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CALIFORNIA TUMOR TISSUE REGISTRY

"U~Tl~GTO~ MEMORlAL "OS~lTAL

PROTOCOL

FOR

MONTHLY STUDY SLIDES

JANUARY 1991

TUMORS OF KIDNEY

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CONTRIBUTOR: Paul Meyer, M. D. JANUARY 1991 - CASE NO . 1 Los Angeles, Cali fornia

TISSUE FROM: Kidney ACCESSION NO. 26899

CLINICAL ABSTRACT:

History: This 60-year-old man died as a result of a motor vehicl e accide~t.

GROSS PATHOLOGY:

Other than for mul tipl e t raumati c injuries and burns, the significant pathologic finding was limited to the right kidney which weighed 190 grams. A tumor-like lesion was located in the middle portion of t his kidney. No other details regarding this lesion were given. The left kidney weighed 165 grams and appeared normal .

CONTRIBUTOR: Joelle M. Lambert., M. D. Milton L. Bassis, M. D. San Francisco, California

TISSUE FROM: Kidney

CLINICAL ABSTRACT:

JANUARY 1991 - CASE NO. 2

ACCESSION NO. 26284

History: This 7-year-old female presented with right abdominal pain and a mass following a fall. The mass rapidly increased in size over a few days.

Physical examination: A large right abdominal mass was easily visible and was tender to palpation.

Laboratory report: Hematocrit dropped rapidly during a short period of evaluation.

Radiographs: Intravenous pyelograms showed a right intrarenal tumor with associated vena cava compression. Liver and spleen scans were negative and no pulmonary metastases were noted on the CT scan.

SURGERY:

A "monstrous" tumor of the right kidney which was adherent to surrounding structures was identified. No invasion of adjacent tissue or the renal vein was seen. A radical nephro-ureterectomy and ret roperi toneal lymph node dissection were performed.

GROSS PATHSLOGY:

The specimen was a 1275 gram kidney and attached ureter . The kidney was 90% replaced by a focally hemorrhagic .and cystic tumor which measured approximately 20 x 15 x 7 em.

CONTR IBUTOR : Joel le Lambert, M. D. JANUARY 1991 - CASE NO. 3 Milton Bassis, M. D. San Francisco , California

TISSUE FR0t1: Kidney ACCESSION NO. 26290

CLINICAL ABSTRACT:

History: This 3-ear-old boy was well until his mother noted that his pants were getting tighter. She also noted increasing listlesness , irritability and a diminishing appetite.

Physical examination : A 14 em. abdominal mass extended f rom the diaphragm to the level of the iliac crest.

Laborat ory reports: Hematocrit was 23. VMA was markedly elevated.

Radiograph: A 14 x 14 em. abdominal mass which distorted the left kidney was seen on CT scan. Foci of cal cification were noted.

SURGERY:

A tumor arose from the left kidney and invaded and surrounded a number of adjacent structures. The pancreas , splenic vessels, and spleen were draped across and around the upper portion of t he tumor, creating a tight waist and pinching it off. The upper porti on was cystic, hemorrhagic, and completely necrot ic. The chi l d expi red duri ng surgery.

GROSS PATHOLOGY:

The kidney weighed 905 grams and measured 17 x 12 x 5.5 em. Necrotic, hemorrhagic tumor, measuring 15 x 11 x 6 em. compressed residual kidney and a small amount of vi abl e tumor had a lobul ated brown appearance .

CONTRIBUTOR: Joelle lambert, M. D. JANUARY 1991 - CASE NO. 4 Milton Bassis, M. D. San Francisco , California

TISSUE FROM: Kidney ACCESSION NO. 25805

CLINICAL ABSTRACT:

History: This 80-year-old Caucasian male was admitted with complaints of night sweats, fever , dizziness and a 20-30 lb. weight loss for over five months. He also complained of periods of shortness of breath and epigastric pain after eating.

Physical examination: A mass 6 em. below the left midclavicular line was palpated. The li ver was tender and had a span of 6 em.

Laboratory report showed anemia and an elevated sedimentation rate. Potassium 4.1; creatinine 1.3; hematocrit 36.2. Urinalysis negative.

Radiographs: Chest xrays and bone scans were negative . CT of the abdomen showed a tumor of the anterior-inferior pole of the left kidney with extension to the anterolateral abdominal wall and compression of the descending colon .

SURGERY: (July 23, 1986)

A left radical nephrectomy was performed at which time tumor was noted to invade Gerota's fascia.

