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Well-differentiated neuroendocrine tumor of the duodenum
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Polypectomy from a 78-year-old man who presented with weight loss. The whole tumor is no more than 0.7 cm in greatest diameter and appears limited to the mucosa and submucosa.

Histologically, the tumor is composed of bland cells arranged in predominantly a cribriform ("type C") pattern, but there are no psammoma bodies. Since the tumor is small and superficial, I expected it to be totally benign. However, I asked the clinician to check the serum levels of gastrin and somatostatin, and the gastrin level was "sky high." This finding would bump the tumor into the "low-grade malignant potential" category. If the patient has clinical Zollinger-Ellison syndrome, then he has a 30% probability of having metastases, the small size of the primary notwithstanding.

Never a dull moment in surgical pathology!

Image from page 207 of “Physiology, hygiene and sanitation, an elementary textbook of physiology, with special attention given to hygiene and sanitation” (1919)
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Identifier: physiologyhygien00heiz
Title: Physiology, hygiene and sanitation, an elementary textbook of physiology, with special attention given to hygiene and sanitation
Year: 1919 (1910s)
Authors: Heizer, W. L. (W. Lucien), b. 1880
Subjects: Physiology Hygiene Sanitation
Publisher: Louisville, Ky., C.T. Dearing Printing Co., Incorporated
Contributing Library: The Library of Congress
Digitizing Sponsor: The Library of Congress

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tion. time that tuberculosis was inherited from parents to chil-dren. It is now known that this is not true. Tubercular parentsare usually not verystrong and oftenhave low vitality. Theirchildren naturally are,as a rule, weakly andlack resisting power,and, for this reason,more likely to developthe disease, if the germsor seed find their wayinto their bodies.A new-born baby may have a mother, who has advan-ced tuberculosis, or be in the1 last stages of the disease, butthe lungs x>r other tissues of thebaby, when born, are always freefrom the germs of the disease.Unfortunately, most mothers donot know how to prevent thespread of this disease and thebaby often becomes infected inthe early days of its life. How the Disease Spreads. Thegerms of consumption are oftendestroyed by white blood cellsin the lungs. The attacking germsattempt to grow in the warm,moist, dark lungs, which furnishthem plenty of food. At once the alarm is given and na-ture sends out her army of policemen, the white

Text Appearing After Image:
Fig. 93.—Feeling for un-usual vibrations fromthe victims voice in aphysical examination. TUBERCULOSIS 207 blood cells, and a great fight to the last man occurs. Ifthe white blood cells are the victors (and they are in thegreat majority of fights or infections), the lung tissuebecomes normal or well. Tf the germs are numerous, persistent and strong, thelung cells are broken down or destroyed, as the army ofwhite blood cells is forced farther away from the scene ofthe first attack. These infected spots become large enough to be seenwith the naked eye and the fight continues or stops depend-ing on the strength ofthe opposing sides. Often these spots,or infected areas, be-come as large as amarble, a plum, or anapple and the whiteblood cells succeed inlimiting the spread ofthe destruction bybuilding a wall orsac all around the in-vading germs and thetissue which has been destroyed. The disease then may besaid to be arrested and the signs of fever, loss of weight,cough, and fickle appetit

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Rowing To Lose Weight
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Lose Weight Learning To Row a 90 day Body By Vi Challenge

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