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CALIFORNIA TIJMOR TISSUE REGISTRY

LOMA LINDA UNIVERSITY

PROTOCOL

FOR

MONTHLY STUDY SliDES

OCTOBER 1994

GENERAL PATHOLOGY

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CONTRIBUTOR: Delbert Didoon, M.D. CASE NO. 1· October 1994 Sa.ata Barbara, CA

TISSUE FROM: SkiD, forehead ACCESSION Nl71547

CLINICAL ABSTRACT:

Hil!2!y. This 59-year-old Filipino male presented with a lump in his mid-frontal scalp which he had noticed for tbe past 2 months. He· has a history of rbeumatoid arthritis..lupus·erytbematosus, and stomach ulcers. He also has a history of excessive smoking and drinking, and reports "pinched nerves•, "blackouts", dizziness and weight loss. There is a family history of diabetes.

Physical examination: A 2 em diameter hard lump was present in the forehead, in tbe area of his receded hairHne. It was not ulcerated or fixed t~ tlie underlying bone.

SURGERY: 06194

Skin excision, forehead

GROSS PATHOLOGY:

A 2 em diameter. finn nodule was present in the portion of resected dermis.

TUMOR MARKERS:

CAM-S, HMB-4S, Acid fast stains negative .. S-100 positive.

CONTRIBUTOR: Farooq Ali, M.D. Veotura, CA

CASE~O. l- October 1994

TISSUE FROM: Left adrenal ACCESSION #rt570

CLINICAL ABSTRACT:

~: This 51-year-<~ld gravida 7, para 5, Hispanic female presented wilh severe anemia due to 3 months of vaginal bleeding . Uterine myomata and adenomyomas werefOUDd and removed ttansvagiDally. During woric-up, a large palpable mass was found in the left upper abdominal quadiant. ACT scan showed a IS em mass in the left suprarenal fossa, with areas of calcification. An ultrasound measured the mass at appro>drnately 18 em, adjacent to the inferior aspect oflhe spleen and left kidney but DOt arising from these organs. The patient deferred further exploration at lhat time of myomectomy; but one year later developed increasing constipation and left flank and abdominal pain, wilh stools negative for occult blood; and elected for swgical removal of the mass. Sbe has a four pack-year history of smokillg, drinks four beers a day and has no family history of cancer.

Lalxlmtory: Sbe had microcytic, hypochromic RBCs wilh an MCY.of 60.1 and an RDW of:ZSO/o. There were 3% nucleated RBCs and 1-2 + stomatocytes, ovalocytes and poik:ilocytes. Her WBCs varied from 14,000 to 70,000; usually wilh over 80% segmented neutrophils; and a thrombocytosis wilh platelets varying from 450,000~,000 mm3. She had a baseline serum cortisol (14.9 mcgldl) and a 30 minute post-ACTH stimulation cortisol (24.5 mcgldl) which were considered within expected limits. A serum erythropoietin was elevated at 80 mulml.

Physical eJG!!I!ination: She was normotensive and non-Cushingoid

SURGERY: 06121/94

Excision of retroperitoneal tumor

GROSS PATIIOLQGY:

The specimen consisted of an 822 gram, 18.5 x 11.0 x 12.0 em encapsulated yellow, slightly lobular fatty mass. It was covered by a red and pink fibromembranous'smoolh connective tissue capsule which appeared to be sharply circumscribed. There was some residual orangc-:yellow tissue suggestive of . adrenal tissue in this conru:ctive tissue capsule on one pole of lhe mass. Cut sections revealed a greasy, pale yellow, yellow-white and red-pink cut surface, wilh the areas ofred-piilk tissue mostly alound the periphery of the mass; and small fibrosclerotic pink-white areas wilh punctate calcification in lhe center of the lesion.

CONTRIBUTOR: Wtlliam We!Zd, M.D. CASENO. 3-0d~r~4 JackJoa, MS

TISSUE FROM: Utenu ACCESSION 1#27549

CLINICAL ABSTRACT:

History: This 28 year old Caucasian female presented with irregular vaginal bleeding. She bad been on oral oontraceptives and it was felt !bat po.rt of the problem was the way sbe '1'1'35 taking the pills. She had a oormal pelvic exam at the time of initial presentation. The bleeding problems continued, Jlowe\.1:1', and sbe began to notice a foul discharge. Six 'l'l'l:dcs later sbe n:tumed and was fOUDd to have a polypoid lesion com.i.Jig tbrou&h tbe cervix into lbe vagina and a biopsy was pe<formed. She is a one pdc -a-day smoket and bas smoked for I 0 years.

SURGERY: 06f03/94

Modl.fied radical hysterectomy with bilateral salpingo-oopboreaomy and lympbadenectomy.

GROSS PAIHOLOGY:

Three discrete lesions were present in the U1etUS, m·o in the endometrium and ooe in the cetvix. Tbe}' varied from I to 3 em in grea~ diameter and bad a fleshy consislency.

CONTRIBUTOR: WtlliaJn J. Wetzel, M.D. CASE NO. 4 - October 1994 Jadooa, MS

TISSUE FROM: Uterus ACCESSION #27565

CLINICAL ABSTRACT:

~: This 54-year-old uwk.cdly obese while female MS found 10 have an enlarged uterus oo.ring a ventral bemia repair. The •-entral hernia had developed foUowing gastroplasty for obesity, dooe 11 years ago, She bad no gynecologic complaints.

