.................. ._ ................................................................ . CALIFORNIA TUMOR TISSUE REGISTRY

LOMA LINDA UNIVERSITY

PROTOCOL

FOR

MONTHLY STUDY SLIDES

OCTODER1993

GENERAL PAT HOLOGY

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CONTRIBUTOR: Mark Janssen, M.D. CASE NO. 1· OCTOBER 1993 Anaheim, CA

TISSUE FROM: Retro rectal mass ACCESSION 27335

CLINJCAL ABSTRACT:

HistoO': The patient was an elderly woman with a past medical history of diabetes and hypertension who over the last two;years bad noted increased pain in the rectal area. During the eight months before surgery, the pain bad been gradually increasing. She bad difficulty having a bowel movement and bad multiple episodes of oonstipation which was notruponsi:ve to fibers and stool softeners. The pain was so intense at times tbal she had difficulty sitting down. She bad no history of weight loss or bright red blood per rectum.

Physical Examination: On rectal examination she bad a large palpable mass in the posterior rclro rectal area,. which did noi extend anieriorly io the vaginal cuff area. Everything else was within nonnallimits. CT scan showed a large rectal -mass adjacent to the sacrum, possibly was arising (rom the sacrum.

SURGERY: !04123193!

Excision of retro rectal tumor

GROSS PATHOLOGY:

The tumor consisted of a 10.0 x 7.0 x 4.0 em rounded nodular mass adherent to, but sbarply demarcated from, adjacent bone. The cut surfaces were trabeculated, tan-white with loculation containing foamy white purulent-appearing fluid.

CONTRIBUI'OR: Arthur L. Koehler, M.D. CASE NO. Z·OCTOBER 1993 Pasadtna, CA

TISSUE FROM: Rlgbt wrist ACCESSION 1:7363

C!.IN!CAL ABSIRACT:

History: Tbis 81 year old white female bad noted a large cystic mass in tbe volar ospect of the rig)lt wrist, just above tbe joint line of the wrist for about a year. Tbe mass was bard almost immoveable. Circulation was intact di&t1lly. In tbe past she bas b1d bypel1ension witb swollen ankles and bas been on vuo lec, k-dur and pre marin. She is known to be allergic to penicillin and fish.

Pbysjca! Ex•mina!jog: A very pleasant, fairly ale11 81 year old white female, petite siu. HEENT was normal. Lungs and vital signs normal. Tbe vaginal and rectal examination deferred at patients request. Tbe only significant findings was the wrist tumor. Everything else was within normal limits. •

SUBGERY: CO?n9/93\

Outpatient surgery with excision and removal of mass. rig)lt wrist.

CROSS PATUOI&CY:

Tbe specimen consisted of an non-encapsulated oval mass of tissue, 4.5 em x 3.0 em in diameters. It was ftrm wbicb revealed surfaces made by cutting to be Oat non-bridging with central softening without cystic changes.

CONTRIBtrrOR: Gary Stric:klaod, M.D. CASENO.~OCTOBER l~

B~mtt, CA

TISSUE FROM: Bladder end prosta~ ACCESSION 127339

CLINICAl. AB5TRAcr:

Hjstorv: This 82 year old Caueasian male had a history of nocturia x 3, a feeling of fullness of the bladder with only a small amount of urination, and trouble with dribbling. About three months prior to surgery, he had an onset of gross hematuria and p~sing of clots. He bad trouble with urinary retention and a Foley catheter was pla<Xd. He apparently pulled the Foley eatheter out with the balloon inflated and continued to have gross hematuria with passing of clots after that. When the patient came in for 1

cy&toscopy, a stricture of the fossa navicularis was noted which needed dilation. Examination of the bladder revealed wbatappeared to be a large papillary tumor involving tbe base of the bladder.

Past History: He bad a history of diabete~ and a partial colectomy for colon can<Xr. He once smoked four packs a day but quit 20 years ago.

Pbysjcal Examination: Rectal exam showed a 3+ nodular prostate.

SURGERY; l06/t6193l

Cystoscopy with transurethral resection of bladder tumor

GROSS PATHOLOGY:

This specimen consisted of a 50 gram aggregate of multiple pink-tan chips.

CONTRIBUTOR: Doug Kabo, M.D. CASE NO. 4-0CTOBER 1993 Sylmar, CA

TISSUE FROM: Left baek ACCESSION 117342

CI.INICAI, ABSTRAct:

History; This 28 year old female from M~xico presented with a five year history of a slow growing mass in the left back. Mass bad become increasingly larger and movement of left arm was painfUl. An aspirate was done !rom tbe back which showed mainly amorphous material and foamy bisliocytu. These findings were felt to be consistent with a benign cyst.

Physjgl Examination: A 9 x 10 em mass was in the left liCapular region. It wu soft, moveable, non·tender and without overlying erythema. Everything else was within normal limits.

SURGERY: C06J30!93l

Excision of large cystic mass from back

GROSS PATHOI.OGY:

The specimen consisted of an irregular shaped portion of red dark brown tissue meuuring 10.0 x 8.0 x 2.0 em. Sectioning revealed mosl of the matuia l in the center to be necrotic brown-tan. A thin rim of viable tissue was noted .

CONTRIBUTOR: Tom Beln:z, M.D. CASE NO. 5-0CI'OBER 1993 Orange, CA

TISSUE FROM: Distal Ueum and proximal .:olon ACCESSION 117346

CLINICAl. ABSTRACT:

Hjstoty: This 76 year old white female presented to her private physician because of occasional spots of blood noticed on the toilet tissue. She denied any history of diarrhea, abdominal pain, distention, weight loss or black tarry stools. Sbe was found to have Hemoccult positive stools. Past history includes • complete abdominal hysterectomy with bilateral salpingo-oophorectomy in 1991.

