..

CALIFORNIA T UMOR TISSUE REGISTRY

Californi a Tumo r T issue R egist r y e/o: Depar1mt'nt of Pathology and Human Anatomy

Lorn a Linda Univer.;ity S<:hool of Medicine 11021 CumJlUS Avenue, AH 335 Loma Unda, California 92350

(909) 824-4788 FAX: (909) 478-4188

Target audience: Practicing pathologists and pathology residents.

Goal: To acquaint the partic ipant with the histologic features of a variety of benign and malignant neoplasms and tumor-like conditions .

. Oh!ecUve:

The participant will be able to recognize morphologic features of a variety of benign and malignant neoplasms and tumor-like conditions and relate those processes to pertinent references in the medical literature.

Educational methods and media: •

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

Principal fa culty: Weldon K. Bullock, MD Donald R. Chase, MD

C ME Credit: The CTTR designates this activity for up to 2 hours of continuing medical education. Participants must return thei£ diagnoses to the .· CTTR as documentation of participation in this activity.

Accreditation: The California Tumor Tissue Registry is accredited by the California Medical Association as a provider of continuing medical education.

CONTRIBUTOR: Mark Janssen, M.D. CASE NO.1 - OCTOBER 1996 Anaheim, CA

TISSUE FROM: Terminal ileum and ascending colon ACCESSION #27869

CLINICAL ABSfRACT:

A 51-year-old male was brought to the emergency room in shock and with an acute abdomen. He reported a five week history of progressively worsening left-sided abdominal pain. An exploratory laparotomy found perforation of an abnormally thickened terminal ileum, peritoneal implants and mesenteric lymph node enlargemenl

GROSS PATHOLOGY:

Terminal ileum, appendix, cecum and ascending colon were resected. The normal structure of the wall was obscured by an infiltrative white tumor with a perforation about 11 em above the ileo-cecal junction.

SPECIAL STAINS: CD-45 Kappa and Lambda

positive negative

CONTRIBUTOR: Pete1· L. Morris, M.D. Santa Borbara

TISSUE FROM: Right anterior thigh

CLINICAL ABST RACT:

Pan B and Pan T negative

CASE NO. 2 • OCTOBER 1996

ACCESSION #27757

..

This 57-year-old female presented with a 5.0 em diameter slightly domed nodule in the skin of the right thigh. She reported that it had been present for about 20 years and had been slowly enlarging for a number of years.

GROSS PATHOLOGY:

The 58 gram, 7 x 4.2 ellipse of skin with subcutaneous tissue was cut to a depth of 3.1 em. In the midportion, separate from the skin, was a 4 x 3.5 x 1.6 em circumscribed pale yellow homogeneous neophl~m.

CONTRIBUTOR: Philip G. Robinson, M.D. CASE NO.3 - OCfOBER 1996 Boynton Beach, FL

TISSUE FROM: Pelvic mass ACCESSION #28074

C LINICAL ABSTRACf:

This 37-year-old Caucasian female presented with lower abdominal pain associated with prolonged menstrual bleeding. Pelvic ultrasound revealed a large pelvic mas.~. At surgery, a 25 em diameter mass was found which was adherent to the retroperitoneum, involved the mesentery of the sigmoid colon and had venous drainage to the uterus.

G ROSS PATHOLOGY:

The peritoneal tumor weighed 1200 grams, and measured 17.0 x 12.0 x 12.5 em. Its cut surface was white with foci of hemorrhage ..

SPECIAL STAINS: S-100 Trichrome stain Desmin

negative collagen present positive

CONTRIBUTOR: Lorna Linda Pathology Group (cz) Loma Linda, CA

TISSUEFROM: Hcnrt

C LINICAL ABSTRACf:

Actin CD-34

focally positive negative

CASE NO. 4 - OCfOBER 1996

ACCESSION #27978 :

This one-year-old patient was the product of a normal deliver with no subsequent problems except for multiple colds. About llh hours after being put to bed for a nap, he was found not breathing. Resuscitation allempts by the parent and paramedics were unsucce.ssful.

GROSS PATHOLOGY:

The hean weighed approximately 85 grams (expected for age: about 50 grams). At the apex of the left ventricle was a 4 x 3.5 x 3 em intramural tumor. Tite tumor replaced most of the apical left ventricular free-wall myocardium, and at the apex extended over into the interventricular septum (which app1;;3red uninvolved).

CONTRIBUTOR: Roger McFadden, M.D. CASE NO. 5 - OCTOBER 1996 Stockton, CA

TISSUE FROM: Spleen ACCESSION #27949

CLINICAL ABSTRACT:

This 22-year-old Asian fema le with Down's syndrome gave a 1 year history of vague left sided. abdominal pain. ACT scan showed a 4.0 x 5.0 em low density anterior splenic mass without significant change over a 10 month follow-up. A splenectomy was performed.

GROSS PATHOLOGY:

The 13.0 x 6.0 x 3.0 em spleen had a 5.6 x 5.5 x 4.5 em protuberant subcapsular nodule near one end. This mass had a red-tan meaty appearance and was tirm.

SPECIAL STAINS: CD-31 Diffuse - Strongly positive HFVIIII - Diffuse- Weakly positive

CONTRIBUTOR: Murk Jans.~en, M.D. CASE NO. 6 - OCTOBER 1996 Anaheim, CA

TISSUE FROM: Lert scapula ACCESSION #27631

CLINICAL ABSTRACT:

This 59-year-old male was found to have a 10.0 x 12.0 em mass in the region of the apex of the left scapula. CT-scan and MRI study showed no evidence of chest wall invasion. "

GROSS PATHOLOGY:

The specimen consisted of an J 1.0 x 9.0 x 3.5 em mass of firm rubbery soft tissue.

