Choledocholithiasis and gastric polyp

Discussion:

Patient proceeded to biopsy of the gastric mass. 

CLINICAL NOTES: Gastric mass - cancer - antrum ?primary vs secondary. Also second lesion @ upper lesser curve.

MACROSCOPIC DESCRIPTION: 1. "Lesser curve Bx": Three pieces of tissue 1-3mm. A1. 2. "Gastric pyloric mass": Numerous pieces of tissue 1-4mm. A1. 

MICROSCOPIC DESCRIPTION: 1. The biopsy of glandular mucosa with muscularis mucosae shows glands and villi lined by markedly atypical columnar cells and foci of incomplete intestinal metaplasia. Desmoplastic stroma is not identified and the muscularis mucosae appears intact. 2. The biopsy of glandular mucosa with muscularis mucosae shows villi and glands lined by markedly atypical columnar cells focally within desmoplastic stroma. There is areas of acute inflammatory exudate. Scattered goblet cells are present within the epithelium.

DIAGNOSIS: 1. Lesser curve biopsy: Intramucosal carcinoma. 2. Gastric pyloric mass: Invasive adenocarcinoma. SUPPLEMENTARY REPORT Immunohistochemistry shows tumor cells stain positive with CK20 and CDX2. focal positive with CK7. Negative PSA, PSAP and TTF-1. Features in keeping with a gastrointestinal origin. Primary stomach or metastatases from colon are most likely possibilities.

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