:ro que ha oontinuaao

hns 'tn l a ac'tualidad, .»code hace un a fio nota ocasionaL'liento ol'inas (la ' co .­

lor oocuro, Refiore ·~o.m)li6n que desde hace treo anos viene advir·ti ondo u-., na tumqr~ci6n en vuc!o i~quierdo .

Estudiada en ll.:lda joz le diag:nostioal'On U.'1a t umoraci6n renal y

·lo intontaron , s i n ~xito :pl'aoti oar una ne:l'rcotcm:ra.

En el labox·a t orio se rec i.bi6 piezn ·de nefrec'tor.~:[a con 5 oms. d,e

ur6ter 'y a;.roximada!'\onto 2 ems, de v~sos rcnales , estr,tcturos que no mos­

traron SiGDos patol6~loos, El riTI6n media 16 cmc, entre ambos poles. El -

polo superio~ incl uia lc suprarenal. Ocupando todo el hilio y prolont;iind.2,

· co basta el polo suparior sa apr ecia una tumoraci6n de 14 ems, de di~.ma -

tro mayor y suparficie externa lobuladn y con des ~reas qua tronaparcntan

color rojo oscuro, 111 corte se aprecia conaiatc!~cia el<is·~ica y Bu:Perficie

dEl color abi ga:v:-rado con ;!lrea:.J rojas , mal limi't:adas y otras amarillas.

..

. .

Paciente de eexo masculino, de 54 ailoe de ednd, casado. El

I!!O" ivo de lc consulta fue que ~l l!!ismo se e.preci6 la tumoraoi6n abdom

nal. Ie explornoi6n :N:cioa descubri6 una tuooraci6n. e.r. h:i.pocondrl.o de­

. :rocho que oJ. est udio r a..liol6etco remoatr6 que . <tor.1pJaza~li\ el pancr eas y el pa.quete inte~:tinal haoi a el l ado izquierdo •

. . So pra.ctic6 una laparoto~~tte exploradora apreci~ndose una

g.r:e.n t urnoraoi 6n rctropel•i'toneal <ftlO ae extend! a desde. l a c6pula de di!!,

fr<t@lla hastn el :polo supodor del riii6n derecho. Ie. consideraron inCA.._

tir~blo por lo que tooaron solamente biopsia.

.. · ...

• ' :0

CASO JiO ll :

Se.x:o masculine, 68 .:1..'ios de edad. Sin antecedentes previos in­gress. el pacit:mtG con \111 cuadro de Ob$trtlcci6n intestinnl acomp!'lfiedo de

eifinos de perforaci6n. Se le interviene y co enouentl·a una tumoraci6n !>2,

dioulada 911 i:tte·stino del.gado y se oompruebn. la por:f'or aci6n. So practioa 0. J.'eoecci6n .de ·i n·testino delga.clo con ol di aeu6stico de p6lipo.

Al laboratorio 11eg6 un fl~~nto defntosti no delgado de 8.5 em. de loneftud. A cuatro ce;ntioetros de uno de los bordcs de resecci6n

se obse:rv6 \Ula soluci6n de oon'ti nu:!.dad de ln pared de o.8 em. de ;:liruno -

tro ~~os bordos eran de aspeo~o neor6tico y de color verde con natau de··

fibri ns. ~ue se exteP.ct!on por el reato de l a oerosa del intestine. ~i a -

brirl os s ~ ·aprooia l a luz ooU!Jad,a por una tumoraoi6n excreoiente y yedi:­

oul2da de 2 om. de di6metro ~mo y cuyo periculo media o.5 em. de lon­

gi tud y a:1ohura. A nivel del pedf culo de im.lJlata.'lci6n se obse:rv6 la muc.2_

sa interruopida y al corte una tumor aoi6n que ~eoe emer&~ de las ca -

pna r.rusoulares y que atraviesa l a mucosa basta af'lorar ell l a l uz inteat!,

nal. Ie. tumoreci6n al corte es l obulada y de color blonqucoino con llrees

parduzcas y otras de homorregla. La oonsis tonci a es el~stioa.

