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CALIFORNIA TUMOR TISSUE REGISTRY

California T11mor Tissue Registry c/o: Department of Pathology and Human Anatomy

Loma Linda University SdJool of Medicine 11021 Campns Avenue, AH 335 Loma Linda, California 92350

(909) 824-4788 FAJ{: (909)478-4188

E-mail: cttr@linldine.com

Target audience: Practicing pathologists and pathology residents.

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

Objective: . 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.

Princiru!l faculty: Weldon K. Bullock, MD Donald R Chase, MD

CME Credit: The CTTR designates this activity for up to 2 hours of continuing medical education. Participants must return their 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: Kenneth Frankel, M.D. CASE NO. 1 - FEBRUARY 1998 , Covina, CA

TISSUE FROM: Right back ACCESSION #23417

CLINICAL ABSTRACT: This 50-year-old female presented with a mass on the right back, which was removed.

GROSS PATHOLOGY: The specimen was a 8.0 x 5.3 x 1.7 em irregular-shaped piece of pink-tan tissue, having a finn

white cut surface.

CONTRIBUTOR: Lorna Linda Pathology Group (dre) CASE NO. 2 - FEBRUARY 1998 Lorna Linda, CA

TISSUE FROM: Left perineal ACCESSION 1#28248

CLINICAL ABSTRACT: This 41-year-old fuma1e presented with a two-month history of a lump on the inner thigh. An

excisional biopsy was perfurmed.

GROSS PATHOLOGY: The specimen consisted of an 8.3 x 4.5 x 3.5 em portion of yellow-tan, lobular, soft tissue

surmounted by a 5.5 x 2.1 em ellipse of brown wrinkled skin with central. 0.5 em suture-bearing scar. The cut surface showed a well-circumscribed, 3.6 x 3.3 x 3.0 em tan, multilobular mass.

CONTRIBUTOR: Loma Linda Pathology Group (drc) CASE NO.3 • FEBRUARY 1998 Loma Linda, CA

TISSUE FROM: Right foot ACCESSION #28123

CLINICAL ABSTRACT: This 27-year-old malo presented with pain in the right foot since ago 12. CT scan showed a

suspicious mass on instep of the right foot.

GROSS PATHOLOGY: The specimen was a 176 gram, 13.5 x 9.5 em amputated foot. The soft tissues were infiltrated

by a 4.5 x 2.0 x 4.0 em multinodular firm white-tan tumor with poorly defined borders.

SPECIAL STUDIES: EMA CAM5.2

2+ positive Trace positivity

CONTRIBUTOR: EDen Ko, M.D. Los Angeles, CA

TISSUE FROM: Left thigh

CLINICAL ABSTRACT:

CASE NO. 4 • FEBRUARY 1998

ACCESSION #28234

This otherwise healthy 78-year-old male was noted to have a left thigh mass by his girlfriend. Following biopsy, a radical excision of the left thigh mass was performed.

GROSS PATHOLOGY: The 640 gram specimen was 21.0 x 11.5 x 5.0 em. Located in the muscular layer, 2.0 em deep

to the skin surface, was a 6.0 x 4.5 x 3.5 em, well-circumscn"bed, oval mass. Serial sections showed a multilobulated, ge)atinous, myxoid neoplasm traversed by fibrous septa There were focal ateas of necrosis and extensive hemorrhage.

SPECIAL STUDIES: Vunentin S-1 00 protein

Strongly positive Weakly positive

, CONTRIBUTOR: Mark Janssen, M.D. CASE NO. 5 - FEBRUARY 1998

Anaheim, CA

TISSUE FROM: Left gluteal ACCESSION #281.54

CLINICAL ABSTRACT: A 57-year-old Caucasian female presented with lump in the left gluteal region which gradually

became somewhat tender. When patient began to have accompanying back pain, she sought fi.u1her medical care. The mass was removed.

GROSS PATHOLOGY: The specimen consisted of three pieces of tissue, 1.3 x 1.0 x 0.2 and 1.5 x 1.5 x 0.5 and 6.0 x

3.5 x 1.5 em. The largest piece was an ovoid mass of translucent pale pink tissue, which, on cut surfuce, exuded mucin-like materiaL

CONTRIBUTOR: Mark Seifert, M.D. CASE NO.6 - FEBRUARY 1998 S~n Bernardino, CA

TISSUE FROM: Right ankle ACCESSION #28041

CLINICAL ABSTRACT: This 22-year-old Caucasian female presented with an enlarging mass in the right ankle for six

months. The mass became increasingly painful on ambulation. An excision was performed.

GROSS PATHOLOGY: The 200 gram specimen was 12.0 x 9.5 x 3.9 em. The specimen was mainly composed of a 7.0

x 6.3 x 3.9 em well-demarcated ovoid tumor. The tumor was solid gelatinous, dark red or necrotic, with foCal viable I)lyxoid, light gray glistening zones. There were also multicystic areas with cleft-like spaces up to 2.5 em in diameter.

SPECIAL STIJDIES: Vimeiltin S-100 Cytokeratin Actin EMA

Positive Positive Negative Negative Negative

CONTRIBUTOR: Anthony Migler, M.D. CASE NO. 7 - FEBRUARY 1998 Oxnard, CA

TISSUE FROM: Right caH ACCESSION #28237

CLINICAL ABSTRACT: This 41-year-old male presented with a 2-year history of progressive enlargement of the right

cait; with recent onset of pain. MRI showed extensive displacement of the muscle with tumor extending tbrough the entire cal£ An open biopsy was perfonned.