GROSS PATHOLOGY:

The specimen weighed 1570 grams and measured 20 x 12 x 9 em. After stripping the capsule, a 14 x 10 x 8 em. firm, well-circumscribed, multinodular tumor was noted which on sectioning had a flesh-like appearance with areas of necrosis. One mucoid area in the tumor was seen.

CONTRIBUTOR : Patrick Fitzgibbons, M. D. JANUARY 1991 - CASE NO . 5 Los Angeles, California

TISSUE FROM : Kidney ACCESSION NO . 25853·

CLINICAL ABSTRACT :

History: This 48-year-old mal e was admitted to the hospital with left l ower quadrant and left l ower back pain, 3 months' duration. Symptoms did not subs.ide with anti biO>tics. Twenty years ago· he had a similar episode of left flank pain for which he saw a doctor in Mexico.

On physical examination, there was fu l lness in the left upper quadrant, some left upper quadrant discomfort and left costovertebral angle tenderness .

Radiograph: KUB showed a complex staghorn cal culus over left renal fossa . IVP showed decreased function of the left kidney. CT scan of abdomen demonstrated a soft tissue tumor of left kidney extending to spl een and pancreas.

SURGERY : (September ·24, 1986)

A left nephrectomy with en bloc excision of tail of pancreas, spleen and portion of left adrenal gland was performed. Findings: There was a very large renal mass which was adnerent and indivisible from the spleen . When the specimen was bivalved, there were 400 to 500 cc . of purulence which extended into the spleen and almost completely replaced the spleen with a large abscess. In order to complete resection, a distal pancreatectomy was performed as well.

GROSS PATHOLOGY :

The en bloc specimen measured 25 x 15 x 10 em. Sections of the kidney showed a golden tan, irregularly-shaped staghorn calculus in the renal pelvis. The kidney measured 15 x 10 x 8 em. and sections revealed the parenchyma to be replaced by cysts up to 2.5 em. in diameter. The wal l s of some of the cysts appeared necrotic . A large "abscess" cavity was noted at the superior pole and extended around the tail of the pancreas and into a portion of the spleen.

CONTRIBUTOR: Douglas Kahn, M. D. JANUARY 1991 - CASE NO. 6 Sylmar, Cal ifornia

TISSUE FROM: Kidney ACCESSION NO. 26725

CLINICAL ABSTRACT:

History: This 66-year-old white female was found to have a mass in her right kidney during evaluation for proteinuria and hypertension. She was asymptomatic but did complain of dull right flank pain and more recently low back pain.

Physical examination: No abdominal masses or tenderness were noted.

Laboratory reports: Chemistry profile including creatinine were normal. Hemoglobin was 12.2. Cortisol level was 29.2 .

Radi ograph: CT scans, MRI and untrasound confirmed the presence of a right upper pole renal tumor.

SURGERY: (February 13, 1990) ·

A right radical nephrectomy was performed. Findings: A 4-5 em. firm mass was present in the upper pole of the right kidney. There was a evidence of extension to adjacent organs. The tumor may have extended through the capsule into Gerota's fascia, therefore , a small segment of peritoneum was left attached to the anterior pole of the upper kidney.

GROSS PATHOLOGY:

The kidney, after removal of adjacent fibroadipose tissue, measured 14 x 8 x 5 em. and weighed 290 grams . In the superior pole, there was a well-circumscribed, thinly encapsulated , gelat inous, amber neoplasm measuring 5 em. in maximum diameter . Focal gray-tan areas of soft tissue were noted in the tumor. The tumor appeared to be at the junction of the capsule and renal parenchyma and did not appear to invade the renal parenchyma .

CoNTRIBUTOR: Peter L. Morris, M. 0. JANUARY 1991 - CASE NOS. 7 & 8 Santa Barbara, California

TISSUE FROM: Kidney ACCESSION NO. 25829

CLINICAL ABSTRACT:

History: This 72-year-old man three years prior to admission was found to have "scar" on his kidney. Recently abdominal pain was noted. Open prostatectomy was done in Guyana about 8 years ago.

Physical examination: A large right upper quadrant abdominal mass was palpated.

Radiograph: CT scan showed a large mass contiguous with both the liver and kidney. Angiography .showed a single metastatic lesion of the right lobe of the liver and a large lesion off of the right kidney off of the renal artery.

SURGERY: (May 9, 1986)

A right radical nephrectomy, right hemicolectomy and liver biopsy were performed. Findings: There was a large tumor in the right upper quadrant. The ascending colon was stuck to the tumor tightly. In addition, the tumor seemed to be stuck to the body wall posteriorly and also densely adherent to the liver.

