111-f( CALIFORNIA TUMOR TISSUE REGISTRY

"GYNECOLOGIC PATHOLOGY"

Study Cases, Subscription A

January,2004

CaJifomia Tumor Tissue Registry . e/o: Department of Pathology and Human Anatomy

Loma Linda University School of Medicine 11021 Campus Avenue, AH 335 J,.,oma Linda, Califo.mia 92350

(909) 558-4788 FAX: (909) 558-0188

E-mail: cnr@linkline.com Web page: www.cttr.<lrg

Web site & Case oftbe Month: www.cttr.org

Tarxet audience: Practicing pathologists and pathology residents.

Goal: To acquaint the participant with the histologic features of a variety of benign and

malignant neoplasms and tumor-like conditions.

Objectives: The participant will be able to recognize motphologic features of a variety of benign

and malignant neoplasms and iumor-like conditions and relate those processes to pertinent references in the medical literature.

Educational metbods aod media: Review of representative glass slides with associated histories. Feedback. on consensus diagnoses from participating pathologists. Listing of selected references from the medical literature .

. Principal faculty: Weldon K. Bullock, MD Donald R. Chase, MD

CMECredit: Lorna Linda University School ofMediCioe designates tbisrontinuing medical

education activity for up to 2 hours of Category I of the Physician's Rerognition Award of the Americao Medical Association.

CME credit is of!Cred for the subscription year only.

Accreditation: Lorna Linda University School of Medi.cine is accredited by the Accreditation

Council for Continuing Medical Education (ACCME) to sponsor rontinuing medical education for physicians.

Contributor: Robert H. Zucb, M.D. Case No. 1 - January 2004 Baldwin Park. CA

Tissue from: Ovary Accession #29593

Clinical Abstract: After having undergone several endometrial curettage procedures, which showed simple &

complex hyperplasia without atypia, this 39-year-old, moderately obese female was found to have a left adnexal mass.

Gross Pathology: The irregularly shaped gray-tan ovary measured 10.0 x 8.0 x 2.0 em and weighed J 95 grams.

SPECIAL STUDIES (Outside facility): Vimentin positive Inhibin negative E~ negative Cytokeratin 7 negative

Contributor: Susan Murakami, .M.D. Case No.2 - January 2004 Pasadena, CA

Tissue from: Ovary .Accession #29629

Clinical Abstract: This 51-year-old female developed ascites and was. found to have pseudomyxoma peritonei.

The involved omentum, spleen, appendix, uterus and biiateral adenxae were removed.

Gross Pathology: The276 gram right ovary measured 10.0 x 8.7x 5.5 em and contained a multiloculated cystic

mass filled with gelatinous mucus. The left ovary was 8.5 x 5 x 4.5 cril, also with a multiloculated cystic mass filled with tan gelatinous mucus. The resected appendix was 4 em in diameter and filled with mucinous material.

SPECIAL STUDIES (Outside facility): KeratinCK7 Keratin CK20 Estrogen receptor Progesterone receptor Her2/neu

negative strongly positive negative negative negative

Contributor: Kumari Wic:kramasiagbe, M.D. Case No. 3 - January 2004 Lynwood,CA

Tissue from: Left Ovary Accession #29458

Cliaic:al Abstract: This 86-year-old female was found to have bilateral ovarian cysts on cr scan.

Gross Pathology: The collapsed cystic left ovary measured 21.0 x 13.0 x 4.0 em. The cyst wall was up to 2.0 em.

The cyst wall and solid areas of the ovary were yellow. The right ovary had a single 4 em diameter cyst with a smooth translucent wall.

SPECIAL STUDIES: PAS + diastase negative in vacuolated cells

Contributor: LLUMC Pathology Group (bl) Loma Linda, CA

Tissue from: Right Ovary

Cliaieal Abstract:

Case No.4 - Jaaaary 2004

Accession #29674

For two months this 58-year-old female experienced abdominal discomfort with increasing abdominal girth. An ultrasound showed a 12 em pelvic mass.

Gross Pathology: This 2210 gram, 23.0 x 19.0 x 9.0 em ovary was entirely replaced by a gray-tan glistening

tumor. There were focal areas with hemorrhage.

SPECIAL STUDIES: PAS + diastase positive in vacuolated cells

Contributor: Alexander IC Lyster, M.D. Case No. S - January 2004 Victoria, TX

Tissue from: Vagina Accession #29707 '

Clinical Abstract: This 49-year-old woman presented with a vaginal mass.

Gross Pathology: The 44 gram specimen consisted of a 6.0 x 5.0 x 4.0 em, firm, rubbecy, multinodular mass.

SPECIAL STIJDIES: Desmin positive .

Contributor: Philip Robinson, M.D. Case No. 6 - January 2004 Boynton Beach, FL

Tissue from: Cervix Accession #29248

Clinical Abstract: FoUowing multiple cervical biopsies, this 35-year-old female had a hysterectomy with bilateral

slilpingoophorectomy.

Gross Pathology: The resected uterus was 9.2 x 4.5 x 3. 7 em. A coarsely granular, tan tumor protruded from the

cervical os. Sectioning sho:>wed a 6.6 x 2.5 x 0.8 em circumfe(eotial tumor centered at the squamocolumnar junction and invading about one-quarter of the thickness of the cervix.

Contributor: Tom Bassler, M.D. Case No. 7 - January 2004 Inglewood, CA

Tissue from: Uterus Acees5ion #27054

Clinical Abstract: After a long history of uterine fibroids, this 33-year-old female had sought treatment for pelvic

pressure. Ultrasound confirmed a 16-week size uterine fibroid.

Gross Pathology: The fairly symmetrical uterus weighed 885 grams and measured 15.0 x 13.0 x 10.0 em. There

was a single intramural fibroid that measured l 0.0 x 8.0 em.

SPECIAL STUDIES: Actin Des min

positive positive

Contributor: Kenneth Frankel, M.D. Covina,CA

Tissue from: Uterus

Clinical Abstract:

Case No. 8 - January 2004

Accession #23587

This 86-year-old female was found to have a pelvic mass. A bysterectomy and bilateral salpingo-oophorectomy was performed.

Gross Pathology: The uterus weighed 370 grams and measured 17.0 x 11.5 x 8.5 em. Within the uterine cavity

were 500 cc of blood and debris. The endometrium contained multiple polypoid pale yellow friable nodules varying from 0 .. 5 to 4.4 em.

Contributor: Livia Ross, M.D. Case No. 9 - January 2004 Alameda,CA

Tissue from: Uterus Accession #14869

Clinieal Abstract: Twenty years after menopause, this 67-year-old female experienced two weeks of vaginal

bleeding. A D&C was performed.

Gross Pathology: The specimen consisted of 50-60 cc of soft tan tissue removed from the uterine cavity.

Contributor: Ellen Ko, M.D. Case No. 10 - January 2004 Birmingham, AL

Tissue from: Small bowel/colon Accession #29267

Clinical Abstract: This 77-year-old ferna,Je developed a large abdominal/pelvic mass.

Gross Pathology: Within the anterior wall of the uterus were multiple, focally necrotic white-tan nodules.

Segmental resections of small bowel and of colon each had bulky hemorrhagic tumors adherent to sef\)sal sw:faces, 13 and 15 em in greatest diameter.

SPECIAL STUDIES: Trypsin Chymotrypsin Smooth muscle actin Muscle specific actin S-100 Cytokeratin

positive positive positive positive negative negative

Note: Due to paraffm block exhaustion, some slides of Case 10 oftheOctobcr, 2003 "A" study set may not be representative or diagnostic. With this maUing, we are substituting a similar case.

Contributor: Paul R. Thompson, M.D. Case No. lOb - October 2003 Burbank, CA

Tissue from: Spleen Accession #22744

Clini.cal Abstract: A 57-year-old male complaing of vague symptoms of fatigue, pressure over the precordium and

tingling of the left arm was noted to have an enlarged spleen. A splenectomy was performed.

Gross Pathology: The spleen was 22.0 x 20.0 x 10.0 em and weighed 2400 gnuns. Most of the cut surface was

dark red and "multicystic".

CALIFORNIA TUMOR TISSUE REGISTRY

GYNECOLOGIC PATHOLOGY

M inutes --Subscription A

January, 2004-

SUGGESTED READING (General Topics from Recent Literature):

Oral Contraceptive Pills Are Associated with Artifacts in ThinPrep Smears that Mimic Low-Grade Squamous lntraepithelial Lesions. Morrison C, Prokorym P, Piquero C, et al. Cancer 99(2):75-82.

Descriptive Epidemiology of Ovarian Cancer in llle U.S. 1992-1997. Cancer (Supplement), May 2003. Liquid-Based Cytology and Conventional Cervical Smears. Cheung AN, Szeto EF, Leung BS, et aL Cancer 2003;

99:331-335. Glandular CeU Atypia on Papanicolaou Smears. Interobserver Variability in the Diagnosis and Prediction of Cell of

Origin. Simsir A, Hwang S, Cangiarella J, ct al. Canoer2003; 99:323-330. A Namagram for Predicting the Likelihood of Additional Nodal Metastases in Breast Cancer Patients with a Positive

Sentinel Node Biopsy. VanZee KJ, Manassek DME, Bevilacqua JLB, et aL Ann Surg Onccl2003; 10(10): 1140-1151.

California Tumor Tissue Registry c/o: Department of Pathology and Human Anatomy

Lorna Linda University School of Medicine 11021 Campus Avenue, AH 335 Lorna Linda, California 92350

(909) 558-4788 FAX: (909) 558-0188

E-mail: cttr@linkline.com Web site & Case of the Month: www.cttr.org

FILE DIAGNOSES

(Diagnoses may also be sent through our website at www.cttr .. . "subscripllous ... submit answers")

Case 1:

easel:

Case 3:

Case 4:

Case 5:

Case 6:

Case 7:

Case 8:

Case 9:

CITR Subscription A

Granulosa cell tumor, adult type, ovary T-87000, M-8620 1

January 2004

Disseminated peritoneal adenomucioosis ("low grade mucinous tumor'', likely of appendiceal origin) T-6YOSO, M-50100

Signet-ring stromal tumor, ovary T-87000, M-69360

Metastatic mucinous (signet ring) adenocarcinoma ("Krukenberg tumor"), ovary T-87000, M-84803

Leiomyosarcoma, vagina T-81 000, M-88903

Villoglaodular carcinoma ("well-differentiated papillary adenocarcinoma"), cervix T -83000, M-82623

Mitotically active cellular leiomyoma, uterus T-82000, M-88921

Clear cell carcinoma, uterus T-82000, M-83103

Malignant mixed mullerian tumor ("carcinosarcoma"), uterus T-82000, M-89803

Case 10: High grade mesenchymal neoplasm consistent with stromal sarcoma, uterus

T-82000, M-89303

Ca5e lOb:

1

Littoral cell angioma, spleen T -07000, M-91200

ClTR, January 2004 "Minutcs" (Subsaiption A)