GROSS PATHOLOGY: The specimen consisted of amorphous portions of lobulated grayish-tan soft tissue that

measured from 3 mm to 3.0 x 1.4 x 1.0 em.

SPECIAL snmms: Keratin Negative

CONTRWUTOR: William Wetzel, M.D. CASE NO. 8 - FEBRUARY 1998 Jackson, MS

TISSUE FROM: Supraclavicular lymph node ACCESSION #27963

CLINICAL ABSTRACT: A 19-year-old female presented with chest pain, pleural effusion and lung opacification. Pelvic

sonogram and CT scan suggested abnormal soft tissue densities along the right and left diaphragm, principally on the side of the thoracic cage. Nodularity was noted on the diaphragmatic abdominal portion of the scan. Retroperitoneal lymphadenopathy surrounded the aorta. Enlarged nodes were also noted inferiorly in. the retroperitoneal space. Moderate ascites was also noted with thickening and caking along the anterior omentum and mesentery. There was also a soft tissue mass in the pelvis anteriorly with enlarged lymph nodes noted in the intemal and extemal iliac chain. A supraclavicular node biopsy was performed.

GROSS PATHOLOGY: The spec~ was a 5.0 em diameter irregular mass of soft friable pink tissue with a fleshy pink

cut surface.

SPECIAL STIJDIES: Vimentin Desmin Leukocyte common antigen Ki-1

Strongly positive Weakly positive Negative Negative

CONTRIBUTOR: Henry Slosser, M.D. CASE NO. 9 • FEBRUARY 1998 Pasadena, CA

TISSUE FROM: SmaU bowel ACCESSION #27964

CLINICAL ABSTRACT: This 64-year-old female presented with symptomatic left lower quadrant lump associated with

pain and vomiting. Past medical history was significant for a malignant melanoma, Stage IIII, of the · right calf eleven years earlier, basal cell carcinoma on the left cheek and mitral valve prolapse diagnosed

eleven years earlier. Physical examination of the abdomen confirmed a bard lump in the left lower quadrant. with one point of tenderness. An exploratory laparotomy and partial small bowel resection were performed.

GROSSPATHOLOGY: . The specimen consisted of 48 em of kinked loops of small intestine, with dense adhesions to

several large palpable firm masses. There were multiple submucosal nodules comprised of white firm tissue that appeared to be either smooth muscle or fibrous tissue, intermixed with some .fill. The largest nodule measured 5.5 em. Others averaged 4.0 em in greatest dimension. In the attached mesentery, nodules merged into a continuous mass.

SPECIAL STUDffiS: Vimentin Keratin Desrnin Actin S-100 HMB-45 CD-34 CD-68 LCA

4+ positive Negative Negative Negative Negative Negative Negative Negative Negative

CONTRIBUTOR: Loma Linda Pathology Group (bhf).CASE N0 .10 - FEBRUARY 1998 Loma Linda, CA

TISSUE FROM: Left para pharyngeal tissue ACCESSION #27943

CLINICAL ABSTRACT: 'A 46-year-old white female presented with an 8·week history of a slowly enlarging neck mass.

It was otherwise asymptomatic. The mass was removed.

GROSS PATHOLOGY: The specimen was a 3 gram, 2.5 x 1.0 em yellow-tan nodule with an attached 4.0 x 0.3 x 0.2 em

red-tan stland of tissue. The cut surfuce of the nodule was homogenous, white, and mucinous.

CALIFORNIA TUMOR TISSUE REGISTRY

MINUTES

FOR

FEBRUARY 1998

SOFT TISSUE PATHOLOGY

SUGGESTED READING (Geoenll Topics from Recent Utenoture):

Rennie, J and Rusting R Making Headway Against Cancer. Sciemific American; September 1996: 56-70. Bridge JA. Cun-ent Concepts Review. Cytogenetic and Molecular Cytogenetic Techniques In Orthopaedic

Surgery. The Journal of Bone and Join/ Surgery 1993; 75A(4): 606-61 4. Wrig)lt-Browne V, McClain KL, Ordonez Nand Estrov Z. Physiology and Pathophysiology of Dendritic

Cells. Human Patho/1991; 28(5): 563-579. Cunningham JD, Aleali R. Aleati M, Brower STand Aufses AH. Malignant Small Bowel Neoplasms.

Histopathologic Determinants of Recurrence and Survival. Annals of Surgery 1997; 225(3}: 300-306. Kinne DW, Chue FCH, Huvos, et al. Trealment of Recurrent Retroperitoneal Liposarcoma. Twenty-Five

Year Experience at Memorial Hospital. Cancer 1973; 53-64. Turbett GR aod Sellner LN. A comprehensive Guide to Pathology Resources Available oo the Internet Adv

lnAnat Patho/1996; 3(5): 313-335.

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

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

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

E-mail: ctlr@linklioe.com

CASE NO. I, ACCESSION NO. 23417

INLAND (RiversidefSan Bernardino) - Elastofibroma (3). LOS ANGELES <UCLA Fellows) - Elastofibroma, PALM SPRINGS <Desert Hoopjtal} - Angiofibrolipoma. BAKERSFfELD (Cen!ral Valley) - Elastofibroma. SACRAMENTO <UC Davis) - Elastofibroma (5). SAN DfEGO (Naval Medical Centcrl - Elastofibroma (13).