Pbysjgl £xamjnatjon: In the right side of the obdomeo there appeared to be finnness in the right guner which was mobile. It was somewhat tender. No other organomegaly was appreciated. AI colonoscopy, a large obstructing lesion in the right colon in the cecal region was found.

SURGERY: 107109193

Right hemicolectomy

GROSS fATROI,OGY:

The specimen consisted of a 32 em segJnent of terminal ileum, an 11 em segment of CIOlon, and 10 em of anached mesentery. ln the area of the ile~al valve was a 12 x 8 x 8 em finn yellow-white tumor. It was predominantly in the surrounding mesenteric and omental adipose tissue. However, it involved the bowel wall and extended to the mucosal surface in the area of ileocecal valve. In an area surrounding the suspected appendiceal lumen was a 3.7 x 3.0 em area of induration and granular nodularity. Upon sectioning, the appendiceal lumen opened into a 2.5 em pouch-like structure surrounded by tumor. Several additional small tumor implant nodules were present on the serosal surfaces of tbe small intestine and mesentery. The largest measured up to 1.2 em. Numerous additional tumor nodules were present within the mesenteric tissue, the largest measuring up to 4.5 em.

CONTRJDUTOR: Arthur L. Koehler, 1\t.D. CASE NO. 6-0CTOBER 1993 Pasadena, CA

TISSUE FROM: Left ntroperitoneum ACCESSION #Z7Z88

CLINICAl . ABSTRACT:

History; This 59 year old hispanic male bad a four year old history of an abdomiru~l mass with ocr and on complaints of abdominal pain. The pain increased and became constant four days prior to admission 10 the hospital.

Past History: BPH with 11JRP in 1991

Physical Examination: He bad a large palpable mass In the mid-epigastrum and LLQ which was tender in the le~ flank.

' .

SURGERY; (03/15{93)

Exploralory laprotomy with excision of a large left retroperitoneal tumor.

GROSS PAmOLOGY;

The specimen weiglled 2230 gram, 18 x 14 x 12 em oval mass. A thin fibrovascular capsule covered the specimen. Hemorrhage and necrosis was prominent with a cystic area approximately 8 ern in greatest diameter. No calcification was identified.

CONTRIBUTOR: Steven Jobst, M.D. CAS£ NO. 7-0CTOBER 1993 San Luis Obispo, CA

TISSUE FROM: Spleen ACCESSION. 117341

CI,JNJCAic ABSTRACT:

1ilill!!x: This 79 year-old palient was admitted to the hospital with a 7-8 day history of abdominal pain. She had not felt well for three weeks prior to admission and complained of a tendency for bloating. She had a two year history of diverticular disease a11d it felttbat these complaints related to recurrent diverticulitis. The potient was put on antibiotics for four doys prior to entering the hospital and was told to take magnesium citrote. She did have some wotery bowel movements thereafter, but her poin ond blooting did not go away. She denied ony fever, chills, sweats, etc.

Physical Examination: Mild tenderness was noted upon obdominal examination. Everything else WIS within nonnallimits.

SURGERY: C07/08m>

Splenectomy plus dissection of perisplenic tumor.

GROSS PATHOLOGy:

The spken with attached adipose tissue (which appeared 10 be of omental nature) weighed 890 grams. The spleen itself was enlarged several times the normal size and measured 15 x 8 x 7 em. An II x 7 em f"h-Oesh solid grey-white mass with central necrosis and bemonbage replaced most of the spleen. The attached omental adipose tissue was 14 x 2.5 em and appeared infiltrated by tumor but was distinct from the discrete, fish·Oesh solid mass described above.

CONTRIBUTOR: Peter Morris, M.D. CASE NO. 8·0CTOBER 1993 Santa Barbara, CA

TISSUE FROM: Thyroid ACCESSION. 126699

CUNICAI. ABSTRACT:

History; This 78 year-old woman bad six weeks of hoarseness for which she was·evaluated by a specialist in otorhinolaryngology. She was found to have a paralyzed vocal cord and a finn neck mass thar involved the left lobe of the thyroid. A cr scan revealed a 4 x 5 x 7 em inhomogeneous mass with areas of low density and calcification which displaced the larynx to the right and extended into the sternal notch. In a review of systems the patient stated she bas liad frequent episodes of rapid irregular heart beat over the past three years, without any other or associated symptoms.

Physjcal Examination: Other than. the neck mass, everything else was within nonnal limits.

SURGERY; CO!t12/90l

Total thyroidectomy

GROSS FAmOI,QGY:

The thyroid resection weighed 105 gm and consisted of a large hemorrhagic and somewhat ovally-shaped mass measuring 6.5 by 5.5 by 4.0 em with an attached 3.1 x 2.5 x 1.5 em lobulated mass of apparent normal thyroid and several node-like structures varying from 0.5 to 1.0 em. One surface of the specimen was concave, the other surface convex. The convexity was covered by dense fibrous tissue with attached skeletal muscle, adipose tissue and dilated blood vessels. The concave surface was nodular and hemorrhagic. Serial sections through the mass showed a mixed pattern in the parenchyma. The central aspect consisted of finn yelloW·SJtY tissue with a 1 x 1 em circumscribed are.a of yellow calcification. There was ·2.5 x 1.5 x 1.5 em area of cystic degeneration and mushy yellow necrotic tissue. The margin consisted of soft pink to red hemorrhagic tissue surrounded by a rim of more dense SJtY fibrous-like tissue wbich was up to 0.6 em wide and extending to the margins.