SURGERY: 06127194

Total abdominal hysterectomy, bilaleral salpingo-ooj>h<nectomy, ventral hernia repair.

GRQSS PATHOLOGY:

The Ulerus, tubes and ovaries IOgether weighed 1200 grams. The endometrial cavity was diSiorted by multiple mural oodules. Tbc myomcuium sho\l"ed msny li.ny, ill-ddinecl DOCllles some of which exleDded "ithout cleman:ation iniO adjacent pericervical soft tissues. Some large, discnle leiomyomas were also prescnc, the largest of which was 8.0 em and appeared while, whorled and well· demarcated.

CONTRIBUTOR: Samuel Yoshida, M.D. CASE NO. !1 - October 1994 Fremo,CA

TISSUE FROM: Termiul !.lauD AC<1SSION m!llO

CLINICAL ABSTRACT:

~: This 42 year-old female presented with intermittent episodes of subxiphoid or suprawnbilical abdominal pain am- the last several months, with vomiting on at least one episode. There was no hnoatemesis or coffee ground emesis, no change in stool habit, and no hematoche:zia, melena or mucortbea. The patient bad been aware of abdominal "gurgling• and bad lost 7-8 pounds since the O<l5d of sympcoms. An upper GI with small bowel follow-through SIUdy demonsuated a definite abnormality within the tenninal ileum with a oodll1ar aweouaoce. Col0005C0p)' revealed a oodWar 111!!CQS!!I pattern of the tenninal ileum resembling a bunch of grapes. CT -scan of tbe abclomeo and pelvis demonsllated mesenJetlc adcnopalhy. A buium enema and ao ultrasouod of tbe gallbladder were negative.

Past History: About 1 1/2 years ago she underwent aT AH-BSO for an 0\'llrian cyst and has been on estrogen pa~ and Triamterene pm for "swelliog" since that time.

SURGERY: 12/29193

Segmental resection of mid and disla1 ileum and cccum with mesenteric lympb node biopsy

GROSS PATHOLOGY:

Two segments of ileum were 4.5 em and 26.5 em long, the laller with 5.5 em of attached cecum. The shorter segment bad an approximately I .5 em area of narrowing with a finely nodular hyperemic scroa, an indurated muscularis and marlcedly enlarged mucosal folds with a finely granular dull mucosal surface. CJOSS«Ctions of the involved segment m.-ealed &JOSS effacement of the mucosa by a tan·pink, fleshy infiltrative process whicb focally CXIeoded into the underlying muscularis propria. The terminal ileum showed extensive involvement of the mucosa by innumerable (approximately ~) polypoid mucosal exuesceuces whicb measured from 0.1 10 0.8 em in diameter, most extensively in the most distal 15 em scgroent of the terminal ileum. The ilcocecal valve and cccum were gJOSSiy uninvoh-ed by the polypoid exaescences. The attached small bowel mesentery had scattered 0.3 10 0. 7 em diameter tan­pink, son lympb nodes ~>ith a homogeneous, tan-pink, fiesby architectu.re.

CONTRIBUTOR: Tllolllas S. Lorey, M.D./Milloa BUlls, M.D. CASE NO. 6 • Ocloller 1994 San Francilco, CA

TISSUE .FROM: Ptrkardiam ACCESSION 1127490

CLINICAL ABSTRACT:

~: This 78 year-old male bad undergone racction of soft tissue tumors of the buttock 20 and 8 years earlier and resection of a similar tumor of the right forearm 1 year ago. He undetwent pericanlial drainage for tamponade ~lated to sudden development of pericanlial effusion, and at the time of that opcralion a mass was DOled posteriorly, but this was noti"CillOWd. SubsequeJUiy, this grew to a mass of 12 em in diameler by cr scan, and became symptomatic because of com;>1ession of the left ventricle, as demonstraled by ecbocardiograpby. Because of the increasing syn~JMms and the il~Cm~Sing size of the mass, the patient was merred for surgical removal, to prevent further cardiac compression.

SUBGERY: 04/13192

Palti.al excision of pericanlial tumor

GROSS PATHOLOGY:

The specimen consisted of 820 grams of irregular tan-yeUow soft tissue fragments agg~egating 14.0 em. Sectioning showed a gelatilloos variegated cut surface with multiple small foci ofbemorrbage.

CONTRIBUTOR: Jack LelssriJig, M.D. CASE NO. 7- October 1994 Saata a.., CA

TISSUE FROM: Umbiliul bera.ia sac ACCESSION ltz7S09

CLINICAL ABSTRACT:

~: This 47 year~ld male bad a longstanding histoey of c:irrbosis and parually CXJmpensatcd bepatic failun:. The patient had a gradually cnlaTging umbilical hernia and tbe overlying skin SW1ed 10 erode. Because of this, the patient was refemd for surgical inler.oeotion. Theze had been no incarceration or strangUlation; but the bcmia had always been somewhat tense due to the patient's asc:iiCS.

Physical El!3!!1ination: Examination of abdomen showed an 8 x 6 em umbilical bemla filled with asc:itic fluid. Tbe skin was eroded over the top of it. The actual fascial defect seemed to be less than 2 em in diameter.

SURGERY: 03/30/94

Umbilical herniorrhaphy

GROSS PAmOLQGY:

The specimen was a 6.5 x 5.0 x 2.5 em polypoid cystic mass CO\Iertd by skin and subculalleous soft tissue.

