1539
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Poorly differentiated gastric adenocarcinoma, intestinal type.
Stomach
Haematoxylin & Eosin (H&E)
73 years
female
73-year old female with a tumor beneath the cardia. The patient already underwent gastric resection (Billroth II) for gastric cancer 41 years ago.
Several grastic biopsy fragments are infiltrated by a predominantly solid growing tumor. There is no clear formation of glandular structures. Note the presence of abundant accompanying inflammatory cells.
Immunohistochemical studies yielded positive results for CK7 and CK22 whereas CK5/6, CK20 and Cdx2 remained negative. This profile is compatible with the diagnosis of a primary gastric adenocarcinoma. In addition, immunohistochemical expression of MLH1 and PMS2 was lost indicating microsatellite instability of the carcinoma. In conjunction with the reported previous gastric cancer (41 year ago!) this finding is suspicious for Lynch syndrome (HNPCC).
Philippe Brunner, University of Basel
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