College of American Pathologists

2010 — November Case of the Month

Posted January 3, 2011


CAP Foundation November 2010 Online Case of the Month

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A 60-year-old man presented with abdominal pain, constipation and melena. The patient underwent nephrectomy for clear cell carcinoma of the kidney 7 years ago. Colonoscopy revealed an ill-defined mass in the sigmoid colon with normal overlying mucosa. Abdominal CT showed a 4.0 cm hypervascular mass on the serosal aspect of the sigmoid colon. Segmental resection of the colon was performed. Received was an 18 cm segment of colon with a 4.0 cm serosal-based mass. Sectioning revealed infiltration of the tumor into the muscularis propria, without involvement of the mucosa. The cut surface revealed areas of hemorrhage and necrosis. The tumor cells were cytokeratin(+), PAX-2(nuclear+), CD10(+), RCC marker(+), vimentin(+), CK7(-), CK20(-), CDX2(-), S-100(-), HMB-45(-), chromogranin(-), and synaptophysin(-).

The master list with the correct answer

  • Colonic adenocarcinoma
  • Metastatic melanoma
  • Metastatic renal cell carcinoma
  • Neuroendocrine carcinoma
  • Perivascular epithelioid cell tumor

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  • Appropriate diagnosis
  • Critique
  • References

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