SPECIAL STAINS: Elastic Strongly positive

CONTRIBUTOR: Nora Ostrzega, M.D. CASE NO. 7 - OCfOBER 1996 Sylmar, CA

TISSUE FROM: Right kidney ACCESSION #27985

CLINICAL ABSTRACT:

This 42-year-old female bad had multiple infections of the right kidney. CT scan showed a large hydronephrosis in the right kidney with the left kidney appearing normal. Because of severe right flank pain and low grade fevers, a right partial nephrectomy was performed.

GROSS PATHOLOGY:

The 10.0 x 7.0 x 7.0 em kidney had a 10.0 x 7.0 em papillary white-tan neoplasm infiltrating the pelvis.

CONTRIBUTOR: Lorna Lindo Pathology Group (drc) Lorna Linda, CA

TISSUE FROM: Left first toe

CLINICAL ABSTRACT:

CASE NO. 8 • OCTOBER 1996

ACCESSION #27976

'

After twice breaking his tOe, this 35-year-old man was found to have a mass expanding the distal phalanx at the time of treatment for the second injury.

:

GROSS PATHOLOGY:

The specimen consisted of a 4 x 3.5 x 3.5 em aggregate of white and pink-tan cartilaginous tissue fragments.

CONTRmUTOR; Lorna Linda Pathology Group (drc) Lorna Linda, CA

TISSUE FROM: Left pnraspinal tissue

CLINICAL ABSTRACT:

CASE NO.9 • OCTOBER 1996

ACCESSION #27627

His mother noticed a non-tender, marble-sized, firm lump on the back of this Hispanic male infant when he was 10 months old. One month later, it had increased in size and was removed.

GROSS PATHOLOGY:

The specimen was a 7.0 x 3.0 x 1.5 em firm white-tan and yellow-tan lobulated mass.

CONTRIBUTOR: R. M . Failing, M .D. CASE NO. 10 • OCTOBER 1996 Santa Barbara, CA

TISSUE FROM: Right thyt·oid ACCESSION #18176

CLINICAL ABSTRACT:

This 64-year-old Caucasian female presented with a slowly growing painless mass in the right side of her neck. Physical examination revealed a 4.0 by 8.0 em mass in the right thyroid area'; minimal posterior cervical adenopathy and a 2.5 em left ax illary mass. No signs or symptoms of hypo- or hyperthyroidism were revealed. A thyroidectomy was performed and the left axillary lymph node was biopsied. :

GROSS PATHOLOGY:

The right lobe of the thyroid was 8.5 by 6.3 by 4.0 em. The transected surfaces exposed uniform firm, rubbery, tan tumor with rare foci of necrosis. An occasional small cuff of beefy red thyroid tissue was present at the periphery of the specimen.

SPECIAL STAINS: LCA L-26

Diffusely positive Diffusely positive

EXTRA CASE (see note)

CONTRIBUTOR: Lilibeth Gulnto-Miranda, M.D. CASE NO. 11 - OCTOBER 1996 (Also was Case #7 for September 1996 Bakersfield, CA

TISSUE FROM: Chest wall ACCESSION #25370

CLINICAL ABSTRACT:

This 79-year-old male presented with an enlarging right upper lateral chest wall mass growing beneath the superficial muscles, between the ribs and possibly into the pleura. The mass was located several inches below the axilla, and over the area of a recent 7th rib fracture. An excisional biopsy was performed.

GROSS PATHOLOGY:

The 14.5 x 12.0 x 9.5 em tumor with four attached ribs weighed 837 grams. The main bulk of the tumor was homogenous pink-tan "fish flesh" in appearance.

SPECIAL STAINS (as originally performed on the "rhabdoid" phenotype tumor . .. no add.itional stains have been performed):

CBA/myoglobin: Vimentin: Desmin/actin/keratin/S-100 PAS (for glycogen):

weak to moderately positive strongly positive negative positive '

CALIFORNIA TUMOR TISSUE REGISTRY

SUGGESTED READING (General Topics l'rom Recent Uterature):

lmage Cytometry Symposium. W.B. Saunders Comp.1ny. Hum Patlwl1996; 27(5). New Wave Pathology (Editorial). Eversole LR (Sulions Ed). Oral Surg, Oral Med, Oral Patlwl

1994; 77(4):315. Reviews in Molecular Medicine. McKusick VA. Medicine 1995; 74(6):301-304. The New American Joint Conunittee on Cancer and International Union Against Cancer TNM

Classificalion of Prostate Cancer. Clioicopatbologic Correlations. Ohori M., Wheeler 1M and Scardino PT. Cancer 1994; 74(1):104-114.

Proliferation Markers in Breast Carcinoma. Mitolic Figure Count, 5-Pbase Fraction, Proltfenting Cell Nuclear Antigen, Ki and MIB-1 Kcsbgegian AA, Cnun A. Aml Clin Patlw/1995; 104:42·49.

Pathologic Correlates of Survival in 378 Lymph Node Negative Infiltrating Ducta~Carel.nomas Clayton F. Cancer 1991; 68:1309·1317.

Wild Type p53 Regulates il Own Transcription in Cell-Type Specific Manner. Hudson JM, Frade R, Bar-Eli M. DNA Cell Bio/1995; 14:759-766.

New.Ciassification. Residual Tumor Classification Wittekind C, Hermanek P .. Advanus A nat Patlwl1995; 2(4):27279.

Retroperitoneum Paragangliomas. Role of Immunochemistry in the Diagnosis of Malignancy and Assessment of Prognosis. Montreoor E, Tacano C. Nifosi F, et a!. Eur J Surg 1994:160-162.

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

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

(909) 824--4788 FAX: (909) 478-4188

CASE NO. 1, ACCESSION NO. 27869 OCTOBER 1996

INlAND CRIVERSIDE/SAN BEBNARQ!NO) • Large cell lymphoma, immunoblastic type (3); Hodgkin's disease (1)

ORANGE (St. Joscl'b Hospital) • Hematopoietic malignancy, NOS (3)

BAKERSfiELD (Central Valley Studv Grovp) • Diffuse large cell lymphoma PLEASANTON/FREMONT • Anaplastic large cell lymphoma (S); Anaplastic LCL with immunoblastic feawres

(1) LONG BEACH • Malignant lymphoma, diiiuse large ceO type, immunoblaslic (bigb·grade) (8).