I MI NISTERIO OE TAAB AJO

INSTITUTO NACIONAL DE PREVISION

CIUDAD 8ANITAniA D~ Ul SICURID.~D SOCIAL " VIRQI N Oil ROCI0 1'

$ EVIlt. A

+ SEMINARIO DE PATOLOGIA QUIRURGICA

GENERAL Y DEL liMO

Organizado por el

DEPARTAMENTO DE ANATOMIA PATOLOGICA

de Ia Cludad Sanitaria de Ia Segurldad Social

de Sevilla

INVITADO ESPECIAL

Doctor JUAN ROSAI Profesor de Patologia y Director del Departamento de Anatomla

Pato16g/ca de Ia Universldad de Minnesota

A CELEBRAR EN SEVILLA LOS DIAS 14 y 15 DE ENERO DE 1977

DIA 14

A LAS 13 HORAS

Contribucl6n de Ia Microscopla Electr6nlca al estudio

de las Neoplaslas.

Dr. J . Rosal.

A LAS 16 HORAS

Semlnarlo de Patologla Qulrurglca General.

D I A 1 5

A LAS 13 HORAS

El tlmo y el Sistema lnmunol6gico.

Dr. J . Rosal.

A LAS 16 HORAS

Semlnarlo de Patologla del tlmo.

las Seslones se celebraran en el Sal6n de Actos

del Centro de Rehabilltacl6n

y T raumatologia.

SURGICAL PATHOLOGY SEMINAR

OR. JUAN ROSAI

SEVILLA, SPAIN, JANUARY 15-16, 197 7

CASE 1 - 47-year-o ld ma 1 e 1~i th a six-month his tory of continuous pain in right hypochondrium with irradiation to epigastrium and shoulder, associated 1~ith mild jaundice. The clinical diagnosis of hepatitis was made. However, a 1 iver biopsy SliJilwed only fatty i nfi ltra·ti on with porta 1 fibrosis and proliferation of bile ducts. The jaundice regressed t~1o months 1 a ter. The patient has not had fever, astnenia, or anorexia but has lost 23 kilograms in the last six months. Physical examination showed a well delineated mass of smooth outlines in the epigastrium and right hypochondrium. Endoscopy showed hiatus hernia, chronic gastritis and a duodenal lesion that 1~as interpreted as diffuse villous adenoma. Laparoscopy showed a dilated ga 11 b 1 adder, omenta 1 adhesions and 1 i ver a 1 tera ti eits that 1~ere regarded as reactive. Gastric biopsy sh01~ed atrophic gastritis. X-rays showed hiatus hernia with reflux, normotonic stomach and an alteration in the duodenal bulb, 1~hich ~1as markedly distended. There were several filling defects in the postbulbar region of the duodenum that were interpreted as compatible 1~i th a tumor mass. The only important 1 aboratory a noma 1 i ty was an eleva ted alkaline phosphatase. A ga:stroduodenpancrectomy was performed. Grossly, there was a segmental stenosis of the du.odenum with numerous f istulae 1~ith a fibrous exudate on the serosa.

CASE 2 - 35-yer-old male with a history of cutaneous bleeding following very m1nor traumas from childhood. At the age of 8 years he had a right lower lobectomy for "angioma" of the lung. For the past 5 years he has had episodes of severe abdominal pain, usually starting two hours following food ingestion. At the beginning they ~1ere associ a ted with diarrhea and me 1 ena. Recently, these episodes were followed by abdomina 1 distention and i1 eus a few days fo 11 owing the episode of abdominal pain. On physical examination, there were numerous scars in the skin, especially in sun exposed areas as well as points of pressure, such as the area of the belt, neck and cutaneous folds. Examination of the fundus oculi sh01~ed numerous small recent hemorrhages. At laparotomy, the entire small b01~el, large bowel and mesentery were edematous friable and with areas of recent hemorrhages. Very small pressure ~1i th the finger would induce hemorrhage throughout the abdomina 1 cavity. The liver and spleen did not shm~ abnorm:alities. Partial resections were performed on segments of bowel showing the most severe abnormaliti es. The patient recovered 1~ell from the operation and a few months later he is relatively asymptomatic. Grossly, two segments of small bowel were received, measuring 14cm. and 4cm. respectively. In both of them the serosa showed irregular areas with red brownish and whitish discoloration. There 1~ere areas of subserous cystic formation measuring up to lcm in diameter containing hemorrhagic dark material. There were also some lineal areas lcm. in length, irregularly affecting the mucosa and producing a mild stenosis. Generally, the mucosa was normal.