CONTRIBUTOR: Petu Morris, M.D. CASE NO. 9-0CTOBER 1993 Santa Barbara, CA

TISSUE FROM: Paacrutic tumor ACCESSION. ll7l01

CI.INJCAL ARS'fMCI:

Hjstory: This 45 year old Hispanic female bad a diagnosis of peptic ulcer approximately 8 years ago, treated with H2 blockers. Approximately three years ago, she bad recurrent symptoms and an upper 01 study showed a hiatal hernia with renux. She was again treated with H2 blockers and did well. Approximately 1 week before being admitted, she noticed burning mid epigastric pain which did not radiate. There was no associated nausea or vomiting. Later, the pain became associated wHh black tarry stool. 1be patienr wenr on Tagmet 400 mg, which she bad at home. However, her symptoms did not abate. The pain seemed to be worsl at night. As her pain persisted and worsened, the patient went in for care where she was admitted for peptic ulcer disease. She had a pest history of hypertension, hiatal hernia, gallbladder disease, starus postlaparoscopic cholecystectomy approximately one year ago.

Physical ExaminBtion: The abdomen was significantly tender in the mid epigastric region. There was no guarding or rebound tenderness. Bowel sounds were hypoactive. The rectal exam revealed there was no mass. There was melanotic stool which was bemoccult positive. Everything else was within normal limits.

SURGERY: OOJ22m))

Pancreaticoduodenectomy (Whipple procedure), incidental appendectomy

GROSS PATHOLOGY:

The 128 gram specimen consisted of an 11.5 em long portion of duodenum with a 7.5 x 7.0 x 2.5 em bead of pancreas. There was an increased firmness in the bead of the pancreas which showed areas of bemonbagic discoloration. Associated with tbe firmness there were n1ultiple 1·2 em diameter nodules which blended with the surrounding parenchyma. The duodenum showed a 1 em area of ulceration which bad a son dark red base witb sharp separtion from the surrounding tan mucosa which was edematous and showed nonnal transverse folds. The area of ulceration was 2.5 em proximal to the ampulla and was 6.0 em from the proximal and 6.5 em from tbe distal matgins. The ampulla was probe patent and tbe probe could be passed to the transection end of tbe common bile duct. Sections through !be duodenum incorporating tbe ulcer showed an underlying neoplasm wbicb bad a soft grey-white and focally bemonbagic and necrotio-appearing parenchyma. This neoplasm abuued the muscularis propria of the duodenum and extended into the base of the previously noted mucosal ulcer. On the superior aspect there wu 1 2.0 x 1.5 x 2.0 em partially cystic and calcified area which bad an outer rim of yellow-white material. Centrally it contained IWO cystic spaces, one of which wu filled wilb soft tan malerial. The neoplam appeared to be surrounded on all aspects by either an areolar membrane or tan pancreatic parenchyma. The medial extent of !be neoplasm was 6.5 em from the transected matgin of !he pancreas.

CONTRIBUTOR: Jilchard Johnson, M.D. CASE NO. 10-0ctober 1993 Pasadena, CA

TISSUE FROM: Thyroid ACCESSION 27368

CYNICAl. ABSTBACT:

History: This 33 year old male was admined to the hospital (07/27/93) because of a non-tender nodule on the left side of the thyroid. The t.byroid was diffusely homogenous with the left lobe larger than the right.

Physical Examination: The patient bad no other significant findings than the thyroid enlargement.

J.abor>tory: The chemistry panel was within normal limits except for calcium of 11.0 gm/dl (reference range 3.4 • 10). •

SURGERY: C07127/93)

Cervical exploration with left total lobectomy and biopsy of enlarged parathyroid gland.

GROSS PATHOLOGY:

The 28 gram left thyroid lobe was 6.5 x.3.5 x 3.0 em. Sectioning revealed a discrete golden yellow nodule with focal hemorrhage and friable zones.

CONTRIBUTOR: Pettr Monis,j\1.D. CASE NO. ll·October 1993 Santa Barbara, CA

TISSUE FROM: Gastric Leiomyoma ACCESSION Z736Z

CLJNJCAL ABSTRACT:

History: This 75 year old caucasian female was admitted to the hospital complaining of melena. She bad bad a previous episode in September 1992 and was endoscoped and diag11osed of having a fundic gastric ulcer. Biopsies were negative. She was re-endoscoped and a gastric mass was found in the region that bad been previously visualized. She had two episodes of a major hemorrhage requiring blood transfusions on the two occasions she went to the hospital.

Physic• I Examination: Reveals a fit •ppearing moderately overweight caucasian female in no acute distress.

SURGERY: ffi7a7f93)

Exploratory lapartomy, proximal gastrectomy

§ROSS PATHOLOGY:

The specimen consislcd of a bosselated 9.0 x 5.0 x 5.0 em rubbery tumor mass over which was partially draped a 11.0 x 7.5 em portion of stomach wall. The specimen weighed 150 grams. The mass pushed a 7.5 x 5.5 em portion of stomach upward to a height of2.S.c.m and contained an e~ntric 1.0 em wide red granular ulceration. The remainder of the mass was covered by intact red to tan richly vascular serosa. The tumor mass on cut section was predominantly pink-tan and finely granular with multiple peripheral areas of hemorrhage up to 3.0 em wide and 5.0 em thick. There was a weiJ-demarcaded interface between the tumor and the overlying stomach wall except for the area immediately surrounding the ulceration.

CONTRIBUTOR: G. Hal DeMay, M.D. CASE NO. 12-0ctobtr 1993 San Pablo, CA

TISSUE FROM: Pl~ura ACCESSION %7361

CI1JNICAI, AB£fRACT;

Hi§!ruy: This 76 year old male retired railroad worker present~ with a history of right sided chest pain and shortness of breath of several months duration. Tb~ pain was 'pleuritic' in natu re.and descri~ as severe. The patient had smok~ approximately one pack of cigarettes daily since tbe age of 16.

Past Historv: Cancer of the prostate was diagnosed in May 1992, for which he received radiation and hormonal therapy.