SAN DIEGO CNovol Medical Centerl • Large cell lymphoma (16)

SANTA BARBARA (SL Francis Mecl Ctr) • Malignant lymphoma (3) SANTA BARBARA (Cottage Hospital) • Malignapt lymphoma, large cell (r/o immunoblastic, r/o anaplastic large

cell lymphoma) VENJVRA CUnilab) · Malignant lymphoma (2) SANIA ROSA • Large cell lymphoma, r/o metastatic melanoma, poorly differentiated carcinoma (1); Malignant

undifferentiated neoplasm (1); Malignant undifferentiated neoplasm· probably large cell lymphoma (1)

BAY AREA • Lymphoma, diffuse, intermediate grade (3)

SAN JOSE O..Oma Prieta Grovp) • Large cell lymphoma (6) SACRAMENTO CUe Davis Med Qrl • Large cell lymphoma, inununoblaslic, higb grade. NEBRASKA (Creigbton University) • Granulocytic sarcoma MISSJSSrPPI (Bal'tist Med Ctr) • Plasmacytoma FLORIDA Cfallhassee) • Large cell lymphoma MARYLAND (Bethesda Naval Med Ctr) - Diffuse large cell lymphoma (10) MASSACHUSETTS <Berkshire Med Qr) • Higb grade lymphoma, possible Kl-1 lymphoma NEW YORK Ompatb Study Group) - Large cell anaplastic lymphoma (4) MAINE - Anaplastic plasmacytoma (4).

NEW HAMfSHTRE (Manchester) - Molignantlymphoma, favor immunoblastic (1); Malignant lymphoma, large cell type (1)

NEW JERSEY (Overlook Hospital Summit) - Malignant lymphoma, large eel! type (4)

CONNEClJCUT CUniv or Conn) - Anaplastic large cell lymphoma ARIZONA (VA Medical Center) • Malignant lymphoma, large cell, higb grade AUSTRALIA (Sydney Group) - Diffuse large cell lymphoma, immunoblastic type

DIAGNOSIS: LARGE CELL IMMUNOBLASTIC LYMPHOMA, ILEUM AND COLON

T65!100f!'1% 123

CONSULTATION: Dr. Koo (Sunset Regional Hematopathologist) - "Large Cell Immunoblastic Lymphoma.~

RP..fllRENCES: Van Dcr Valk P, Meyer Jl.M. The NOn·Hodgkin's Lymphomas. Old and New 1binking. Histopathology 1988; 13:367-384. Hall PA, Levison D. Malignant Lymphomos in the Gastrointestinal Trae1. S.min Diagn PaJ/wl 1991; 8(3):163·177 .. Lasota J, Hyjek E, Koo CH,et al. Cyrokerorin-Pooitivc Large-Cell Lymphomu orB-Cell Unage. A Srudy of Five

Phenotypically Unusual Cases Veriroed by Polymerase Olain Rcac:lic>n. Am J Surg Pallwl 1996; 20(3):3~-354. Chan JKC. A New Classification or Lymphomas. The Revised &lropean-AmcricanOassification. Act.ancu Anal PaJiwl

1994; 1(3):166-172.

CASE NO. 2, ACCESSION NO. 27757

INLAND <RIVERSIDFJSAN BERNARDiNO\ - Benign fibrous histiocytoma ( 4) ORANGE (St. Joseph Hospital) - Fibrous histiocytoma (3)

BAKERSFIELD (Central Valley Study Group) - Fibrous histiocytoma PLEASANTON/FREMONT - Fibrous histiocytoma, xanthomatous variant(6) LONG BEACH - Dermatofibroma (8)

OCTOBE R1996

SAN.DrEGO <Naval Medical Center) - Atypical fibrohistiocytoma (13); Atypical fibroxantboma (3) SANTA BARBARA (St. Francis Med Or) - Fibrous histiocytoma (3)

SAN BARBARA (Cottage Hospital) - Deep cutaneous histiocytoma VENTURA C!Jnilab) - Cellular fibrous histiocytoma (2)

SANTA ROSA - Cutaneous fibrous histiocytoma (1); Giant fibrous histiocytoma (1); Fibrous .histiocytoma (1). BAY AREA - Fibrous histiocytoma (3). SAN JOSE (Lorna Prieta Group) - Fibrous histiocytoma (6) SACRAMENTO CUC Davis Med Or) - Benign fibrous histiocytoma NEBRASKA (Creighton University) - Benign fibrous histiocytoma MISSISSIPPI <Baptist Med Or) - Fibrous histiocytoma FLORIDA Cfallahassee) - Dennal fibrous histiocytoma MARYLAND <Bethesda Naval Med Ctr) - Benign fibrous histiocytoma (10)

MASSACHUSETI'S <Berkshire Med Or) - Pleomorphic lipoma; Benign fibrous histiocytoma NEW YORK (Jmpath Study Group) - Fibrous histiocytoma MAINE - Fibrous histiocytoma (4) NEW HAMPSHIRE (Manchester) - Hibemoma vs benign t'ibroxanthoma; Nodular fibrous histiocytoma NEW JERSEY (Overlook Hospital Summit) - Fibrous histiocytoma with atypia (1); Cellular fibrous histiocytoma

(3)

CONNEcrtCUT C!Jniv of Conn) - Dermatofibrosarcoma protuberans ARIZONA (VA Medical Center) - Dermatofibrosarcoma protuberans (low grade fibrosarcoma) AUSTRALIA (Sydnev Group) - Demtatofibroma (histiocytoma)

DIAGNOSIS:

FIDROUS ffiSTIOCYTOMA, TffiGH

TY9100/M88300

FOLLOW-UP:

One and' a half years after surgery, there was no evidence of disease.