CASE 3- 56-year-old male. Four years previously, the patient had a small tumor excised from the penis and two years later another one in the scrotum and in the skin. At the present time, a small tumor was excised in the right arm similar to the others and the diagnosis made was that of histi .ocytoma. Grossly, an eliptical piece of skin measuring 2.cm. in greatest diameter 1~as received. An elevated nodule was present which on cross section was seen to be located in th·e superficial dermis. It measured 3mm . in greatest diameter and had a yellowish color.

-2-

CASE 4 - 55-year-old male with diffuse abdominal pain. At operation, a retroperi toneal mass was found surrounding several organs without direct invasion. A biopsy l-IaS performed .

CASE 5- 5-month-ol d girl with tumor masses i n the occiptial region of the scalp and ri ght side of the thorax. Physical expl oration revealed tonsillitis , cervi cal lymphadenopathy (measuring up to 2cm. in diameter). There were also papuloerythematous lesions in the skin. Biopsy of a cervical lymph node was performed .

CASE 6 - 32-year-old male. In 1969 , an operation was done because of increased intracranial pressure and right hemiparesis. A tumor was found in the parasagital left parietal region. The tumor recurred in 1970 and 1973. In 1970, radiation therapy was administered (400r) . La tely, the patient presents convulsions and increase of the right hemi paresis and afasia. A left pari eta 1 craniectomy ~1as performed . A ~1e 11 circumscribed solid tumor was found in the parietal region; it was excised with the clinical di agnosis of "recurrent tumor" . Grossly, a specimen measuring 6x4x2 .5cm. was received. It was multinodular, br~m . of elastic consistency; the cross section showed yel low areas alternating wi th others of whitish and red color.

CASE 7 - 28-year-old fema le, 6 mon ths pregnant . She presented with acute abdomina 1 pain, for which laparotOtl\Y 1·1as performed. Hemorrhage fi 11 i ng the Douglas pouch was encountered. This extended behind the uterus and adnexae along the posterior wall of the abdomen. Exploration of this region revealed a large tumor located in the pos terior abdominal wall and uterus. It was highly necrotic and hemorrhagic. A hysterectomy with bilateral salpingo­oophorectomy was performed , together with excision of part of the mass.

CASE 8- 5-year-old girl with clinical diagnosis of sepsis. Hepatomegaly was found (lOcm. below the costal margin) of fi rm consistency and accompani ed by colateral circulation and ascitis . There was also jaundice and increase of transmi nases and alkaline phosphatase. Exploratory laparotomy was performed. The findings were hepatomegaly and acitis. There was also a moderate degree of splenomegaly. A wedge biopsy of the liver was carried out.

CASE 9 - 27-year-old female with symptoms of anorexi a and weight loss for 1~ years. She also referred that for the last few years she has noted a tumor in the left flank . She was diagnosed as having a renal tumor and a nephrectomy was performed. Grossly, the kidney measured l6cm. in greatest diameter; there was a 14cm. mass occupy; ng the hi 1 urn and extending into the upper po 1 e. It had a lobulated outer appearance with two areas of dark red color. The cross section showed red foci alternating with ot hers of yellow color.

CASE 10- 54-year-old male with abdominal tumor. On physical examination, a tumor mass was palpated in the right hypochondrium. X-ray studies showed that this mass was displacing the pancreas and the small bo1~el to the left. An exploratory laparotomy was carried out and a large retroperitoneal tumor was found. This extended from the diaphragm to the upper part of the left kidney. The tumor was inoperable and only a biopsy was taken.