CONTRIBUTOR: Tbom.u Lorey, M.DJMiiiOD Ba.ud, M.D. CASE NO. 8 - October 1994 Su f'n!w;:jwo, CA

TISSUE fROM: Left tatis ACCESSION 1127561

CLINICAL ABSTRACT:

~: This 25-year-<lld CaiK:asian male presented with a seven-week his«ny of a slowly enlarging, painless left restirnJar mass. Ultrasound examioation demonstta!Cd a belerogenoous mass wbkb almost lOcally replaced the left leStis. The cbesl x-ray was unrenwbtlle. Alpba-fcloprolei:n aDd beta-HCG levels were within normal limits.

SURGERY: 02121/90

Left radical orchiectomy

GROSS PA.TBOLOGY:

The 85 gram specimen consisted of testis with attached spermatic c:ord and soft tissues. The 6.0 x 4.0 x 4.6 em testicle had an inlaCI capsule. Within the testicular pareocbyma was a 4.6 em diameter soft, Illhbeiy, tan-gray-yellow tumor. The cut surface oflhe tumor was variegated tan-white with areas of bemot • bage and DI)'XOid degCDel'lltion. Separate from lhe main tumor was a 1.1 em diameter whi1c-lan nodule. Distinct from one edge of lhe tumor was a I. S em diameter mulliloculaled cyst.

CONTRIBUTOR: Slclert, Mark, M.D. CASE NO. 9- October 1994 Sau Bemanlillo, CA

TISSUE FROM: Rigbt c.tlf ACCESSION t127SlS

CLINICAL ABSTRACT:

History: This 40-year-old black female was presented wilh a painful protruding mass extending from her knee to her ankle while"she was pregnant a year ago. She had been diagnosed with Von Rcrllinghausen's disease and exhibited multiple cutaneous masses of the trunk and extremities as well as cafe au Jait spots" A superficial biopsy was pcrfomed initially though it Wlis composed mainly of fat.

I ,ahnratory: MRI scan revealed a" "huge• mass in lhe posteromedial aspect of lhe right leg extending from lhe distal femur ·to the distal gastrocnemius.

SVRGERY: 02/03/94

Resection of right posterior leg mass

GROSS PATHOLOGY:

The specimen of the right calf was an irregular multinodular darlc red to tao mass of tumor tissue measuring up to 18.0 x 28.0 x 8.0 em. Tbe surface of the mass varied from smoolh to bosselated and displayed some attac:hed red membrane" Di~on revealed that it was composed of multiple irregular mostly ovoid nodular masses of solid myxoid to gray-yellow tissue. Individual tumor nodules are separated by strands of gray-pink stroma. The largest coherent nodule of tumor measured 16"0 em. Each nodule appeared to have pushing as opposed to infiltrative borders with surrounding membrane and rubbery gray stroma. Among the larger tumor nodules were found occasional cystic sites measuring up to about a centimeter as well as foci of gray-red discoloration. After the specimen was divided, it was found to weigh a total of 1885 grams.

TUMOR MARKERS:

S-1 00 stain did not seem to stain lhe small tumor cells.

CONTRIBUTOR: Ullbetb Guillto-Mll'I.Dda, M.D. CASE NO. 10- October 1994 Bakel'lfleld, CA

TISSUE FROM: Rlgltt breut ACCESSION 1112!813

CLINICAL A»STBACT:

HiS!!J:x: This 36-year-dd gravida 3, para 3, female had an on-going nipple discharge for about a year. The discharge varied from pink to greenish. Over the last four months a mass was dUc:ovmd which had become larger and firmer. Mammogram I'C\Ulcd a 4.~ x 2.7 x 2.~ em deeply infiltrative tumor.

Pas! Historv: She bad a lesion removed from the left breast in I 972 and one from the right breast in 1977.

Physical Expminorion: The exam I'C\Uled a ~.0 em long by 2-3 em wide firm mass in upper­inner quadrant of the right breast.. Pressure produc:cd Oow of blood and greenish fluid from the nipple.

SUBCERY: 09/11186

Breen biopsy

GROSS PATBOLQGY:

The modified radical mastectomy specimen weighed 6" grams and measured 27.0 x IS.O x 4.0 em. At the medial portion was a S.O x 3.0 x 2.~ em firm tumor with irregular borden and an adjacent cavity consistent with a previous biopsy site. The tumor was soft and yellow-tan with areas of hemorrhage. The underlying fascia was markedly adherent to the tumor. The nipple was unremarkable. The rest of the breast tissue showed irregular fibrosis.

JUMOR MABKERS:

Actin stain positive and CEA positive.

MINUTES

FOR

OCTOBER 1994 MONTHLY STUDY SET

"GENERAL PATHOLOGY"

Suggested Reading:

Lawrence Walter, Jr. (Guest Ed). Seminars in Surgical Oncology (Sept-Oct 1994); 1 0(5).

Chang KL, Advances in Pathology 1994; 1(1): 53. Invades Pathology 1994; 1(1): 38-43.

Spagnolo D, Turbett G, Dix B, lac, Advances in Pathology. Review Article. Polymerase Chain Reaction and Single Strand Conformation Polymorphism - Analysis (PCR-SSCP): A Novel Means of Detecting DNA Mutations 1994; 1(2): 61-77

ibid, (New Gene) Mutated APC Gene: The Genetic Defect of Familial Adenomatous Polyposis and a Common Finding in Sporadic Colorectal Cancer. Advances in Pathology 1994; 1(1): 49-55.