GROSS PATHOLOGY:

The kidney, attached mass and soft tissues weighed 1960 grams. The cecum, ascending colon and terminal ileum were also attached. A 15 x 17.5 x 4 em. mass replaced tne anteroinferior ·aspect of the kidney. The sectioned surfaces were partially necrotic and cystic with variegated color from ·yellow-tan to dark tan to pink. Adjacent soft tissues were infiltrated focally by tumor.

CONTRIBUTOR: Wilmier Talbert, M. D. JANUARY 1991 - CASE NO. 9 Long Beach, California

TI SSUE FROM: Kidney ACCESSION NO. 26714

CLINICAL ABSTRACT:

History: This 59-year old man was admitted to the hospital because of increasing shortness of breath, severe paroxymal dyspnea and orthopnea. He was found to be in respiratory and cardiac fa ilure. He was febrile but failed to respond to antibiotics . He developed severe di arrhea with abdominal distension , as well as renal fa ilure. He expired on the 11th hospital day .

GROSS PATHOLOGY:

The kidneys weighed 190 and 180 gms. and appeared unremarkable.

CONTRIBUTOR: John Glassco, M. D. JANUARY 1991 - CASE NO. 10 Van Nuys, California

TISSUE FROM: Kidney ACCESSION NO. 26106

CLINICAL ABSTRACT:

History: This 80-year-old female presented with history of gross painless hematuria of 30 days' duration. Nine years ago she underwent definitive radiation therapy for invasive tumor of the urinary bladder. An ileal condu it uri nary diversion was eventually performed and the bladder was finally excised because of intractabl e radiation cystitis. Although a filling defect was noted in the right upper pole infundibulum on IVP 2 years ago, she refused further studies or treatment.

Physical examination was unremarkable except for a functioning ileal conduit in the r ight lower quadrant of the abdomen.

Radiograph: IVP showed irregularity of the right renal infundibulum leading to the upper calyceal system. A retrograde pyelogram confirmed the l esion of the infundibulum. CT scan showed a 1.5 em. lesion affecting the right renal col lecti ng system.

SURGERY: (September g, 1987)

A right nephroureterectomy was done after frozen section evaluation of the renal tumor.

GROSS PATHOLOGY:

The kidney measured 10.5 x 6.5 x 4.5 em. and weighed 130 gm. A focally hemorrhagic bosselated red-tan tumor bulged from the lateral aspect of the kidney. A 2 x 1 em. friable, granular red-tan tumor ari si ng in the superi or calyx and growing laterally into the renal parenchyma presenting as a tumor was noted prior to sectioning .

CONTRIBUTOR: Albert Garib, M. 0. JANUARY 1991 - CASE NO. 11 Huntington Beach, California

TJSSUE FROM: Kidney ACCESSION NO. 26479

CLINICAL ABSTRACT:

History: This 39-year-old female was admitted for evaluation of intermittent hematuria of two years' duration.

Physical examination: The only posit·ive finding was left costo­vertebral angle tenderness.

Radiograph: IVP and CT scan revealed what appeared to be a cystic mass of the left kidney. Left renal arteriogram was highly suggestive of a malignancy or a xanthogranulomatous pyelonephritis.

SURGERY: (October 10, 1986)

Resection of lower pole of left kidney was performed.

GROSS PATHOLOGY:

The specimen consisted of lower pole of the left kidney, which weighed 80 grams and measured 8 x 5 x 5 em. Sections showed a 4.5 em. yellow-gray fleshy mas.s. The tumor extended to the margin of excision. The residual kidney measured 8 x 6.5 x 5 em. and weighed 106 grams.

CONTRIBUTOR: E. DuBose Dent, M. D. JANUARY 1991 - CASE NO. 12 Glendale, Cali fornia

TISSUE FROM: Kidney ACCESSION NO. 26914

CLINICAL ABSTRACT:

History: This 89-year-old white male presented with chief complaint of hematuria secondary to urinary tract infection, treated with sulfa medications with good resolution. Physical examination at that t ime revealed a large prostate and a urological workup advised.

Radiograph: Intravenous pyelogram revealed a nonfunctioning left kidney and a large right kidney. Renal ultrasound showed a definite kidney on the left side with som~ lobulation of its contours .

He underwent cystoscop.x and prostatic biopsy. Retrograde pyelogram revealed a markedly abnormal l eft kidney. It was small, with irregular renal pelvis and filling defects of the calices. Prostatic biopsy was significant only for benign prostatic hyperplasia. Cytology washings of the renal pelvi s were negative for malignant cells.

SURGERY: (December 4, 1990)

There was an extremely hard mass invol ving the whol e kidney and appeared to be infiltrating the fat and extending from the hilum onto the peritoneum. Following frozen section of the hard tissue extending out of the hilum, the decision was thus made to do a radical nephrectomy. At the renal pedicle site there was hard involvement by tumor. As much as this was excised as appeared to be safely possible, but there was still remaining hard tissue at this level.