Case No. 1, Accession No. 29593 January 2004

Alameda CAIAI!!<da Coumy Medical Ccntql - Adult gn~nulosa cell tumor Bakersfield - Granulosa eelltumor Baldwin PJitk <Kaiser Permaucptel - Leydig cell rumor (3) HaywE!!'l!!frsmont - Prolifcraling transitional cell (Brenner) tumor, ovary Irvine rue [)avjs Medical Ccnta) - Gnnulosa cell tumor Laguna Beach !South Cow MC!lica! Cemql - Granulosa cell tumor l,oma Ljodo (!.oma Lindo Up!yersity Rcsjdcn(Sl - Sex cord stromal ov3rian tumor, favor juvenile gronulosa cell tumor (unusual

inhibin negative variant) J,ong Beach C!..akewood Beaiona! Medical Ccntql - 1uvcoUe gronulosa-ee!ltumor (9) Monterey <Coqununitv Homital ofMontcrey Penfusulal - Granulosa eel! tumor Mounlllin Vjew CEI Camino Pathology Grouo. Inc.) - Granulosa cell rumor Ollkland IKnlscr.Pennanentel - Adult granulosA cell rumor (S) Orause !Orange County PAUJOiogv Medjcal Oroupl - Gr.J.Oulosa cell tumor Sacn!mcnto C\JC Davis Mcdjca! Center\ • Poorly diiJercntiated Sertoll·Leydig C<:lltumor San Diego CNayal Medica] Ceoter> - Adult gronulosa-ccl! tumor, Juvenile granulosa cell tumar (2 .. choice) San Ftancjg;o WCSFl - Granulosa cell tumor Sants Rosa !Snnta Rosa Memorial HoMilul) • Granulosa cell tumor (3) ~ • Granulosa cell tumor Alaska I AI•*" Natiyc Medjcal Ceotcrl - Granulosa eel! tumor, adult type Arizona IM!I!Wale Medical Ceoterl - Adult granulosa cell tumor Arlgma• aJnjyersity of Arkan"'-< Medical Center) - Granulosa cell rumor Colorado !Evcweenl - Granulosa cell tumor Colorad9 fkuberan Medico! Center! - Adult granulosa cell tumor florida ITalla!!a.<!¢! - Endometrial stromal sarcoma, diffilsc adult granulosa cell tumor florida !Winter Haven tlomila!l • Granulosa cell tumor Wiu2il! - Adult granulosa cell rumor Illinois <Northwestern Memorial Hospital! - Granulosa cell tumor !odiana (Kokomo) • Tbccoma Looi&ana lloui.siana State Unjyersiry Mqljcp.l Center> • Granulosa cell tumor Marvland 1/oltns Honkjns Homital) - Granulosa cell rumor vs. ovarian tumor of probably Wolflian origin (iohibin) Maryland INntjopal Naval Modjcal Cemer) - Granulosa cell tumor Mmrohu.<etts <Berkshire MC!lical Center) - Granulosa eel! tumor MassachUS<!!S <New En21and Medical Cguq Residcn"l • Granulosa cell tumor, adult 1ypc Michi2l!!! fKa!wpamo) • Juvenile gr9nulosa cell tumor Mlnnesom (fairview Soulhdale Hospil!l!) • Sc~ cord stromal tumor favor adult granulosa cell tumor Nebraska !Creillhton Uolyeality School of Mcdicjne!!.esidcmsl - Adult granulosa cell tumor New Jmcv COverJook Hospila!l - Granulosa cell tumor New York a.on. Island Jewish Medical Center) - Granulosa cell tumor. possibly juvenile type Nev.o· York CNns!" Univ<nirv Medical Centcrl • Granulosa cell tumor New York !New Yorkl - Sex cord stromal tumor-favor granulosa cell rumor New York !New York Prcsbvtcrian HQl!niW] Residents) - Granulosa cell tumor (8) New York !Stony Brook University HospjJAI RC<jdentsl • Granulosa cell tumor North CaroJjna(MounJAin An;a Pathology\ - lnhibin ncptivc granulosa cell tumor (4) Objo !MC!lical College of Ohio) - Juvenile granulosa eel! rumor Objo (McCyl!ouoh-Hyde Memorial Hospilll!l - Adult granulosa cell tumor Oklahoma IIylsal - Epithelioid leiomyoma of borderline type Pqmsvlvanja CAI!egbeny General Hosnitall - Granulosa cell tumor, adult type Pen:nmvanja <Centre Comroynjrv Hosnitall - Ovarian thecoma Pennsylvania (Conemaugh Memorial Medicnt Center) - Granulosa cell tumo_r Pcnnsy!vanjaiDrexel !Jnjymity Sehool ofMe<licinol - GrtUlulosn eel! tumor PcD!\SYlvanja <I&high Valley Hospjta!l - Juvenile granulosa cell tumor (I); Gnutular cell rumor (I) Pennsv!vania NPMC Heal!h Svsteml • Adull granulosa cell tumor Rhode Island CR! Homjt;tl Rc;sidcntsl - Adult gronulosa cc:ll tumor. diffuse pattern Iew CPronn!IJ AssociatCI!l - Granulosa cell 1\lmor (2) Texa.< fScott & White Memorial Hospim!l - Gnnulosa cell rumor West Yirginja <Greenbrier volley Medical Center) - Granulosa cell earcinoma

C'lTR, JllnUII!)' 2004 "Minu1<0" (Subscription A) 3

Wisconsin IMeritu Hospital\ - Juvenile gtanulosa cell iumor Australia !North Queensland Pathology) - Granulosa cell tumor Australia <Roval Prince Alfred Hospital! - Part.ially luteinized adult granulosa cell tumor Canada!Foothills Medjc;al Center) - Unclassified sex cord stromal tumor Hong Kon21Hong Kong Baptist Hospital! ·Adult granulosa cell tumor llaly !Naoles\ - Adult granulosa cell tumor Jamaica ((Jnivernjtv Hospital of the West lndie.<) - Adult granulosa cell tumor Jaoan !Chibal - Mixed germ cell sex cord stromal tumor of ovary · Netherlands !Amsterdam\ - Sex cord stromal tumor (granulosa cell tumor) Oatar !Hamad Medical Comomtion\ • Granulosa cell tumor Saudi Arabia • Adult granulosa cell tumor

Case 1 • Diagnosis: Granulosa cell rumor, adult type, ovary

T-87000,~-86201

Case I References: Bondestarn J, Kaivo-oja N, Kallio 1, et al. Engagement of Aclivin and Bone Morphogenetic Protein.Signaling Pathway Smad

Proteins in the Induction oflnhibin B Production in. Ovarian Granulosa Cells. Mol Cell Endocrino/ 2002; 30(195):79. Fujimoto T, Sakuragi N, Okuyama K, et al. Histopathologic Prognostic Factors of Adult Granulosa Cell Tumors of the Ov;uy. Acta

Obsw Gynecol Scaiul2001; 80(11):1069-1074. Mayr D, Daltz-Wiltmer C, Arbogast S, et al. Characteristic Pattern of Genetic Aberrations in Ovarian Granulosa Cell Tumors. Mod

Patho/2002; 15(9.):95 1-951. AI-Badawi lA, Brasher PM, Ghatage P, et al. Postoperative Chemotherapy in Advanced Ovarian Granulosa Cell Tumors. tnt J

Gynecol Cancer 2002; 120): 119-123. Gusberg SB and Kardon P. Prolifel"dtive Endomelrial Response to Theca-Granulosa Cell Tumors. Am J Oh.<ret Gyneco/1971 ;

til :633-643. Vesco KK and Carney ME. Granulosa Cell Tumor oftbe Ovaty. Extensive Late Recurrence after lnitital Occult Microscopic

Disease. Obstel Gyneoo/2002; 99:888-891.

Case No. 2, Accession No. 29629 January 2004

AlanJeda !Alameda Coumy Medical Center) • Jv!ucinous tumor of low malignant potential with associated pseudomyxoma peritonei Bakersfield • Atypical proliferative mucinous tumor Baldwin Park (Kaiser Pennanente\ • Pseudomyxoma ovarii from pseudomyxoma or nppendix (2); Mucinous adenocarcinoma,

metastalic from nppendix (Krukenberg tumor) Hayward/fremont - Pscudomyxoma peritonei due to appendiceal mucinous CBtCinoma Irvine ClJC Davjs Medical Center) - Mucinous adenocarcinoma, mctastalic from appendix Laguna Beach !South Coast Medical Ceoterl - Low grade mucinous appendioealtumor Lorna Linda !Lorna Linda University Residen(<\ • Bilateral mucinous cystadenoma favor implants from appendiceal origin kong Beaeb (Lakewood Regional Medical Center\ • Mucinous adenocarcinoma of nppendiceal prim;uy (9) Monterey CCommunitv Hosoital of Monterey Peninsula> - MetaStatic mucin prodUcing adenocarcinoma, appendix Mountain View <EI Camino Pathology Group Inc.\ • Metastatic mucinous adenocarcinoma , nppendix primary Oa)<!nnd !Kaiser Permanentel • Metastatic appendiceal mucinous carcinoma (5) Oranse !Orange County Pa!hology Medical Grouo\ · Adenocarcinoma, consistent with metastasis from appendix Sacramento roc Davis Medical Center\ • Disseminated peritoneal adenocinosis San Djego (Naval Medical Center) · Disseminated peritoneal adenomucinosis San Francisco GJCSFl - Mucinous cystadenoma ,Santa Rosa (Santa Rosa Memorial Hosnitai) • Metusta!ic mucinous carcinoma, most likely nppendiccal prim;uy (I); Mucinous

carcinoma, probably me18Silltic (I); Pscudomyxon\a ovarii, ,.,;th pscudomyxoma peritonei syndrome due to low grade intestinal type mucinous neoplasm ofprobablcappcndiccal origin ( I}

Yenll!!!! • Mucinous rumor oflow malignant potential Ala.•ka !Alaska Natjve Medjca! C1.11ter) • Append local mucinous adenocarcinoma metastatic to ovary Arizona IM!!rvyalc Medical Center\ • M:ctusta!ic colonie mucinous carcinoma Arl<ansas <university of Arkansas Medical Center\ • Disseminated peritonea! adenomucinosis Colorado <Everoreenl - Mucinous adenocarcinoma consistent with melllS!atic from appendix Color'Jdo !Lutheran Medical Center) - Mucinous borderline tumor, intestinal typ<:

4 CITR. JanWJI)' 2004 "Minutes" (Subscription A)

florida Cfallahasseel - Mucinous tarcinoma florida CWinter Haven Hospha!l - Mucinous cystadenoma J.ll.in!lil - Mucinous adcnocoreinoma IIUpojs <Northwestern Mttru)rJnll4ospitaJ) • Adenornucinosis Indiana (Kokomo! - Borderline mucinous adenocarelnoma of appendix l,oyjsjana CLoujsjana State Unlyerslty Medjcal Center) - Peritoneal adenomuclnosis (scoondary to mucinous cystadenoma oflhc

appendix Mvylanc! (Jphns Hool;ns Homitall - Signet-ring stromal tumor Mvylanc! <National Naval Medical Center) - Mucinous cystic rumor Mmar!tusens !Berl<sbire Medjcal Centerl - Borderline mucinous cystadenoma of probable appendice~~l ori@in Ma.~gehysett<: tNew England MesljCQI Center Rcsidco\3) .. Disseminated peritoneal ndenomucinosis, appendix primary Micbjoan CKalnmazool - Metastatic mucinous adenocarcinoma from appendix Mjnnc;;ota CFniryjew Southda!e Hosoitan - Metastatic mucinous adenocarcinoma Ncb!8skn !Creighton Univcrs!tv School of Medicine &esidentsl - Mucinous adenocarcinoma New Jmey (Overlook Hosoj!Ail - Mei8Static adenocarcinoma (wcll-<lifferentiated with pseudomyoma features) from appendix New Yott <Long !<lane! Jewjsh Mc<lical Centffl - Mucioous cystadenocarcinoma. metastatic New Yor!s.<Nassau Uniymjtv Mg!jcal Center) - Ptcudomyxoma ovarii New York <New York) - Mucinous neoplasm associated with pseudomyxoma perltonei with features intermediate between

dissemii)Jl!ed pc:ritonelll adeoomucinosis and peritoneal mucinous carcinoma (appendiceal primary) New York <New York Presb\1erjan Hosnital Resjdema> .. Well·diffcn:ntiated mucinous adenocarcinoma, mctD.)'tatic pseudomyxomn

pcritonei (3); Well-differentiated mucinous adenocarcinoma, metastntic (I); Mucinous adenocarcinoma (I); Mucinous ftdenocareinoma, metastatic ps.:udomyxoma pcrltonel (I); Mucinous adenocarclnomu, consistent with metastatic from appendix (I); Mucinous neoplasm, fllvor well-differentiated adenocarcinoma, rule out mctasta1ic ( I);

