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11qENTI ETH ANNUAL TtDIOR SE/.IINAR

SAN ANTONIO SOCI ETY OF PATHOLOGISTS

December 7, 1963

Brooke General Hospital Brooke Atmy Medical Center, fort Sam Houston, Texas

CASE 1:

CASE 2:

CASE 3 :

CASE 4:

CASE 5:

CASE 6:·

CASE 7:

CASE 8:

CASE 9 :

CASE 10:

DIAGNOSES BY PRANK 1~. FOOTE, ,JR, 1 ' ·1, 0 ,

Lobular. carcinoma in situ.

Postmastectomy l ymphangiosarcoma . of a.Jl.<...,

Cellular mixed tl11lor . o~ f "'""h.l -

Adenoid cystic carcinom<J. §: o;-....... ~·"·'•:1{~ 1l"· · 1 -

~~coepidermoid car-ci noma, ot r~oh dL

Papillocystic carcinoma, ~~ f~

Adenocarcinoma--pseudoadamantine, oF .,a.~ CA.N•~

Sebaceous lymphadenoma. rk f...n.oh<L

Basaloid carcinoma.(do~of'-'"'..:..:...} .,p- 4""~ Leiomyos·arcoma . of '> \., "• ~ •!....

CASE 11: Synovial sarcoma , of 1" I";......Q. ~'~ t;.\<.d.' -"" .. e_...

CASE 12: Stromal sarcoma.

CASE 13:

CASE 14 ~

CASE 15 : .

CASE 16:

So-called seminomatous tumor of medi astinum,

•'- ~ 'UR.I_. Oncocy)Ofila, c:AtUtl.nul!

Alveolar sof t part sarcoma. J

Granular ceH t t.Pllor-- ? tissue of oTi~in-. ~· ~ ~ r~""-'1 ~

N ANTONIO SOCIETY OF PATHOLOGISTS SAN ANTONIO, TEXAS

TWENTIETH ANNUAL TUMOR SEMINAR

December 7, I 963

BROOKE GENERAL HOSPITAL Brooke Army medical Center

fort Sam Houston, Texas

CONDUCTED BY

FRANK W. FOOTE , JR.,

Chairman, Department of Pathology

Memorial Hospital for Cancer and Allied Diseases

New York City

M. V.

This Tumor Seminar is supported in part by

THE ~IERICAN CANCER SOCIETY , TEXAS DIVISION and

TilE SOUTH CENTRAL REGIONAL C<l-11-UTTEE OF TtiE COLLEGE OF AMERICAN PATHOLOGISTS

•

The meeting will be held in the Auditorium , Building 1026 (behind the ~lain Hospital) , at Brooke General Hospital on December 7, 1963, beginning at 9:00 a.m •

•• ••

The San Antonio Soc..i.ety o6 Pa.tho!og.<Au .i.nv.Uu a.U con6eJteU and .the..iA wivu

no~ coc~~ and bu66e.t a.t .the Fo~ Sam Hou.o.ton 06Mcvu. Open MU6

6oliowing .the. SembtM

;::

Please fill in your diagnoses on the form provided on the last page, detach, and mail to the Chief of Pathology Service, Brooke General Hospital , Fort Sam Houston, Texas, at your earliest convenience prior to the meeting, ~o that diagnoses may be summarized for presentation at the Seminar.

<;ontrlhutctl by l)r . l'llOt('

A 44- year-old white woman, otherwis e asymptomatic , had scant bleeding from the right nipple on several occasions for three weeks , There were bilateral small nodular thickened areas but no discrete masses. Both axi llae were clear. 'The duct system and surrounding tissue of the ris:ht breast were locally excised. The specimen was 6 hy 4 by 1.5 em., discoid, and oink to yellow-white, No ~ro:;s cysts , papillomas, or dilated ducts ~<ere noted on section ,

~ly dia!(nosis:

Dr. Foote's dia~nosis:

Co•11r.1cn t:

·-·--··--- ·----· -- ----·--.. ·-----~

CASE 2

Contributed by Drs , A. ~~. Richmond, C. J . Farinacci, and II. E. Ford, Nix Clinical Laboratory, San Mtoni o , Texas