GROSS PATHOLOGY:

The kidney measured 8 x 5.5 x 5 em. The kidney was virtually replaced by a pale yellowish-white to grayish-white mass that extended into adjacent perirenal fat. In the renal pelvis, an irregular slightly nodular projection was seen.

THE JANUARY 1991 CONFERENCE CONTAINS ONLY 11 CASES. WE RAN OUT OF THE LESl ON ON CASE 10. THEREFORE YOU WILL BE RECEIVING 13 SLIDES IN THE FEBRUARY 1991 SET.

STUDY GROUP CASES FOR

JANUARY 1991

CASE NO. 1 - ACCESSION NO . 26899

LOS ANGELES: Clear ce.ll renal carcinoma, vascular- 4; clear cell c?rcinoma and hemangioma - 2; abstained - 1

LONG BEACH: Renal cell carcinoma- 10

t1ARTINEZ: Renal ce'll carcinoma - 3; multilocular cyst - 1; angiomyo-1 i poma - 4.

SAN BERNARD I NO cystic nephroma

OAKLAND: Renal cel l carcinoma- 12

SAN DIEGO: Renal cell carcinoma - 9

SACRAMENTO: Medullary interstitial tumor - 9

GRASS VALLEY: Renal cell carc inoma - 1

SANTA BARBARA: Myxoid l iposarcoma - 1

HAWAII: Renal cell carcinoma - 1

NORTH DAKOTA: Hemangioma - 1

DIAGNOSIS: -

Renal cell carcinoma , kidney

REFERENCES:

5; multil ocul ar - 3

ANDERSON JB, LEE JJ, HANCOCK RZ, and BLACK SR: Hemangioma of the Kidney Pelvis. J Urol 7b:869, 1953.

PASCO M, SAFADI D, and ORRIN JV: Unilateral Polycystic or Mul ticystic Kidney Associated with Focal ·Mural Renal Cell Carcinoma. J Urol 109:559, I973.

ElSENKRAFT S, ENGLANDER L, WOLF RM et al: Multilocular Cyst of the Kidney: A Case Report. J Surg Oncol 27:45-47, 1984. [good reference­metastases are rare - some have sarcomatoid stroma which have metastasized]

CASE NO. 2 - ACCESSION NO. 26284

LOS ANGELES: Wilms ' tumor - 7

LONG BEACH: Wilms' tumor- 10

MARTINEZ: ~li lms ' - 7

SAN BERNARDINO (INLAND) : Wilms ' tumor - 8

OAKLAND: Wilms' tumor- 12

SAN DIEGO: Wilms' tumor - 13

SACRAMENTO: Wi lms' tumor- 9

GRASS VALLEY: Nephroblastoma - ·1

SANTA BARBARA: Wilms' tumor - 1

HAWAII: Wilms' nephroblastoma- 1

NORTH DAKOTA: Wilms' tumor - 1

FOLLOW-UP :

'

She was last seen December 30 , 1989 at which time there was no evidence of recurrent tumor.

DIAGNOSI S:

Wilms' tumor, kidney

REFEREN CES :

DROZD, ROUSSEAU-MERCK MR, JAUBERT Fetal : Cel l Differentiation in Wil ms' Tumor (nephroblastoma) : An Jmmuno~istochemi ca l Study. Human Pathol 21 :536-544, 1990.

WEEKS DA, BECKWITH JB, and MIERAU GW: Benign Nodal Lesions Mimicking Metas tases from Pediatri c Renal Neopl asms: A Report of the Nati onal Wilms' Tumor Study Pathol ogy Center. Human Pathol 21:1 239-1244, 1990 .

SARIOLA H et al: Extracellular Matrix and Epithelial Differentiation of Wilms' Tumor. Am J Pathol 118:96-107 , 1985 .

CLOUSE JW, PATRICK RM, THOMAS NB et al : The Changing Management of Wilms ' Tumor over a 30-year Period. Cancer 56 :1484-1489 , 1985 .

MESROLIAN HGJ et al: Wilms' Tumor Past, Present and Future (Review Articl e) . J Urol 140:231-238, 1988.

ALLSBROOK WC et al: Recurrent Renal Cell Carcinoma Arising in Wilms' Tumor. Cancer 67(3):69D-695, Feb 1, 1991 .