New York!S!Ony Brook !lnjymity Hospilal Resid0!!!$l • l.owgnde mucinous adenocarcinoma of the appendix Noah Cl!rolina !Mountain Anal Pll)hotogvl - Mcwtatic appendiceal adenocarcinoma (4) Objg (Medical Colle&c ofOblol - Mucioousc:ystadenomaofappendiccal oriain Ohjo (McCullougb-H@ Memorial Hosoitall - Mucinous cystic tumor Oklllhoma !Tulsa) • Mucinous c}'lltlldenomu, borderline Pcnn$\llvnnia !Allegheny Gcneml Hospitall • Metastctic mucinous carcinoma from an appendiceal prlmllt)' Pennsylyanja !Centre Cnmmunily HgspjJAI\ • Metastatic low-grade mueinou.~ adenocarcinoma of probable appendiceal origin fennsylvaoia !Conemauab Memorial Medical Center\ - Metastatic mucinous cystadenotarcinoma of appendix PepnsyiYMi• lDrexel Unjvqsjty Scl!ool ofMc<ljcjncl - Mucinous adc:noeareinoma, appendiceal PennsyiV!)!!ia CLe!ti!!h Valley Homi!al> - Mucinous adenocarcinoma probably colonic primary (I); Adcnocareinoma (I) Penn'Y!vania fUPMC Health Svs!crnl - Mucinous cystadenoma Rhode Island IRI Hosnjm! Rcsjdcn!Sl - Mucinous cystic rumor of appendix associ Bled with pseudomyxomo peri10nei Texas (propath As<ncia)esl - Mucinous cystadenoma of borderline malignancy ( I); Mucinous cystic tumor of borderline

malignancy with pseudomyxoma peritonel (I) TexM !Soou & White Mcmodo! Hosnita)l - Metastatic mucinous adcnocarclnomo WCSJ Yir&inJa <Greenbrier Valley Medical Center! - Mucinous cystadenoma, borderline Wimgsio CMeriter HospiraJl • Metastatic mucinous adenocarcinoma A)ISI!Piia CNorth Ouccnsland Pa!!to!oW • Pseudomyxoma perltonei ? associated with wc:U-<Iiff=tiaicd appendiceal carcinoma Au.mlia CRoval Prince Alfn;d Hospi!Ail - Pseudomyxoma ovarii (cell rich) likely metastatic low grade mucinous adCDOCareinoma

from appendix Cann4a (foothills Mc<lico! Cemcr\ • Low grade mucinous tumor of ovary consistent with origin from appendiceal mucinous

neoplasm Hgng Kong CHong Kong BanliSI Uospitall • Mucinous borderline rumor, appendiceal origin lln!y !Noplesl - Mucinous carcinoma (pscumyxomn ovadi), probably mcta."atlc Jamajca OJoivmitv Rosnital o(thc West Indies> - Ovarian cystic mucinous cumor, borderline JP!!IJQ !Cl!ibel · Mucinous adenocarcinoma of appendix Nethcdands (Amstmlaml • Mei8Static mucinous adenocarcinoma of the digestive tnoct Oa!ar CHama4 Medical Cnrpot111ionl - MCiaSialic mucinous carcinoma of appendiceal origin Saudi Arabia - Metastatic mucinous cystic tumor

Cote 1- Diag.nosis: DisseminAied peritoneal adenomuci.nosis ("low grade mucinous tumor",likely of appendiceal origin)

T-{;YOSO, M-50100

C'ITR, Junwuy 2004 "Minutes'' (Sul>lcripUon A) 5

Case 2 - References: Yaldiz M, Uzunlar AK, Kiline N, et al. Mucinous Tumors ·orthe Ovary. Analysis of38 Cases. Eur J Gynaeco/ Onco/ 2001;

22(5):358-36Q. . Young RH. Gilks CB and Scully Rll. Mucinous Tumors of the Appendix Associated with Mucinous Tumors of the Ovary and

PscudomyxomaPeritonei. A Clinicopathological Analysisof22 Cases Supporting an Origin in the Appendix. AmJSurg Patlwl 1991; 15(5):415-429.

Nomura K and Aizawa S. Noninvasive, Mic'TOinvasive, and Invasive Mucinous Carcinomas of the Ovary. A Clinicopathologic. Analysis of 40 Cases. Cam;er 2000; 89(7): 1541-1546. ·

Bouzourene Hand Genton CY. Mucinous Tumors ofthc Ovary. Anatomo-Clinical Aspects, Histological Classification, Prognostic Factors and Histogenesis. Arch At10t Cytol Patho/ 1997; 45(4):192-198.

Groisman OM, Meir A and Sabo E. 'llte Value ofCdx2 lmmuoostaining io Differentiating Primary Ovarian Carcinomas from Colonic Carcinomas Metastatic to the Ovaries. lnt J Gynecol Pathol 2001; 23(1):52-57.

Case No. 3, Accession No. 29458

Alameda (Alameda Countv Medical Center) .. Thecoma with incidcntaJ Brenner epithelial nests Bakcr.dield - Thecoma Baldwin Park CKaiser Permanente) - Steroid cell tumor (3) Hayward!Fremont - Gonadal stromal IUmor (Sertoli-Leydig cell tumor), ovary lryine rue Davis Medjcal Center\ - Sigoet-riog cell stromal tumor Laguna Beach (South Coast Me<ljg!l Center) - Signet·ring stromal tumor ofihe ovary Lorna f.inda CLoma Linda \Jnivet'$itvResident~) • Ovarian thecoma Long Beach <Lakewood Regional Me<Jjeal eenter) - Signet-ring stromal (9) Monterey <Community Homjta) of Monterey Penim:ula) · Leuteniud thecoma Mountain View ffil Camino Pathology Group. Inc.) · Fibrothccoma Oakland <Kaiser Permanentel - Thecoma (5) Orange !Oranoe Couotv Pa!ho!ogy Medical Group) - Brenner tumor plus signet-ring stromal tumor Sacramento rue Davis Medical Center) - Signet ring stlllmal tumor San Diego fNaval Medical Center) - Thecoma, leutcinized (I}; Signet-ring stromal tumor (2"' choice) San Francisco NCSFl - Signet-ring stromal rumor

January 2004

Santa Rosa !Santa Rosa MemOfiallfosnital) - Signet-ring stromal tumor vs. sclerosing stromal tumor (I); Sclerosing stromal tumor (2)

~-Thecoma Alaska (Alaska Narivc Medical Center) - Luteinized thccoma.<lthecosis (2); Krukenberg tumor (1) Ariz.ona (Marvyale Medical Centerl - Krukenberg tumor with amyloidosis Arldmsas <University. of Arkansas Medical Center) - Thecoma Colora<lo CEvergrcenl - Thecoma Colorado <Lutheran Me<lical eenterl - Signet-ring stromal tumor Florida (Tallahassee) - Steroid cell tumor Florida (WinterHaven Hospital) - Steroid cell tumor, Brenner tumor Illinois - Fibrothecoma Illinois (Northwe.5tem Memorial Hosnita)l · Signet·ring stromaJ -tumor, incidental Brenner tumor Indiana <Kokomo l - Yolk sac tumor Loujsjana O,oujsjana Stajc University Medical Center) - Signet-ring stromal tumor of the ovary Marrland (Johns Hopkins Rospitall - Mucinous adeno!lla ftom appendix (pseudontyxomn perilonel) Maryland (National Naval Medical Center) - Brenner tumor/signet-ring stlllmal tumor Massachusetts (Berkshire Medfeal Center) - Thecoma Mlh<Sa£buseus !New England Me<Jica! Center Resideo!S) - Sclerosing stromal tumor Michigan <Kalama7.Qo\ - Thecoma Minnesota <Fairview Southdale Hospital) - Sex cord stromal tumor consistent with signet-ring stromal tumor Nebraska CCrel2!1ton University School ofMcdiCinc Residents) - Thecoma vs. signet-ring stromal tumor New Jersey (Qver)ool< Hospit!l!l - Fibroma consistent with lipidization New York <Long Island Jewish Medical Center) - Signet-ring cell stlllmal turoor New York fNassau University Medical Center) - Ffbrothccoma New York (New Yotl<l - Clear cell carcinoma of ovary New York <New York Presbyterian Hospital Residenl<l - Sclerosing stromal tumor (8)

6 CTIR, January 2004 "Minutes" (Subscription A)

New York /Stony Brook University Hospital ResidenL•l - StrOmal tumor, signet-ring celi type North Garoijna(Moun!Bin Area Pathology! - Signet strOmal rumor (2); Signet-nos stromal rumor of the ovazy (Brenner tumor) (I);

Stromal tumor(si~-ring ceO slrOmal tumor){ I) Ohio !Medjcal College ofOhjol - Signet-ring stromal tumor Ohio IMcCul!ou•h-Hyde Memorial Hospiflll\ • Signet-ring stromal tumor Okl8homa /Tulsa) - Clear cell carcinoma PennsYlvania (Allegheny Genena! Hospi!Ail • Thecoma Pen.ns>•lyonja CCentrc Commupjty RomitaJl · Leuteini;zcd thecoma Pcnm>ylyania CConemauab Memorial Medjcnl Center> • Cystic variant or yolk sac tumor Pennsvlvan!a (Drexel llnivmitv School pf Medjcinel • Fibrothecoma Pcnosvlyanja C!&hi2h Valley Hospital) • 'lbccoma (1); Steroid cell tumor (I) PcnnsviYIDi• (UpMC Heal!b System! - Sclerosing suomal tumor Rhode Island IRI Hospitl!l Rcsidcn!Sl - Sign<t-riog SU'Omal tumor '!'exas<Prooath Associates) • Thecoma (2) Texas ISco!! & White Memorial Hospito!l • Sclerosina stromal tumor Wes! Viminja /Greenbrier valley Medjeal Caner) • Adenocarcinoma sign<t-ring (Krukcnberg's) Wisconsin !Meriter Hospj!Ail - Si~-riog SU'Omallull\I)C Ausualia <North Oueeoslnod Pathology! - Upidized stromal cell tumor AysiTlllja !Royal Prince Alfrtd Hospjwl\ • Signet-ring cell gonadal stmmal tumor oftl1e ovary (type of ftbrothcoomn} Canada CFoolhms Medical Center) • Signet-ring stromal tumor and benign Brenner tumor Hong Kono (Hone Kong Bap!jS! Hospi!Ail - Signet·rin& stromal tumor Italy !Naplt3l • Krukenburg tumor and associated benign Brenner tumor Jamaica IUolyersity Hospital of the West lodjes} - Signet-riog suomal tumor Janan IChjbal - Signet-ring stromal tumor of left ovary Netherlands {Amsterdam) - Signet-ring slrOmaltumor Oa!ar CH!It!!ld Medical CO!!lO@!ionl - Brenner rumor Saudj Arnbjo - Sigoe!-riog stromal tumor

Cas 3- Dlagnosjs; Signet-ring stromal rumor, ovary

T-87000. ~-69360

Case 3 - References: Ramzy I and Delaney M. Signet-Ring Cell Stromal Tumor of Ovary Cytologic Appearnnccs of Fine Needle Aspirntlon Biopsy. A al a

Cy;o/19n; 21(1):14-17. Syed SP and Chase DR. Signet-Ring Stromal Tumor ofOvasy. Web PubUcatioo at www.cttr.org. Oel2003. Cashell AW, Jerome WG 1111d Flores E. Signet Ring S1r001al Tumor oflllc Ovary Occurring in Conjunction with Brenner Tumor.