A i7-year-olcl •~oman had been asymptomatic for sevcn ~'Cnrs after rndical mnstcc t omy for adenocarcinoma, r. rnt1c 11 , of; tho rip.ht breas t «ith no metastases in lymph node~ . Then massive raised reddish areas appeared scattered ovo1· the entire right arm, a nd five months l a t er a mass 1;n~ rn­oove<.l from the anterior c hest wall. On cut section t he snecimen contained a well-circumscribed, hemorrhar.ic, somewhat translucent firm area I .5 em. in d~nl!leter sur­rounded by f'at and continuous with t he ovorlyin~ si:.i n.

lly diagnosis: --------------------

Dr . Foote ' s diagnosis: --~-------· ------ ... _ .. ·-

co.~ment: ---------------------

CASF. 3

Contributed by Drs. N. H .. Jacob, G. C. ~lani, and J. 1\ . Lowry, Santa Rosa Hospita l , San Antonio, Texas

A 57-year-old male had a nodule in the left parotid ar ea with no arpreciable increase in size for fifteen or sixteen years followed by rapid increase for a year and a half . There was no facia l nain or evidence of facia l ne rve paralysis. The mass removed fro-n the lower pole of the lef t parotid !(land measured 7 by 5 hy 3. 5 em., weighed 53 grams , and 1~as very firm and s lightly l obul ated with a light ·gray to yellow- tan pattern . The c hes t x- ray and all other l aborator y data were within normal range .

My diagnosis:

Dr. Foote's diagnosis :

Comment:

CASE 4

Contributed by Or . . 1. r.ordon Webster , Chief, Ocrartment of Pa t holor:y, l'ii l ford Ha ll li,S, Air Force llosni ta l

A 32-vear-old whi t e woman with a lar~e , firm, sl i l(htly tender right suhmaxi ll<~ry <:land h;lll h<1d p:~in :~nd swel ling for one year. A sialo~ram revealed "a erst in the right submaxillary !!land." The excised gland measured 3. 8 by 3. 2 by 2 em. and was lobulated, soft, and red-brown. Section revealed a homogeneous , . so£t, , light tan , more-or- · les s circu-nscribcd, discrete 2-cm. nodule containin~ areas of degeneration and hemorr hage filled with white , liqui d opaque material.

My diagnosis:

Or . Foote's diagnosis:

• Comment:

CASE S

Contributed by Drs. A. 0. Severance, H. A. Van Auken, and ~1. W. Delmer, Bap tist Memorial llospital, San Antonio, Tex

A 7-year-old girl had somewhat painful swe lling and some dischar~e from an a rea in the region of the left pa­rotid gland wh i ch had been biopsied six months previously. She had no difficulty in swallmdng or in moving her neck, but there was slight weakness of the left facia l muscles. A lobulated, pink tumor measuring 4 by 3.5 by 2. 5 em. wun some admixed fibrofatty tissue and bulging into the sur­face skin was removed .

~ly diagnosis :

Dr. roote ' s d iagnosis :

Coounent:

CASE 6

Cont ri.h\lted by Dr, Foote

A 70- year- old edentulous man had a lump i n the roof of his mouth for three months. lt had been t ender for one month , A smooth, nodular, nonulcerated, 3.5-by-3-cm. le­sion arising i n the l eft hard palate ami extending into the soft palate was very close to the mucous membrane at one point. Ex3JIIination of the neck was negative. The specimen was a portion of maxilla with attached soft tis­sue measuring 4 by 4 by 2 em., with a centra 1 ulcerated lesion l<hich on section was gray-white and soft . The tumor nowhere i nvolved bone.

"ly diagnosis:

Ur . Foote's diagnosis :

Cnmment :

CASE 7

Contri buted by Drs . A. 0 , Severance, II. A. Van Auken, and M. N. Delmer, Baptist ~lemorial Hospital , San Antonio , Tex

A 47-year-old white woman had a nass in the left cheek for about a year which had become painful shortl y before examination. A hard, indurated, well - circumscri bed , ten­der and free ly movable mass was fixed to the mucosa but not to the skin. Gross specimen was 3.3 by 2. 5 by 2. 1 em. and appeared to be encapsulated. On cut section there was a gray margi n i n one por tion, the rest of the surface being pinkish gray and gr anular .