Human Pathology. Gastrointestinal Pathology- Part I, W.B. Saunders Company (Oct) 1994; 25(10).

CASE NO. 1, ACCESSION NO. 27547 OCfOBER 1994

SAN BERNARDINO <INLAND> ·Benign fibrohistiocytic pseudotumor {6); Reticulohistiocytic granuloma {1).

LA MESA- Hanson's disease {lepromatous leprosy){4); Juvenile xanl.hogranuloma (1); Reticulohistiocytosis.{l).

LONG BEACH. Granular cell tumor {3); Epithelioid sarcoma {I), Benign tumor of Schwannian origin (I); Infectious lesion (1); Fibrous histiocytoma {2).

MARYI,AND • ~'tranodal Rosai-Dorfman disease {7); Inflammatory pseudotumor (5); Benign peripheral nerve sheath tumor { 4 ).

SAN DIEGO • Inflammatory pseudotumor (14).

SAN'fA ROSA· Extra nodal manifestation ofRosai Dorfman disease (SHML) {1); Extra nodal manifestation ofRosai Dorfman disease; inflammatory pseudotumor; granular cell tumor (1).

SANTA BARBARA · Granular cell tumor vs Schwannoma variant (1).

NEW .JERSEY -Fibroxanthoma of skin, r/o leprosy {1); Fibroxanthomatous lesion {1).

FLORIDA • Cutaneous meningioma/Plasma cell granuloma.

OKINAWA - Proliferative .lilsciitis (3).

NEBRASKA !OMAHA) · Lepromatous leprosy.

FOLLOW-UP:

The patient was seen about two weeks ago and has healed satisfactorily.

SPECIAL STAINS:

CAM-5, HMB-45. and acid fast negative. S-1 00 positive

DIA.GNOSJS.:

GRANULAR CELL SCBWANOMMA T02104/M95800

REFERENCES:

Apisarnthanaraz P. Granular Cell Tumor. Analysis of 16 Cases and Revie'i\·ofthe Literature. J Am Ac:ad Dermatopatholl981; 5: 171-182.

...

Case #1, October 1994

REFERENCES (Continued):

Khansur T, Balducci L, Tavassoli M Identification of Desmosomes in ihe Granular Cell Tumor. Implications in ihe Histologic Diagnosis and Histogenesis. Am J. Surg Paiholl985; 898-904.

Bhawan J, Malhalra R, Nair DR. Gaucber·Like Cells in a Granular Cell Tumor. Hum Pathol !983; 14: 730-736.

Kershisnik M, Batsakis JG, Mac:hay BM Pathology Consultations Granular Cell Tumors. Am Otol Rhingol LaryngaJ 1994; 103(5): (Pan I) 416-419.

LeBoit PE, Barr DJ, Burall S, Metcalf JS, eta!. Primitive Polyploid Granular-Cell Tumor and Other Cutaneous Granular-Cell Neoplasms of Apparent Non-Neural Origin. Am J Surg Paihol 1991; 15(1): 48·58.

Garancis C, Komorowski RA, Kusma JE. Granular Cell Myoblastoma. Cancer 1970; 25: 542· 552.

Moore S A. Sc:hwann Cell Heterogeneity· Might It Underlie the Diversity Seen in Sch'l>ann Cell Tumors? (Editorial) Hum Pathol 1994; 25(11): 11 13.

CASE NO. 2, ACCESSION NO. 17570

SAN BERNARDINO fiNLAND) • Adrenallll}'clolipoma (7).

LA MESA ·Myelolipoma (6).

LONG BEACH ·Myelolipoma (8).

MARYLAND· Myelolipoma (16).

SAN DIEGO· Myelolipoma (14).

SANTA ROSA ·Myelolipoma (2).

SANJ"A BARBARA· Myelolipoma (1).

NEW JERSEY • Adrenal myelolipoma (2).

FLORIDA· Myelolipoma (4).

OJ<INA WA • Myelolipoma (3).

NEBRASKA <OMAHA) ·Myelolipoma.

FOLLOW-UP:

The patient on follow-up had essentially unremarkable hemogram.

DIAGNOSIS:

ADRENAL MYELOLIPOMA T93020/M88700

REfERENCES:

OCTOBER1994

BoudreatLx D, Waisman J, Skinner DG, et al: Giant Adrenal Myelofipoma and Testicular Interstitial Cell Tumor in a Man with Congenitai21-Hydroxylase Deficiency. Am J Surg Pathol3: 109, 1979.

Selye H, Stone H. Hormonally Induced Transformation of Adrenal intn M}'cloid Tissue. Am J Pathol 26: 211, 1950.

Goetz S, Niemann T, Robinson R. Coben M. Hematopoietic Elements Associated with Adrenal Glands. Arch Pathol Lab Med . 1994; Vol 118: 895~96.

CASE NO. J, ACCESSION NO. 27549 OCTOBER 1994

SAN B£RNARPINO C!NLAND> • Adenosarcoma "ith rhabdomyosarcomatous features (7).

LA MESA· Endometrial strOmal tumor (4); Endometrial strOmal saswma (2).

LONG BEACH · Mullerian adenoS31COma (8).

MARYLAND • Adenosarcoma (13); Stromal saswma (3).