Gyneco/ Onco/2000; 77(2}:323-326.

Case No. 4, Accession No. 29674 January 2004

Alameda <Alameda Cpyorv Medical Center) • Mucinous adenocarcinoma Bakersfield - Klukenberg tumor Baldwin Park CKaiscr PermNJen!el - Mcta.mdc adenoc:a.n:inoma (3) Hayward/Fremont - Metastatic mucinous cnrcinoma, ovary lryine <UC Dayjs Medical Center\ • Goblet cell carcinoid l.aguna Bea&h CSoutb Coas! Medical Cen!CC) - Krukcnberg tumor !.oma kinda CLoma !JndJI University Rt$idents) · Krukenbetg rumor. tubular varian~ rule out? (especially gastric signel-ring

can:inoma) kon• Beach 0.8kcwood Renional Medjcn! Center) - Me!nstaric mucinous signet ring cell carcinoma (Krukenberg tumor) (9) Monterey lCommynitv llospjtal of Monterey Peninsula) - Metastatic in stomach Mountain View CEI Camino Pathology Omup Inc. I • Metastatic signet-ring ceO adenocarcinoma (Krukenberg tumor) Oakland IKaiw Pmnanque) • ~ctastarlc mucinous carcinoma (Krukenberg tumor) (S) Orange <Orange County PaJbn!ogy Medjegl Groupl ~ Adenocarcinoma, eonsisrent with metastasis from .stomaeh $•C!'!U!!ento rue Dayjs Mc<ljcol Center) - Metastntic signet-ring cell carcinoma/mucinous carcinoid tumor should also be considered San Dieoo <Nayal MedicBl Center! - Krukcnberg ( I); Goblet cell carcinoid (2"' choice)

CTl1\, JIJlullr)' 2004 '"Minute$'" (Subscription A) 1

San Francisco CUCSf) - Mucinous adenocarcinoma SantA R9!!A CSAQlll RO-<a Memorial Hospilafi - Krukcnbcf3 rumor (2); Metastatic signet ring cell adenocarcinoma (I) Ymn!!i - Krukenbcf3 rumor Alaska (Aia.<!ca Natiyc Medical Center) - Metaslalic mucinous edenocarcinoma/Krukenberg IUtnor Arizono CMacyyale Mec!ica! Center) - Krukrobcf3 tumor AtkJnW Nnjvmirv of Arbn_g.c; MecJicaJ Centerl . K.rukcnbcrg twnor Colorado CEvcam;enl - Sertoli-Jeydig cell tumor eolorado CLytheran MedjcoJ Center) - Metastatic signet-ring carcinoma Florida qal!ohassecl - KNI<enberg tumor Florida twiotcr Hayen t!osoitall - Metastatic mucinous adenocarcinoma (Krukcnberg) ~ • Metastatic mucus producing adenocarcinoma ll!jnojs CNorthwcstcm Memorial Hospjtan - Goblet cell carcinoid Indiana (Kokomo) • Leydig cell tumor LoujsjAQa!Loybjana Stnte Universitv Medical Center) - Krukenbere tumor, ovary Maryland (Johns Hookins Hosnjta]l - Metastatic adenocarcinoma Mmland CNntjonnl Naval Medical Center) - Goblet cell carcinoid (12); Krukenberg rumor (3) MassachuAA< CBerkshire Medical Center) • Signet ring,cell carcinoma Mji<S!!Cby§d(S !New llnoland Mec!icaJ Center Residents) - Goblet cell carcinoid Michigan (Kalgmn.zool .. Scrtoli-Leydig celJ Wmof' M"lJU11;$01ll Cfajrview Sou!hdale Hospital} • Signet-ring p41ttem adcnocan:inoma Cl Krukenbcrg) NrbmW CCtejsh!On University Se!Jool of Medicine RqidenJS) - Krukcnbcf3 rumor New Jersey COyerJook Hosoitall - Signet ring cell carcinoma. mcustaric New Ycnt; !l.gns!siAQd kl!ish Medical Centerl • Signet-ring cell adenocareinoma New York CNa.-.su University Medical Center) - Mucinous adenocarcinoma,. favor metas~atic New York (New York) - Meta.<tatic adenocarcinoma with signet-nne featur~s New York (New york PresbV'crian Hosoital Sesjdentsl - Adenocarcinoma favor metastntic (8) New YorJs CStony Brook Univcrsi!V Hospital Residens.s) - Mucinous carcinoid North CA!oljno (Mountain Area Pathology) - Metastntic slgnet-rlns adenocarcinoma (4) Qbjo !Mc!llcal Co!lcne ofOblol - Metastatic signet-ring cell carcinoma (Krukenberg tumor) Ohio CMcCu!loygh-Uyde Memorjal Hospital) - Krukenbcrg tumor (malignant signet-ring) Ok!ohoma CTulsal - Clear cell earcinoma PennsylyAQja CNie•heny Generai lfospitall • Krukenbere tumor (metastatic poorly differentiated adenocarcinoma) PennsylyAQja CCenjJ'e Communjtv Hospital) - Krukenberg's tumor (mcwtatic signet-ring carcinoma) vs. mucinous carcinoid of

ovary Pennsvlyaoja CCenO!!WJgh Memorial Medical Center) - Krukenbcf3 tumor Pennsylvania CPrexel Univern!V School of Medicine) - Meta.Static mucinous adenocarcinoma, signet-ring c:ell type (Krukenbcf3

rumor) Pennsvlyanla !l.ebloh Valley Hospital! - Adcnocan:lnoma with signet-ring fcatun:s ( I); Metastatic (?) adcnoearcinoma ( I) PennsylvMi• NPMC 11ea!Jh SVS!em) - Krukrobcf3 tumor (mewtatic signe<-ring cell carcinoma) Rhode lsiAQd CRl Hospital Residents) - Krukcnbcf3 rumor (metastatic mucinous adcnocareinoma) Texas ()>mnadt As!iQciBies) • Krukcnberg tumor (2) Texas CSeoU & White Memorial Hosoitall - Metastatic signet-ring adenocarcinoma West Virginia <Greenbrier Valley Medical Center) - Adenocarcinoma, endometrioid Wlseonsjn (MeriJer Ho:roital\ • Metastatic adenocarcinoma (Krukenberg rumor) Austra,lja (North Queensland Pathology\ - Krukenberg tumor Australia CRoynll>rinco Alfred Hosojtall - Krukenbcrg tumor Canada (Foothills Me<lical Center) - Metastatic signet-ring carcinoma (Krukenbere rumor) Hong Kong (tiona Kong Baptist Hospital) - Metastatic signet-ring cell carcinoma (Krukenberg tumor) Italy CNapl.,) • Goblet cell carcinoid Jamaica !Unjyeahy Hospital of the West fndiesl - Krukenbera tumor Japan CChibal - Krukenberg tumor of ovary NeJbqlgnds CAJD!fmWnl - Metastatic mucinous adenocarcinoma? Oatar lt!amad Mcclical Corporation) - Krukcnberg tumor Saudi A!Jibio • Mucinous carcinoid romor

Case 4 • Diag-nosis: Metastatic mucinous (signet ring) adenocarcinoma ("Krukenberg rumor"), ovary

T-87000, M-84803

8 CITR, Janunry 2004 "Minut<$" (Subscription A)

Case 4 - References: Holtt F and Hart Wit Krukenbcrg Tumors of the Ovary. A C!inlcopalhologic Analysis of27 C11Ses. Cancer 1982; 50(11):2438-

2447. Mtad K. Morice P, Falxe A, <tal. Krukenbcrg Tumor. A Clinioopalhological Study of 15 Cases. Ann Palho/2000; 20(3):202-206. Sandmcier D, l.obrinus JA, Vial Y, ct al. Bilateral Krukcnberg Tumor of the Ovary During Pregnancy. Eur J Gynaecol Onco/2000;

21(1}:58-60. Kiang DT and Kennedy BJ. Estrogen Receptor Assay In the Differential Diagnosis of Adenocarcinomas. JAMA 1977; 238(1):32-34. Kim HK. Hco DS, Bang YJ, et al. Prognostic Factors ofKrukenbcrg's Tumor. Gynecol Onco/2001; 82(1):10S-109.

Case No. 5, Accession No. 29707 January 2004

Al8111eda CAlame<!• County Medical Centql - Leiomyosarcoma !lakrnfle!d - Rhabdomyosan:oma Baldwjn Paris <Kaiser Permanentcl - Leiomyosarcoma, intermediate grade (3) Haywwd!fremont - Leiomyosarcoma, vagina Irvine CUC navis Meslical Center! - Leiomyosarcoma Lai!!!J!A Bach ISO!Itb r,,. Medical Center) - Leiomyosan:oma Lorna Linda !Lorna Linda llniyeaity Resjdcntsl - Symplastic leiomyoma Long Beru;h (Lakewood Resionnl Medical Center) - Lciomyosareoma (9) Monterey <Community Hospil81 of Monterey Peninsula) - Lci~myosarcoma

Mounmin view <EI CAmino PA!ho!ogy GrouP. Jne.l - Lciom)'OSIIrCOma Oa!tland CKaiser Perrnanentel - lciomyoSlliCOma (5) Orange !O!!!QKe County Palhology Medical Group! - Leiomyosarcoma· Samuncn!O CUC Davis Medica! Center) - Leiomyosarcoma San Diego CNayal Medical Center> - lciomyo""""ma San Francisco 1\/CSF) - Atypical leiomyoma Santa Rosn /Santa Rosa Memorial Hosoitall - Leiomyosarcoma (3) Ventum - Leiomyosan:oma Alaska!AIQSkaNatiyc Medical Center) - Leiomyosarcoma ArjzonaiMoryva!c Medical Center! - Lclomyosarcomn Arkansas 0/njvmity of Arlsan&• Medical Center) - LclomyoS&zcoma Colo!Pdo !Ever!!I!!Qil - AtypicaJisYIDPiastic leiomyoma Colo!!!do lluthC!1!!J Medical Center! - Leiomyosarcoma Florida!Tallahosseel - Leiomyosarcoma florida (Wjnter Haven HospjfAil - Lc:iom~ Ulinois - Rbabdomyos=oma lllinols INoJ!hwesrern Memorial Hosnjta!) - Symplastic leiomyomslleiomyosarooma lndlana <Kokomo l - Leiomyosarcoma Louisiana ll.ouisiana SQ!!e Uni!ll:lliity Medical Center) - leiomyosan:oma Marvland <Joltns Hopkins Hospital) - Leiomyosarcoma Maryland CNntiono! Naval Medical Centerl · Smooth muscle tumor of unknown mo!ignant potential Mp~husetts 1Berj@i3 Mcdjca1 Center> • Leiomyosarcoma Massacl!u'idtS !New England Medical Center Residents> - Leiomyosarcoma Mlchiaan <Kalamazoo> - Leiomyosarcoma Mjnnespra CFairview Southdglc Hospital) .. Lejomyosarcoma Nebm!!a ICteighton University Sc!Jool of Medicine Rcsidenl$1 - Leiomyoma with biwn: nuclei vs. leiom)•osarooma New Jen;ey <Overlook. Hosoi!llll - Leiomyosarroma New York IL&ng lslqnd Jewjsb Medical Center! - Leiomyosarcoma New York CNassay Uojversirv Mc<lical Center) - Leiomyosarcoma New Yorl! <New Yodel - Leiomyosarcoma New Yod!: !New Vorl< Presbvtcrian Hosoj!AJ Resjden!S) - Leiomyosarcoma (8) New York !Stony Bawk Uniycaity Hosplto! Residents> - Leiomyoma with symplastlc change NO!!h Carolina <MounWn An;a Pa!ho!ogyl - Leiomyosarcoma (2); Atypical (symplllslie leiomyoma) (2): Ohio IMc;dical Col!eac ofOhiol - Lciom~ Ohio IMcCu!!ough-Hyde Memorial Hospjta!l • Leiomyosarcoma

