Canadian Association of Pathologists - Case of the Month - February 2008

Two GI Surgical Pathology Cases

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CASE 1

"A 50-year-old woman with right lower abdominal pain"

Contributed by Drs. Mowafak Hamodat (mowafak.hamodat@easternhealth.ca) and Amrah Pirzada
Eastern Health of Newfoundland and Labrador St. John's NL

Clinical history:
A 50-year-old female with a history of right lower quadrant abdominal pain for one week was treated with antibiotics for two weeks with a plan to proceed with appendectomy. Following antibiotic treatment, the patient developed fever, chills and abdominal pain. A CT scan showed an appendiceal abscess.
Operative Findings:
A right paracolic gutter abscess and acutely inflamed appendix were encountered during appendectomy. The tissue specimen sent for pathology was given the following gross description.
Gross Description:
Appendix measuring 7cm in length and 4cm in diameter with hemorrhagic and purulent exudate with two perforations 0.5 and 2.5 cm from the apex. Cut section shows white jelly-like material.

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CASE 2

"A 60-year-old woman with epigastric pain, fever, and chills"

Contributed by Drs. Farah Moid (moidfa@stjoe.on.ca) and Richard Hart
Divisions of Pathology and Surgery, St. Joseph Health Center Toronto

Clinical history:
A 60-year-old Vietnamese female presented with epigastric pain, fever and chills. Laboratory investigations revealed abnormal liver function tests. CT scan showed multiple stones in segment 2 of the liver with dilation of ducts distal to this area. A segmental resection of liver (11 x 8 x 3cm) was done. Serial sectioning of the specimen showed an irregular white area measuring approximately 3 x 1.5 x 3cm on the cut surface.

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