Gastric biopsy

[LADoc00]

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Otherwise perfectly normal gastric biopsy with microcalcs all over it....no carcinoma, no inflammation, no parasites/bugs...who has also seen this??

 

[anencephalic]

My knee jerk reaction would say ask for a recut of the slide to ensure it wasn't contaminant...but wtf do I know?

 

[LADoc00]

My knee jerk reaction would say ask for a recut of the slide to ensure it wasn't contaminant...but wtf do I know?

microcalcs within tissue arent contaminants. but every contribution is worthwhile, even the silly ones.🙄

May need to call in the big guns and send an email to UMich.

 

[anencephalic]

microcalcs within tissue arent contaminants. but every contribution is worthwhile, even the silly ones.🙄

May need to call in the big guns and send an email to UMich.

Ah yes...within the tissue is a completely different story. Even brainless folk know that...

 

[futureresident]

Hi,

is the patient on kayexalate? I was thinking kayexalate induced colitis/necrosis....morphologically, kayexalate may look like microcalcs.

Hopkins has 2 cases in their surgpath unknown conference:
week 260 case 4
week 179 case 4

keep us posted, LA

 

[futureresident]

Ah!

Gastric biopsy...scratch my last post 🙂

 

[djmd]

Ah!

Gastric biopsy...scratch my last post 🙂

Don't sell yourself short... It could be Kayexalate

Kayexalate in sorbitol given orally has also been associated with necrosis in the upper GI tract (Am J Surg Pathol. 2001 May;25(5):637-44.).

How about it LADoc look like the JHU picts? That stuff sure looks like MicroCalcs...

 

[Mrbojangles]

Did they give any clinical history? Was it a mass?

Metastatic calcification? Pancreatic heterotopia with calcifications? But you'd expect to see fibrosis and chronic inflammation.

 

[pongo]

has the patient been taking a lot of antacids? A visiting GI pathologist (he was famous, can't remember his name right now) showed us a case like that during his resident seminar, then he talked about a study he did using microdissection on similar sounding cases and was disappointed to find that the microcalcs consisted of calcium and magnesium.

 

[LADoc00]

has the patient been taking a lot of antacids? A visiting GI pathologist (he was famous, can't remember his name right now) showed us a case like that during his resident seminar, then he talked about a study he did using microdissection on similar sounding cases and was disappointed to find that the microcalcs consisted of calcium and magnesium.

The patient is on dialysis...interesting, I do believe that this maybe drug related. Maybe a paper is in order, I could slap everyones name on it from the SDN path forum🙂

 

[djmd]

The patient is on dialysis...interesting, I do believe that this maybe drug related. Maybe a paper is in order, I could slap everyones name on it from the SDN path forum🙂

LADoc, Et al?

 

[b&ierstiefel]

LADoc, Et al?

No...it would be Doc00, L.A., et al (2006) ... assuming he gets off his ass, writes the manuscript, and gets that shiznit published before New Years.

 

[yaah]

The patient is on dialysis...interesting, I do believe that this maybe drug related. Maybe a paper is in order, I could slap everyones name on it from the SDN path forum🙂

We have had this shown at conference a couple of times - the "antacid effect" (from certain antacids) can do this as well as kayexelate as stated above. The dialysis patient may also have a calcium of 12 and be depositing all over the place.

And I guess make sure they are not calcified schistosomiasis eggs... 😱 I once saw a breast core biopsy for microcalcs and the microcalcs were all schistos.

 

[caffeinegirl]

calciphylaxis or metastatic calcs in ESRD...?

1: Milliner DS, Zinsmeister AR, Lieberman E, Landing B. Related Articles, Links
Soft tissue calcification in pediatric patients with end-stage renal disease.
Kidney Int. 1990 Nov;38(5):931-6.
PMID: 2266678 [PubMed - indexed for MEDLINE]
2: de Graaf P, Pauwels EK, Schicht IM, Feitsma RI, de Graeff J. Related Articles, Links
Scintigraphic detection of gastric calcification in dialysis patients.
Diagn Imaging. 1979;48(3):171-6.
PMID: 535528 [PubMed - indexed for MEDLINE]

 

[EUA]

Had a case of metastatic calcifications in a gastric biopsy not too long ago -- attending said it was a not-too-infrequent finding in ESRD.

 

[pathdawg]

Dude, its gotta either be metastatic calification or some kind of iatrogenic thing.

 

[triguy]

It sounds like mucosal calcinosis, especially with the history of renal failure. Check out Case #11 on the Johns Hopkins GI Pathology website.

http://pathology2.jhu.edu/gicases/

The site has GI scenarios with a short description and list of references.

 

[LADoc00]

Answer: mucosal calcinosis secondary to ESRD.

Case was sent in consultation to Wolverine Pathology Consultants aka UMich... (but Yaah wont be able to trace it back to me to find my real identity because I didnt send it🙂