CASE NO. 3 - ACCESSION NO. 26290

LOS ANGELES: Neuroblastoma- 8; small cell tumor of chil dhood - 1

LONG BEACH: Neuroblastoma/PNET - 10

MARTINEZ: Neuroblastoma - 8

SAN BERNARDINO INLAND : ~lilms' t umor- 5; small round cell tumor of infancy/childhood ? neuroblastoma) - 3

OAKLAND: Neuroblastoma - 12

SAN DIEGO: Neurobl astoma - 14

SACRANENTO: Neurob 1 as toma - 9

GRASS VALLEY: Neuroblastoma - 1

SANTA BARBARA: Neuroblastoma - 1

HAWAII: Neuroblastoma - 1

NORTH DAKOTA: Wilms' tumor- 1

SPECIAL STAIN:

NSE: Negative

FOLLOW-UP:

Additional findings at autopsy included metastases in the right lung and opposite kidney.

DIAGNOSIS:

Nephroblastoma, kidney

REFERENCES:

DROZ D, ROUSSEAU-MERCK ~1R, JAUBERT F et al: Cell Differentiation in Wilms' Tumor (nephroblastoma): An Immunohistochemical Study. Human Pathol 21:536-544, 1990.

WEEKS DA, BECKWITH JB, and MrERAU GW: l~etastases from Pediatric Renal Neoplasms: Tumor Study Pathology C1mter. Human Pathol

Benign Nodal Lesions Mimicking A Report of the National Wilms • 21:1239-!~44. 1990.

SARIOLA H et al: Extracellular Matrix and Epithelial Differentiation of ~lilms' Tumor . Am J Pathol 118:96-107., 1985.

CLOUSE JW, PATRICK RM, THOMAS ~18 et a·l: The Changing Management of Wilms' Tumor over a 30-year Period . Cancer 56:1484-1489, 1985.

MESROLIAN HGJ et a 1: Wilms; Tumor Past, Present and Future (Review Article). J Urol 140:231-238, 1988.

CASE NO. 4 - ACCESSION NO. 25805

LOS ANGELES: Mal ignant f ibrous histiocytoma - 8; fibroxanthosarcoma - 1

LONG BEACH : Halignant fibrous histiocytoma - 7; sarcomatoid renal cell carcinoma - 3

MARTINEZ: Malignant fibrous histiocytoma - 4; sarcomatoid renal cel l - 4

SAN BERNARDINO (INLAND): Malignan t fibrous histiocytoma - 7; sarcomatoid renal cell carcinoma - 1

OAKLAND: Malignant fibrous histiocytoma - 12 •

SAN DIEGO: Mali gnant fibrous histiocytoma - 5; sarcomatoid renal cell carci noma - 6

SACRAMENTO : Sarcomatoid renal carcinoma - 9

GRASS VALLEY: Sarcomatoid renal cell carcinoma - 1

SANTA BARBARA: Leiomyosarcoma - 1

HAWAII: Malignant fibrous histiocytoma; R/0 sarcomatoi d renal cell carcinoma variant - 1

NORTH DAKOTA: Malignant fibrous histiocytoma - 1

CONSULTATION : Hector Battifora, MD, City· of Hope National Medi cal Center: Pleomorphic malignant fibrous histiocytoma. This interpretation is supported by the intermedi ate filament immunophenotype which revealed abundance of vimentin and absence of keratin within the neoplastic cells. A pleomorphic rhabdomyosarcoma is ruled out by immunostain for muscle speci fic actin, which showed this filament only within vascular structures .

FOLLOW-UP:

This patient was last seen alive and well on 11arc tr 16, 1990. There was no evidence of metastatic carcinoma.

DIAGNOSIS:

Malignant fibrous histiocytoma, kidney XF: Sarcomatoid renal cell carcinoma

REFERENCES :

CHATELANAT F: Sarcomat ous Tumors of the Kidney. Chapter 9 in Progress in Surgical Pathology III. Ed Fenoglio and Wolf, Masson Publishing USA, 1981 .

CHEN KTK: Fibroxanthosarcoma of Kidney. Urology 13:439-440, 1979.

ibid: Mal ignant Fibrous Histiocytoma of the Kidney. J Surg Oncol 27 : 248-250, 1984.

MacEACHERN NM, ANDERSON RR, and WRIGHT WL: Fibroxanthosarcoma of the Kidney. Report of a Case, J Urol 126:684-685, 1981 .