Physical p amjnatjon; ACT scan showed pleural thickening wrapping tbe periphery of the right hemithorax. Portions of the pleural thickening appeared lobular. The left hemithorax was clear.

SURGERY: 104/16/93)

Right Pleurectomy and Flexible Bronchoscopy

GROSS PATHOLOGY:

Multiple specimens were received, descri~ as either 'pleura' or a 'fissure mass'. Most of these consist~ of more or less homogenous firm gray-white tissue. Individual tissue fragments vary~ from 2.5 to 11 em in greatest diameter.

,

STUDY GROUP CASES OCTOBER 1993

SUGGESTED READING

American Cancer Society and Roche Laboratories Interactive Workshop on

Medical Ethics Versus Medical Economics: A Health Case Dilemma in Cancer Patient Care

Washington, DC February 16- 17, 1993

Cancer (Supp #9) November I, 1993; Vol 72.

Burke H, and Henson D. Criteria for Prognostic Factors and for an Enhanced Prognostic System. Cancer 1993; 72:3131-3135, Number 10.

CASE NO. 1, ACCESSION NO. 27335 OCTOBER 1993

LOS ANGELES - Squamous cell carcinoma, retro~ ? possible anal duct origin (5).

SAN BEBNA!U>INO <INLAND> - Squamous cell carcinoma (10).

LONG BEACH - Squamous cell carcinoma (7).

SANIA BARBARA- Cloacogenic carcinoma (3).

FLORIDA -Squamous cell carcinoma (3).

SANTA ROSA- Malignant suggestive of cloacogenic carcinoma (I); (A) Malignant; (B) Cloacogenic carCinoma (squamous cell carcinoma) (I); Squamous cell carcinoma (cloacogenic carcinoma) {I).

QH1Q - Cloacogenic carcinoma.

lAPAN- Cloacogenic carcinoma (I).

NEW JER5EY- Squamous cell carcinoma ? site of origin. (4).

MARYLAND - Carcinoma arising from anal transition zone (9); Anal carcinoma (1).

SACMMENTO- Anal carcinoma of transitional zone (13).

ALM1EDA COUNTY- Clacogenic carcinoma, bladder (4); Squamous carcinoma, bladder (2).

FOLLOW-UP:

Lesion was resected. She underwent a course of external radiation. She was seen by her surgeon the last week of August of 1993 and at that time here was no c:videnoe of disease.

DIAGNOSIS:

SQUAMOUS CELL CARCINOMA "RECTUM" NOS

REFERENCES:

Herzog U, Von Fliie, Fondeli P. Scluyspiser. How Accurate is Endo~ Ultrasound in Pre­Operative Staging of Rectal Cancer? Dis Colon Rectum 1993; 36: 127-134.

Abel ME, Chin Y, Russell TR. Volpe PA_ Adenocarcinoma oflhe Anal Glands- Results of Survey. Dis Colon Rectum 1993; 36: 383-387.

You YT, Wang JY, Cbangchien CR, Chen JS. et al. An Alternative Treatment of Anal Squamous Cell Carcinoma - Combined Radiotherapy and Chemotherapy. J Surg Qncol 1993 Jan; 52(1): 42-45.

CASE NO. 2, ACCESSION NO. 27363

LOS ANGELES • Granular cell tumor (5).

SAN BERN ARPINO (INLAND> · Granular cdl tumor (10)

LONG BEACH· Granular cell tumor (7) ..

SANIA BARBARA· Granular cell tumor (3)

Fl,ORIDA -.Granular cell tumor (3) ..

OCTOBER 1993

SANIA ROSA • Granular cell tumOr vs other benign mesecbymal tumor (1). (A) Benign; (B) Granular cell iumor (I); Granular cell tumor (1).

QH!.Q • Granular cell tumor.

~ • Granular cell tumor ( l).

NEW JERSEY • Granular cell ( 4 ).

MARYLAND· Granular cell tumor (10).

SACMMENTO • Granular cell tumor of wrist (I 3 ).

ALAMEDA COUNTy • Granular cell tumor (6).

FOLLOW-UP:

No followup at this time.

DIAGNOSIS:

GRANULAR CELL TUMOR, DERMIS, INVOLVING PARTOID GLAND

REfERENCES:

Enzinger FM. and Weiss SW. Soft Tissue Tumots, Second Edition. StLouis, The C. V. Mosb)• Company, 1988: 757-767.

(See references on Case 119, Accession N26633 of September 1993 monthly srudy set).

CASE NO. 3, ACCESSION NO. 27339 OCTOBER I 993

LOS ANGELES • Transitional ocll carcinoma, papillary inverting Grade U. X-File: Inverted transitional cell papilloma (S).

SAN BERNARDINO C!NLAND\ • Transitional cell carcinoma of bladder (8). lnvened papilloma (2).

LONG BEACH - Invasion papillary tnlnsitional cell carcinoma, Grade II (7).

SANTA BARB AM • PapillaJy transitional carcinoma (3).

FLORIDA • Transitional cell carcinoma, Grade liili! (3).

SANIA ROSA ·Transitional cell carcinoma (2); (A) Malignant, (B) Transitional cell carcinoma with muscle invasion. Grade II/liT (I). ·

QH!Q -Invasive transitional cell carcinoma, Glade IJ.

JMAN ·Transitional cell carcinoma, low grade (I).

NEW JERSEY· Transitional cell carcinoma, Grade II, papillary and inverting (4).

MARYLAND· Low grade papillary transitional cell carcinoma with invening fearures (10).

SACRAMENTO • Bladder, transitional cell carcinoma, Grade ll (13).

ALAMEDA COUNTY· Transitional cell Grade II (4); Grade I (I); Non-invasive TCC (1).

FOLLOW-UP:

Unable to obtain followup history.

