Self Instructional Manual for Cancer Registrars - SEER - National ...

EXAMPLE G10 (continued)
CLINICOPATHOLOGICAL CORRELATION AND DIAGNOSIS
This 70-year-old white man was diagnosed in May 1982 at age 61 as having chronic
lymphocytic leukemia. He received one intravenous injection of nitrogen mustard with good
results.
In January 1983, the patient was admitted to the hospital for evaluation and his white
blood count was 5200 with 55% lymph., 37% mature polymorphs, 4% monocytes and 2%
eosinophils. He was asymptomatic, and his prognosis for the future was described as
excellent. In November 1991, the patient was admitted to the hospital, about 18 days before
his death. There the diagnosis of undifferentiated adenocarcinoma of the stomach with
massive dissemination of the disease was made. The patient died on December 1, 1991.
Microscopic examination showed a signet ring cell carcinoma of stomach infiltrating the
muscular coat with fibroblastic proliferation and thickening of the serosa. Metastatic signet
ring cell carcinoma was found in "many organs (see final pathologic diagnosis) and
represented massive widespread metastatic disease.
Only microscopically were we able to diagnose adenocarcinoma of the right bronchus,
locally invasive and infiltrating bronchial cartilage and adjacent nerves but without
metastases.
Although, the patient was free of any symptoms of chronic lymphocytic leukemia, sections
of the liver and bone marrow showed lymphocytic leukemic infiltrates. The enlargement of
the spleen (770 gm.) and lymph nodes might be due to metastatic signet ring cell carcinoma
as well as to leukemic involvement.
At autopsy this case revealed three histologically different tumors. Two of them were
carcinomas: signet ring cell carcinoma of the stomach with widespread metastases and
adenocarcinoma of the right bronchus with local infiltration. The third malignancy was
chronic lymphocytic leukemic infiltrates without definite clinical manifestation. It is quite
possible, that the signet ring cell carcinoma with metastases, diagnosed in late stage of such
disease, covered other slightly marked features of leukemia or adenocareinoma of the lung.
The myelofibrosis could be secondary to metastatic signet ring cell carcinoma or the results
of the previous leukemic chemotherapy or connected with leukemic involvement of the
bone marrow, or all of them caused such condition.
Doe, John Hosp. No. 000046 Autopsy #A91-21
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