LONG BEACH - Elastofibroma (6). BAY AREA - Elastofibroma (3). SANTA ROSA - Elastofibroma (dorsi) (3). OAKLAND (Kaiser) - Elastofibromo. NEVADA (Reno) - Elostofibroma (2). WVOMTNQ - Extra-abdominal desmoid'tumor. MICHIGAN (Oakwood Hospital} - Elastofibroma. NEBRASKA (Creighton University) - Elastofibroma. FLORIDA (Tallahassee) - Elastofibroma dorsi (4).

MARYLAND CBelhesda Naval Medical Center) - Elastofibroma (13). MARYLAND (Sinai Hospital} - Elostofibroma. NEW HAMPSHIRE (Manchester) - Elastofibroma. NEW YORK fimpath) - Ela.stofibroma (4).

NEW YORK CNorthoortl - Elastofibroma. NEW JERSEY (Overlook Hospital Summit) - Elasto.fibroma (3).

MAINE - Elastofibroma. CQNNECTICUT <Univ CT Health Ctrl - Elastofibroma. AUSTRALfA (Sydney) - Elastoflbroma.

DIAGNOSIS:

ELASfOFIBROMA, BACK TY2200, M88100

RfifERENCES:

FEBRUARY 1998

Nogllmlne N, Nohara Y and Ito E. Elnstofibroma in Okinawa A Clinicopathologic Study. of I 70 C.Se.;. Cancer 1982; SO: 1974-1805.

Kum8111tilake JS, Krishnan R, l..on)ax-Smith J, et al. Elastofibroma. Disturbed Elastic Fibrillogenesls by Periosteal Derived Cells? An lmmunoelectron Microscopic and ln·Siru Hybridll'lltion Srudy. Hum Patho/1991 ; 22: 1017-1029.

Naylor MF, Nascimento AG, Sherrick AD and McLeod RA. Elastofibroma Dorsi. Radiologic Findings in 12 Patients. AJR AmJ Roentgenol (United Stlues), Scp 1996; 167(3): 683-687.

Hoffinan JK. Klein MH and Mcinerney VK. Bilateral El:mofibroma. A Case Repon and Review of the Ut<:r.lhln:. Clin Orthop (United StaleS) Apr 1996; 325: 245-250.

CASE NO. 2, ACCESSION NO. 28248 FEBRUARY 1998

INLAND (Riverside/San Bernardino) . Proliferative myositis (I); proliferative (nodular) fasciitis (2).

LOS ANGELES CUCLA Fellows) - Proliferative fasciitis. PALM SPRINGS (Desert Hosoital) - Myxoid fibrous histiocytoma. BAKERSFIELD (Central Valley) - Nodular fasciitis. SACRAMENTO CUCDavisl - Nodular fasciitis vs. proliferative myositis (5). SAN DIEGO (Naval Medical Center) - Nodular fasciitis (13). LONG BEACH - Nodular faseiitis (6). BAY AREA - Fibrous histiocytoma (3). SANTA ROSA · Proliferative myositis (3).

OAKLAND (Klliser) - Nodular fasciitis. NEVADA (Reno) - Nodular fasciitis (2).

WYOMING - Nodular fasciitis. MICHIGAN (Oakwood Hospital) - Nodular fasciitis. NEBRASKA <Creighton University) - Benign spindle cell neoplasm, favor fibrous histiocytoma. FLORIDA <Tallahassee) - Nodular fasciitis (4).

MARYLAND <Bethesda Naval Medical Center) - Nodular fasciitis (13). MARYLAND (Sinai Hospital) - Nodular faseiitis. NEW HAMPSHIRE (Manchester) - Nodular fasciitis. NEW YORK (lmpath) - Nodular faseiitis (4).

NEW YORK (NonbJXrt) - Nodular fasciitis. NEW JERSEY <Overlook Hospjtnl Summit) - Nodular fasciitis (2); Pseudosarcoma (I). MAINE - Nodular fasciitis. CONNECTICUT CUniv CT Health Ctrl - Nodular fasciiiis. AUSTRALIA CSydnevl - Nodular fasciitis.

DIAGNOSIS:

NODULAR FASCDTlS, PERINEAL REGION Tl8181, M76130

REFERENa'.S: Weiss SW. Prolili:ralive fibrobluic Lesions. From Hyperplasia to Ncaplnsia. Am J Surg Poth<>/1986; 10 (suppl) 14-

21. WinnanJA. Nodulur Fasciitis, a Lesion ofMyofibroblosb-An Ultra•trucl\trlll Study. Cancer 1976; 38: 2378·2389. Bernstein K. Lottes R. Nodulur (l'seudooaroomatous) Fasciitis, a Non·Recum:nt Lesion. Clinicopa~Jologic Study of 134

Cases. Canctr 1982; 49: 1668-1678. O'Connell JX. Young RH. Nielsen 0', ct al. Nodular Fasciitisofthe Vulva. A SludyofSix Cases and l..itmnure

Review. lntJGyneco/Pathoi(UnitedStates) 1997; 16(2): 117-123.