CASE NO . 5 - ACCESSION NO. 25853

LOS ANGELES: Keratinizing, well -differentiated squamous cell carcinoma - 9

LONG BEACH: Keratinizing squamous cell carcinoma - 10

~1ARTINEZ: Squamous cell carcinoma - 8

SAN BERNARDINO ( INLAND): Squamous cell carci noma of renal pelvis- 8

OAKLAND: Well-differentiated squamous cell carcinoma secondary to schistosomiasis - 11; chronic pyelonephritis with squamous metaplasia - 1

SAN DIEGO: Squamous cell carcinoma - 14

SACRAMENTO: Squamous carcinoma of renal pelvis - 9

GRASS VALLEY : Squamous cell carci noma - 1

SANTA BARBARA: Squamous carcinoma - 1

HAWAII: Squamous metaplasia of pelvis with well-differentiated keratinizing squamous cell carci noma - 1

NORTH DAKOTA: Squamous cell carcinoma - 1

FOLLOW-UP :

In September 1987 he was admitted for ~va l uation of progression of disease and pain control titration. CT scan of lumbar and sacral pl exes revealed a cystic lesion of the vertebra at L2. CT scan of abdomen reveal ed left psoas muscl e invasion by a mass consistent with recurrent cancer. He received a total of 4400 rads with relief of pain. He moved to Mexico and los~ to follow-up .

DIAGNOSIS:

Squamous cell carcinoma, kidney

REFERENCES:

GRABSTALD H, BELL JR, and MELAMED M: Renal Pelvic Tumors. JANA 218: 845, 1971.

CHASKO 58 et al: Urothelial Neoplasia of the Upper Urinary Tract . Path Ann 1981, Part 2:127-153.

CASE NO . 6 - ACCESSION NO. 26725

LOS ANGELES: Benign renal capsular tumor, NOS - 9; fibroma with neuroid features - 1

LONG BEACH: Benign nerve sheath tumor - 8; neurothequeoma - 2

MARTIN EZ: Neurofibroma - 7; neurilemoma - 1

SAN BERNARDINO (INLAND): Neurofibroma - 7; neurilemoma- 1

OAKLAND: Neuril emmoma - 9; neurofibroma - 3

SAN DIEGO: Benign peripheral nerve sheath tumor - 9; benign spindle ce 11 tumor - l

SACRAMENTO: Benign peripheral nerve sheath tumor - 9

GRASS VALLE Y: Neurilemmoma - 1

SANTA BARBARA: Schwannoma - 1

HAWAII: Gangl ioneuroma- 1

NORTH DAKOTA : Leiomyoma - 1

CONSULTATIONS : Richard L Kempson, MD, Stanford Uni versi ty Hospital: "Ultrastructural studies show thin, polar cytoplasmic processes which extend l ong distances, frequent junctional comp lexes between cell -processes, numerous surface vesicles , and fragmented and variable basement membranes. Ultra­structural find ings are in keeping with benign peripheral neural sheath tumor, specifical ly perineurinoma. Thus , in our opi nion, despite negative EMA s taining, the histologic, immunol ogic , and ul trastructural studies are in keeping with a perineurinoma." EMA, S-100, PAS, and cytokeratin negative.

AFIP: Probable low grade mYXOid sarcoma.

FOLLOW-UP:

She was subsequently fol lowed in cl i nic for microcalcification noted on mammogram. She refused surgery and wi shed to be followed with successive mammograms. Last seen on August 11, !990 following a fal l from a stool. Lumbosacral spine seri es repor ted as diffuse severe osteapenia.

DIAGNOSIS:

Perineurinoma (by light microscopy neurofibroma), kidney

REFERENCES:

LAZAROUS Setal: Ultrastructural Identification of a Benign Perineural Cel l Tumor . Cancer 41, #1:823 , 1978.

ARIZA A et al: Immunohistochemical Detection of the Epithelial Membrane Antigen in Normal Perineural Cel ls and Perineurinoma. Am J Surg Path 12:678, 1988.

CASE NO. 7 - ACCESSION NO. 25829

LOS A~GELES: C1ear ce11· carc1noma ~rena1) - 9

LONG BEACH: Renal cell carcinoma - 10

MARTINEZ: Sarcomatoid renal cel l carcinoma - 8

SAN BERNARDINO (INLAND ): Renal cel l carcinoma - 8

OAKLAND: Renal cel l carcinoma with clear cell and sarcomatoid components - 12

SAN DIEGO: Renal cell carcinoma - 14

SACRAMENTO: Renal carcinoma - 9

GRASS VALLEY: Renal cell carcinoma - 1

SANTA BARBARA: Hemangioperi cytoma; sarcomatous renal cell carcinoma - 1

HAWAII: Renal cell carcinoma with sarcomatoid variant ; two separate tumors (collision tumor) (a) clear cell carcinoma of kidney (b) angiosarcoma of liver ? metastatic to kidney ? - 1

NORTH DAKOTA : Renal cell carcinoma - 1

CONSULTATION: AFIP: Renal cell carcinoma, clear cell type, with extensive spindl and pleomorphism, infi l trating perinephric fat and serosal aspect of colon.