DIAGNOSIS:

TRANSITIONAL CELL CARCINOMA (INVERTING TYPE), GRADE D

REFERENCES:

Herr HW. Staging Invasive Bladder Tumors· Bladder Tumors that Show Muscle Invasion with a Papable Mass have Worse Prognoses than that of Deep Muscle Invasion. J Surg Oocoll992; 51: 211· 220.

Murphy WM, Deana DG. The Nested Variant ofTransitional Cell Carcinoma • A Neoplasm Resembling Proliferative of Brunn's Nest. Modem Pathol 1992; S: 240-243.

Kaufman D, Shipley W, Griffin P, Heney N. et al. Selective Bladder Preservation by Combination Treatment of Invasive Bladder Cancer. New Eng J Med 1993; 329(19): 1377-1382.

Woehre H. Ous S, Klevrnark B, Kvarstein B. A Bladder Cancer Multi·Iostinrlional Experience with Total Cystectomy for Muscle-Invasion Bladder Cancer. Cancer 1993; 72(10): 3044-3051.

Fossa S, Woehre H. Aass N, Jacobsen A. et al. Bladder Cancer Definitive Radiation Therapy of Muscle-Invasion Bladder Cancer • A Retrospective Analysis of 317 Patients. Cancer 1993; 72(10): 3036-3043.

CASE NO. 4, ACCESSION NO. 27342 OCI'OBER 1993

LOS ANGELES - Malignant melanoma, primary site un.lrnown (5).

SAN BERNARDINO (INLAND) - Pigmented malignant scbwannoma(7); Malignant melanoma (2); Peripheral neuroblastoma (I).

LONG BEACH - Malignant melanoma (7).

SANTA BARBARA- Melanoma (3).

FLORIDA - MetaStatic melanm;na (3).

SANTA RQSA • Pigmented mmor of soft pans vs otber mesenchymal rumor witb epitbeloid feamres vs melanoma (l); (A) Malignant. (B) Melanoma of soft pans (I); Malignant melanoma (I).

QlilQ • Melanoma.

JAPAN- Poroid hidradenoma (1).

NEW JERSEY - Malignant melanoma (4).

MARYLANJ). Cellular blue nevus (8). Malignant melanoma (2).

SACRAMENTO· Secondary melanoma (4); Melanoma soft pan (9).

P!.EASANTQN- Malignant melanoma (2); Melanoma witb post BCG (1).

SPECIAL STAINS:

The neoplastic cells were positive with S-100 (1+) and HMB-45 (J+)

FOLLOW-UP ·

The lesion was unresectable, extending into skeletal muscle down to bone. Follow up not available.

DIAGNOSIS:

METASTATIC J.\.IALJGNANT MELANOMA, MUSCLE, NOS

REFERENCES:

Patel JK, Didolkar MS, Pickren JW, Moore RH. MetaStatic Pattern of Malignant Melanoma, Am J Surg 1978; 135: 807-810.

Sirott MN, Bajorin D. Wong GYC, Tao Y. et a!. Prognostic Factors in Patients with MetaStatic Malignant Melanoma. Am 1 Surg 1993; 72: 3091-3098.

CASE NO. 5, ACCESSION NO. 27346 OCTOBER 1993

LOS ANGELES - Unusual mucinous adenocarcinoma of the colon (5).

SAN BERNARDINO <INLANPl - Mucinous adenocarcinoma (8); Mucinous carcinoid (2).

LONG BEACH - Poorly differentiated mucinous·adenocarcinoma (7).

SANf A BARBARA - Undifferentiated carcinoma (3).

H.ORJDA - Adenocarcinoma (3).

SANTA ROSA - Adenocarcinoma, favor GI origin, RIO ovarian vs other origin (I); (A) Malignant, (B) Adenocarcinoma mucin secreting focally poorly differentiated(!); Adenocarcinoma foCally poorly differentiated (1).

OfnO - ? Granular cell tumor.

JAPAN. Pleomorphic liposarcoma (1).

NEW JERSEY- Adenocarcinoma, poorly differentiated (4).

MARYLAND- Mixed adenocarcinoma- carcinoid tumor (5); Adenocarcinoma (4); Adenocarcinoma with sarcomatoid dedifferentiation (I).

SACRAMENTO- Colon, mucinous adenocarcinoma (13).

PLEASANTON -Carcinoid (I); MetaStatic renal cell(!); Mucinous carcinoma, metastatic (1).

SPECIAL STAINS:

Cbromogranin present in the odd granular staining cells. Acid mucopolysaccharide · positive mucin.

FOLLOW-UP:

The patient was left with gross residual disease and began on continuous 5-FU. Disease currently is stable without evidence of clinical response.

DIAGNOSIS:

MUCINOUS ADENOCARCINOMA

REFERENCES:

Boughdady IS. Kinsella AR, Haboubi NY, and Schofield PF. K-Ras Gene Mutations in Adenomas and Carcinomas of the. Colon. Surg Oncol, Aug 1992; Vol 1(4): 275-283.

Cuenca RE, Azizkhan.RG and Haskill S. Characterization ofGRO a, b. andy Expression in Human Colonic Tumours· Potential Significance of Cytokine Involvement. Surg Oncol. Aug 1992; Vol 1(4): 323-331.

J.;eon KE, Dozois RR. Epidemiology of Large Bowel Cancer. · World J Surg 1991; 15: 562·567. Corman ML. Principles of Surgical Techniques in Treaunent of Carcinoma of the Large Bowel.

Case #5, October 1993

REFERENCES (Continued):

World J Surg 1991; 15: 562-596. Yao T, and Tsuneyosbi M. Significance of Pericryptal FibrOblast$ in Colorectal Epitbelial

Tumors- A Special Reference to the Histologic Features and Growth Patterns. Hum Patbol1993; 24(5): 525-533.