CTTR. January 2004 "Miniii'S" (Subs<ription II) 9

Oklahoma !Tulsa) - Leiomyosarcoma Pennsylyania (At1eghenv General Hosnital) · Leiomyosarcoma 'Pennsvlvania <Centre Communitv HosoitaJl - Leiomyosarcoma of the vagina" Pennsylvania !Conemaugh MemOrial Me!lical Center) - Leiomyosarcoma Pcnnsvly&nla (Drexel Unjyersjtv School of Medicine) - Smooth muscle_tumor of unknown malignant potential Pennsylvania (Lehigh Valley Hospital) • Leiomyosarcoma (2) PennsylvaniaiUPMC Health System) - Atypical leiomyoma with bizarre nuclei Rhode fs!and (Rl Hospjtill Resjdent•l - Leiomyosarcoma Texas lfropath Associates) .. l.ow grade leiomyosarcoma (2) Texas !Scott & Wbitc Memorial HOS!!itall - Symplastic (atypical) leiomyoma West Vir•inia !Greenbrier Valley Medical Center\ - Leiomyosarcoma Wisconsin IMcrller Hospi!all - Leiomyosarcoma Australia <North Queensland Pathology) - Leiomyosarcoma Australia !Royal Prince Alfred Hospital) - Atypical leiomyoma Canada <Foothills Medical Centerl - BiZIUTe leiomyoma · Hong Kong CHong Kong Baptist -Hosnitall .. Leiomyosarcoma Italy <Naples) - Leiomyosarcoma Jamaica. CUniyersit'{ Hosp!taJ of the Wes' Indies> - Leiomyoma Japan IChiba) • Atypical leiomyoma of vagina Netherlands !Amsterdam) - Leiomyosarcoma Oatar 0-!amad Medjcai .Comomtjonl - Leiomyosarcoma (4); Oizarre(symplastic) leiomyoma (4) Saydj A!llbia - Leiomyosarcoma

Case 5-Diagnosis: Leiomy.osarcoma, vagina

T-81.000, M-88903

Case 5 -References: Akhtar M, Ahmeduddin 1 and Valencia M. Primary Leiomyosarcoma of the Vagina. Light and Electron Micl))scopic Study of a

Case with Review ofLitemturc. Tex Med 1918; 74(9):67-71. Tavassoli FA and Norris HJ. Smooth Muscle Tumorn of the Vagina. Obstet Gyneco/1919; 53(6):689-693. Peters WA 3"', Kumar NB and Andersen W A. Primary Sarcoma ofthe Adult Vagina. A Clinicopathologic Study. Obstet Gyneco/

1985; 65(5):699-704. Kosary CL. FlGQ Stage, Histology, Histologi.c Grad~ Age and Race as Prognostic Factors in Determining Survival for Cancers of

the Female Gynecologi_cal System. An Analysis of 1973-87 SEER Cases of Cancers of the Endometrium, Cervix, Ovary, Vulva and Vagina. SemlnSurgOnco/1994; 10(1):~1-46.

Cwtin JP, Saigo P, SlucberB, eta!. Soft Tissue Sarcoma of the Vagina and Vulva. A Clinicopathologic Study. Obstet Gynecol 1994; 86(2):269-272.

Case No. 6, ~c:cession No. 29248

Alameda !Alameda Countv Medical Center) - Villoglandular adenocarcinoma Bakersfield - Well-differentiated villoglandular adenocarcinoma Baldwin Parle (Kaiser Permanentel • Well-differentiated vil!oglanduJar ade.oocarcinoma (3) Hayward/fremont - Villoglandular adenocarcinoma, cervix Irvine (UC Davis Me!lica! Cepterl - Vittoglandular carcinoma Laguna Beach I South Co""1 Medical Center) • Villoglandular adenocarcinoma of the cervix Lorna Linda !Lorna Linda University Residents) - VilloglanduJar adenocarcinoma of cervix Lon• Beac!J ILa!cewopd Regional Medical Centerl - Papillary adenocarcinoma (9) Monlerev ICommunjtv l!Ospjtal o{Mopterev Penjnsula) - Villoglandu!ar carcinoma Mowttain View CEI Camino Pathology Group. Inc.) • Villoglandular adenocarcin.oma

January 2004

Oakland !Kaiser l'ermanentel - Well-differentiated endocervical adenocarcinoma (3); Well-difl'ercntiatod villoglandular type (2) Orange <Omn•e County Patholo&v Me<ljco.! Groupl - Well-differentiated villoglandular adenocarcinoma Sacramento IUC Davis Medical Center) - Well-differentiated villoglandular adenocarcinoma San Diego <Naval Medical Center) - Well-diffe-rentiated villoglandular adenocarcinoma, endocervical type San Fmncisco CUCSF) - Modemtely differentiated adenocarcinoma, endocervical

10 CTIR. January 2004 "Minutes" (Subscription A)

•

Santa Rosa CSanta Rll1!il Mo:moriol Hospjmll • Adonoc:ucinoma, low 8Jllde endomelrioid type (I); Endocervical adonoc:ucinoma(l); WcU-diif.:ten!aitcd villoglandular adenocarcinoma (I}

Y.mWil! · EndoccrviCOI! adeoocarcinoma AfliSko CAI""ka Natjve Medical Center) · Wcll-diJferentiaJcd villoglandular adenocarcinoma Arizona fM8Diva!e Medlen! Center> • Well-differentiated villoglandular adenocarcinoma Manw (Unjymity of Artan.,< Medical Center\ • Well-differentiated villoglandular adenocarcinoma Colorado IEven!!eenl • Well-difrerentiat:ed villoglandular adenocarcinoma Coloru<lo !Lutheran Medical Cen!Crl • Vllloglandular pllJ)illary adenocarcinoma Florida Cia!tehpssecl • l!ndoccrvica! adenocarcinoma Florida !Winter Haven Hospital! • Papillary adenocarcinoma with villoglandular fearurtS ~ • Adenocarcinoma Illinois CNonhW!:Stcm Memorial Hospi!!!ll • Villoglandular adenocarcinoma Indiana (!(okomo> • Papillary serous carcinoma Loyjsjaoa floujsjana State University Medical Centql • Villoglandular carcinoma of the cervix witb endomelrioid features Mmlond Uohns Hon!dns Hospitall • Villoglandular adenocarcinoma M!!!'iland (National Nayal Medical Center\ • Vi!loglandular adenocarcinoma, weiHlifren:ntiated MMW<husct1S CBedsshjre Medical CeOJerl • Villoglll!ldular adenocarcinoma Mi""ct'!!SCI!S <New Eoaland Medical Cen!et Residents! • Vil!oglandular adenoc:uciooma, cervix Micbioan (!(alom!!200> • Endocervical adenocarcinoma Minncsota (fairview Southdale Hospital) • Villogltutdular adenocarcinoma Nebmlo! ICreiobton Unjvcrsitv School of Medicine Residents> . Villoglandular adenocarcinoma of the cervix New Jersey (Qyerlook HgspiJal} • Villoglanduiar. well-di!fcrentiatcd adenocarcinoma New York CLona Island Jewjsh Medjca! Center\ · Wcll-diflcrentiatcd villoglandular adenocarcinoma New Yo!lc CNMlj!!u Uniymitv Medical Center) • Serous pllj)iUill)l carcinoma New York (Now Vorl<) • Endocervical adenoc:ucinoma with villoglandular fetUures New Yo!lc.lNew York Presbytcr!W! Hospi!!!l Residents! · l'llpillary villoglandular adenocarcinoma New M !Stony Brook University HosojJal Residents! · Adenocarcinoma of cervix, villoglandular type Noah CI!!Qiino fMoumain Area Pathology) • Villoglandularadenocan:inoma (4) Ohio !Medical Cotleao ofOhiol • Well-differentiated villoglandular adenocarcinoma Ohio (McCulloygi!-Hvde Mqnoria! HospimJl • Well-difreren!Wed adenocarcinoma (1 villoglaodular) O!;Jahoma IThlsal • Adenocarcinoma Pc!U)Sylvania IAIIe•heny Genemlliosoitall • lnvMive villoglandular pllj)iUill)l adenocarcinoma of the ~rvlx Penosvlvania (Centre Conynunity Hospita!l • Villoglandular adenocarcinoma of the oervix fcnnsvlvOJJia CConcmayah Memorial Medical Center) • PllJ)illary adenocarcinoma Pennsylvania <Drexel Unjvcrs!ty School of Medicine\ · Villoglandular adcoocnrcinomn Pennsylvania flchish Valley HO!!!!itall - Well-differentiated villoglandular adenocarcinoma (I); Adenocarcinoma (I) Pennsylvaniai!J!>MC Heal!h Svsteml · Vllloglandular carcinoma of cndocervix (well-diffen:ntiated) Rhode Island IRI Hospjtal Resident,<\ • VU!oglandular adenoearcinomn Ttl<&$ CPropath Associ!UC$) • EndooerviCOI! adenocarcinoma (2) Tex.., CScon & Wh~t Memorial Hosoital\ - Well-diffcn:ntlatcd villoglandu!ar adenocarcinoma West Ylrgjnja f0n:cnbdq Valley Medjcal Center) • Adenocarcinomtt. villogiOJJdular Wisconsin fMeriter HO!pjtall - Papillary adenocarcinoma Austm!ia (Noah Queensland P!!!holoavl - Villoglandular adenocarcinoma Au.<l!J.!ja fRnval Prince Alfred Hospjtal) • Well-<liffcrentiatcd villoglandular adenocarcinoma of the cervix (cndo~rvix-

adenocarcinoma in-situ) Omada !Foothills Medica! Center) • Wcll·differentia!ed vi!Loglandular adenocarcinoma of cervix Hong Kon• CHon• 'Kon• Baptist Hosoltall • Well-differentiated cndomclrioid adenocarcinoma. vllloglandu!ar variant lla!v fNanlcsl • Well-differentiated villoglandular adenocarcinoma Jamajca (llnivepity Hospi!Bl of the West Indies! • Wcll-diffcn:otiated villoglandular ade~inoma JananiChibal • Well·dUferentiated villogllllldular adcnocareinoma of uterine cervix Netherlands CAmsten!aml · Papillary adenocarcinoma of the uterine cervix Oatnr CHomad Medical Comoralionl • Villog!andular papillary adenocarcinoma Saudj Arabia • Endocervical viiiOgllllldular adenoC<~CCinoma

Ca~e 6 .. Diagnosis: VlllogJandu!ar can::inoma ("well-differentiated papillary adenocarcinoma"), cervix

T-83000, M-82623

CITR, JII!IWY 2004 "M'UOJtes" (Subscriptioo A) !I

Case 6 - Ref•=ren=: Jones MW, Silverberg SO and Kurman RJ. Well-Differentiated ViUoglandular Adenocarcinoma oflho Uterine Cervix. A

Clinioopalhologic SlUdy of24 Cas<$. lnt JGynecol PaJho/1993; 12(1):1-7. Zaino RJ. Sympo5ium Part I. Adenocarcinoma In-Situ, Glandular Dysplasia, Wld Early Invasive Adenocatcinoma oflhe Uterine

Cervix. lnt JGyneco/ Pmlro/2002; 21(4):314-326. · ChMg WC, Malisic JP, Zhou C, ct al. Cytologic Features ofVilloglandular Adenocatcinoma oflhe Uterine Cervix. Comparison

wilh 't)1>ical Endocervical Adenocarcinoma with a Villoglandular Component Md Papilhuy Serous Carcinoma. Cancer 1999; 87(l):S·l I.