-3-

CASE 11 - 68-year-old male with intestinal obstruction accompanied by signs of perforation. At operation a tumor mass 1~as found on the small bo~1el which had perforated. Segmenta 1 resection of sma 11 bowel was carried out ~Ji th the diagnosis of polyp. The gross specimen con.sisted of a segment of small bowel measuring 8.5cm. in length. Located 4cm. from one of the surgical margins there was an opening in the wall measurin.g 8mm in diameter. The borders had a necrotic appeara'nce and a greenish co 1 or .and were covered by fibrin 1~hi ch extended to the remaining serosa of the bowe l. After opening the specimen, an exophYtic tumor was found. It measured 2cm. in greatest diameter and had a pedicle measuring .Scm. in length and diameter. At the level of the pedicle the mucosa 1~as interrupted and the cross section showed that the mass 1~as arising from the muscle of the wall and was pushing through the mucosa and protruding into the lumen. It was lobulated, whitish, with brownish foci and areas of hemorrhage. The consistency ~/as e las tic.

CIUDAD SANITARIA VIRGEN DEL ROCIO CENfRO DE REHABIUTACION Y TRAUMATOf.OGIA

SERVICIO OE ANATOMIJ\ PATOLOGICA SEVIl tA

SEMINARI O DR. ROSAI

C.!\so n2 1 Enf'erme.dad de-C!rohn sin granulomas y a£ectando

" 2 Enfermedad de Eaposi intestinal II 3 Enfermedad de Kaposi

duo.deno

II 4 Histiocito~a fibroso maligno inflamat orio retroperitoneal II 5 Enfermedad de Iettere:t'-Siwe II 6 Hemangioblastoma Hemisf~rioo II 7 Carcinoma embrionario II 8 Reticulosarcoma hep4t i co en nino II 9 Angiomiolipoma renal II 10 Oncocitoma suprarenal II 11 Hemangioendotelioma intestina delgado.

, , SEHINARIO DE PATOLOGIA QUIRURG ICA GENERAL

Dr. Juan Rosai

Profesor de Patologfa y Director de Anatomfa Patol6gica, Escuela de Medicina de la Universidad de Minnesota, Minneapolis, Minnesota, Estados Unidos .

CASO 1 - DUODENO - DUODENITIS CRONICA ULCERATIVA NO GRANULOt-1ATOSA ? ENFERMEDAD DE CR HN

Haggitt, R.C. , et al.: Crohn' s disease of the upper gastrointestinal tract . Am. J . Clin. Pathol. , 59:613- 622, 1973 .

Sachar, D.B., et al.: A transmissi ble agent in Crohn' s disease? New pursuit of an old concept . N Engl . J. Med., 293 : 354-355, 1975.

Savage, R.A. , et al .: Carcinoma of the small intestine associated with transmural i lei tis (Crohn 's disease) . Am. J . Clin. Pathol . , 63 :168-178, 1975 .

Wise, L., et al.: Crohn's disease of the duodenum. Am . J. Surg., 121:184-194, 1971' .

Bird, J.M. , et al.: Vascular l esion of hereditary hemorrhagic telangiectasia . N Engl. J . Med., 260: 597-599, 1959 .

Gentry, R . ~l. , et al.: Collective revie1·1 : vascular malformations and vascular tumors of the gastrointestinal tract. Int. Abstr. Surg . , 88:281 - 323, 1949 .

Halpern , M., et al . : Angiodyspl asias of t he abdominal vis cera associ ated wi th hereditary hemorrhagi c t elangiectasia . Am. J. Roentgeno l . Radium Ther. Nucl . Hed., 102:783-789, 1968.

Halpern , 14., et al.: Hereditary hemorrhagic t elangiectasia ; an angiographic study of abdominal visceral angiodysplasia associated with gastrointestinal hemorrhage . Radiology, 90:1143-1149, 1968.

Beighton, P.H . , et al.: Gastrointestinal complica tions of the Ehler-Danlos Syndrome . Gu t , 10:1004, 1969 .

CASO 3 - PI EL-ENFERMEDAD DE KAPOSI

Kuo, T-T., et al.: Masson ' s "vegetant intravascular hemangioendothelioma :" A lesion often mistaken for angiosarcoma. Study of sevent een cases located in the skin and soft t i ssues . Cancer, 38 :1227- 1236 , 1976.

O'Brien, P.H . , et al.: Kaposi's sarcoma. Cancer, 19:1497- 1502, 1966.