CASE NO. 6, ACCESSION NO. %7:188 OCTOBER 1993

LOS ANGELES - Sarcoma. awaiting nwker studies (S).

SAN BERNARDINO <INLAND>- Hcmangiopericytoma (3): Liposarcoma (3); Malignant fibrous histiocytoma (2); Soft tissue neoplasm, NOS (2).

LONG BEACH-Hemangiopericytoma (7).

SANTA BARBARA- Hemangiopcricytoma (3).

FLORIDA- Sarcoma. MFH (3).

SANTA ROSA- Sa=ma 'l>ith possible osteoid production vs hemangiopcricytoma (I); (A) Malignant, {B) Mesenchymal neoplasm (lciomyosan:oma. RIO others) (I); Malignant mesenchymal tumor, RIO leiomyosan:oma, hemangiopericytoma, etc. ( I ).

QlilQ - Fibrosarcoma.

lA:e6li- Rhabdomyosarcoma (I).

NEW JERSEY-Leiomyosarcoma (4).

MARYLAND- Leiomyosarcoma (10).

SACBAMENTQ- Retroperitoneal leiomyosarcoma (4); Mallgrulllt nerve sheath tumor (5): Malignant sttomal tumor (4).

PLEASANTON - Malignant schwannoma (I); Don't know (2).

SPECIAL STAINS:

S-100: positive. NSE: focal positivity. Lysozome: positive Actin: negative. Vimentin: focally positive.

FOLLOW-UP:

Unable to obtain followup hiSIOI)'.

CONSULTATION:

Dr. Murakami: ModeraLely dlfferentialed neurogenic sarcoma, left retroperitoneal area.

DIAGNOSIS:

MALIGNANT PERIPHERAL NERVE SHEATH TUMOR

CASE NO.7, ACCESSION-NO. l7341 OCTOBER 1993

LOS ANGELES • Rhabdomyosarcoma, pleomorphic of spleen (5).

SAN BERNARDINO CfNLAND} ·Pleomorphic rhabdomyosarcoma (10) . .

LONG BEACH • Pleomorphic rhabdomyosarcoma (7).

SANTA BARBARA ·Rhabdomyosarcoma (3).

FLORIDA • Rhabdomyosarcoma (3).

SANTA ROSA • Histiocytosis vs lymphoma vs carcinoma vs soft tissue rumor, pending immunohisto chemical stainS(!); (A) Malignant, (B) Mesenchymal vasoformative neoplasm c/w angiosarcoma (I); Malignant neoplasm. RIO lymphoma. angiosarcoma. sarcoma NOS.

OHIO • Rhabdomyosarcoma.

JAPAN. Rhabdomyosarcoma (1).

NEW JERSEY - Adult rhabdomyosarcoma (4).

MARYLAND- Rhabdomyosarcoma (8); Sarcoma with rbabdomyosarcomatous differentiation (2).

SACRAMENTO: Spleen- Rhabdomyosarcome (13).

PLEASANTON - Rhabdomyosarcoma (2); Melanoma (I).

SPECIAL STAINS:

Mucin: negative Epilllelial membrane antigen: negative Vimentin: positive Actin: positive

l<OLLOW-UP:

Patient died in August. In addition to her splenic tumor, she al~o bad an ovarian papillary adenocardnoma diagnosed at llle same time. Chemotherapy was not effective.

DIAGNOSIS:

ADULT PLEOMORPHIC RHADOMYOSARCOMA

REEERENCF-~ :

Wein.stein MJ, Carpenter JL, Schunk CJ. Nonangiogenic and Nonlympbomatous ~arcomas of tbe Canine Spleen- 57 Cases (1975-1987). JAm VetMed Assoc 1989 Sep 15; 195(6): 784-788.

(Could not fmd reference for homo sapiens.)

CASE NO. 8, ACCESSION NO. 26699 OCfOBER 1993

LOS ANGELES· Mixed carcinoma of thyroid, iocluding papillary, follicular and squamous type (5).

SAN BERNARDINO (INLAND> • Widely invasive poorly differentiated papillary carcinoma of thyroid with squamous differentiation (10).

LONG BEACH • Anaplastic carcinoma of thyroid in association with papillary carcinoma (7).

SANTA 13ARBARA • Papillofollicular carcinomalaoapla5tic (3).

FLORIDA· Mucoepidermoid tumor (3).

SANTA ROSA • Papillary carcinoma \\ith extensive Hurthle cell (possibly squamous cell) features (l ); (A) Malignant, (B) Papillary carcinoma with Hunhle cell change and focal squamous cell differentiation (I); Papillary carcinoma with sclerosis, Hurtble cell changes and squamous metaplasia (I).

omo • ? papillary carcinoma.

JAPAN · Papillary carcinoma, tall cell \'ariant (1).

NEW JERSEY· Papillary thyroid carcinoma with Hurtble cell and squamous feattm:S (4).

MARYLAND· Anaplastic carcinoma, squamoid varian~ arising inl)apillary carcinoma (8); Papillary carcinoma, diffuse Sclerosing variaru (1); Papillary carcinoma tall cell variant (1).

SACRAMENTO· Thyroid Hurtble cell carcinoma (4); Squamous carcinoma (6); Papillary carcinoma (3).

PLEASANTON· Papillary carcinoma with poorly differentiated squamous foci (3).

FOLWW-UP:

Patieru received post·o1rradiotherapy to the neck with some re5p9nse. CT scan in June showed 'infiltration of the left neck with tumor, as well as nodules in the lungs and a right subpleural diaphragmatic mass. She was hospitalized in July for syncopal episode. No additional followup.

DIAGNOSIS:

PAPILLARY AND SOLID V AR1ANT CARCINOMA WITH FOCI OF SQUAMOUS CELL CARCINOMA

REFERENCES:

Thompson NW, McLeod MK, Burney RE. Macha M. The Incidence of Bilateral, Well· Dilfereotiated Thyroid Cancer Found in Completion ofThyroidoctomy. World J Surg 1992; 16: 711-717.