Case No. 7, Attession No. 27054

AIA!Dcda !Alameda Countv Medical Center) • Cellublr leiomyoma Blll<eafield • Leiomyoma Baldwin Park (Kaiser Permanentcl - Leiomyoma (I); Cellular leiomyoma (2) Uoywardlfrcmont • Atypical leiomyoma, probably benign uterus lrvjoe (UC Davis Medical Center) • Mitoticelly active leiomyoma Laauna Beach !South Coast Medical Ctoterl • Mitotically active leiomyoma Lgma Linda O.,oma Linda Universjty Resjdeotsl ~ Cellular leiomyoma Long Beach !!.aJseworu! Regionlll Medjea! Ceotcrl · Mitotically active leiomyoma (9) Monten;v(Community Hosoital ofMon!erey Pepjnsulal . Lciom)roma MounWn View CEl Cemino Pathology Group Inc.) - Mitotically active leiomyoma O!k!Md !Kaisq Pennanentel - LeiOC'IIyorna (mitotically active) (S) Oranu «>range Couotv Pathology Mcs!lq! Group! - Leiomyoma, cellular S!!eramtnto rue Davis Medical Center> • Cellular leiomyoma

January 2004

Sao l)jcao !Naval Medical Center) - Leiomyoma, mitotically active ( !); Smooth muscle rumor of uncertain malignant potential (2"' choice)

San Fmoclsco CUCSfl - Ccl!ulnr !c!omyonlll, mitotically active Santa Rosa !Santa Rosa Memorial Hospilall - Leiomyoma, mitotically active (I); Cellular leiomyoma (2) Ymlliri - Smooth muscle tumor of uncer!Ajn potentilll Alaska (Alaska Native Medical Cemerl • Mitotically active cellular leiomyoma Arirpno <Maryvale Medical Center) • Leiomyosarcoma ArkaoW CUnivmity of Arlcanw Mcs!ica! Center) • M'notically active leiomyoma Co!O!Jido CEymm;enl - CeUular leiOC'IIyomu Colorpdo !Lulhenm Medical Center) • Leiomyoma wilh inc:ncased mitotic figures flodda ITa!lahasseel • Leiomyoma florida (Winter HQ!·cn Hoso!tall - Leiomyosarcoma lllirulJ.I • Smoolh muscle tumor of uncenain malignant potential !l!!nols !Northwestern Memorial Hospital) • Cellular leiomyoma Jndjnno !Kokomo\ • Cellular leiomyoma !.ou!sion• <Louisiana State Univecyjty Mcs!lea! Cencerl - Cellular leiomyoma, uterus Marvlond Clobns Hookins Hospi!J!\ - Mitotico.Uy active leiomyoma Morvtond CNatjonal NavalMedjcat Center\ - Leiomyoma, otitotically active Mnmhusens <Bettsbire M¢jcaJ Center> • SmoodJ muscle tumor of uncenain malign811t potential (STUMP) Ml!W£hogetls !New Eoeland Mediea! Ceotq Residents) - Mitotically active leiomyoma Mjcbil'3J) <Kalamazoo) • Mitotically active leiomyoma Mjnn§)Ja CFajrvjew Southd.als HnsnitaO · Mitotically active leiomyoma Ncbn!.<kn !CrcighCon University School of Medicine Residents) · Leiomyoma New Jersey (Qyerlook Hosoital} - Leiomyosarcoma New York (Long Jsian4 Jewjsh Mcs!ita! Center> • Smoolh muscle tumor of uncertain malignant potential (STUMJ>) New York <Nac;sau Univcrsirv Medical Center> . Leiomyosarcoma New York !New Yorl<l - Mitotically actlvc leiomyoma New Yor!c <New Vorl< Presbyterian HO$Pi!al Residents) • Leiomyoma mitotically active (8) New Ypdt !Stony Brook !Jgjvecyjty tfos!ib!l Rcsideotsl - Intravenous !eiomyomatosis Nonb Carolina (MounWo Area Palho!oW · CeUuiM leiomyoma (I); Smooth muscle rumor of uncertain biologic bella vi or (I);

Leiomyoma (2) Objo IMedjclll Col!ese ofOhioJ - Smooth muscle tumOr ofuoce1Uiin malignant potential (S11JMP)

12 CITR. Janumy 2004 "Minu~es" (Subscri]llioo A)

Ohio IMeCullouah-Hydc Memorj•l Huspita!l · Mitotically aetive leiomyoma Oklahoma ITulsa) • Lelomyon~ cellular Pcnn;;ylvania (A}Jegbegv General Hosoitall • Cellular leiomyoma Pennsylvania (Cen!re Communjrv HomitaD - Cellular leiomyoma with incrtaSed mitotic activil)l of the UteruS PennsylvaniaiDI'l!xcl UnivertiiV School of Me4jcincl - Leiomyoma, mitotically active PCJl!!>"Yiyania CLohigh Valley Hgspita!l - Smooth muscle tumor of uncertain malignant potential (I); Mitotically active leiomyoma

(I) Pennsylvania IUPMC Health S>'!!tcm) - Cellular leiomyoma Bbode Island <RI Homj(a! Residents> • Cellular leiomyoma Texas fProoa(h Associates) - Cellular leiomyoma (I); Leiomyoma (I) Texas (Scott .t. White Memorial Hosoita!l - Mi!Otlc:ally active cellular leiomyoma WeSf Virginia <Greenbrier Valley Medical Center> • Cellular leiomyoma Wisconsin (Medter Hosoitall · Leiomyoma AuS!!aJia<North Queens lane! f>Alhologyl - Leiomyoma of uncertain malignant potential AUS(Ij!lia <Royal Prince Allhld Hmilall • Benign mitotically active cellular leiomyoma Canada ffoothm• Medical Cemer) • Mitotically active leiomyoma Hong Kgno (}jgng Kong BaDtiS! Hospita!l - Cellular leiomyoma llaly CNanlesl • Cellular leiomyoma Jamaica CUnjvml!Y Hospjtal of (he West !ndle<l - Leiomyoma Japan !Chibal • Leiomyosacoma of uteruS Netherlands (AmsJerdarnl • Mitotically active leiomyoma Oatat CHamru! Mcdjcal Corno!!l!lonl • Cellular leiomyoma Saudi A!llbia • Mitotically active leiomyoma

Case 7- Diagnosis: Mitotically active cellular leiomyoma, uterus

T-82000, M·8892l

Case 7 - References: ForsncsEV, Dorrough KR and O'Donoghuc M. A Mitotically Active Myoma in Rokitansky·Kustcr·Bauscr Syndrome.. Obstel

Gyneco/1999; 94{5 Pr2):862. RavioaJH, Herbrctcau 0, Oiraru-Vigneron N, et al. Arterial Embolisatioo !0 Trcu Uterine Myoma1a. Loncer 1995; 346:671-6n. Visvanathan D, Connell R, Haii-Craggs l\fA, et al. Interstitial Laser Photocoagulation for Uterine Myomas. Am J Olmet (iynecol

2002; 187:382·384.

Case No. 8, Accession No. 23587

Alameda (Alameda County Medjcal Center! • Clear cell adenoc~~~<:inoma Bakersfield ·Clear cell carcinoma Baldwin Parts (J{alsq l'enru!ncnfel - Clear cell carcinoma (3) tlavwan!JFremont • Clear cell carcinoma, endometrium Irvine CUC Day!! Medical CenteO • Clear cell carcinoma Laguna Beach (South Coast Medlen! Ccnterl • Clear cell carc!nomn (endometrium)

January 2004

!.oma Linda CLoma Linda Unjveaily Resident<) - Clear cell endomctriul carcinoma wilb superficial myoinvasion (cytokcrat!n stain to assess depth ofmyoinvasion)

Long Beach ILaJsewpod Regional Me4ica! Center) - Clear cell adenocamooma (9) Monterey tCommunitv HosoitNoCMonterey Penjnsulal · Clear cell carcinoma Mountain Vjew lEI Camirw Pa(hology Group. Inc.) • Clear cell adenocarcinoma O•kland (Kaiser Permaocntel • Clear cell carcinoma (5) Onmgc CQmoae County Pathology Medical Grouo) • !llldomelrial clear cell carcinoma SI!C!l!!De!!to cue Davis Medical Center! • Clear cell carcinoma San Diego <Naya! MC!Ijca! Cemer) - Clear cell adenocarcinoma San Francisco CUCSI'l • Clear cell carcinoma Santa RoS!I ISpOJa Rosa Mernodo! Hospitall - Clear cell carcinoma of endometrium (3) ~ • Clear cell adenocarcinoma Alaska CAIMka Natjye Medical Center) - Clear cell endometrial eareinoma