Rosai , J ., et al . : Angiosarcoma of t he ski n; A clinicopathologic and fi ne structura l study. Human Pathol ., 7:83- 109, 1976 .

Straehley, C.J., III . , et al. : Kaposi sarcoma in a renal transplant recipient. Arch. Patho 1. , 99: 611 -613 , 1975.

Tayior, J . F., et al.: Kaposi's sarcoma in Uganda; A clinico-pathological study . Int. J. Cancer, 8:122-135, 1971.

• CASO 4 - RETROPERITONEO-HISTIOCITOt1A FIBROSO MALIGNO (PLEOMORFICO)

Kahn, L.B.: Retroperitoneal xanthogranuloma and xanthosarcoma (malignant fibrous xanthoma). Cancer, 31 :411-422, 1973.

Kempson, R.L . , et al.: Fibroxanthosarcoma of the soft tissues. Cancer, 29:961-976' 1972.

Kyriakos, 11., et al.: Inflammatory fibrous histiocytoma; An aggressive and lethal lesion. Cancer, 37: 1584-1606, 1976.

O'Brien, J.E., et al.: Malignant fibrous xanthomas. Cancer, 17:1445-1455, 1964.

Soule, E. H., et al.: Atypical fibrous histiocytoma, malignant fibrous histio­cytoma, malignant histiocytoma, and epithelioid sarcoma . Cancer, 30:128-143, 1972.

, CASO 5 - GANGLIO LINFATICO - HISTIOCITOSIS X

Breathnach, A.S.: The cell of Langerhans. Int. Rev. Cytol . , 18:1-28, 1965 .

Lieberman, P.H., et ~1.: A reappraisal of eosinophilic granuloma of bone, Hand­Schuller-Christian syndrome and Letterer-"Sh1e syndrome. Med., 48:375-400, 1969.

Newton , W.A., Jr., et al.: Histiocytosis; A histol ogic classification v1ith clinical correlation. Persp. Ped. Pathol., 1:251 -283, 1973.

Nezelof, C., et al.: Histiocytosis X; Histogenetic arguments for a Langerhans cell origin. Biomedicine, 18:365-371, 1973 .

• CASO 6 - CEREBRO, REGION PARIETAL-OLIGODENDROGLIOMA

Earnest, F., III, et al.: Oligodendrogliomas : a review of 200 cases. Arch. Neural., Psychiat., Chicago, 63:964-976, 1950.

Jeffreys, R.: Clinical and surgical aspects of posterior fossa haemangioblastomata. J. Neurol., Neurosurg., and Psychiatry, 38:105-111, 1975.

Jeffreys, R.: Pathological and haematological aspects of posterior fossa haemangio­blastomata. J. Neural., Neurosurg., and Psychiatry, 38: 112-119, 1975.

Marc, J.A., et al .: Intracranial hemangiopericytomas; angiography, pathology and d·ifferential diagnosis. J. Roentgenol., 125:823-832, 1975.

Reymond, A., et al.: L'oligodendrogliome. Etude anatomo-clinique de 74 cas. Schweizer Arch. Neural. Psychi at. , 65 :221-254 , 1950.

Roberts, r~., et al.: A long-term study of patients with oligodendrogliomas; follov1-up of 50 cases, including Dr. Harvey Cushing's series. J. Neurosurg., 24:697-700, 1966 .

• Spence, A.M., et al.: Cerebellar capillary hemangioblastoma; its his togenesis studied by organ culture and electron microscopy. Cancer, 35:326-341, 1975 .

' Takei ,. Y., et al.: Eosinophilic granular cells in oligodendrogliomas; An ultra­structural study. Cancer, 38:1968-1976, 1976.

Weir, B., et al .: Oligodendrogliomas . An analysis of 63 cases. J. Neurosurg., 24:500-505, 1968.

CASO 7 - OVARIO - DISGERI~INOMA

Asadourian, L.A., et al.: Dysgerminoma; an analysis of lOS cases. Obstet . and Gynecology, 33:370-379 , 1969.

Kurman, R.J., et al.: Endodermal sinus tumor of the ovary: a clinical and patho­logic analysis of 71 cases. Cancer, 38:2404-2419, 1976.

