2007 Winter Meeting - London - The Pathological Society of Great ...

P21A Case of Oesophageal Carcinosarcoma withAdenocarcinoma Differentiation and Sarcomatous Metastasis{P} AD Christian, AG Douglas-JonesUniversity Hospital of Wales, Cardiff, United KingdomCarcinosarcomas of the oesophagus are rare tumours, clinically presenting aspolypoid exophytic masses with squamous cell and spindle cell components.We present the case of a 63 year old man with epigastric discomfort andweight loss. On endoscopy an ulcer with raised rolled edges was found in thelower oesophagus. A biopsy was performed which showed a small fragment ofa highly pleomorphic malignant tumour composed of aggregates of plumpepithelioid and spindle cells with high mitotic activity. Immunohistochemicalstaining showed vimentin positivity and weak cytokeratin positivity. Initialdiagnosis was of a malignant fibrous histiocytoma.Gastro-oesophageal resection showed a 3 by 2cm polypoid tumour in thelower oesophagus. The tumour was composed of spindle – sarcomatouselements with adjacent adenocarcinoma. Tumour invaded through muscularispropria, with lymph node deposits of sarcomatous elements (6 out of 12 nodes).Immunohistochemical staining showed positivity for p53 and AE1/AE3 in bothelements of the tumour, consistent with a carcinosarcoma.This unusual tumour showed adenocarcinoma as the carcinomatouscomponent. Positive p53 staining in both elements of the tumour suggests asingle monoclonal origin for this tumour. Metastases from carcinosarcomastend to be of the carcinomatous element whereas, in this case, the lymph nodescontained metastatic sarcoma.P22Immunohistochemistry Shows No Difference in E cadherinExpression Pattern Between Early and Late Onset GastricCancer{P} C R Parkinson 1 ,TEBuffart 2 , A Gill 1 , E Morrison 4 ,B Carvalho 2 , C J H van de Velde 3 ,GAMeijer 2 ,N C T van Grieken 2 , P Quirke 1 , H Grabsch 11 Pathology and Tumour Biology, Leeds Institute of Molecular Medicine,Leeds, United Kingdom, 2 Dept of Pathology, VU University MedicalCenter, Amsterdam, Netherlands, 3 Dept of Surgery, Leiden UniversityMedical Center, Leiden, Netherlands, 4 Cancer Research UK ClinicalCentre at Leeds, Leeds Institute of Molecular Medicine, Leeds, UnitedKingdomWe have demonstrated that early onset gastric cancer has a different arraycomparative genomic hybridisation (CGH) profile compared to late onset GC.The expression and distribution of E cadherin (CDH1) are often abnormal inGC. Very few studies have compared CDH1 expression in early and late onsetGC and results from these studies are contradictory.We investigated CDH1 expression by immunohistochemistry on tissuemicroarrays constructed from sporadic GC of 77 patients younger than 50 yearsand 163 older patients. Staining pattern was classified as normal (completemembranous staining), abnormal (reduced membranous or cytoplasmicstaining) or negative and correlated with patient age, clinicopathological data,survival data and CDH1 copy number from array (CGH) data.CDH1 expression pattern was markedly heterogeneous even within the sameTMA core. 18% of the cases showed normal expression, 70% abnormalexpression and 12% were negative. Higher number of lymph node metastasesand higher stage were both related to a higher frequency of tumour cells withabnormal CDH1 expression. CDH1 expression was more often abnormal indiffuse type GC. Abnormal CDH1 expression was more often associated with ahigh grade of differentiation. No association was found between CDH1expression pattern and patient age, survival, CGH copy number or any otherclinicopathological parameter.Our study confirms the relationship between CDH1 expression, tumourprogression and tumour differentiation in GC, but does not support arelationship between CDH1 expression pattern, patient prognosis or age ofdiagnosis. Furthermore, our array CGH data indicate that a mechanism otherthan CDH1 copy number change could be responsible for abnormal CDH1staining pattern in GC.P23Coincident Granular Cell Tumour of the Stomach withInvasive Adenocarcinoma: A Case Report and Review ofLiterature{P} SP Sah, JN Thompson, AC WotherspoonThe Royal Marsden Hospital, London, United KingdomBackground: Granular cell tumour (GCT) is relatively uncommon benignneural tumour. Approximately 5% to 9% of GCTs occur in the gastrointestinaltract, most commonly in oesophagus. Gastric localization is very rare and onlysix cases have been reported since 1996.Case Report: A 49-year-old man presented with 4 months’ history of weightloss and dysphagia. Endoscopic examination revealed an exophytic tumour atoesophago-gastric junction. Following 4 cycles of pre-operative neoadjuvantchemotherapy he underwent an oesophago-gastrectomy. The resected specimenshowed a tumour involving distal oesophagus and proximal stomach. Sectionsfrom tumour revealed an invasive moderately differentiated adenocarcinoma ofintestinal type (pT3N0Mx). Within muscularis propria of the stomach, in theregion of the adenocarcinoma, a circumscribed lesion measuring 1.5 x 1.2 cmwas seen. The lesion composed of oval to polygonal cells with a small centralnucleus and abundant granular cytoplasm. The cytoplasmic granules werepositive for periodic acid-Schiff. The cells stained for S-100 protein and NSE.Morphologic and immunohistochemical findings favoured a benign GCTinfiltrated by adjacent adenocarcinoma at places. The patient is doing well aftera follow up of 3 and half years.Conclusion: We report a rare case of GCT colocalized with an invasiveadenocarcinoma of the stomach.P24Poster withdrawnWinter Meeting (191 st ) 3–5 January 2007 Scientific Programme33