REFERENCES: Calonje E, Meatzel T, Fletcher CD. Cellular &nign fibrous Histiocytoma. anioapathologic Analysis of74 Cases of a

Distincrive Variant of CutaiiCOus Fibrous Histiocytoma with Frequent Recurrence. Am J Surg Patlw/1994; 18(7): 663-676.

Kcmp.on RL, Kyrikos M. Fibroxanthosarcoma of the Soft Tissues. A Type ofMalignant.Fibrous Histiocytoma. Cancer 1972; 29: 96!-976.

Singh-Gomez C. Calonje E. Fletcher CD . .Epithelioid Benign Fibrous Histiocytoma of Skin. Clinico-Pathological Analysis of 20 Cases of a Poorly Known Variant. Histapothalagy 1994; 24{2): 123-229.

Colome-Grimmer Ml and Bvans, If. Metastasizing Cellular D<:rmatofibroma. A Report of Two Cases. Am J Sm'g Pathal 1996; 20(11); 1361-1367.

CASE NO. 3, ACCESSION NO. Z8074 OCTOBER 1.996

INLAND ffiJVERSIDE,ISAN BERNARDINO) - Vascular leiomyoma (3); Lymphangiomyoma (1) ORANGE<St. Joseph Hospital) - Parasitic leiomyoma (1); Smooth muscle tumor ofun~rtain malignant potential

(1). BAKERSFIELD (Central Valley Study Group) - Low grade leiomyosarcoma PLEASANTON/FREMONT - Leiomyoma, apparently parasitic (5); Adenomatoid tumor (1) LONG BEACH - Leiomyoma (8) SAN DIEGO (Naval Medical Center) - Leiomyoma (parasitic) (16) SANTA BARBARA (SL Francis Med Ctr) - F9ithelioid leiomyoma (3) SAN'TA BARBARA (Cottage Hosoita)) - Leiomyoma VENTIJRA (Unilab) - Desmoplastic mesothelioma (2) SANTA ROSA - Solitary fibrous tumor (1); Mesenchymal neoplasm (stromal rumor of unknown malignant

potential (i); Mesenchymal neoplasm possibly malignant (1)

BAY AREA - Myo6broblastoma (3)

SAN JOSECLoma Prieta Grounl - Leiomyoma (6) SACRAMENTO (UC Davis Med Ctr) - Low grade stromal myoma with no histologic evidence of malignancy NEBRASKA (Creighton University) - Endometrial stromal sarcoma MISSISSIPPI (Baptist Med Ctr) - Parasitic leiomyoma FLORIDA <Tallahassee) - Smooth muscle tumor of uncertain malignant potential MARYLAND (Bethesda Naval Med Ctr) - Parasitic-leiomyoma (10) MASSACHUSETTS (Berkshire Med Ctr) - Leiomyoma NEW YORK (Impalh Study Groun) - Hyalinized leiomyoma (4) MAINE- Leiomyoma (4) NEW HAMPSHIRE (Manchester) - Leiomyosarcoma; Low grade leiomyosarcoma NEW JERSEY (Sununit) - Fibroma (?ovarian in origin) (1); Leiomyoma (3) CONNECTICUT <Univ of Conn) - Leiomyoma ARIZONA (VA Medical Center) - Leiomyosarcoma AUSTRALIA (Sydney Group) - Vascular leiomyoma

DIAGNOSIS:

HYALINIZED SMOOTH MUSCLE TUMOR ("DEEP LEIOMYOMA") OF UNCERTAIN MALIGNANT POTENTIAL, RETROPERITONEUM

TY 4600/MSS%0

REFER!lliC@: Rader JS, BinetteSP, Brandt ID, et al. Ileal Hemorrhage caused by a Parasitic Uterine Leiomyoma. Obste/-Gyneco/1990;

76(3 Pt 2):531-534. Lourie S, Gorbacz S, Cas pi 8, eta!. Parasitic Leiomyoma: A case Report C/in Exp Obst<t·Gyncco/1991; 18(1):7·8. Kilpatrick SE, Mentzel T, Fletcher CDM, Leiomyoma of Deep Son Tissue. airuopalhologic Analysis of a Series. Am 1 Surg

Patloa/!994; 18: 576-582. Fletcher CDM, IGipatrick SE, Mentzel T. The Diffieully in Predicting Behavior of Smooth Muscle Tumors in Deep Soft

Tissue. Aml Surg Pnt/oo/1995; 19: 116-117.

CASE NO. 4, ACCESSION NO. 27978

INlAND CRI\IEBSIDF/SAN BERNARDINO) - Cardiac fibroma (4)

OBANGE CSt. Joseph Hospit.aQ - Cardiac fibroma (3) BAJ<ERSf!ELO (Ceplrlll Valley Study Group) - Fibroma PLEASANJPN/FREMONT - Cardiac fibroma (6) LONQ BF.ACH - Cardiac fibroma (8) SAN DIEGO (Naval Medical Center) - Cardiac fibroma (16) SANJ'A BARBARA (St. Francis Med Ctr) - Cardiac fibroma (3) SAN'fA BARBARA (Cottage Hospital} - Cardiac fibroma

' VENTURA CUnilab) - Fibroma; Leiomyoma

OCTOBER 1996

SAN'fA ROSA - Congenital fibromatosis "Fibroma" of heart (1); Congenital fibrous tumor (fibromatosis) (1); Fibrous tumor of myocardium (1)

BAY AR!!A - Cardiac fibroma (3)

SAN JOSE a.oma Prieta Group) - Cardiac fibroma (6)

SACRAMEtfiO CUC Davis Medical Center) - Fibrom.a NE8RASI<A (Qeigbton Univ) - Cardiac fibroma MISSISSIPPI @aptist Med Or) - Cardiac fibroma FIPRIDA ITallahassce) - Fibroma MARYLAND @etbesda Naval Med Ctr) - Cardiac fibroma (10)