CTTR, January 2004 "t.fmutes" (Subscription A) 13

Arizona IM!I!'YYa!e Me<lica! Center\ · -Clear cell carcinoma Ar!sansas lllnlversjty of Arklln.as Medical Center\ · Clear cell carcinoma Cotorndo (Evergreen) • Clear cell carcinoma Colorado !Lutheran Medical Center\ · Clear cell carcinoma Florida Cfallahasseel • Clear cell carcinoma Florida CWjnter Haven Hospitall ~ Clear cell carcinoma Illinois • Clear cell adenocarcinoma !!!lnols /Northwestern Memorial Hospital) • Clear cell carcinoma Indiana !Kokomo\ • Endometrial clear cell carcinoma Louisiana <Loujsiana State University Medical Center) · Clear cell carcinoma , endometrium Marvland (Johns Hopkjns Hospjrall • Clear cell adenocarcinoma Maryland (National Nayal Medical Center\ • Clear cell adenocarcinoma Massachusetts <Berkshire Medical Cemerl · Clear cell careinom8 Massachusetts IN.W England Medjcal Ce11ter Residents) • Clear cell carcinoma Mjchigan <Ka!amaz.oo) . Clear cell carcinoma Minnesota (fairview Southdalc Hospital) • Clear cell carcinoma .Nebraska (Creighton l!niv¢tsi!V School of Medjeine Residents) • Endomelrial adenocarcinomll, clear cell type New Jersey !Oyedook HospjtaJl • Clear celladenocareinoma New York (Long lsland Jewish Medical Center) · Clear cell adenocarcinoma New York <Nassau University Medjcal Cepterl · Mucinous adenocarcinoma New York (New York,} - Clear cell carcinomaofthe endometrium New York (New York Presbyterian Hospital ResidentS) • Clear cell carcinoma (8) New York !Stony Brook UniverSity Hosnita! Resjdents) • Clear cell carcinoma Nortll Carolina !Moyptain Area Pathologvl • Clear cell adenocarcinoma (4) Ohio !Medical College ofOhlol - Clear cell carcinoma Ohio (McCullough-Hvde Memorial Hospital) - Clear cell adenocarcinoma OkiOhoma !Tulsa} • Clear cell carcinoma Pennsylvania IA!Iegbeny General Hospitall - Clear cell carcinoma Pennsvlyanja <Centre Communjty HosnitaJ) .. Clear cell adenocarcinoma of the endometrium Pennsvlvania <Conemaugh Memorial MCdical Center) .. Clear cell carcinoma Pennsylvania <Drexel UniverSity Scho91 ofMe<ljcjnel • Endometrial adenocarcinoma. clear cell type Penosvlvapja (lehjgh Valley Hospital) - Clear ceil adenocarcinoma (I): Clear cell carcinoma ( 1) Pennsylvania (!JPMC Bealth Svsteml - Clear cell carcinoma of cndomelrium Rhode Island (RJ Hospiral Rcsiden!Sl - Clear cell carcinoma Texas (Propath Associates! - .Endomelrial carcinoma, clear cell type (2) Texas !SOO& Wbjte Memorial l·losnitall - Clear cell adenocarcinoma West Virninia (Greenbrier Valley Medical Center! • Endometrial adenocarcinomll, secretory Wisoonsin (Meriter Hosoitall - Clear cell carcinoma AusU:Wia (North Queensland Pathology) - Clear cell carcinoma Australia !Royal PrincoA!ftedllospirall - Clear cell carcinoma Canada (Foothills Medical Center) - Clear cell caicinoma ofendometrium Hong Kong !Hong Kono BaotjSI liosojtaJ) • Clear cell adenocarcinom'! 'Italy !Naples} - Clear cell carcinoma Jamaica CUniytniity Hospital of the West !ndjesl - Clear cell adenocarcinoma Japan (Chjbal - Clear cell carcinoma ofend<imetrium 'Netherlands !Amsterdam) • Clear cell adenocarcinoma of the endomelrium Qatar <Hamad Medical Comoralionl - Clear cell carcinoma en~ometrium Sa)ldj Affibja - Clear cell carcinoma

Case 8 ·Diagnosis: Clear cell. carcinoma, uterus

T-82000, M-831 03

Case 8 References: Lax SE, Pizer ES, Ronncn, BM, ct aL Clear Cell Carcinoma of the Endometrium is Characterized by a Dislinctive Profile orp53, Ki-

67, Estrogen and Progesterone Receptor Expression. H11m Parho/1998; 29(6):551-558. Schwartz DR, Kardia SL, Shedden KA, et at. Gene Expression ln Ovarian Cancer Reflects Botb Morphology and Biolog·ical

Behavior, Distinguishing Clear Cell from Other Poor-Prognosis Ovarian Carcinomas. Cancer Res2002; 62(16):4722-4729.

14 CITR, January 2004 "Minutes" (Subscription A)

Malpica A. Tomos C, Surke TW, ct al. Low Stage Clear-Cell carcinoma of the Endometrium. Am J Surg Porlu>/1995; 19(7):769-774.

Patsncr 8. Late Recurrence of a Uterine Clear Cell Adeno.;arcinoma Confined to an Endometrial Polyp. Co.se Report. Eur J Oynaecol Onco/1998; t9(6):S22-S23.

Vang R, Whitaker BP, Farhood AJ, ct al. Immunohistochemical Analysis of Clear Cell carcinoma of the Oynccologic Tract. In/ J Gyr~~~col l'aJho/2001 ; 20(3):252·259.

Matias-Guiu X, Lenna E, Prat J, ct a!. Cleu Cell Tumors of the Female OenitaJ TracL Semin Diagn 1'11rho/ 1997: 14(4):233-239.

Case No. 9, Accession No. 14869

Alameda CAiameda CoyniV Medjcal Ccotcrl - Cll(clnosarcoma (nuilig)lant mixed mullerian tumor) Balsersficld • Malig)lant mcsodennal mixed tumor Baldwjn Parl< (Kaiser PgmMente) • Malig)lant mixed mullcrian tumor (3) Haywwd!frcmont - Malig)}Mt mixed muDtrian tumor (eucinosarcoma), Uttnl$ lryjne rue Davis Medical CcntqJ • Mixed malig)lant mullcrian tumor Lacuna Beach CSoU!h Coast Mqljcal Center) • Malignant mixed mullerian tumor

January 2004

L9ma Linda Clomal.jnda !lniyersity Residents) - High grade endometrial sarcoma, fovor mullcrian adenosarcoma Long Beacb Cbalsewood Becjonnl Medical Centetl • Malignant mixed mu!lerian tumor (careinosarcoma) (9) Monterey CCommunitv HospilnlofMonterev Pcninsu!B) .. Uterine sarcoma MountAin Yiow lEI Camino Pathology GrouP. lne.l - Malignant mixed mullerlao tumor lcarcinosarcoma) OB!slaod <Kaiser Pennanente\ • Malig)lantmixed mul!criao tumor(carcinosarcoma) (4); Adenosarcoma(!) Omn•• (Orange Counrv Plllhology Me<ljeal Gmupl • Malignant mixed mullcrian tumor Sacmmento IUC Davis Me<liCQI Center! • Mllig)lant mixed mullcrian twnor

San Diego <Naval Medical Ccptctl - High grade endometrial stromal sarcoma San Francisco IUCSFl • Carcinosarcoma Santo Rosa CSanto Rosa Memorial Hospitall • Stromal sarcoma vs. carcinosarcoma ( I ): Carcinosarcoma (I); Malignant mixed

mul!eriwt tumor (carcinosarcoma) (I) ~ • Carcinosarcoma Alaska (Alaska Native Medical Center) - Carcinosarcoma/malignant mixed mulletian tumor homogenous (2); Adenosarcoma, high

grade ( I) Arimpa CMaryva!c Medical Center) • Endometrial stromal sarcoma, high grade Ad!Jna:; IUnivmily ofAdcJpw Medical Center) • Adenosarcoma Coi9Ado !Evergreen) • Malignant mixed mullcrian tumor Co!orodo !Lutheran Medical Ccnlcrl • Malignant mixed mullcrian rumor Plorjd• IT!\llabasseel - Adenosarcoma Flgrlda (Winter Haven HosojlaD • Adenosarcoma l.I.U!lllLI • Carcinosarcoma ll!jnojs <Northwes!en! Memorial Hosoitall - High grade sarcoma Indiana O<okomol • Endometrial sttomaJ sarcoma l.ouitjanafLouisiana State Vnjymity Medical Ccntctl • Malignant mixed mullcrian tumor vs. undifferentiated sarcoma Ma!ylagd (Jobns Hookins t lospjtall • Malignant mixed mullerian tumor Mwlaod <National Naval Medjcal Center) - Adenosarcoma M..sacbusctts !Berkshire Mc;dlca! Ceoterl • Malignant mixed mullcrian tumor (homogenous) Mas!!Qchusctts CNew llng!and Medical Center Residents) • Malignant mixed mullerian tumor Mjcbjl!liiJ fKalama?.ool • High grude ondometrinl stromal sarcoma Minnesota fFairview Sou!hdale Hospjtall • Malignant mixed muUcrian tumor NebmUp (Creighton Uni\•ersjtv School off\fcdieinc Rcsjdent~l .. Endometrial strOmal tumor vs. adenosarcoma New Jersey COverlook Hospjta!l • Adenosarcoma New York fLonelsland Jewjsh Me<lica! Center) • Adenosarcoma with heterologous clements New vorkCNassau UniversjiX Medical Center) • Adenosarcoma New vortc <New York) • Malignant mixed mulleri!U1 tumor New Yortc <New York Presbyterian Hospital Residen!sl • Adenosarcoma sarcomatous overgrowth (S) New Yprll (Stony Broo]s Unlveajty Hospital ResidenL<) • Mullerian adenosarcoma. OOMMMT North Carolina(Moun!!ljn Area Pathology) • Adenosarcoma (4) Objo IMes!ica! Collece ofObjol • Hlgh grade endometrial sttomaJ sarcoma Ohio (McCullough=Hvde Memorial Hosoi!BI) • Stromal sarcoma Oklahoma CfU]sal - Malignant mixed muDerian tumor (carcinosarcoma)

CTIR.Ianuary 2004 "Minutes" (Subscription A) 15

Pennsylvania !Allegheny General Hospital) - High grede sarcoma can't exclude mixed mullerian rumor Pennsylvania !Centre Community Hospital! - Adenosarcoma of the endometrium Pennsylvania !Conemaugh Memorial Medjcal Center) - Mixed mullcrian tumor Pennsylyanja mrexel University School of Medicine) - Malig~~ant mixed mesodermal (mullerian) tumor (MMMT) with hcterologus

clements Pennsylyanja CI;ehigh Valley Hospjtall - Mixed mesodennal mullerian tumo.r (I); High grade malignant neoplasm, favor component

of malignant mixed mullerian tumor (I) Peonsvlyanja aJPMC Health Svsteml - Placental site trophoblastic rumor Rhode Island CRI Hospital Re.<identsl - Adenosarcoma Texas fProoalh Associates\ - Adenosarcoma (2) Texas !Scon & White Memorial Hospjta!l - Carcinosarcoma (MMMT) \Vest Viminia !Greenbrier Valley Medical Center) - Bndomeirial sarcoma, high grade Wjsconsjn !Mcriter HoSpital) - Malignant mixed mullerian tumor Australia !North Queensland Pathology\ - Carcinosarcoma Austrnlia CRowl Prince Alfred Hgspjtal\ - Carcinosarcoma Canada CFoothills Medical Center\ - High grade endometrial sarcoma HOng Kon& CHona Kong Bantist Hospjtall - Undifferentiated endometrial sarcoma Italy !Naples) - Malignant mixed mullerian tumor Jamaica fUniverslty HoSpital of the West Indies\ - High grade endometrial-stromaltumor Janan !Chjbal - Malignant mesodennal mixed tumor of uterus, homo)ogous type Netherlands (Amsterdam) - Car<:inosarcoma Qatar CHamad Medical COroorationl - High grade sarcoma of probably mullcrian origin Saudi Arqbia - Mullerian adenosarcoma

Case 9- D!agnMis: Malignant mixed muUerian tumor ("carcin<isarcoma''), uterus

T-82000,~-89803

Ca.~e 9 References: Watanabe M, Shimizu K Kato H, et al. Carcinosarcoma oftl:le Uterus. Jmmuoohistochemlcal and Genetic Jlnalysis ofClonality of

One Case. Gynecol Oneal 200 I; 82(3):563-567. Wada H, Enomoto T, Fujita M, ct a!. Molecular Evidence that Most but Not All Carcinosarcomas of the Uterus arc Combination

Tumor>. CQncer Res 199.7; 57(23):5379-5385. Yamada SD • .Burger RA, Brewster WR, eta!. Pathologic Variables and Adjuvant-Therapy as Predictors of Recurrence arid Survival

for Patients with Surgically Evaluated Carcinosarcoma of the Uterus. Cancer 2000; 88(12):2782-2786. Evans MJ, Langlois NB, Kitchener HC, et al. Is There an Association Between Long-Tcnm Tamoxifen Treatment and the

Development of Carcinosarcoma (Malignant Mixed Mullerian Tumor) ofthc Uterus. Int J Gyneco/ Cancer 1995; 5(4):3 10-313.