~!y diagnosis :

Dr. Foote's diagnosis:

Comment:

CASE 8

Contributed by Dr. Foote

A 57-year-old white woman noted fullness in the right parotid area eleven months before surqery. There was no evidence of facial nerve dysfunction. The mass 1~as ra­ther soft, fairly discrete , nontender, and about 4 em. in diameter. In the deep port ion of the parotid gland was a yello~<-tan, encapsulated tumor which measured 5 by 2.5 by 1. 75 em. The cut surfaces wer e finely ~ranular with irre­gular areas of yellow and white chalky discoloration . At one pole was an 0. 5-cm . cyst containing yellow necrotic material and fluid.

~!y diagnosis:

or. Foote's dia~nosis:

Comment:

..

CASE 9

Contributed by Drs. A. ~1. Ric~mond, C. J. Farinacci, and H. E. Ford, Nix Clinical Laboratory, San Antonio, Texas

A 55-year-old white woman had no symptoms except for a small amount of rectal bleeding and t enesmus f or four or f i ve weeks . Examination revealed a tumor mass at the ano­rectal junction, measuring 6 by 2 by l.S em. and extending into the rectum. Specimen was encapsulated, coar sely lo­bulated, firm , and pedunculated, on a short, thick stalk .

• My diagnosis:

Dr. Foote's diagnosis : - ----- ------- ----

Comment:

CASE 10

Contributed by Dr. C. J. Farinacci from the San An tonio State llosnital, San Antonio, Texas

A 67-year-old female psychiatric pat ient underwent surgery for a large, nontender and movable abdominal mass discovered about two weeks prior to oooration. I t was within the oment um but attached to the lesser curvature of the stomach by a l'edic le containing i ts blood supply. The t umor was encapsulated and measured 10 em. in diameter. Its cut surface had a coarse spongy appearance due to variously sized cystic areas, many of '~hich appeared to be fil led with bloodv fluid.

~!y diagnosis :

Dr. Foote's diaqnosis: ---------- - --- - --

Comment :

CI\SF. 11

Contributed by llr . . J . Cio rdon licbster, Chi c [, llcpartmcn t of Pathology, Wilford llall US. Air Force llospi t a l

A 12-year-o l d •<hi t e hoy hild a fi rm, nonr educible, non­fluctuant , nontender mass i n t he ri ght inguinul region for questionab ly a few months to one year , At surgery a friable, hemorrhagic, tan t o t annis h-l<hitc tumor seemed to ari se f r rnn the cr emas teric musc l e. The 4-by-3-by-2-cm . tumor had an apparent capsule less than 0 , 1 em, in thick­ness. i n several are:1s . Testi s a nd spermatic cord were normal. Chest films and bone survey 1~e re negative.

·~ diagnosis: --------------------------------------

Or. Foote ' s diagnosis :

Comment:

CASE 12

Contr i buted by Or . l~ehs ter

A 46-ycar-ol d, prcn1enopausal, otheTh•isc healthy woman wi t h profuse vagina l bleeding and pelvic pain ~·a s found to have a f a irly 1~el J -de lineated f ungating mass i n the cul-de-sac perforating t he posterior liall of the vagina. At surgery an orange- s ized mass behind the uterus was en­t i rely retroperitoneal in the cul -de - sac , but as t he peri­toneum was t o rn in stripping t he a dherent ovaries, it was not certain i f the tumor were entirely retroperitoneal. Gross tumor was i n both ovaries, the omentum , and the 1roll of the rectum. It was not i n the endometri um or myome­trium, but was adherent to t he paramet rium.

My diagnosis:

Dr. Foot e's diagnosis,

Comment:

CASE B

Contributed by Dr •• J. Gordon Webster, Chief, Department of Pathology, Wilford Hall U.S Air Force Hospital

A 30-year-old white man hosp1talized for depression, headaches, insomnu, and weight l oss had had parietal p leurectomy two years before for idiopathic recurrent right pneumothorax. Chest film revealed a 4,5-cm. righ t paratracheal mass which had doubled in size 1n two months . The tumor was removed easily. It was a fi:rm, tan-white , g ross!¥ encapsu lated, 28-gram mass with a s mooth , lobu­lated surface and a homogeneous , white, mucoid-appearing cut section . Small cysts , up to 0. 1 em , i n diameter, ~~ere filled with mucinous material.