CASE NO. 3, ACCESSION NO. 28123 FEBRUARY 1998

INLAND (Riverside/San Bernardino) - Synovial sarcoma {I); Monophasic fibrous synovial sarcoma (2). LOS ANGELES CUCLAl - Monophasic synovial sarcoma. PALM SPRINGS (Desert Hospital) - Malignant fibrous histiocytoma. BAKERSFIELD (Central Valley) - Spindle cell sarcoma (probably synovial). SACRAMENTO cue Davis) - Synovial sarcoma, monophasic (5).

SAN OJ EGO (Naval Medical Center) - Synovial sarcoma, monophasic (I 3). LONG BEACH - Synovial sarcoma (6). BAY A REA - Synovial sarcoma, monophasic (3). SANTA ROSA - Consistent with monophasic, fibrous synovial sarcoma (malignant) (I}; Synovial sarcoma

(2). OAJ<LAND (Kaiser) - Synovial sarcoma. NEV APA (Reno) - Synovial sarcoma (I); Synovial sarcoma, mooophasic type (I). WYOMING - Monophasic synovial sarcoma. MICHIGAN - Synovial sarcoma, monophasic. NEBRASKA (Creighton University) - Synovial sarcoma, monophasic fibrous type.

FLORIDA <Tallahassee) - Monophasic synovial sarcoma (4).

MARYLAND <Bethesda Naval Medical Center) - Monophasic synovial sarcoma (13). MARYLAND (Sinai Hospital) - Monophasic synovial sarcoma. NEW HAMPSHIRE (Manchester) - Epithelioid sarcoma. NEW YORK Omoath) - Synovial sarcoma (4).

NEW YOR!( <Northport) - Synovial sarcoma. NEW JERSEY <Oycrlook Hospital Summit) • Synovial sarcoma (monophasic) (3).

MAINE - Synovial sarcoma. CONNECTICUT CUniv CT Health Ctr) - Synovial sarcoma, monophasic. AUSTRALIA <Sydney) - Synovial sarcoma.

DIAGNOSIS:

MONOPHASiC SYNOVIAL SARCOMA, RJCHT FOOT TY9700, M90403

REfERENCES: Clark J. Rocques PJ, Oew AJ, ctal. ldentiJication of Novel Genes. SYT and SSX,Involved in the t (x; l8) (pll.2q-

112.2) Translocation Found in HWIUUl Synovial Sarcoma. Nat Gtnet 1994; 7: 502-508. Shipley J. Crew J. Birsall S, ct al. Interphase In-Situ Hybridization and Reverse Transcription Polynterasc Chain

Reaction"' a Diagnostic Aid fur Synovial Sarooma. Am J Pat!rolog;y 1996; 148: 559-567. Viguer JM, Jimcnez.Hc!Tennan JA. Vicandi B, et al. CytoloJ!ic Features of Synovial Sarcoma with Emphasis on the

Monophasic Fibrous Variant. A Morphologic and Immunohistochemical Allalysis ofbcl-2 Protein ExprC$Sion. Cancer Cytolog;y 1998; 84(1): 50-56.

Guillou L. Coindre J-M, Bonichon F, Bui NU, Terrier P, ct ol. Compamtive Study ofthe National Canoer Institute and Frencll Fcdemtion of Cancer Centers Sarooma Groop Orading SysJcms in a Population of 410 Adull Pnlicnt wilh Soft Tissue Sarooma. J ofC/in Onco/1997; 15(1): 350-362.

CASE NO. 4, ACCESSION NO. 28234 FEBRUARY 1998

INLAND (Riverside/San Bernardino) - 010ndroma wich myxoid change(!); Myxoid chondrosarcoma, extraskeletal (2).

LOS ANGELES (UCLA fellows) - Extraskele!al myxoid chondrosarcoma. PALM SPRINGS <Desert Hospital) - ExtraskeleUtl chondrosarcoma. BAKERSFIELD(Cen!J'l!l Valley) - Myxoid sarcoma (Probably myxoid chondroma). SACRAMENTO CUC Davis) - Liposarcoma, myxoid variant (5).

SAN DIEGO (Naval Medical Center) - Myxoid chondrosarcoma (13).

LONG BEACH - Extraskeletal myxoid chondrosarcoma (6). BAY AREA - Exiraskele!al myxoid chondrosarcoma (3). SANTA ROSA - Extraskeletal myxoid chondrosarcoma ( I); Myxoid chondrosarcoma vs. myxoid

liposarcoma (2).

OAKLAND (Kaiser) - Extraskele1al myxoid chondfosarcoma. NEVADA (Reno) - Chondrosarcoma (I); Extraskeletal chondrosarcoma (I). WYOMING - Extraskeletal myxoid chondrosarcoma. MICHIGAN - Myxoid chondrosarcoma. NEBRASKA (Creighton University) - Extraskeletal cllondrosarcoma. FLORIDA (Tallahassee) - Extraskelelal myxoid chondrosarcoma (4). MARYLAND (Bethesda Naval Medical Center) - Extraskeletal myxoid chondrosarcoma (13).

MARYLAND (Sinai Hospital) - Myxoid chondrosarcoma. NEW liAMPSHIRE (Mancllester) - Myxosarcoma. NEW YORK Om oath) - Myxoid cllondrosar(X)IJ)a (4). NEW YORK <Northport) - Extraskeletal myxoid chondrosarcoma. NEW JERSEY <Overlook Hospital Sllmmit) - Extraskeletal myxoid chondrosarcoma (3). MAINE - Extraskeletal myxoid chondrosarcoma (chordoid sarcoma). CONNECTICUT CUniv CT Health Ctr) - Extraskeletal myxoid chondrosarcoma. AUSTRALIA (Sydney) - Chondrolipoma.