FOLLOW-UP:

Five months after surgery, he developed recurrent intra-abdomina 1 neoplasm with gastrointestinal bleeding because of colon involvement . He received radiation treatment for metastatic bone lesions . He expired several months later without benefit of an autopsy .

DIAGNOSIS:

Clear cel l sarcomatoid renal cell carcinoma, ki dney

REFERENCES:

MEDEIROS LJ, MICH SA, JOHNSON DE et al: An Immunoperoxidase Study of Renal Cell Carcinomas : Correlation with Nuclear Grade, CeTT Type, and Histologic Pattern. Human Pathol 19:980-987, 1988.

HOLTHOFER H, MIETTREN A, PASSIVUO Ret al: Cellular Origirr and Oifferen­tati on of Renal Carcinomas . A Flouresence Mi croscopic Study ~lith Kidney­Specific Antibodies, Anti-intermediate Fil ament Antibodies, and Lecti ns. Lab Invest 49:317-326, 1983.

ULRICH W, HOWAT R, and KRISCH K: and its Pathomorphological Relevence .

Lectin Histochemistry of Kidney Tumors Histopathology 9:1037-1050, 1985.

REJS M and FARIA V: Renal Cell Carcinoma: Reevaluation of Prognostic Factors . Cancer 61:1192-1199. 1988.

CASE NO. 8 - ACCESSION NO . 25829

LOS ANGELES : Clear cell · carcinoma, sarcomatoid- 9

LONG BEACH: Renal cel l carcinoma with sarcomatoid and pericytomatous pattern - 10

MARTINEZ: Sarcomatoid renal cel l carcinoma - 8

SAN BERNARDINO (INLAND) : Angiosarcoma - 8

OAKLAND : Renal cell carcinoma with clear cell and sarcomatoid components - 12

SAN DIEGO: Sarcomatoid renal cel l carc inoma- 14

SACRANENTO: Sarcomatoid variant of renal carcinoma - 9

GRASS VALLEY: Sarcomatoid renal cell carcinoma - 1

SANTA BARBARA: Hemangiopericytoma; sarcomatous renal cel l carci noma - 1

HAWAII : Renal cell carcinoma with sarcomatoid variant; two separate tumors (collis ion tumor) (a) clear cell carcinoma of kidney (~) angiosarcoma of liver ? metastatic to kidney ? - 1

NORTH DAKOTA: Renal cel l carcinoma - 1

CONSULTATION: AFIP: Renal cell carcinoma, clear cell type, with extensive spindl irn and pl eomorphism, infiltrating perinephric fa t and serosal aspect of colon.

FOLLO~I-UP :

Five months after surgery, he developed recurrent intra-abdomina 1 neoplasm with gastrointestinal bl eeding because of colon i nvolvement. He received radiati on treatment fo r metastatic bone lesions. He expired several months later wi t hout benefi t of an autopsy.

DIAGNOSIS :

Clear cell sarcomatoid renal cell carcinoma, kidney

REFERENCES:

MEDEIROS LJ, MICH SA, JOHNSON DE et al: An Immunoperoxidase Study of Renal Cel l Carcinomas: Correlati on with Nuclear Grade, Cell Type, and Histologic Pattern. Human Pathol 1g:980-987, 1988.

HOLTHOFER H, MIETTREN A, PASSIVUO Ret al: Cellular Origin and Differen­tation of Renal Carcinomas. A Flouresence Microscopic Study with Kidney­Specific Antibodies, Anti - intermediate Filament Antibodies, and Lectins . Lab Invest 49:317-326, 1983 .

ULRICH W, HOWAT R, and KRISCH K: and its Pathomorphological Relevence.

Lec tin Histochemistry of Kidney Tumors Histopathology 9:1037-1050, 1985.

REIS M and FARIA V: Renal Cell Carcinoma: Reevaluation of Prognostic Factors. Cancer 61:1192-1199. 1988.

CASE NO. 9 - ACCESSION NO. 26714

LOS ANGELES: Intravascular lymphoma (B cel l type) - 9

LONG BEACH: Malignant angioendotheliomatosis (intravascul ar lymphoma) - 10

I~ARTINEZ: Acute leukemia - 8

SAN BERNARDINO (INLAND): Acute leukemia - 8

OAKLAND: Acute l eukemia - 11; angiotropic lymphoma - 1

SAN DIEGO: Leukemic infiltration - 14

SACRAMENTO : Acute myelogenous leukemia - 9

GRASS VALLEY: Extramedul lary hematopoiesis - 1

SANTA BARBARA: Angiomyolipoma - 1

HAWAII : Acute myelocytic leukemia (leukoerythroblastic anemia) - 1

NORTH DAKOTA : Immunoblastic sarcoma - 1

SPECIAL STAINS:

UCHL-1 and L-25 were positive for B-ceTT

DIAGNOSIS:

Malignant a:ngioendotheliomatosis (intravascular lymphoma), kidney

We neglected to include in the history that CBC done prior to death was within norma 1 1 imits.