Salmon 1, Gasperin P, Remmelink M, Rahier I. et al. Ploidy Level and Proliferative Activity Measurements in a Series of 407 Thyroid Tumors or Other Pathologic Conditions. Hum Pathol 1993; 24: 912·920.

Saito K, Kwatomi Y, Youramato. et al. Primary Squamous Cell Carcinoma of the Thyroid with Marked Leucocytosis and .Hypercalcemia. Cancer 1981; 48: 2080.

Case 118, October 1993

REFERENCES (Continued):

Mayloyama T, Watanabe H. Simultaneous Squamous Cell Qucinoma and Papillaty Adenocarcinoma of the Thyroid Gland Hum Patholl983; 14: 1009-1010.

Zedenius J, Arer J. Blackdabl M, Falkner. et al. Follicular Tumors oftbe Thyroid Gland· Diagnosis, Clinical Aspects and Nuclear DNA Arialyru. World J Surg 1992; 16: 589-594.

Demeter JG, DeJong SA, Lawrence AM. Anaplastic Thyroid Carcinoma ·Risk Factors and Ou!COme. $urgery 1991; II 0: 956-963.

Chan, John. Practical issues in Thyroid Pljthology • California Seminars in Pathology. California Society of Pathologists • December 2, 1993.

CASE NO.9, ACCESSION NO. 27318 OCTOBER 1993

LOS ANQEI ES- Solid and papillary epithelial n~lasm. pancreas. X-filc: Papillary cystic tumor of 113ncreas (characteristically in young people) (5).

SAN BERNARDINO /INLAND) - Solid and papillary epithelial neoplasm of pancreaS ( 10).

LONG BEACH- Solid. and papillary epithelial neoplasm of pancreas (7).

-SANTA BARBARA· Papillary carcinoma (3).

FLORIDA -ISlet cell tumor (3).

SANTA ROSA- Adenocarcinoma with papillary features (I). (A) Malignant, (B) Papillary C)-stadenosarcoma (1); Papillary cystadenosarcoma of pancreas (1).

JAPAN- Ampullary carcinoma (1).

NEW JERSEY- Adenocarcinoma, partly papillary (4).

MARYLAND- Acinar cell carcinoma (2); Islet cell tumor (2); Solid and papillary epithelial neoplasm of the pancreas (6).

SACRAMENTO- Duodenal-pancreatic epithelialleiomyoblastoma clear (2); Clear cell carcinoma (3); Acinar cell carcinoma (8).

SPECIAL STAINS:

Chirukian: Negative Gastrin, Insulin, Chromagranin and Synaptophysin: Negath'C PAS: Negative

FOLLOW-UP:

The patient was hospitalized November 1992 for epigastric pain, attributed to gastritis. No additional followup.

DIAGNOSIS:

SOLID AND PAPILLARY TUMOR OF THE PANCREAS

REFERENCES:

Cubilla AL, Fitzgerald PJ. Tumors of the Exocrine Pancreas - Atlas ofT umor Pathology Second Series, Fascicle 19. 1982: 201-207.

Coben RJ. Neuro-Endocrine Tumours - Their Origin and Classification. S Aft J Surg 1.992 Jun; 30(2): 34-38.

Case 119, Octcbet 1993

REFERENCES (Colllinued):

TaiVer OS, Bii'Ch SJ. Case Report: Life Threatening Hypercalcaemia Sec;ondaJy to Pancreatic Tumour Secreting Parathyroid Honnone-R.clated Protein - Suocessful Control by HqJBiic Ancrial Embolization.

De-Leewc FE, Jansen GH. Balanero E, Van-Wicben OF- The Nemal and NCUJ'()oEodocrioe COi"l'"""'' of the Human Thymus I. Nerve-Like Structures. Brain Behav 1mmun 1992 Sep; 6(3): 234-248.

Batanero E. De-Leeuw FE, Jansen GH, Van-Wicben OF. et al. The Neural and Neuro-Endocrine Component of the Human Thymus. U. Hormone lmmuooteactivity. Brain Bebav lmmun 1992 Sep; 6(3): 249-264.

CASE NO. 10, ACCESSION NO. 27368 OCTOBER 1993

LOS ANGELES - Lipid-rich follicular adenoma of tbe thyroid (5).

SAN BERNARDINO QNLAND\ - Paralhyroid adenoma (10).

LONG BEACH - Medullary carcinoma (7).

SANTA BARBARA- Parathyroid carcinoma (3).

FLORIDA · Hurthle cell tumor (3).

SANTA RQSA - Follicular/trabecular adenoma wilh areas of pro1>able capular invasion (follicular carcinoma)(!); (A) Malignant potentialCiow; (B) Hurthle cell neoplasm, mixed follicular neoplasm(!); Low grade follicular carcinoma (l ).

ill:!!Q - ? Hurtble cell neoplasm.

JAeA!j - Parathyroid hyperplasia (1).

NEW JERSEY- lnfrathyroid paralhyroid adenoma (4).

MARYLAND - Paralhyroid adenoma (10).

SACRAMENTO- Paralhyroid ailenoma (13).

PLEASANTON • Parathyroid adenoma (inttalhyroid) (3).

SrEClAL STAINS:

Oil Red 0 Fat Slain: 4+ positive

FOLLOW-UP:

No foUowup at lhis time.

DIAGNOSIS:

LIPID-RICH FOLLICULAR ADENOMA, THYROID

REFERENCES:

Schroder s. Hussei.J,nan H, Bo,eber. Lipid-Ricb·Cell Adenoma of the Tbyroid Gland - A Repon of a Peculiar Tbyroid Tumor. Vircbows Arch (Pa!hol Anat) 1984; 404: 105-10&.