DIAGNOSIS:

EXTRACELLULAR MYXOID CHONDROSARCOMA, THIGH TY9100, M92203

REFERENCES: Sawyer JR, Swanson CM, Lukacs JL, c:t Ill. Evidence of an Association Bc:twcen 6q 13-21 Chromosome Abcrrtlli011S and

Locally i\ggrC$$ive lld!avior in PBlic:t!lS with Canila~~t Tumors. Canctr 1998; 474483. Martin RF, MelnickPJ, Womer NE, Teny R, Bullock WK and Schwinn CP. Chonloid Sarcoma. Am J Clin Pothol

1973; 59: 623~35. Salek Y, Evans FIL, Ro JY, et Ill. Extraskeletal Myxoid Chondrosarcoma. A Clinicopathologic Study ofTen Patients

with Long-Term Follow-Up. Conctr 1992; 70: 2827-2830. Soz:zi G, Minoletti F. Mlo>20 M. Sard L, Musso K. Azzarelli A, Pieroni MA, ct al. Relevance of Cytogenetic Wld A~t ln-Silllliybridizalion Amll}lCS in the Clinical Assessment of Soft Tissue Sarcoma. Hum Pothol Feb 1997; 28(2): 134-142.

Oordick I, Lagace R, Cattier MT and Jung RC. Chondoid Sarcoma (E.'<ll':!Sktletal Myxoid Chondrosarcoma). A Light and Election Microscopic Study. Vlrcllows Arch (A) 1983; 399: 61-78.

CASE NO. 5, ACCESSION NO. 28154

INLAND (Riverside/San Bernardino) - Intramuscular myxoma (3). LOS ANGELES <UCLA Fellows) - Intramuscular myxoma. PALM SPRINGS (Desert Hospital) - Chondromyxofibroma. BAKER5FIBLD (Central Yalley) - Myxoma. SACRAMENTO CUC Davis) - Intramuscular myxoma (5). SAN DIEGO <Naval Me!lical Center) - Intramuscular myxoma (13) LONG BEACH - lnll1lmuscular myxoma (6). BAY AREA - lnll1lmuscu!ar myxoma (3). SANTA ROSA - Intramuscular myxoma (2); Intramuscular lipoma (I). OAKLAND CKaiser) - Myxoma. NEVADA <Reno) - Intramuscular lipoma (2). WYOMING - Myxoma. MICHIGAN - lnll1lmuscular myxoma. NEBRASKA (Creighton University) - Intramuscular myxoma. FLORIDA (Tallahassee) - Aggressive angiomyxoma ( 4).

MARYLAND @e!hesda Naval Medical Center) - Intramuscular myxoma (13). MARYLAND (Sinai Hospital) - Myxoma. NEW HAMPSHIRE (Manchester) - Myxoma. NEW YORK Clmooth) - Intramuscular myxoma (4).

NEW YORK (Northpon) - Intramuscular myxoma. NEW JERSEY (Overlook Hospital Summit) - Intramuscular myxoma (3).

MAINE - Intramuscular myxoma. CONNECTICUT (Univ CT Health Ctr) - Intramuscular myxoma. AUSTRALIA CSvdnev) - Intramuscular myxoma.

DIAGNOSIS:

INTRAMUSCULAR MYXOMA, LEFf GLUTEAL REGION TV9001, M88400

REFERENCES:

FEBRUARY 1998

Caraway NJ>, Stacrkel GA. Fnnning CV, Varma DG and Pollock RE. Diagnosing Intramuscular Myxoma by Fine> Needle Aspiration. A MultidisciplinarY Approach. Dlagn Cytopothol (United Sbllcs) 1994; 11(3): 255-261.

Schwartz liA and Walker R. R=gnizable Magnetic ResonllJ'Ioe Imaging Characceristics of Intramuscular Myxoma. Orth~dics (United Swes) 1997: 20(5): 431-435.

Eozinger FM. Intramuscular Myxoma. A Review and Follow-Up Studyof34 Cases. Am J Clin Patho/1%5; 43: 104-113.

Klndblom L-G, Stener B and Angervall L Intramuscular Myxoma. Cancer 1974: 34: 1737-1744. Miettinc:r M, et al. Intramuscular Myxoma--A Clioicopatllologic Studyof23 Cases. Am J C/in Pat hoi 1985; &4: 265-

272.

CASE NO. 6, ACCESSION NO. 28041 FEBRUARY 1998

INLAND (Riverside/San Bernardino) - Myxoid chondrosarcoma (I); Extraskeletal mesenchymal chondrosarcoma (2).

LOS ANGELES (UCLA Fellows) - Schwannoma with degenerative changes (5); Benign vascular lesion (1); Epithelioid hemangioendothelioma (1).

