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Case prepared by: Jennifer Scudiere MD
GI Pathology Fellow
Attending: Elizabeth Montgomery, M.D.
  Case 46
Clinical History: The patient is a 65-year-old man who presents for an upper endoscopy because of reflux symptoms. On endoscopy, a 5 cm gastric mass was noted. The endoscopist noted that the lesion was suspicious for lymphoma. Subsequent imaging revealed lesions in the lung, liver, and spleen. The following images are from 5 cm gastric mass biopsy.

For this case, immunohistochemistry is extremely helpful. What lesions remain in the diagnosis after the following panel is performed?

CD45RA: Negative
Cytokeratin AE1/AE3: Negative
Synaptophysin: Negative
S-100 Protein: Positive
HMB-45: Positive
Melan-a: Positive

Image 1 Image 1
Image 2 Image 2
Image 3 Image 3
Image 4 Image 4
Image 5 Image 5
Choose the correct diagnosis:
  a. Clear Cell Sarcoma and Malignant Melanoma
  b. Gastrointestinal stromal tumor and clear cell sarcoma
  c. Lymphoma and melanoma
  d. rhabdomyosarcoma and melanoma
  e. Malignant nerve sheath tumor and clear cell sarcoma

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