~ly diagnoSls: -------------- -------

Dr. Foote's dingnos1s , --~=---------------------------

Comment:

CASE 14

Contri buted by Col, !1. B, lloefflcr and Capt . C. N. Conant , Brooke r.ener:~l llos1ntal , Fort S1t r.1 Houston, Texas

A 78-year- old wfute man with pa1nlcss hematuria for one ~<eek had on expanding lesion 1n the left kidney on JVP. The left kidney measured 11 by 6,5 by 5 em, A reddish­tan, lobulated mass filled the pelvis and extended into the renal parenchyma. The center was <J raylSh-white and firm. Portions of the tumor could be 11 fted up from the underlying renal pelvis and extended through the capsule i n other areas . Several small r enal calculi we r e found .

~ly diagnosis:

Dr Foote's diagnosis.

Comment:

CASE 15

Contributed by Or. Foote

A 16-year-old white girl had occasi onal left-hip pain after a fall in May 1960. X- rays were negative in .June, but in December showed two osteolytic l esions of the left ilium above the acetabulum. Chest films were negative. At surgery i n January 1961 a roughly globoid 7-by-5-by-5-cm. tumor with a pseudo capsul e was found close to the ilium, beneath and media l to the gluteus maximus. It in­volve~ the gluteus mi nimus, the region of the anterior iliac spine , and the ilium 5 em. below that region. Cut surfaces were light tan, soft , focally hemorrhagic, and slightly bulging.

~1y diagnosis:

Dr . Foote ' s diagnosis :

Comment:

CASE 16

Contributed by Col ~1. H. Sulak, Fourth u. s. Army ~ledical Laboratory, Fort Sam Houston, Texas

A 39-year-old woman died twenty months after diagnosis of an inaccessible hypothalamic or third ventricular tumor treated wi th deep radiation therapy. At autopsy a soft, brownish, 2. 5-cm., thinly encapsulated, vascular-wa lled tumor occupied the entire area between the two temporal pole.s posterior to the optic chiasma and anterior to the two peduncles, apparently replaci ng the hypothalamus and part of tho thalamus . The pituitary appeared slightly compressed but normal.

My diagnosis :

Dr. Foote ' s diagnosis: ----------------

Comment:

DIAGNOSES;

CASE 1~

CASE 2:

CASE 3:

CASE 4:

CASE 5:

CASE 6;

CASE 7:

CASE 8:

CASE 9:

CASE 10:

CASE 11:

CASE 12:

CASE 13:

CASE 14:

CASE 15:

CASE 16:

TWENTIETH ANNUAL TUMOR SEMINAR

SAN ANTONIO SOCIE1Y OF PA1l!OLOGISTS

BROOKE GENERAL HOSPITAL BROOKE ARMY MEDICAL CENTER Fort Sam Houston, Texas

December 7, 1963

[TIW. page mcuJ be Jte.tahted 6oit you.Jt own Jte6e.~tenc.e.. J

DIAGNOSES:

CASE 1:

CASE 2:

CASE 3:

CASE 4:

CASE 5:

CASE 6:

CASE 7:

CASE 8:

CASE 9:

CASE 10:

CASE 11:

CASE 12:

CASil 13:

CASil 14:

CASE 15:

CASE 16:

n~ENTIETH ANNUAL TU:.IOR SEMINAR

SA.>-1 ANTONIO SOCIETY OF PA'IliOLOGISTS

,

BROOKil GENERAL HOSPITAL BROOKE AllJI1Y ~lED! CAL CENTIJR

For t Sam llouston, Texas

December 7, 1963

[Ptea.H 6-U? .<.n IJOu.A cUa.gtto.l>eA on tJU.o 6o~~m, detach, ) [a.nd ma..<..e to the. Chief of Pathology s.ervice, Brooke) [General Hospital, Fort Sam llouston, Texas , a..t you.A] [e.MUut conven.<.ence p/Uolt.' to the. me.etbtg, 110 tha..t) [d-<:agno~Ju ma.y be 11wrmaM.u.d 6oll. p11.uen.ta..t.<.on a..t the.] [S~. Th.<.IJ 6o11m tteed not be. .1>-igne.d. )