Pathlet 012
Heather Wilson '15
with the pathology team

These pathlets are edutainment. This site collects no information about visitors, and cannot substitute for your own doctor's care. There are many questions without clear right-or-wrong answers.

Vintage Poster
Ms. Suntan, a 36 year old white woman, lives on Hawaii's big island. A hard-working Hawaiian tropics model and photographer, she comes to see you becasue of severe indigestion, loss of appetite, fatigue, and a ten pound weight loss during the past month.

Her current medications include a daily multivitamin, omeprazole 20 mg PO daily since she was in high school. She has smoked one pack of cigarettes per week for four years, and eats fast food and pineapple every day. She lives with her 68-year-old father Mr. Suntan, who has suffered from similar symptoms for the past five years. He is a professional surfer and surf instructor and has never sought medical attention.

A complete physical exam is remarkable only for some mild epigastric tenderness on palpation. CBC and routine chemistries are normal.

Which of the following are you really considering?

Acute viral hepatitis
Celiac sprue / gluten enteropathy
Esophageal cancer
Emotional illness
Gastric carcinoid
Gastric carcinoma
Gastric lymphoma
Gastric ulcer
Helicobacter gastritis
Hiatus hernia
Liver carcinoma, primary
Reflux / peptic esophagitis
Pancreatic cancer

You work with a fine health-care team. Which of your colleagues will you consult?
Dr. Flex, the gastroenterologist
Dr. Scatterbrain, the psychiatrist
Dr. Sharp, the surgeon
   (a chance to cut is a chance to cure)
Dr. Sinktest, the clinical pathologist
   (Helicobacter breath test)
Dr. Ray, the radiologist
   (abdomianal CT for starters)

What do you see?

Big lymphocytes ("centrocytes / centroblasts")
Infiltrate expanding lamina propria
Intestinal metaplasia
Intestinal-type carcinoma
Lymphocytic nodules
Many small lymphocytes
Reactive glandular changes
Signet ring cells

And what diagnoses are you really considering now?

Atrophic / autoimmune gastritis
Chronic gastritis
Gastric carcinoid
Gastric lymphoma
Gastric ulcer
Helicobacter infection
Intestinal-type carcinoma
Signet ring carcinoma

Let's order up some special stains for this man. You choose.

   (some B-cell lymphomas)
   (acute lymphoblastic leukemia, more)
   (pan B-cell)
   (pan B-cell)
   (malignant lymphoid follicles)
   (pan B-cell)
   (pan B-cell)
Epithelial membrane antigen
Kappa & lambda light chains
   (pan B-cell)

When you are done, make the diagnosis.

Autoimmune gastritis
Gastric carcinoid
Gastric ulcer
Helicobacter gastritis, uncomplicated
Intestinal-type carcinoma
MALT lymphoma secondary to helicobacter
Reactive gastropathy
Signet ring carcinoma
T-cell lymphoma


The daignosis was confirmed with FISH (fluorescent in-situ hybridization). The familar t(11;18)(q21;q21) translocation was demonstrated.

As is often the case with these stomach lymphomas, eradication of the helicobacter resulted in disappearance of the malignant lymphoma. This is one of a very few cancers that will often vanish permanently when the factor that keeps them going -- in this case, the helicobacter, is eliminated.

In this case, the patient made a rapid and complete recovery.

Pomaika'i is the Hawaiian term for "good luck."

Heather Wilson KCUMB '15

More Pathlets