Van Heerden JA, Hay ID. Goellner R, Salomao D, Ebersold JR. et al. Follicular Thyroid CarC,inoma wilh Capsular Invasion Alone- A Non·Thi'eatening Malignancy. Surgery Dec 1992; 112(6): 1130-1136.

Campo E, Perez M. Aristidis A, Charon is CA. et al. Patterns ofBasement Membrane l:.amin Distribution in NoncNeoplastic and Neoplastic Thyroid Tissue. Modem Patboll992; 5: 540-546.

Zedenius J, Arer J, Blackdabl M, Falkner. et al. Follicular Tumors of the Thyroid Gland -Diagnosis, Clinical Aspects and Nuclear DNA Ar)alysis. World J Surg 1992; 16: 589-59

Case 10, October 1993

REfERENCES (Continued):

Lang W, Georgii, Stoudl G, IGenz.le E. Tbe Differentiation nf Atypical Adenomas and Encapsulated Follicular Carcinomas in the Thyroid Gland. Virobows Arch (A) 1980; 385: 125-141.

Johannessen N, Sobrino Simoes M. Well-Differentiated Thyroid Tumors· Problems in Diagnosis and Understanding . Palb Annu 1983; Pt 1: 255-285.

Bloom AD, Adler LP, Sbuclc JM. Determination of Malignancy of Thyroid Nodules witb Positron Emlsion Tomography. Surgery 1993; 114: 728-735.

Rosai I Carccangiu ML. DeLellis RA. Tumors of the Thyroid Gland. AFIP Atlas of Tumor Patbology, Third Series, Fascicle 7 1990: 183·188.

CASE NO. 11, ACCESSION NO. 27362 OCTOBER 1993

LOS ANGELES- Stromal tumor of unknown malignant potential (5).

SAN BERNARDINO (!NLANDl - Neurilemmoma (7); Spindle cell stromal tumor (3).

LONG BEACH- Benign gastric stromal tumor (6); Rbythmic leiomyoma (1).

SANTA BARBARA - Neurilemmoma (3).

B ,()RIDA - Gastric stromal tumor of uncenain malignant potential (3).

SANTA ROSA - StrOmal tumor consistent witb nettrilemoma (l); (A) Benign or low malignant potential; (B) Mesenchymal .neoplasm, RIO scbwannoma leiomyoma (I); Leiomyoma vs nettrilemmoma- do immunoperoxidase to differenliale (1).

~·Leiomyoma (1).

_NEW JERSEY - Low grrade leiomyosarcoma (4).

MARYLAND - Leiomyosarcoma (7); Epithelioid Leio!l)yosarcoma ()); Malignant gastrOintestinal stromal tumor (2).

SACRAMENTO - StOmach suomaltumor (13).

SPECIAL STAINS:

Trichrome stain: Cytoplasm of tbe cells stains red • suggestS smootb muscle origin.

FOLLOW-UP:

Patient was last seen August 27, 1993, one montb post-Qp. Physical exam on lungs and abdomen were negative.

DIAGNOSIS:

CELLULAR STROMAL TUMOR, STOMACH, OF UNCERTAIN MALIGNANT POTENTIAL

REFERENCES:

Cunningham R, Federspiel B, McCarthy W, Sobin L. eta!. Predicting Prognosis of Gastrointestinal Smooth Muscle Tumors - Role of Clinicai and Hi~tologic Evaluation. Flow Cytometry and Image Cytometry. Am J Surg Pathol 1993; 17(6): 588-594.

Kimura H, Yonemura Y, Kadoya N. et al. Prognostic FactOrs in Primary Gastrointestinal Leiomyosarcoma- A RetrOspective Study. World J Surg 1991; 15: 771-777.

Appleman HD. Smooth Muscle Tumors of !he GastrOintestinal Tract- What We Know !hat Stout Didn't Know. Am J Surg Pathol1986, 10 (Supp 1): 83-99.

CASE NO.J2, ACCESSION NO. 27361

LOS ANGELES- Malignant mesothelioma, bipbasic.

SAN BERNARDINO CJNi.AND> • Malignant mesothelioma (10).

J.ONG BEACH · Malignant mesothelioma (7).

SANTA "BARBARA· Mesothelioma (3).

f!..ORIDA. Malignant mesothelioma (3) ..

OCfOBER1993

SANTA ROSA - Adenocarcinoma vs mesothelioma (1); (A) Malignant; (B) Mesothelioma vs metastatic carcinoma (need special stains) (1); Mesothelioma vs carcinoma, favor me-sothelioma. Need immunoperoxidase to differentiate (1).

JAPAN. Malignant mesothelioma (1).

NEW JERSEY • Mesothelioma, epitheloid type

MARYLAND· Malignant mesothelillma (10).

SACRAMENTO· Pleura, metastatic adenocarcinoma (13).

SPECIAL STAINS.:

Iron stains: All sections exhibited lung parenchyma. None showed the presence of ferruginous bodies.

No evidence of positivity with antibody to carcinoembryonic antigen.

FOLLOW-UP:

Patient doing well, recovery uneventful.

DIAGNOSIS:

MALIGNANT MESOTHELIOMA, BIPHASIC, PLEURA

REfERENCES:

Kannerstein M, Cburg J. P~ritoneal Mesothelioma. Hum Pathol1977: 8: 83-94. Hanasb KA, Mostofi HE. Primary Pleural Mesotheliomas in Soulh India • A 25 Year Study.

J Surg Oncoll992; 49: 196-201. Bolen JW, Tboring D. Mesothelioma- A Light and Electron Microscopical Study Concerning

Histogenic Relationships Between Epithelial and Mesenchymal VarianiS. Am J Surg Patboll980; 4: 451.