SAN DIEGO· High grade endometrial stromal S3JCOma (9); Adenosarcoma (4).

SANTA ROSA· Mullerian adenosarcoma (2).

SANTA BARBARA· Adenosarcoma (1).

NEW JERSEY • Endometrial adenosarcoma (2).

FLORIDA · Endometrial strOmal saswma/Adenosarcoma.

OKINAWA· AdenOS31COma (3).

NEBRASKA <OMAHA) • Adenosarcoma.

FOLLOW-UP:

Patient had no recurrence.

DIAGNOSIS:

ADENOSARCOMA, UTERUS T820001M8960J

OUTSIDE CONSULTATION:

Roben Young, MD. · Primary embryonal rhabdomyosarcoma.

REFERENCES:

Kaku T, Silverberg SG, Major FJ, Miller A, eta!. Adenosarcoma of the Uterus: A Gynecologic Oncology Group Clinicopathologic Study of31 Cases. Int J Gynecol Pathol1992; 75-88.

Clement PB, Scully RC. Mul.lerian Adenosarcoma of the Uterus: A Clinicopathologic Analysis of 100 Cases with a Review of the Literature. Hum Pathol1990; 21: 363-381.

Chen KTK. Rhabdosarcoma Uterine AdenOS3JCOma. Int J Gynecol Patho.ll985; 146·152. Gast MJ. Radkins LV, Jacobs AJ, et at. Mullerian Adenosarcoma with Heterologous Elements.

Diagnostic and Therapeutic Approach. O,.necol Onco11989; 32: 381-384.

CASE NO. 4, ACCESSION NO. 27565 OCTOBER 1994

SAN BERNARDINO ClNLAND) - Low-grade endometrial stromal sarcoma (7).

LA MESA- Uterine hemangiopericytoma (4); Uterine angiomatosis (2).

LONG BEACH- Low-grade stromal sarcoma (7); Intravascular leiomyomatosis (1).

MARYLAND- Intravenous leiomyomatosis (6); Low grade Stromal sarcoma (9); Adenomatoid rumor (1).

SAN DIEGO- Low grade endometrial stromal sarcoma (14).

SANTA, ROSA- Endolymphatic stromal myosis (2).

SAN'fA BARBARA- Plexiform cellu.lar leiomyoma (1).

NEW JERSEY - Low grade stromal sarcoma (2).

FLORIDA - Low grade stromal sarcoma (endolymphatic stromal myosis) (4).

OKINAWA -Low grade endometrial stromal sarcoma (3).

NEBRASKA <OMAHA) -Low grade stromal sarcoma.

DIAGNOSIS:

LOW GRADE STROMAL SARCOMA T82000/M89303

REfERENCES:

Kempson RL, Hendrickson MR. Pure Mesenchymal Neoplasms of the Uterine Corpus. Selected Problems. Seminin Diag Pathol; Vol5(2) May 1988: 172-198.

Chang K, Crabtree G, Lim-Tan SK, Kempson RL, and Hendrickson MR. Primary Extrauterine Endometrial Stromal Neoplasms. A Clinicopathologic Study of 20 Cases and a Review of the Literature. lnt J Gynec:ol Pathol, Vo112(4) 1993: 282-296.

Berchuclc A, Rubin S, Hoskins W, and Saigo Pet a!. Treaunent of Endometrial Stromal Tumors. Gynec:ol Oncol 1990; 36: 60-65.

el Naggar AK, Abdul KF, Silva EG, and McLemore eta!. Uterine Stromal Neoplasms: A Clinicopathologic and DNA Flow Cytomelric Correlation. Human Pathol (Philadelphia PA) 1991; 22: 897-903.

Stanford University School of Medicine. Mesenchymal Neoplasms of the Uterus. September 29, 30, Oct 1, 1993. Department of Pathology. A Surgical Pathology Course.

CASE NO. 5, ACCESSION NO. 27Sl0 OCfOBER 1994

SAN BERNARDINO (INLAND) -Low-grade lymphoma of MALT (6); Multiple lymphomatous polyposis (1).

LA MESA -Lymphomatous polyposis (intestinal mantle cell lymphoma) (6).

LONG BEACH- Low grade lymphocytic lymphoma (MALT) (7); Mantle cell lymphoma (I).

MARYLAND -Multiple lymphomatous polyposis (16).

SAN DIEGO- Malignant lymphomatoid polyposis (14).

SANTA ROSA· Non-Hodgld.n's lymphoma (:Z).

SANTA BARBARA - Lymphoid hypeiplasia? Giardia (1).

NEW JERSEY ·Lymphocytic lymphoma, nodular, small bowel (2).

FLORIDA - Nodular lymphoid hypeiplasia (plasma cell present in lamina propria)IMAL Toma lymphoma.

OKINAWA - Multiple lymphomatous polyposis (2); Lymphoma ofMALToma (1).

NEBRASKA <OMAHA> - MALToma

FOLLOW-UP:

Patient was having some ctamP>' abdominal distRSS and a little bit of dysuria. The rest of tbe examination proved unremarkable. She will be put on Bentyl . If cramping persists a CT abdomen will be done.

SPECIAL STAINS:

CD20, B-Cell (L-26) -strongly positive B-Lymphocyte (LN2) -strongly positive

OUTSIDE CONSULTATION:

Ronald F. Dorfman, M.D., Stanford University Hospital: Malignant lymphoma, low grade, follicular small cleaved type.