PALM SPRINGS CDeser1 Hosoitall - Myxoid chondrosarcoma. BAKERSFIELD (Central Valley) - Synovial sarcoma (monophasic). SACRAMENTO <UC Davis) - Neurofibroma with minority opinion schwannoma (S). SAN OTEGO <Naval Medical Center) - Hemangiopericytoma (12); Synovial sarcoma ( I). LONG BEACH - ExtraskeleW mesenchymal choodrosarooma (6). BAY AREA - Myxoid chondrosarcoma (cannot rule out peripheral nerve sheath rumor) (3).

SANTA ROSA - Extraskeletal myxoid chondrosarcoma vs chondroblastoma (1 ); Clear cell sarcoma (1); Choodroblastoma vs Clear cell sarcoma ( 1). _

OAKI.AND (Kaiser) - Extraskeletal myxoid chondrosarcoma NEVADA <Reno) - Myxoid chondrosarcoma (2).

WYOMING - Clear cell sarcoma. MICHIGAN - Mesenchymal chondrosarcoma. NEBRASKA <Creistuoo Univmjty) - Hemangiopericytoma !LORIDA (Tallahassee) - Ossifying fibromyxoid rumor of soft tissue (4).

MARYLAND <Bethesda Naval Medical Center) - Schwannoma, degenerated (13).

MARYLAND (Sinai Hosoital) - Mesenchymal chondrosarcoma. NEW HAMPSHIRE {Manchester l - Clear cell sarcoma of soft tissue. NEW YORK Qmpath) - Nerve sheath myxoma. NEW YORK (Northport) - Synovial chondrosarcoma. NEW JERSEY (Oyer look Hospital Summit) - Hemangiopericytoma (benign) (3).

MAINE - Cellular scbwannoma. CONNECTICUT <Univ CI' Health Ctrl - Round cell liposarcoma. AUSTRALIA (Sydney) - Exll'askeletal myxoid chondrosarcoma.

DIAGNOSIS:

OSSIFYING FIBROMYXOID TUMOR OF SOFT PARTS (NON-OSSIFYING VARIANT). RIGHT ANKLE TY9500,M88900

CONSULTATION: James Woodruff, M.D. Memorial Sloan-Kettering Cancer Institute, New York. ''OssifYing Fibromyxoid Tumor of Soft Parts."

REf'ER!lNCES: Walling AK and Onsser SL Soft Tissue and Bone Tumors About the Foot and Ankle. Clln Sports Med (United SUlles)

1994; 13(4): 909-938. Enzillacr EM, Wei" SW and Uana CY. Ossif)'ina Fibromyxoid Tumor of Soft Parts. A Oinicoanalysis of S9 Cases.

Am J Surg Path 1989; 13(1 0): 817-f/27. Micuiner M. Ossizylng Fibromyxoid Tumor of Soft Parts. Additional Observations of a Distinctive Soft 1issue Tumor.

AmJC/in Patholl99l;95: 142-149. Schofield JB, ct al. OssifYing l'ibromyxoid Tumour ofSof\ Pans- Immunohistochemical and Ultrastructural Anal)~is of

a Series. Histopathology 1993; 22: 101-1 12

CASE NO. 7, ACCESSION NO. 28237 FEBRUARY 1998

rNLAND (Riverside/San Bernardino) - Liposare<>ma (myxoid- round cell) (l); Hemangiopericytoma, aggressive type (I); Malignant hemangiopcricytoma ( 1 ).

LOS ANGELES <UCLA Fellows) - Myxoid liposare<>ma and round ccllliposare<>ma (4); Alveolar rhabdomyosarcoma (I); Hemangiopericytoma (1).

PALM SPRINGS 0?esert Hosnital) - Myxoid chondrosareoo~a. BAKERSFIELD (Central Valley) - Liposarcoma. SACRAMENTO (UC Davis) - Liposarcoma, ro~md cell variant (S). SAN DIEGO <Naval Medical Center) - Round cell liposarcoma (7); Hemangiopericytoma (4); Pleomorphic

sarooma, NOS (2).

kONG BEACH - Dedifferentiated liposarcoma (4); Embryonal mabdomyosarcoma (2).

BAY AREA - Sarcoma, NOS, consider extraskeletal Ewing's /PNET or mabdomyosareoma (3). SANTA ROSA - Synovial sarcoma with high concentration ofm;ut cells (1); Mesenchymal

chondrosarcoma ( I); Mesenchymal neOplasm, NOS (1).

OAKLAND (Kaiser) - Alveolar mabdomyosarcorna. NEVADA (Reno) - Hemangiopericytoma (2). WYOMING - Extraskeletal Ewing's sarcoma. MICHIGAN - Round cell liposarcoma. NEBRASKA (Oeighton Universitvl - Embryonal mabdomyosarcoma. FLORIDA fTallahassee) - Round cell lipOsatCOOla (4).

MARYLAND {Bethesda Naval Medical Center) - Clear cell sarcoma (13). MARYLAND (Sinai Hospital) - Rhabdomyosarcoma, alveolar. NEW HAMPSI-URE (Manchester) - Malignant tumor, favor epithelioid hemangioendothelioma. NEW YORK Clmoath) - Ewing's sarcoma/PNET. NEW YORK (Northport) - Alveolar mabdomyosarcoma. NEW JERSEY <Overlook Hosoital Swnmit) - Malignant bemangiopericytoma (3). MArNE - Round cell liposarcoma. CONNECTICUT Nnjv CT Health Ctr) - Round cell liposarcoma. AUSTRALIA (Sydney) - High grade myxoid liposarcoma (round cell liposarcoma).

