12th Ljudevit Jurak International Symposium on
Comparative Pathology
June 1-2, 2001

F. Kneževiæ, V. Šeparoviæ, M. Šèukanec, D. Vrdoljak, V. Orešiæ, R. Šeparoviæ
University Hospital for Tumors: Zagreb, Croatia
Authors report of a 71-yeas-old man admitted for manifestations of subileus. US and CT revealed an indefinable, extensive and expansive process in the abdomen. Laparotomy showed a tumor of about 15 cm in diameter attached to the mesenteric ileum and with its upper portion coalesed to a jejunum loop. In order to remove the tumor, resection of the jejunum, ileum and ascending colon was performed using termo-terminal anastomosis and ileotransversal anastomosis, respectively. Macroscopic examination demonstrated a lymphoma-like multinodular lesion of 15 cm in diameter, gray-white at cross section, homogenous and soft situated on the mesenteric root. Small intestine loops, cecum, apendix and ascending colon were macroscopically normal. Moreover, extensive histologic and imunohistochemical examination excluded mucinous adenocarcinoma (cytokeratin -, EMA -), non Hodgkin lymphoma (LCA -, CD20 -, CD3 -, CD68 -), extra-adrenal paraganglioma (NSE -, chromogranin -, sinatophysin -, factor  no perivascular rosettes), yolk-sac tumor (alpha-fetoprotein -), and desmoplastic small round cell tumor (cytokeratin -, EMA -, vimentin +, desmin -).Ultrastructural examination of the described tumor showed a cell arrangment with wide intercellular spaces and desmosomes at the contact area of adjacent cells. A considerable number of cells were covered by microvilli. Moreover, many cells contained a  well-developed Golgi apparatus with extended vesicles filled with fluffy material also found in intercellular spaces. In addition, cytoplasm of many cells accommodated lamellar inclusion bodies or myelosoma. Based on the above ultrastructural picture and positive anti-thrombomodulin markers the diagnosis of poorly differentiated peritoneal mesothelioma was made.

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