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Histo-Meeting 07-01-2016
82 year old male
2
• Ischemic cerebral infarction 09/2015
–Stent A. carotis re 09/2015
–ASS & Plavix
–Rehabilitation
• Hematochezia 10/2015
–Gastroscopy: gastritis, axial hernia
–Colonoscopy
Colonoscopy 10/2015
Tumor in the distal colon ascendens
3
Histologie
Tubulovillöses Adenom mit
schwerer Dysplasie
Weiter unter Tunica muscularis
infiltrierend Carcinom
4
30 year old male
5
• Crohn`s disease, initial diagnosis 11/2014
– Ileitis terminalis 2014
–Anal fistula 05/2015
–Therapy:
• Steroids 11/2014
• 02/2015 Budesonid & Salofalk
• 05/2015 Start with Puri-Nethol stopp (pancreatitis)
• 07/2015 Start with MTX, continuation with Budesonid
Gastro- & Colonoscopy 09/2015
DuodenitisAcute erosive antrum gastritis
6
Histologie
• Fokal neutrophile Granulozyten enhanced gastritis; passt zum M. Crohn
• DD wäre: Medikamenteninduziert (Eisen), Fremdkörper, Parasit
7
76yo male
8
Metastasised Non Small Cell Lung Carcinoma
(adenocarcinoma), ED 04/2015
• 07/15 St.p. palliative RT bone metastases, 30 Gy
• 07/15: palliative CT cisplatin/alimta. Complication:
pancytopenia
Refractory dysfagia
• Herpes stomatitis 07/2015
• 30/07/15 Gastrografin Swallow: No stenosis.
Dysmotility lower Esophagus: muscular?
Paraneoplastic?
30/07/15 Gastroscopy: Severe circular
Esophagitis
• Selective culture: Candida albicans ++
• Histology: possible Medication-induced esophagitis, no HSV, CMV
9
Course
10
• 01/08/15: CMV DNA 2874 Cp/ml
• Diflucan 2w, valcyte 3w, persistent symptoms
• Aspiration pneumonia
• 03/09/15 Oral mucosa smear: Candida +++
• 04/09/15 Gastroskopie
Gastroscopy 04/09/2015
• Healed mucosa, Schatzki ring
11
Histologie
Esophagus, neutrophilic infiltrates
Support diagosis of esophageal
Candidiasis (as opposed to eosinoph.)
Detection of candida spores
Confirms diagnosis
12
13
Titel: Schriftgrösse 40
Beschriftung der Bilder:
Unterhalb des Bildes, Schriftgrösse
20, Angabe des Organs,Erklärung,
was die Befunde bedeuten und
Diagnose
Bilder: Seitenverhältnisse beibehalten,
wichtiges herausvergrössern (erkläre ich
Euch gerne wie), herausvergrösserte Bilder
mit schwarzer Umrandung, 2.5Punkte breit
Beachtet auch die Ausrichtung amRaster.
Pfeile: schwarz, 2.5 Punkte
breit (!!!)
Nicht den Text damit
überschreiben.
Course
14
• CMV PCR: 326 cp/ml
• HSV PCR: weakly positiv
• Start Diflucan iv 10/09/15 (oral candidiasis)
Course
15
• CMV PCR: 326 cp/ml
• HSV PCR: weakly positiv
• Start Diflucan iv 10/09/15 (oral candidiasis)
• 19/09/15 Death by refractory recurrent aspiration
pneumonia
47yo male
16
IgA nephropathy
- 13/03/2007 Deceased donor kidney transplantation
- 25/12/14 Second deceased donor kidney transplantation : CMV
S+/E-
- Immunosuppression: Induction with Basiliximab, maintenance
with tacrolimus, mycophenolate mophetil and Prednison
- 09/2015 End of prophylaxis with Valcyte
11/2015 Beginn chronic diarrhea
• 20/11/15: Hospitalisation with sepsis, elecrolyte dysregulation,
metabolic acidosis
• Blood, stool cultures, CD toxin negative
• CMV PCR in blood 1996 Cp/ml
Colonoscopy 24/11/15
Terminal Ileum Coecum
17
Colonoscopy 24/11/15
Suboptimal bowel preparation, no sings of a
CMV infection, no cause for the diarrhea
18
Histology
Colon
1. Inflammatory infiltrate
2. Distraction of the crypt architecture
«as if cut with a rezorblade»
Differential diagnosis:
1. Infectious colitis in healing stadium
2. Diversion colitis
3. Colonic Ischemia
4. Toxic (medications associated)
colitis
19