MASSACHUSETTS CBerkshire Med Ctr) - Fibroma NEW YORK Gmpath Study Group) - Cardiac fibroma MAINE - Cardiac fibroma (4) NEW HAMPSHIRE (Manc-hester) - Benign spindle cell tumor, fibroma vs schwannoma vs 7 (1); Benlgn lesion,

favor fibromyxoma NEW JERSEY (Summit) - Cardiac fibroma (4) CONNECf!CUT CUniv of Conn) - Infantile cardiac fibroma~osis (cardiac fibroma) ARIZONA CVA Medical Center) - Cardiac fibroma AUSTRALIA (Sydney Group) - Neurofibromatosis (3); Fibromatosis (3)

DIAGNOSIS:

CARDIAC FIBROMA, LEFT VENTRICLE AND APEX X16501M88100

REfBRENCfS: · Burke A, Vinnani R. Tumors of the Heart and Grcac Vessels. Atlas of Tumor Pathology. Third Series, Fascicle 16. Armed

Forces Institute ofl'athol, Washington, DC 1996; 69-75. Tahernia AC, Bricker JT, Ott DA. Intracardiae Fibromoln an Asymptomatic lnfanL Clin Cardio/1990; 13:506-512. Feldman PS, Meyer MW. Fibroblastic Hamartoma (Fibroma) ofthe Heart. C~er 1976; 38: 314-323.

CASE NO. 5, ACCESSION NO. 27949

INl..AND (R!VERSIDFJSAN BERNARDINO) - Lymphangioma (3); Hemangioma (1).

ORANGE (St. Joseph's Hosoit.1D - Lymphangioma (3) BAKER$f1Fl.D <Centnl Valley Study Group) - Lymphangioma PLE.ASANTQN/FREMONT - Lymphangioma (6) LONG BEACH - Lymphangioma (4); Lymphangioend?lheUoma (4)

SAN DIEGO <Naval Medical Center) - Lymphangioma (16) SANTA BARBARA (St. Francis Med Ctrl - Lymphangioma (3) SANTA BARBARA (Cottage Hosoita!l - Benign lymphangioma VBNIURA CUnilab) - Lymphangioma (2)

OCTOBER 1996

SANTA ROSA - Littoral cell angioma vs hemangioma (I); Lymphangioma of spleen (1); Vascular proliferation, r/o littoral cell angioma •

BAY AREA - Splenic hemangioma (hamartoma) (3)

SAN JOSE <Lorna Pril't• Group) - Littoral cell angioma (6) SACRAMBN'fO CUC Davis Mcd Or) - Lymphangioma NEBRASKA (Creighton UniversHy - Cavernous hemangioma MISSISSIPPI <Baptist Mcd Ctrl - Splenic lymphangioma FLORIDA ITo!lahassee) - Lymphangioma MARYLAND CBethc.~a Naval Mcd Ctr) - Splenic lymphangioma (10) MASSACHYSETIS <Bcrksbire Mcd Ctrl - Lymphangioma NEW YORK Om path Study Group) - Splenic hemangioma ( 4) MAINE - Lymphangioma (4)

NEW HAMPSHIRE <Manchester) - Amyloidosis (1); Hemangioma (I) NEW JERSEY (Overlook Hospital Summit) - Lymphangioma (3); Hemangioma (1)

CONNECJJCUI CUniv of Conn) - Splenic lymphangioma ARJZONA CVA Medical Center) - Lymphangioma AUSTRALIA (Svdney Group) - Amyloid tumor

DIAGNOSIS:

LYPJlANGIOMA, SPLEEN T07000/M91700

REI'ERENQ'S: Ito K, Murata T, Nokllnishi T. Cystic Lymphangioma of the Spleen. MR Findings with Pathologic Correlation. Abdbm

lf1Uigino (U.S.) 1995; 20(1):8Z-84. Morgenstern 1., Bello JM, Fisher BL. Verham RP. 'lbe Clinical Spectrum of Lymphangiomss and LymphangiomAI<lSiS of the

Spleen. Am Surg (U.S.) 1992: 58(10):599-604. Bostick WL Primary Splenic Neoplasms. AmJ Pat/u>/1945; 21:1143-1165. Chan KW, Saw D. Distinctive Multiple Lymphengiomos ofSploen. J Patho/1980; 131:75-81.

CASE NO. 6, ACCESSION NO. 27631

INLAND CRrVERSIDFISAN BERNARDJNO) - Elutofibroma (4) ORANQE CSt Joseph HospitaO - Ela.stofibroma (2) BAKERSfiELD (Centnl Valley Srudy Group) - Elastofibroma PLEASANJPN/FREMONT - Elastofibroma (6) LONG BEACH - Elastofibroma (8) SAN DIEGO CNoval Medical Center) - Elastofibroma (16)

SANTA BARBARA - CSt. Francis Med Ctrl - Elastofibroma (3) SANTA BARBARA (Cottage Hospital) - Elastofibroma YENJVRA CUnilab) - Elastofibroma (2) SANTA ROSA - Elastofibroma (3) BAY AREA • Elastofibroma (3) SAN JOSE <Lorna Prieta Group) - Elastofibroma dorsi (6) SACRAMENTO CUC Davis Med Ctr) - Elastofibroma NEBRASKA (Creighton University) - Elastofibroma MISSISSIPPI @ap!ist Med Ctr) - Elaslofibroma dorsi FLORIDA ITallabassee) - Elastofibroma MARYLANP CBeth~a Naval Med Ctr) - Elastofibroma (10) MAS$ACHVSEITS (Berkshire Med Ctr) - Elostofibroma NEW YORK Ompaih Studv Group) - Elastofibroma (4) MAJNE - Elastofibroma (4) NEW HAMPSHIRE (Manchester) - Elastofibroma (2)

NEW JEBSEY (Summit) - Elastofibromo (4) CONNECIJC!.IT CUniv of Conn) - Elastofibroma ARIZONA <YA Medical Center) - Elastofibroma AUSTRALIA CSydnev Group) - Elastofibroma

DIAGNOSIS:

ELASTOFlBROMA, LEFT INFRA-sCAPULAR 1rl1280~88200

RJWilRIJNC!lS:

OCTODER1996

Nagamine N, Nohara Y. Ito E. Elastofibroma in Okinawa. A Clinioopathologic Study of 170 Cases. CaltC<T 1982; S0:1974-180S.