DIAGNOSIS:

MALIGNANT LYMPHOMA (MULTIPLE POLYPOSIS) LOW GRADE, FOLLICULAR SMALL CLEAVED TYPE

T 65520/M96903

.. Case #S, October 1994

REFERENCES:

Burke JS, Sheibani K, Nathwani l3N, Winberg CD, Rappaport H. Monoclonal Small (Well· Differentiated) Lymphocytic Proliferations of the Gastrointestinal Tract Resembling Lymphoid Hyperplasia A Neoplasm of Uncertain Malignant Potential. Hum Patho11987; 18: 1238·1245.

Chan JKC. Ng CS, Isaacson PG. Relationship Between High-Grade Lymphoma and Low-Grade B-Cell Mucosa-Associated Lymphoid Tissue Lymphoma (MALToma) of the Stomach. Am J Pathol1990; 136: 1153-1164.

Grody WW, Magidson JG, Weiss LM, and HuE. Gastrointestinal Lymphomas. Immunohistochemical Studies on the Cell of Origin. Am J Surg Pathol1985; 9: 328-337.

Hairis NL. Extrariodal Lymphoid Infiltrates and Mucosa-AssOciated Lymphoid Tissue (MALT). A Unifying Concept. Am J Surg Patholl99l; 15: 879,884.

Solidora A, Payet C, Sanchez-Lihon J, and Montalbetti JA. Gastric Lymphomas. Chemotherapy as a Primaty Treatment. Semin Surg Oncol 1990; 6: 218-225.

Van Krieken JH, Otter R, Hermans J, eta!. Malignant Lymphoma of the Gastrointestinal Tract and Mesentery. A Clinico-Pathologic Study of the Significance of Histologic Classification. Am J Pathol 1989; 135: 281-289.

Cossman J, Uppenkamp M, and Sundeen J, ct at Molecular Genetics and the Diagnosis of Lymphoma. Arch Pathol Lab Med 1988; 112: 117-127.

Woods AL, Hall P A, Shepard NA, et al. The Assessment of Proliferating Cell Nuclear Antigen (PCNA) lmmunostaining in Primaty Gastrointestinal Lymphomas and its relationship to Histological Grade, S+G2+ in PhaSe Fraction (Flow C)-tometric Analysis) and Prognosis. Histopathology 1991; 19: 21-27.

Chan John, Wotherswon AC, Doglioni C, Diss TC, 'Pan L, et al. Antibiotic-Responsive Gastric Lymphoma? Regression ofPrimaty Low-Grade B-Cell Gastric Lymphoma of Mucosa-Associated Lymphoid Tissue Type after Eradication ofHelicobacter Pylori. Advan in Anal Patihol1994; 1(1): 33-37.

Lavergne A, Brouland JP, Launay E, Nemeth J, et al. Multiple Lymphomatous Polyposis of the Gastrointestinal Tract. An Extensive Histopathologic and Immunohistochemical Study of 12 Cases. Cancer 1994; 74(11): 3042·3050.

CASE NO. 6, ACCESSION NO. 27490 OCTOBER 1994

SAN BERNARDINO CINLAND> ·Liposarcoma, NOS (4); Myxoid liposarcoma (I); Extra-osseous myxoid chondrosarcoma (2).

LA MESA • Myxoid liposarcoma, metasratic (6).

LONG BEACH· Myxoid and round ceU liposarcoma (8).

MARYLAND· Cellular myxoid liposarcoma (myxoid with round ceU ditferentiation) (16).

SAN DIEGO· Myxoid liposarcoma (14).

SANIA ROSA • Mesenchymal neoplasm, r/o choJl(lrosarcoma liposarcoma (I); Mesenchymal neoplasm, rio liposarcoma (1).

SANIA BARBARA· Myxoid liposarcoma (I).

NEW JERSEY ·Mesothelioma (2).

FLORIDA • Merastatic chondrosarcomalmyxoid liposarcoma.

OKINAWA ·Liposarcoma with myxoid and round ceU features (3).

NEBRASKA <OMAHA> • Myxoid liposarcoma.

FOLLOW-UP:

Shortly after, patient expired

DIAGNOSIS:

MYXOID ROUND CELL LIPOSARCOMA T31000/M88523

REfERENCES:

McAllister HA, Fenoglio JJ. Tumors of the Cardiovascular System. AFIP 2nd Series, Fascicle I S: 108-109.

Walaas L, Kindblom LG. Lipomatous Tumors. A Correlative Cytologic and Histologic Study of 27 Tumors Examined by Fine Needle Aspiration Cytology. Hum Patholl985; 16: 6-18

Azumi N, Curtis J, Kempson R.I., Hendrickson MR. Atypical and Malignant Neoplasms Showing Lipomatous Differentiation. A Study of Ill Cases. Am J Surg Pathol 1987; ll : 161-183.

AUen PW. Myxoid Tumors of Soft Tissues. Pathol Ann 1980; JS(ptl): 156-160. Deitos AP, Mentzel T, Newman CD. Spindle CeU Liposarcoma, A Hitherto Unrecognized

Variant of Liposarcoma. Analysis of Six Cases. Am J Surg Patbol 1994; 18(9): 913·921. RaafHN, Raaf JH. Sarcomas Related to the Heart and Vasculature. Sem Surg Oocol 1994; 10:

374-382.