DIAGNOSIS:

ROUND CELL LIPOSARCOMA, RIGHT CALF TY9400, M88533

REFERENCES: Babbitts TH, Forster A. Lurson Rand Nathan 1'. Fusion of the Dominant Negative Transcription Rcaulator CHOP with a

Novel Gene I'US by Trwtslocalion (12; 16) In Malignant Liposarcomo. Not Genet1993; 4: 175-180. Mw-cove AM. Sarcoma Management Based on SlMdardized 1MN Classification. Sem Surg Onco/1992; 8: 98-103. Tanabe K, Pollock R. EIJisl.., Murphy A. et al. tnOucnoc of Surgical Margins on Outoome in Patients with

l'leoperatively lrradloted Extremity Soft Tissue Saroomas. Oznctr 1994; 73(6): 1652-1659. Sam E, Kilpalrid< OJ, Pet<:r fM, e~al. The Oinicopatbologic Spectrum of Myxoid and Round Cell Liposatal<lla. A

Study of 55 cases. Cancer 1996; 77: 1450-1458.

CAS£ NO. 8, ACCESSION NO. 27963 FEBRUARY l 998

INLAND (Riverside/San Bernardino) - Primitive ncuroootodermal tumor (I); Embryonal rhabdomyosarcoma (2).

LOS ANGELES CUCLA Fellows) - Rhabdomyosarcoma (alveolar vs embryonal). PALM SPRINGS ffiesert Hospital) - Extraskeletal Ewing's sarcoma. 1lAKERSFIELD (Central Valley) - Round cell sarcoma (probably liposarcoma). SACRAMENTO (UC Davis) - Rhabdomyosarcoma alveolar type(S). SAN DIEGO (Naval Mcdleal Center) - Rhabdomyosarcoma (10); Rhabdomyosarcoma, alveolar type (2);

Desmoplastic small cell tumor of childhood (1). LONG BEACH - Embryonal rhabdomyosarcoma (6). 1lA Y AREA - Rhabdomyosarcoma, cannot rio PNETfEwing's sarcoma (3). SANTA ROSA - Metastatic rhabdomyosarcoma (I); MelaStatic rhabdomyosarcoma vs. PNET (I);

Rhabdomyosarcoma (I). OAKLAND <Naval Hospital) - Embryonal rhabdomyosarcoma. NEVADA CReno) - Rhabdomyosarcoma, metastatic (I); Rhabdomyosarcoma, alveolar type (I); WYOMING - Peripheral neuroectodermal tumor (Askin tumor). MlCHlGAN - Alveolar rhabdomyosarcoma. NEBRASKA (Creighton Universirv) - Rhabdomyosarcoma, alveolar variant, solid type. FLORIDA Cfallahassee) - Embryonal rhabdomyosarcoma (4). MARYLAND {Bethesda Naval Medical Center) - High grade sarcoma: Rhabdomyosarcoma

(alveolar/embryonal vs. intra-abdominal desmoplastic small round cell twnor) (13). MARYLAND (Sinai Hospital) - Small cell desmoplastic tumor. NEW HAMPSHIRE (Manchester) - Histioc;tic sarcoma. NEW YORK Clmpath) - Alveolar rhabdomyosarcoma metastatic to lymph node. NEW YORK <Northp«t) - Embryonal rhabdomyosarcoma. NEW JERSEY (Overlook Hospital Summit) - Malignant metastatic carcinoma, NOS (3). MAfNE - Embryonal rhabdomyosarcoma. CONNECTICUT CUnjv CT Health Ctrl - Alveolar rhabdomyosarcoma vs. desmoplastic small cell tumor

(need a positive epitbelial marker to diagnose the latter). AUSTRALIA (Svdnev) - Alveolar rhabdomyosarcoma.

DIAGNOSIS: ALVEOLAR RHABDOMYOSARCOMA METASTATIC TO SUPRACLAVICULAR LYMPH NODE T08220, M89203

REFERJlNCES· Tallin 0~ Parham OM, Olas P, cc al. Myogenic Regulatory Protein Sxpressioo in Aduh Son Tissue Sarcomas. A Sensitive and Specific

MarkerofSkele~al MuiCleDiffcrentiation. AmJ P•tho/199~; 144: 693-701. Asmar L. Ocban EA, Newton W A, Webber BL. et al. Agreement Among and Within Oroups of PathotoaiSts in tbc Clasoificalion of

Rblbdomyosa=ma and Related Childhood Sal<omas. Repon oru !otemational Study ofFOU< PathoJosy Classifications. U.nur 1994: 7~('1): 2.579-1581.

Kilpatrick SE, Tcot LA. Oc:istnacr KR. Mutin PL. c:t al. Relationship l)fONA Ploidy to Hi$lology and Prosnosi$ in Rhabdomyosarcoma. Compori$0n ofFiowCytometry and Imago Analysis. Canclf 1994; 75{11): 3227-3233.

Parham OM and Jenkins JJ Ill. Short CouTSe. Pathology of Selected Pediatric Embryonal Neoplasms. Mod•rr• Ptuhology 1 994~ 7(4): SOloS 19. (Note: De>min and MSA have been found 10 be tho n>OSt useful. Cytogtoie studies indicate that a chrotOOSOm&l lrulsloation. S (2; ll)(q)S:ql4);. sp<dfie fur rllabdomy...,_,.aod isrestriaed tolhe al•·colar S\lblypc.)