KumRratllakc JS, Krishnan R, Lomax-Smith J. et al. Elastofibroma. Distwted Elastic Fibrillogenesis by Periosteal-Derived Cells? An lmmunoelectron Microscopic and In-Situ Hybridization Study. flumPtJJho/1991; 22: 1017-1029.

MacKenzie DH, Wilson JF, Cooke KB. Elastoflbroma. J Clin PtJJho/1968; 21: 470-475

CASE NO. 7, ACCESSION NO. 17985 OCfOBER 1996

INLAND (RIVERSIDE/SAN BERN ARPINO) - Transitional cell carcinoma of renal pelvis, high 8Jllde (4) ORANGE (St. Joseph Hospital) - Papillary Transitional cell carcinoma li/Ill (3} BAKERSFIELD (Central Valley Study Group) - Papillary transitional carcinoma PLEASANTON/FREMONT - Papillary transitional cell carcinoma, 8Jllde ll (6) LONG Bl1ACH - Papillary transitional cell carcinoma, 8Jllde m on a scale ofl toN (8) SAN DIEGO <Naval Medical Center) - Transitional cell carcinoma of renal pelvis, high gillde (16) SANTA BARBAR-A (St. Francis Med Ctr) - Transitional cell carcinoma (3) SANTA BARBARA(Cottage HospitaD - Papillary transitional cell carcinoma \IENTI!RA CUnOab) - Papillary transitional cell carcinoma of renal pelvis (2) SANTA ROSA - Transitional,cell ·carcinoma renal_pelvis (3) SACRAMENTO CUC Davis Med Ctr) - Transitional <;ell carc,inoma, Grade II/Ill BAY AREA - Papillary transitional cell carcinoma of renal pelvis (3) SAN JOSE <Lorna Prieta Group) - Transitional carcinoma (6) NEBRASKA (Creigbion University - High grade papillary transiiional cell carcinoma MISSISSIPPI <Baptist Med Ctr) - Papillary transitional cell carcinoma (high gillde) liLORIDA <Tallhassee) - High grade papillary transitional cell carcinoll)a with focal invasion MARYLAND (Bethesda Naval Mcd Ctr) - High grade papillary transitional cell carcinoma (10) MASSACHUSETIS <Berkshire Moo Ctr) - Transitional cell carcinoma, grade III/Ill NEW YORK <Impath Study Group) - Papillary transitional ceO carcinoma of renal pelvis ( 4) MAINE - Transitional cell carcinoma (4) NEW HAMPSHIRE (Manchester) - Papillary transitional cell carcinoma (2)

NEW JERSEY (Summit) - Papillary transitional cell carcinomai grade II/III; stage? CONNECTICUT CUniv of Conn) - Transitional cell carcinoma, grade ill and xanthogranulomatous

pyelonephritis ARIZONA CVA Medical Center) - Papillary transitional cell carcinoma II/Ill AUSTRALIA (Sydney Group) - Papillary transitional cell carcinoma, grade u· of lli and xanthogranulomatous

pyelonephriti·s

DIAGNOSIS:

~APILLARY TRANSITIONAL CELL CARCINOMA, RIGHT RENAL PELVIS T72010/M81303

REFBRI'.NCF.S: . . Murphy WM, Beckwith JB and Fanow GM. Tumors of the Kidney, Bladder and Related Urinary Structures. Atlas ofTulnl)r ·

Patha/, 3rd Series, Fasicle 11, Washington, O;C. Armed Forces Institute of Pathology 1994; 105-110. Dos AI<, Carson CC, IJ<>IickD, Paulson OF. Primary Catcinoma of the Upper Urinary Tract. Effect of Primary and Secondary

Surgery Therapy on Survival. Cancer 1990; 66:1919·1923 . .OI<fbring J, Hellsten S, Lindholm K, et aL Flow DNA Analysis of the Characterization of Carcinoma of the Renal Pelvis and

Ureter. Cancer 1989; 64:2141-2945. Mabadevia PS, Karwo G. Koss LG. Mapping ofUrotbelium in CarcinomaS of the Renal Pelvis and Ureter. A Report of Nine

&ses. Cancer 1983; 51:890-897. Johnansson S, Angervalll., Bengtsson U, Wahlqvist L Uioepithelial Tumors of Renal Pelvis Associat~d witb Abuse of

Pehnactio-Contaioing Analgesics. Cancer 1974; 33:743-753. ·

CASE NO. 8, ACCESSION NO. 27976

IN!.AND CRIVERSIDE/SAN BERNARPINO) - &cbondroma (4) OBANGE (St. Joseoh HosoitaQ - &chondroma (2)

BAKERSFIELD (Central Valley Stlldy Group) - &chondroma PLEASANTQN/FREMONT - Enchondroma (6) LONG BEACH - Enchondroma (8)

OCTOBER 1996

SAN DffiGO CNaval Medical Center) - Benign cartilaginous tumor, favor chondroma (IS); Bizarre parosteal osteochondromatous proliferation (1)

SANTA BARBARA (St. Francis Med Or) • Enchondroma (3) SANTA BABBARA (Cottage HoSJiital) - Enchondroma (vs grade I chondrosarcoma-check wltb radiologist) VENTIJRA CUnilabl - Enchondroma (2) SANIA ROSA - Chondrosarcoma. low grade (!);.Enchondroma vs chondrosarcoma (1); Chondrosarcoma low

grade vs enchondroma BAY AREA - low grade chondrosarcoma (2); Atypical enchondroma (1) SAN JOSE (l.oma Prieta Group) - &chondroma (1); Chondrosarcoma (5) SACRAMENTO cue Davis Med Clr) - Enchondroma VS low pde chondrosarcoma NEBRASKA (Creighton Universirv) - Chondroma (nud x-ray) MISSISSIPPI <Baptist Med Ctrl - Enchondroma FLORIDA ITallaha~) - Chondroma MARYLAND C&tbesda Naval Med Ctrl - Enchondroma (10) MASSACHUSE'TTS (Berkshire Med Ctr) - Chondroma NEW YORK Ompath Study Group) - Enchondroma (4)