Case 116, October 1994

REFERENCES (Continued):

Frable W. Pathologic Classification of Soft Tissue Sarcomas. Sem Surg Oncol1994, 10 (5): 332-339.

McCormick D, Mentzel T, Beham A, and Fletcher C. Dedilferentiated Liposan:oma. Clinicopathologic Analysis of32 Cases Suggesting a Better Prognostic Subgroup Among Pleomorphic Sarcomas. Am J Surg Palhol 1994; 18(12); 1213-1223.

CASE NO. 7, ACCESSION NO. 27509 OCTOBER 1994

SAN BERNARDINO <INLAND> - Mesothelial sar:Jcyst with intlammation and reactiv-e mesothelial oeU hyperplasia (7).

LA MESA -Omphalomesenteric duct remnant anomaly (3); xanthomatous peritonitis (2); Desmoplastic mesothelioma (1).

LONG BEACH- Synovial melaplasia (7); Exuberant mesothelial reaction (1).

MARYLAND -Pseudocyst (9); Urachal cyst (7).

SAN DIEGO- Peritoneal fibrosis with reactive changes (11); Multicystic peritoneal mesothelioma (3).

0

SAN'fA ROSA -Mesothelial pseudoepithelial cystS of peritoneum (2).

SANIA BARBARA- Granuomatous peritonitis (1).

NEW JERSEY -Hernia sac with xanthogranulomatous infiammation (2).

FLORIDA - ? Urachal cyst; reactive mesothelial hyperplasia ( 4 ).

OI<JNA W A - Hiatal hernia with benign metaplastic changes (3).

NEBMSKA COMAHAl -Benign reactive mesothelial proliferation in a hernia sac.

DIAGNOSIS:

MULTIPLE MESOTHELIAL ~lA TORY CYSTS, PERITONEUM TY4400/M33680

REfERENCES:

Weiss SW and Tavassoli FA. Multicystic Mesothelioma. Am J Surg Pathol 1988; Vol. 12(10): 737-746.

Mennemeyer Rand Smith M. Multlcystic Peritoneal Mesothelioma. A Report with Electron Microscopy of a Case Mimicking lntra-Abdomiilai Cystic Hygroma (Lymphangioma). Cancer 1979; 44: 692-698.

Ford JR. Mesenteric CystS. Review of the Literature with Report of an Unusual Case. Am J Surg 1960; 99: 878-884.

Miles 1M, Hart WR. McMahon JT. Cystic Mesothelioma of the Peritoneum. Report of a Case with Multiple Recurrences and Review oftheLitemture. Clev Clin Q 1986; 53: 109-114.

Gussman D, Thickman D, Wheeler JE. Postoperative Peritoneal CystS. Obstel Gynecol 1986; 68: 53S-55S.

Lees RF, Feldman PS, Brenbridge NAG, et al Inflammatory CystS of the Pelvic Peritoneum. Am J Roentgenoll978; 131: 633-636.

CASE NO. 8, ACCESSION NO. 27561

SAN BERNARDINO (INLAND> • Seminoma (1).

LA MESA • Seminoma (6).

LONG BEACH • Seminoma (8).

MARYLAND· Seminoma (16).

SAN DIEGO· Seminoma (14).

SANIA BARBARA· Seminoma ( I).

SANIA ROSA · Spermatic seminoma (2).

NEW JERSEY • Seminoma (2).

FLORIDA· Seminoma (4).

OKINAWA • Seminoma (3).

NEBRASKA <OMAHA> ·Seminoma.

FOLLOW-UP:

Follow-up after three years was unremarkable.

DIAGNOSIS:

CLASSIC SEMJNOMA T78020/M90613

REFERENCES:

OCfOBER 1994

Dekker I, Razeboom T, Delmarre I, Dam A, et al. Placental-Like Alkaline Phosphastasc and DNA Flow Cytometiy in Spermatocytic Seminoma. Cancer 1992; 993-996.

Mikulowski P, Oldbring J. Microinvasive Germ Cell Neoplasia of the Testis. Cancer 1992; 70: 659~.

Czaja IT, Ulbright IM. Evidence for Transformation of Seminoma 10 Yolk Sac Tumor, with Histogenetic Considerations. Am J Clin Patholl992; 97: 468-4n.

Sumithran E, Susil BJ. Concomitant Mucinous Tumors of Appendix and Ovary. Result of a Neoplastic Field Change? Cancer 1992; 70: 2980-2983.

Friedman NB and Moore RA. Tumors of the Testis. A Report of922 Cases. Mil Surgeon 1946.; 99 573-593.

CASE NO. 9, ACCESSION NO. 17525

SAN BERNARDINO (INLAND) · Plexiform neurofibromatosis (7).

LA MESA- Diffuse neurofibroma (6).

LONG BEACH · Neurofibroma (8).

MARXLAND- Diffuse neurofibroma (16).

SAN DIEGO · Neurofibroma (14).

SANIA ROSA ·Neurofibroma (2).

SANTA BARBARA · Neurofibroma (1).

NEW JERSEY - Plexiform neurofibroma (2).

FLORIDA- Neurofibroma (4).

OKINAWA- Neurofibroma (2); Plexiform neurofibrosarcoma (1).

NEBRASKA CQMAHA) -Plexiform neurofibroma.