REFERENCES:

OTRAKJI CL, VOIGT W, AMADOR A, NADJI M, and GREGORIOS JB: Malignant Angioendotheliomatos is -A True Lymphoma: A Case of Intravascular Malignant Lymphomatosis Studied by Sout.hern Blot Hybridization Analysis. Human Pathol 19:475-478, 1988.

KEAHEY TM , GUERRY DP, TUTHILL RJ et al: Malignant Angioendotheli.omatosis Proliferans Treated with Doxorubicin. Arch Dermatol 118:512-514, 1982.

D'ANGATI V, SABLOY LB, KROWLES OM, and WALTER L: Angiotropic Large· Cell Lymphoma (Intravascular Malignant Lymphomatosis) of the Kidney: Presentation as Minimal Change Disease. Human Pathol 20:263-268, 1989.

~liCK MR, MILLS SE, SCHEITHAUER BW et al : Reassesment of Malignant Angioendotheliomatosis - Evidence in Favor of its ReclassifiCat ion as Intra­vascular Lymphomatosis. Am J Surg Pathol 10:1120-1123, 1986.

CASE NO . 11 - ACCESS ION NO. 26479

LOS ANGELES: Lei omyosarcoma - 9

LONG BEAC H: Sarcomatoid renal cell carcinoma - 10

MARTINEZ: Sarcomatoi d reha 1 ce 11 - 7; leiomyosarcoma. - 1

SAN BERNARDINO (INLAND): Angiomyol i poma - 8

OAKLAND: Sarcomatoid variant of renal cell carcinoma - 12

SAN DIEGO: Xanthogranul omatous pyel onephriti s - 3; rhabdomyosarcoma - 1; sarcoma NOS - 4; sarcomatoid renal cell carcinoma - 3

SACRAMENTO: Sa·rcomatoid renal carcinoma - 9

GRASS VALLEY: Sarcomatoid renal cell carcinoma - 1

SANTA BARBARA: Leiomyosarcoma - 1

HAWAII: Rhabdomyosarcomat oid renal cel l carcinoma - 1

NORTH DAKOTA: Sarcomatoid renal cell carcinoma - 1

SPECIAL STAINS:

EMA and desmin negative; vimentin and actin positive

FOLLOW-UP:

One and a hal f years later. a metastatic nodule was excised from the left abdominal wal l .

DIAGNOSIS:

Leiomyosarcoma, kidney • REFERENCE:

LOOtoliS RC : Primary Leiomyosarcoma of the Kidney: Report of a Case and Review of the Literature. JUral 107:557, 1972.

~SE HO. 12 - ACCESSION HO . 26914

lOS ANGELES: Adenosquamous carcinoma - 9

lONG BEACH: Adenocarcinoma of renal pelvi c epi thel ium- 10

MARTINEZ: Adenocarcinoma - 8

SAil BERNARDINO (INLAND) : Mixed adenocarcinoma and transitional cell carcinoma - 5; transi tional cel l carcinoma with glandular differen­tiation - 3 .

MKLAND: Collecting duct carcinoma- 12

SAN DIEGO : High grade transitional cell carc inoma - 3; adenocarcinoma and transitional cell carcinoma 1~ith squamous features - 1; pel vic adenocarcinoma - 8 ·

SACRAMENTO: Transitional cell carcinoma with glandular component - 9

G~SS VALLEY: Mixed transit ional cell carcinoma and adenocarcinoma - 1

SANTA BARBARA: Carcinoma, adenosquamous - 1

HAIIAil: Transitional cell carcinoma 1~ith glandular and squamous cell differentiation {high grade) - 1

NORTH DAKOTA: Adenosquamous ce ll carcinoma - 1

FOllOW-UP :

Radiation therapy was started on January 21, 1991. rt was felt that some of the tumor was left behind at the time of surgery. He is doing well considering hi s age . There is no evidence of spread outside of abdomen and retroperi toneum.

DIAGNOSIS : •

Adenosquamous cel l carcinoma, pelvis of kidney

REFERENCES:

On cursory review of the literatures, there were no adenosquamous references.