MAINE - low grade chondrosarcoma (4)

NEW HAMPSHIRE (Manchester) - Chondroma (1); Probably grade I chondrosarcoma (1) NEW JERSEY (Summit) - Enchondroma CONNECTICUT CUniv of Conn) - Chondroma ARIZONA (VA Medical Center) - Enchondroma AUSTRALIA (Sydney Group) - Chondroma

DIAGNOSIS:

CELLULAR ENCHONDROMA, LEFT-FIRST TOE TY9800/M92ZOO

REFERENCES: • Dahlin D.C., Unni KK. Done Tumor. General Aspects and Data on 8,542 cases. Fourth Ed. Charles C. Thom.,, Springfield,

Illinois, USA 1986; 33·47. Mirra JM, Gold R, Downs I, Eckardt II. A New Histologic Approach lD The differentiation of Enchondroma and

Chondrosarcoma of the Bones. A OinioopathoiQS.IcAnalysis of 51 Cases. Clin Ortloop 1985; 201: 214·237. Noble J, Lamb OW. Enchondromata of Bones oft he Head. A Review of 40 Cases. HIJIId 1974; 6: 275·284. Dahlin OC. Salvador AH. Olondrosarcomas of Bones of the Hands aod Fee~ A Study of30 ~. Ct»tUr 1974; 34: 755·

760.

CASE NO. 9, ACCESSION NO. 27627

INlAND QUYERSIDE/SAN BERNARDlNO) - Fibrous hamartoma of infancy {4) ORANGE - Fibrous hamartoma (2); Fibromyxolipoma (I) BA.KERSFIELD (Central Valley Study Group) - Fibrolipomatous hamartoma PLEASANTON/FREMONT - Infantile fibromatosis {fibroblastic type) (6) LONG BEACH - Fibrous bamartom1 of infancy (8)

OCTOBER 1996

SAN DIEGO (Naval Medical Center) - Upoblastoma, benign (14); Fibrous hamartoma of infancy (2) SANTA BARBARA CSt. Francis Med Ctrl - Lipoblastoma (3) SANTA BARBARA (Canace Hosoil!!l - Fibrous hamartoma of infancy VENTURA IUnilab) - Fibrolipom1 SANTA ROSA - lnfantile·fibromatosis, mesencbymal/di!Tuse type (J) BAY AREA - Hamartoma of infancy {benign mesenchymal proliferation) (3) SAN JOSE <Loma Priet• Group) - Upoblastoma (6) SACRAMENTO cue D!lviS Med Ctrl - Fibrous hamortoma of infancy NEBRASKA (Creighton University) - FibrolipomaJhanurtoma M!SSISSIPPI @apti~t Med Or) - Lipoblastoma FLORIDA Q'alla bassecl • Infantile {ibromatosis MARYLAND @ethe&da Naval Med Qr) - Lipoblastoma (10) MASSACHUSEITS <Berkshire Med Qrl - Lipoblastom1tosis NEW YORK Omoath Study Group) - Fibrous hamartoma (4) MAINE - Infantile fibromatosis (4)

N!!W HAMPSHIRE (Manchester) - Fibro!ipoma (1) Benign lesion (t:ibrolipomyxoma) NEW JERSEY <Overlook Hospital Summit) • Lipoblaslomosis (1); Hamartoma (1); Fibrous hamartoma of

infancy (1) CONJI!ECI1CUT CUnjv of Conn) - Infantile fibrous hamartoma ARIZONA CVA Medical Center) - Lipoblastoma AUSTRALIA (Sydney Group) - Lipoblastomatosis

DIAGNOSIS:

LIPOBLASTOMA, LEFT PARASI'INAL U8810/M96303

REFERENCR'l: Bolen IW, Thomigi>. Benign Lipoblascoma and Myxoid uposarmma. A Olm(»rative ugbt and Elcclron-Microsoopic Study.

Ami Surg Pm/oc/1980; 4: 163·174. Coffin CM. Lipoblastoma. An Embryonal Tumor of Soft Tissue Related to Organogenesis. &min Diag Patho/1994;

11:98·103. Mentzel T. Calonje R. Pletcher COM. Upoblastoma and upoblastomatosis. A Clinicopatbologie Srudy of 14 Cases.

HiMopatho/ogy 1993; 23: 527-533. O>ung EB, Enzinge< FM. Benign upoblastomatosis. Can«r 1973; 32; 482-492.

CASENO. 10, ACCESSIONNO. 18176

INlAND <RIVERSIDE/SAN BERNARDINO) - Large cell lymphoma (4) ORANGE - Malignant lymphoma, diffuse large cell (4) BAKERSFIELD (Central Valley Study Group) - Diffuse large. cell lyinphorila PLEASANTON/FREMONT - Malignant lymphoma, diffuse, .large cell (6) LONG BEACH - Diffuse large cell B-ceU lymphoma (intermediate grade) (8) SAN DIEGO CNavat Medical Center) - Diffuse large B-celllymphoma (16) SANTA BARBARA (St. Francis Med Ctr) - Non-Hodgkin's lymphoma (3) SANTA BARBARA(Cottage Hospital) - Large B-celllymphoma VENTURA !Unilab) - Malignant lymphoma (2) SANTA ROSA - Lymphoma (large oell) (3) BAY AREA - Lymphoma, diffuse, small cleaved cell (B-cell) intermediate grade (3) SAN JOSE <Lorna Prieta Group) - Lymphoma, large cell type (6) SACRAMENTO (UC Davis Med Ctr) - Non-Hodgkin's lymphoma, large cell, B NEBRASKA (Creighton University) - Diffuse large cell lymphoma MISSISSIPPI <Baptist Med Or) - Malignant lymphoma large cell polymorjlhous FLORIDA Cfallhassee) - Diffuse large cell lymphoma MARYLAND <Bethesda Naval Med Or) - Diffuse B-celllymphoma (10) MASSACHUSE'ITS <Berkshire Med Ctr) - Lymphoma, diffuse large cell type NEW YORK Ompatb Study Group) - Malignant lymphoma, large cell, B-cell (4) MAINE - Large cell lymphoma (4)