Cas~ No. 10, Accession No. 29267 January 2004

AlamedA (A]ameda Countv Medical Center) - Sarcoma (rhabdomyosarcoma vs. malignant fibrous histiocytOma) &Jser<field - Leiomyosarcoma Baldwin Park (Kaiser Permaneritel - High grade sarcoma (2); Epithelioid leiomyosarcoma (epithelioid GIST) (I) Hayward/Fremont - Leiomyosarcoma, metastatic from uterus lryjne IIIC Dayis Medical Center\ - LelomyOSl!fCOma Laguna Beach !South Coa.rt Meaical Genter\ - Leiomyosarcoma Lorna Linda !Lorna Linda University Residents) - t.eiomyosarcoma Long Beach (l,al\ewood Regional Med_ical Center) - Leiomyosarcoma (9) Mountain Vjew <EI Camino Pathology Group. Inc.\ - Leiomyosarcoma, epithelioid type Oakland !Kaiser Pennaneutel - Epithelioid leiomyosarcoma, high grade (S) Qrange <Orange County Pathology Medical Group) - Leiomyosarcoma Saciarnento CUC Davis Medical Center) - .Leiomyosarcoma San Diego !Naval Medical Center> - High grade leiomyosarcoma San Francisco IUCSFl - Rhabdomyosarcoma, high grade Santa Rosa !Santa Rosa Memorial Hospital) - Leiomyosarcoma (3) Ventura - Pleomorphic malignant fibrous blsrioC}1oma

t6 CrrR, Janulll)' 2004 "Minutes" (Subscription A)

AIM!ca <Alaska Native Medical Center> - Epitbelioid lciomyosareoma Ad•ona CMaryvale Medjq! C.ntcrl - Angiosarcoma Arkana, CUniversitv or ArkAnsg3 Medical Cent·cr) .. Sarcoma C!lloro<lo <Evergreen) - Epithelioid leiomyosarcoma C!lloro<lo !Lutheran Medjcal Centcrl - Leiomyosarcoma f lodc!a ITAllahmre) - Malignant fibrous histiocytoma Flodda (Winter Haven Hosnitall - LeiomyoSSICOma lllin!l.il - Utcrin<: sarcoma Illinois <Northwestern Memorial HospiUID - Hlgh grade stromal sarroma fndjMn CKokomol • Pancn:ntic carcinoma ? Loyjsjana CLouisiana State Vnlymjty Medical CemeC) - Epithelioid leiomyosarcoma Murvland CJohns Hopkins Ho•ollllll - Malignant fibrous histiocytoma MJ!!YIMd <National Naval Medjcal Center) - Hlgh &rade sarcoma Massachusetts !Berkshire Mcd!ql Center) - Ltiomyosarcoma M& .. pphuscns <New England Mc;dical CcnW Re_t;fdentsl ~ C8rcinosarcoma Mjehjgn CKalamamo) - Leiomyosarcoma Ncl!mka1Crci$ton UnivqsiiY School ofMedicine Rnis!emsJ - Leiomyosarcoma New Jersey (Ovcriook Hosplmll - Sarcoma, NOS, probably leiomyosarcoma New York <Long Island Jcwjsh Medical Center) - Le!omy<mrcoma New York <Nassau Vnlveajty Medical Center) - Leiomyosarcoma New York <New Yorkl - Bigll grade sarcoma consistent with leiomyosarcoma New vorl!: <New Yorl!: Prcsbl'!edan Hospital Residents> - Leiomyosarcoma (8) New Yor!c (Stony Brook UniYersi!v Hospital Rcsid01Jt<l - High grade endometrial stromal ~ma Noah Clrp!ina <Mountain An:a Pa!hologyl - Leiomyosarcoma (4) Objo (M!!Iical CoDcge or Obiol - Epithelioid leiomyosareoma Ohio /MeCullou$ -Hyde Memorial Hospita!l - Leiomyosarcoma Oklahoma ITulsa) - Leiomyosarcoma Penwlvonia (AI!e@eny Geneml!iospital} - High grodo leiomyosarcoma J'eonsylyanja (Centre Commynity Hospj!all - Higll-pelciomyosarcoma Pennsylvwia fDrexe1 University School ofMediclnel • EpitheUoid leiomyosarcoma Pennsylvania Cuhi$ Valley HQ'Pi)l!fl - High grade sarcoma(!); Leiomyosarcoma (I) l'(nnsyl)'ania fUPMC H!!!!lth Sys1cml - Malignant fibrous histiocytoma. bigll pe sarcoma Rhode Island <RI Hmita! RgjdtpW - Epithelioid lciomyosareoma or bigll-gnwle enclomctrial stromal sarcoma (uodiffereotial.ed

endometrial~)

Texn.1 IPropatb Associates) - Ct~ttinosarcoma " ith rbabdomyosarcoma features mullcdan tumor (!); Ct~ttinoma with rbabdo (I) Texa., <Scott & White Memodnl Hgspita]l .. Leiomyosarcoma Wc.<t Virginia (Greenbrier volley Medical Center) - Malignant fibrohistiocytomn Wisconsin CMerjter Hospital) - Sarcoma with muscular ditrcn:ntiation Ausl!!l!ia <North Queensland P!!Jhologyl - Pleomorphic sarcoma vs. rbabdoid leiomyosarcoma Ausnli• CRoyal Pdnre Alfjsd Hmita!l - epithelioid leiomyosan:oma Canada !food! ills Medical Ccntql - MetasWic lelomyosareoma Hong Kong CHong-Kons B;mdst tlospjtaJl .. Epithelioid leiomyosarcoma JJA!y <Naples) - Hlgll grade sarcoma, NOS Jamaica CUoiyersity Hosnital of the West Indies> · Leiomyosarcoma Jooan CChibal - Pleomorphic rl10bdomyosarcoma NcJberlands CAmstenlarnl - HiSh grade uodiJforentiated sarcoma 0a(8[ IHB!D!!d Medical Comomtionl - uiomyosarcoma Saudi Al'abia - Leiomyosarcoma

Caoe 10 - Diagnosis: High grade mesenchymal neoplasm consistent with stromal sarcoma, uterus

T-82000, M-89303

Case I 0 - References: MeCluggoge WQ, Sumathi VP and Maxwell P. COlO is a Sensitive and Diagnostically Useful Immunohistochemical Marker or

Normal Endometrial Stroma and ofEndometrial Stromal Neoplasms. Hi.rtopal!ro/2001; 39{3):273-278. Oliva E. Clement PB and Young RH. Endometrial Stromal Tumors. An Update on a Group ofTUmors with a Pro<ean Pben.otype.

Adv A nat PQJ/ro/2000; 7(S):2$7-281.

CrrR. January 2004 "M"mutes" (Subscription A) 17

. '

Miturski R, Se:mezuk A Md Jakowichi JA Expression of ras p21 in the Stromal Cells of Human Neoplastic Endometrium. Eur J GynDecol0ncoll998; 19(3):308-311.

KoontzJI, Sorena AL, Nucci M. ct aL Frcqucot Fusion of the JAZFI and JJAZI Genes In Endometrial Stromal Thmors. Proc Nat/ Acod ScllOOI; 98(11):6348-6353.

Blom R, Malmstrom and Ouctrieri C. Endometrial Stromal Satcoma of !he Uterus. A Clioicopalhologic, DNA Flow Cytometric, pS3, and mdm-2 Aoal)'>l$ of 17 Cases. Int J Gyoecol Canctr 1999: 9(2):98-1 04.

Case No. JOb Acc~,ion No. 22744 (substitute for Case #10 in October's set)

Alameda (Alameda County Medioni Center\ - Littoral cell anglomll Bakersfield • Littoral cell hent81lgioma Baldwin Park IKojser PermwJCnte) - Littoral cell angioma (2) L~~g~tpa Bench (South Coast Medical Cegter) - Littoral cell angioma Monterey <Community Hospjta) ofMonterev Peninsula) · .. Angiosarcoma Mountain View (EJ Camjno Pathology Orouo.lnc.l • Littoral cell angioma Sacrame!Jto IUC O.yjs Medical ContqJ - Hemangioma Santa Rosa !SonJa Roa Memorial Hosnitall - Littoral cell angioma (3) Ym!l!!l - Splenic hemangioma AfaslcACAias!ca NPljYl' Medical Center) - Littoral cell angioma Arj1pna (MaryyPic Mcs!ical Center) - Angiosarcoma Colorn!lo CLytherno Me<lica1 Center) - Littoral cell angioma florida CWintcr Haven Hospital) - Hemangioma Illinois lNor!hwcsJcm Memorial Hospjtall - Littoral cell angioma Louisiana <Loyjsjan• SIJ!Ie University Medical Center) - Splenic hemangioma Marylood CNotjonal Naval Medical Center) - Littoral cell Mgloma Massaclmseus (Berkshim Medical Center> • Angiosarcoma M!ISSllcbuseus(Ncw lln&land Medical Center Residents\ • Littoral cell angioma Nebraska <Creighlon Uojymity School of Medicine Rgidentsl - Hemangioma New Jersey COyerlook Ho:;njta!l - Littoral cell angioma New Yorlc O,ons Island Jewish Medical Center! - Littoral oc!l angioma New Yort CNew Yorl<) - Littoral angioma of spleeo New Yort CNcw Yort Psesbyterjao Hosnit!l Residents) - Linoral cell angioma (8) North Cam!!na lMounllin Area Pathology) - Littoral cell hemangioma (4) Ohio CMcCidfoyeJt.HVdc Memorial Hospital! - Petiosis Oklahoma ITI!Isal • Liaoral ceU angioma PeppsyiVI!!)ja Cl&hjsh Ya!ley Hosnitall • Littoral cxU angioma (2) Pepnsylxanja OJPMC Health System) • Littoral cell angioma Texas IPrgpjllh M•ocjatcs) - Allgiosareoma of spleen (I); Mixed ? Texas CScon & White Memorial Hospjtal) - LittOral cell angjoma West Vjrojnja (Qrpcnbricr Valley Medical Center\ - Angiosarcoma Canada (foothills Mcs!jcal Center) - Littoral cell angioma ofsplcen Hong Kong CHong Kons Bantist Hospjta!l - l'eliosis, splc~n

Japon (Chjbnl • Littoral cell angioma of spleen Oatar CHama4 Mcdjca! Co!Jl9ra!ionl • Littoral cell angioma

Case lOb- DjagpO!p: Littoral cell angioma, spleen

T -07000, M-91200

Case I Ob- Refercps;es:

January 2004

Garvin OF and King EM. C)-'S!S and Nonlymphomatc>usTumors of !he Spleen. Pathol Ann (Part I) 1981; 16 Pt 1:61-80. Tang WY, eta!. Splenic Littoral Cell Angioma. Not B!!Cilhuy Angiomatosis. PaJho/1994; 26(3):347. Falk S. Stuttc J, and Fmzers G. Littoral Cell Angioma. A Novel Vascular Lesion Demoostrating HistiOC)1ic Differentiation. Am J

Surg Palho/1991; lS(I):I023·1033. Arbcr DA, Strickler JO, Chen Y-Y and Weiss LM. Splenic VascularThmors. A Histologic, lmmunopheootypi.c and Virologic

Study. Am J Surg Patho/1991; 21(7):827-835.

18 CTIR, Ianullty 2004 "Minuto$" (Subscription A)