Case 110

Surgical Pathology Case



A 52-year-old male who began having abdominal discomfort in June 2007 that had been evaluated several times by the ER and felt to be consistent with irritable bowel syndrome.  The pain was mostly in the left abdomen and was quite severe at times and was intermittent (usually worse after meals).  He had some significant weight loss of up to 40 pounds over the past couple months due to this pain. A repeat CT scan showed a small bowel obstruction.  He was admitted and treated with conservative management but did not have complete resolution of his obstruction and therefore requiring exploratory laparotomy on 9/26/07, which showed a mass in his ileum along with several lymph nodes.  A small nodule in the liver was also present and biopsied. His preoperative CT really showed no evidence of metastatic disease and the liver tumor was not visualized.  The patient does report a history of flushing/sweating episodes for a number of months and states that he has had diarrhea symptoms really for years that has always been attributed to IBS.



The specimen consists of two oriented segments of resected small intestine measuring 65.0 cm in length x 5.0 cm in diameter.  The surface of the specimen is pink and dark red. 25.0 cm from the proximal margin reveals a stricture and adhesion. 30.0 cm from proximal margin reveals a nodule in the peri-intestinal fat tissue with an adhesion to the small intestine.  Upon sectioning through the stricture area at 25.0 cm reveals one tumor mass invading through the entire wall and measuring 2.5 x 2.3 cm with a pale tan solid cut surface. Sectioning through the mass at 30.0 cm reveals several tumor nodules measuring 3.0 x 2.5 x 2.5 cm in aggregate with a pale/tan homogeneous cut surface. All the tumor nodules are firm when sectioning through.


HE, 2

HE, 20


HE, 40

HE, 40


Liver nodule, HE, 4

Liver nodule, HE, 40


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Source: Department of Pathology, Creighton University Medical Center, Omaha, NE

Photo: Zenggang Pan

Discussion: Zenggang Pan