NEW HAMPSHIRE <Manchester) - Malignant lymphoma (2) NEW JERSEY (Overlook Homilal Summit) - Large cciiJymphoma (4) CONNECTICUT !Univ of Conn) - Inununoblastic high-grade lymphoma

OCTOBER1996

ARIZONA <VA Medical Center) - Malignant lymphoma, large ceU, high grade, B-cell type AUSTRAUA (Sydney) - Malignant lymphoma, large B-cell (high grade MAL 1)

DIAGNOSIS:

DIFFUSE lARGE JI.CELL LYMPHOMA, RIGHT THYROID T96100/M9S903

REFERENCilS: Uollema H, and Poppema Sibrand. lmmunophenotypes of Malignant Lymphoma. Centroblastic-Centrocytic and Malignant

Lymphoma Ccntrocytic. An Immunohistologic Study lndicali~g a Derivation From Different Stages ofB-Cell Differentiation. Hum Patho/1988(1~) 9:1053-1059. _

Sbiota M, Fuji100to J, Takenaga M. et al. Diagnosis of t(2;S)(p23;q35)--Associated Ki-1 Lymphoma with •lmmunobisloChemistry. Blood 1994; 84:364S.3652.

Chan KC (Commentary) . bcl-6 Gene Aberrntions. The CUlprit of Diffuse Large B-cell Lymphoma. Adv in Anat Patho/1995; 2(3),153-158.

Deverell M,Salisbury J. Nuclear Morpbomelry of Primary B-Cell Thyroid Lymphoma. Patlwl Res Pract 1992; 188 ( 4-5): 500-503.

CASE NO. 11, ACCESSION NO. 25370

(Additional material from Case #7 of September, 1996 Study Set)

INI.AND CRIVERSIDP./SAN BERNARDINO) - carcinosarcoma (3); Glandular Triton tumor (1) ORANGECSt. Joseph Hospital! - Malignant neoplasm with epithelial and rhabdoid featlltt$ (4) BAKERSFIElD CCentrnl Valley Study Group) - Metastatic adenoCarcinoma Pl.llASANTQN/FREMONT - MMMTwith heterologous elements (6) LONG BEAOi • carcinosan:oma (8)

OCTOBER 1996

SAN pmGO (Nayal Me<Jical Ceoterl - Adenocarcinoma with san:omatous metaplasia (5); carcinosarcoma (5); Collision rumor (prostaticiOdenocarcinoma with sarcoma, NOS-5

SANTA BARBARA CConaae Hospital) - Pleomorphic rhabdomyosarcoma with metastatic adet~ocarcinoma (lung, Gl) VENTIJRA CUnilab) • carcinoid/carcinoma (1); carcinoid (1) SANTA ROSA • carcinosarcoma with rhabdoid features, vs metaplastic carcinoma with rhabdoid features (1); PrObably

metas!Jitic prootate carcinoma (1); Metastatic-carcinoma oonsistentwith prostate vs carcinosarcoma vs collision tumor BAY AREA - Sarcomatoid(metaplastic) ca.einoma, metastatic(3) SAN JOSE IJ..oma Prieta Group) Metastasis with carcinoid and rhabdoid element (5); Metastatic saroomatous renal carcinoma

with carcinoid-like elements (I) SAGRAMENJO CUC Davis Med Ctrl - carcinosan:oma NEBRASKA (Qpjghton Unjvmjly) - Carcinosan:oma MISSISSIPPI (Baptist Med Qr) - Pulmonary blastoma FLORIDA (Tallahassee) - Sarcomatoid carcinoma MARYlAND (Bethesda Naval Med Ctrl - carcinosan:oma (6); Synovial sarcoma ( 4) MASSAOIHSETfS (Ber!sshire Med Orl • carcinosarcoma NEW YORK Ompath Study Grouo> • Carcinosarcoma (4)

MAINE - Rhabdoid tumor with mctaslalic adenocarcinoma (4) NEW HAMPSffiRR (Manchester) - Biphasic malignant neoplasm (1); Metastatic poorly differentiated adenocarcinoma

consistent with rhabdoid features (I) NEWJEBSEY (Overlook Hospital Summit) • carcinosan:oma (mixed endometrioid and rhabdomyosarcoma) (4) CONNECJJCUT IUniv of Conn) - Metastatic adenocarciooma consistent with prostate primary ARIZONA IVA Medjg l Qnter) - carcinosarcoma AUSTRAUA (Sydney Group) - carcinosarcoma

DIAGNOSIS:

CARCINOSARCOMA WITH GlANDULAR AND "RHABDOID" COMPONENTS, CIIEST WALL TY2100/M89803

FOLLOW-UP: Twelve hours following the resedion o[ the rumor the patient went into sudden uncontrolled bleeding episodes at the

thorncotomy site. The patient expired and no autopsy was performed.

REFERENCES: Cbase DR. Rhabdoid vs Epithelioid Sarcoma (letter to Editor). Am J Surg Pat/w/1990; 14:792. Kndet R, Newtoo WA, et a!. Rhabdoid Tumors of Soft Tissues. A Oinicopathological Study of26 cases Enrolled in the

Intergroup Rhabdomyosarcoma Study. JfumPatlwl !g91; 22:674. Tsuncyoshi M, et a!. The existancc o[ Rhabdoid Cells in Specified Soft Tissue Sarcomas. Histopathological, Ultrastructural

and lmmuoohistochemical Evidence. Virc/wwsArdl (Palho/Anat) 1987; 4II.

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