SPECIAL STAINS:

S-100 · strongly positive

DIAGNOSIS:

DIFFUSE BENIGN NEUROFIBROMA TY9440/M95400

REfERENCES:

OCTOBER 1994

Leon P, PrigoffMM, Smith AR, and Humble FN. Malignant Degeneration of Benign Neurofibroma. J Foot Surg 1992 Mar-Apr; 31(2): 170-172.

Wader N , Gupta TK. Neurofibromatosis: Curr Prob1 Surg (1977) 14: 81. Peltonen J, Jaakkola S, l£bwolll M, Renvall S, et al. Cellular Differentiation and Expression of

Matrix Genes in '!}ope I Neurofibromatosis. Lab Invest 1988 Dec; 59(6): 760-771. Rubenstein A. BungeR. Housman D, eds. Neurofibromatosis: A Review of the Clinical Problem

In Neurofibromatosis. Ann MY Acad Sci 1986; 486: l-13. Fountain JW, Wallace MR, Bruce MA, Seizinger BR, et al. Physical Mapping of a Translocation

Breakpoint in Neurofibromatosis. Science 1989; 244: 1085-1087.

1285.

Ponder B. Human Genetics: Neurofibromatosis Gene Cloned. Nature 1990; 346: 703-704. Riccardi VM. Neurofibromatosis. Past, Present and Future. N Engl J Med 1991; 324: 1283-

Talcata M, Imai T, and Hirone T. Factor-XIIIa.J'ositivc Cells in Normal Peripheral Nerves and Cutaneous Neurofibromas ofType-1 Neurofibromatosis. Am J ofDermatopathol 1994; 16(1) : 37-43.

Case 119, Odober 1994

REfERENCES (Continued):

Megahcd M Histopathological Variants of Neurofibroma. A Srudy of 114 Lesions. Am J of Dermatopathol 1994; 16(5): 486-495.

CASE NO. 10, ACCESSION NO. 25813 OCfOBER 1994

SAN BERNARDINO (INLAND)· Intracystic papillary carcinoma (4); Papillary carcinoma (1); Florid papillomatosis (2).

LA MESA • Adenomyoepithelioma (6).

LONG BEACH- Intracystic papillary carcinoma (6); Intracystic papilloma (2).

MARYLAND· Papilloma (16).

SAN DIEGO ·Intraductal papilloma with foci of in-situ papillary carcinoma (9); Invasive papillary carcinoma arising from intraductal papilloma (4).

SANTA ROSA ·Papillary carcinoma (2).

SANTA BARBARA • Intraductal papilloma (1).

NEW JERSEY ·Intraductal papilloma with focal atypical ductal proliferative change (2).

FLORIDA- Papilloma with secretory carcinoma; papilloma (4).

GRASS VALLEY •

OKINAWA - Adenomyoepithelioma (3).

NEBRASKA <OMAHA) - Invasive papillary carcinoma.

FOLLOW-UP:

The patient has done weU since her surgery.

SPECIAL STAINS:

Actin and CEA positive.

OUTSIDE CONSULTATION:

Kern Medical Center Department of Pathology agreed, "papillary carcinoma of the breast"

DIAGNOSIS:

INTRADUCTAL PAPILLARY CARCINOMA, BREAST T04000/M85002

Ca.se #10, October 1994

REFERENCES:

Komaki K, Sakamoto G, Sugano H. The Morphologic Features of Mucus Leakage Appearing in Low Grade Papillary Carcinoma of the Breast. Hum Patholl991; 22: 231-236.

Corkill ME, Snerge N, Fanning T, El-Naggar A. Fine Needle Aspiration Cytology and Flow Cytomeuy ofintracysticPapillary Carcinoma ofBreast. 1 Clin Patholl990; 94: 673~80.

Papotti M, Gugliotta P, Eosebi V, et al. Immunohistochemical Analysis of Benign and MalignantPapillaryLesionsoftheBreast. AmJ SmgPatholl983; 7: 451-401.

Carter D, Orr SL, Merino MJ. lntracystic Papillary Carcinoma of the BteaSt after Mastectomy, Radiotherapy or ExcisionalBiopsy Alone. Cancer 1983; 52: 14-19.

Czemobilsky B. intracystic Carcinoma of the Female Breast. Smg Gynecol Obstet 1967; 124(1): 93-98.

CASE NO. 10, ACCESSION NO 27100

CORRECTED DIAGNOSIS:

MESOTHELIOMA, MALIGNANT TI9200/M90S03

REFERENCES:

SEPTEMBER 1994

Shebani K, Esteban J, Bailey A, et al. Immunopathologic and Molecular Studies as an Aid to the Diagnosis of Malignant Mesothelioma. Hum Patholl992; 23: 107-116.

Kannerstein M, Churg J. Peritoneal Mesothelioma. Hum Pathol 1977; 8: 83-94. Hanash KA, Mostofi HE. Primary Pleural Mesotheliomas in South India- A 25 Year Study. 1

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

Histogenic Relationships Benveen Epithelial and Meseocbymal Variants. Am J Surg Patholl980; 4: 451.

Weiss LM, Battifora H. The Search for the Optimallmmunobistochemical Panel for the Diagnosis of Malignant Mesothelioma. Hum Patholl993; 24(4): 345-346.

Brown RW, Clarlc GM, Tandoo AK, and Allred DC. Multiple-Marl<er Immunohistochemical PhenotypeS Distinguishing Malignant Pleural Mesothelioma From Pulmoruuy Adenocarcinoma. Hjm Pathol1993; 24(4): 347-354