Journal of the Louisiana State Medical Society
Figure 1A and 1B: (A) Transverse plane image of a CT scan showing the mass-like thickening of the ascending colon (circled) with dilated large and small bowel proximal to the tumor. (B) Frontal plane image of a CT scan showing a 5 x 4 cm mass-like thickening within the hepatic flexure (circled) accompanied by adjacent fluid and scattered lymph nodes.
Figure 2: Clear cell adenocarcinoma tumor cells with abundant clear cytoplasm and well-defined cell borders. (Hematoxylin & Eosin stain, original magnification 200x)
logic sections showed a clear cell adenocarcinoma, circum- ferentially involving the colonic wall. The tumor cells were pleomorphic with hyperchromatic, rounded to angular, vesicular nuclei, some with prominent nucleoli, exhibiting well-defined cell borders and containing abundant clear cytoplasm (Figure 2). Immunohistochemical stains revealed the tumor cells to be strongly and diffusely positive for cyto- keratin 7. There was patchy moderate to strong staining for CDX2, CD15, and cytokeratin 20. Focal spotty positivity was
seen for CD10 and neuron specific enolase. Tumor cells were negative for vimentin, thyroid transcription factor 1, alpha inhibin, calretinin, alpha-fetoprotein, placental alkaline phosphatase, chromogranin A, synaptophysin, and CD56. No other source of malignancy could be identified by CT, full-body positron emission tomography (PET) scan (Figure 3), or additional biopsy sampling of the liver, stomach, and duodenum. The hemicolectomymargins were free of tumor. One of 19 identified pericolonic lymph nodes was positive
144 J La State Med Soc VOL 166 July/August 2014
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