Kurman, R.J ., et al.: Embryonal carcinoma of the ovary: a cli nicopathologic entity distinct from endodermal sinus tumor resembling embryonal carcinoma of the adul t testis. Cancer, 38:2420-2433, 1976.·

CASO 8 - HIGADO - HISTIOCITOSIS J•IAL!GNA

Byrne, G.E., Jr., et al .: Malignant hi stiocytosis. Gann ~bnograph on Cancer Research, 15:145-162, 1973.

liarnke, R.A. , et al.: Malignant histiocytosi s (histiocytic medullary reticulosis) Clinicopathologic study of 29 cases. Cancer, 35:215-230, 1975.

#

CASO 9 - RINON - ANGIOMIOLIPOMA

Farro~t, G. M., et al.: Renal angiomyolipoma; A clinicopathologic study of 32 cases. Cancer, 22:564-570, 1968.

Hajdu, S. I., et al. : Angiomyolipoma of the kidney: Report of 27 cases and revi e11 of the 1 iterature. J. Uro 1. , 102:396-401 , 1969.

Price, E.B., Jr., et al.: Symptomatic angiomyolipoma of the kidney. Cancer, 18: 761 -774, 1965.

#

CASO 10 - RI!IlON - ONCOCITOMA

Klein, N.J., et al.: Proximal tubular adenomas of kidney with so-called oncocytic features. A clinicopathologic study of 13 cases of a rarely reported neoplasm. Cancer, 38:906-914, 1976.

Riopelle, J.L . : The nature and origin of the so-called true kidney hypernephroma . Cancer, 4:789-802, 1951.

, CASO 11 - INTESTINO DELGADO - TUHOR I~ALJGNO INDI FERENC IADO (? CARC INOt~A METASTAS ICO)

CIU.DAD SANITARIA VIRGEN DEL ROCIO C!NtaO D£ Rf HABILtTACION YTRAUMATOLOGIA

• SERVICIO OE ANATOMIA PATOLOGICA Sevilla ! de Enaro de 1.977 S E VILLA

Dr. Juan Rosai Daparment og Laboratory Medicine and Pathology Medical School Box 609 Mayo Building :Minneapolis, I'llinnasota 5§455

Estimado Dr. Rosai:

Le adjllJ.lto los d~gnosticos recibidos basta este

memento del Seminario preparado por nosotros, puesto que del S~

minario sobre !llimo no hay ninglfu nuevo diagnostico con respecto

aJDSque le envie en mi carta del 15 de Diciembrel•'

Los diagnosti cos son :

Caso n~ 1 . Para s itosis

Caso n2 2. Compatible con en:fermedad de Weber-Rendu- Osl er

Tenlagiectasia familiar hereditaria

Caso n2 .3o Sarcoma de Kaposi

Caso n2 4'. Fibrohistiocitoma maligno

Caso n2 5'. Hi s tiocitosis X

Enfermedad de Letterer Siwe

Caso n2 6. Oligodendroglioma maligno

H Ema.ngi o blastoma

Ca.so n!l 7. Disgerminoma

Carcinoma embrionario

CIUDAD SANITARIA V IRGEN DEL ROCI() CZtNiRO DE RfHABIUTACION Y TRAUMATOLOGI'A

SERVICfO Df ANATOMIA PATOLOGICA

SEV I L LA

Caso n2 8. Hepa t obl ast oma mul ticen·tr i co

Linfoma con i nvasion hepatica

Caso n2 9 . Hamarto~a renal (Fibromioangi oli poma)

Caso n210. Sar coma alveolar (si nonimias : Miobl as toma de celula

granular organoide, Paranglioma no cr oma.fi nmaligno) .

Caso n21~ Sarcoma alveolar .

Angiosarcoma

Leiomiobl astoma.

Como le dije en ~~a carta ant erior estos diagn6s t i­

cos ae los tendre prepa.rados en sl ide, cads. caso por separado.

Hasta la pr6xima semana r eciba un afect uoso saluda.

Fdo. Dr . /

J . M. L i zaga Iriondo.

JEFE DEL DEPARTAMENTO,.