Patbam OM, Wdlbe< 8, Hollll, Waliams WK lad MI.,.. H. lrnmuooll-.ruc.l SluclyofCbildhood Rhabdomyosa- and Relal<d N«>plasms. Rtsulls of an lni"''J''"p Rhabdomyo.arcomo SIU<!y P!Ojoet C<m<tr 1991; 67: 3072-3080.

SouJe EH, Ocil% M and Hc:ndctsoo EO. Embryonal Rhabdomyosarcoma oflbe Limbs and Limb-Girdles. A Clinicop;nholo&ic Study of 61 Ce!<s. Cancer 1969:23: 1136-1346.

Do\\,ingJR, Head D. Parham OM and Shapiro ON. A Multiplex RT·PCR Assay for lhe Diagnosis of Alveolar Rhabdomyosarcoma and Ewing's S=oma. (AbsiJ) .lfod Patho/199<1: 7: 146A.

La"T<n<:e W. Jr .. ~ JR. (idlan EA and MolU<I' H. Pr<tr<aLm<nl TNM S'"&iO& of Childhood Rblbdomyosarcoma. A Report of lhe tntagruup Rhabdomyo...-oocna Study Group. Children's Can= Swcly GAlOp. Pediatric Oneol"8)' Group. wn<"<' (United s~a~es) rm: 80(6t- 116S-1170.

CASE NO. 9, ACCESSION NO. 27964 FEBRUARY 1998

INLAND CRivl)[side/San Bernardino) - Gl stromal tumor, malignant ( I); Myxoid MFH (1); Leiomyosarcoma (I).

LOS ANGELES (UCLA Fellows) - Matigr>ant Stromal tumor. PALM SPRINGS <Desert Hospital) - Malignant small intestinal Stromal tumor. BAKERSFIELD (Central Valley) - Leiomyosarcoma. SACRAMENTO <UC Davis) - GaStrointestinal Stromal tumor, malignant (5). SAN DIEGO CNaval Medical Center) • Malignant Gl StromaliWtlor {13). LONO BEACH - Fibrosarcoma (6). BAY AREA - Myofibromatosis (? Gardner's syndrome) (3).

SANTA ROSA - Gastrointestinal stromal tumor. malignant (I); Sarcoma. NOS (fibrosarcoma vs. malignant GIST (I); Stromal sarcoma of bowel, NOS(!).

OAKLAND <Kaiser) - Metastatic melanoma,. NEVADA CReoo) • Fibromatosis {I); Abdominal fibromatosis (I). WYOMING • Malignant fibrous biSiiocytoma. MlCHJGAN - High grade sarcoma. NEBRASKA <Creighton University) - Epithelioid smooth muscle tumor. FLORIDA (Tallahassee) - Malignant gastrointestinal stromal tumor (4).

MARYLAND (Bethesda Naval Medical Center) - Malignant gastrointestinal stromal tumor (13). MARYLAND (Sinai Hosoitall - Liposarcoma vs. GIST. NEW HAMPS!iTRE (Manchester) • Malignant gastro-intestinal SlromaliWtlor. NEW YORK (lmpath) - Sclerosing well-differentiated liposarcoma. NEW YORK <Northport) - Sarcoma (malignant OlST vs. fibrosarcoma). NEW JERSEY (Overlook Hospital Summit) - Stromal tumor of gastrointestinal tract, malignant, NOS (3). MAINE - Sarcoma, ? Gl stromal tumor. CONNECTIC!IT <Univ CT Health Ctrl • Malign110t Gl stromal tumor. AUSTRALIA (Sydney) - Sarcoma--? Sclerosing liposarcoma.

DIAGNOSIS:

FffiROSARCOMA, MESENTERY T64200, M88103

CONSULTATION: Sharon W. Weiss, M.D. The University of Michig110. Mesenteric and small bowel mass, excision: "Fibr()S81'(X)O)a, probably high grade."

REEER£NCC\S: Pricl1urd DJ, Sim Fli, Ivins JC, et al. Flbroso.rroma oCthe Bone und Soft Tissues oflhe Trunk and Extremities. Orthop

ClinNorlh 1977; 8: 869-881. Iwasaki Hand Enjoji M. lnfuntilc and Aduh Fibiosa~CX>Inas of the Soft TISSues. A cia PatJrol Jpn 1919; 29: 377-388. Srott SM, Reiman HM, Pritchard DJ, et al. Soft Tissue l·ibrosarcoma. A Cliniropathologic Study of 132 Cases. Canctr

1989; 64: 925-931. Mcis JM and Enzinger FM. lnOwnmatory Fibrosarooma of lhe Mesentery and Rttroperitoneum. A Tumor Closely

Simulating InflammatorY Pseudowmor. Am J Surg PotJro/1991 ; IS: U<I0-1156.

CASE NO. 10, ACCESSION NO. 27943

INLAND <Riverside/San Bemnrdino\ • Neurofibroma (3).

LOS ANGELES <UCLA fellows\ - Neurofibroma. PALM SPRINGS <Desert HO!S[)ital} - Myxoma. BAKERSFIELD <Central Valley) - Myxofibroma. SACRAMENTO (UC Davis\ - Neurofibroma (5). SAN DIEGO <Naval Medical Center) - Neurofibroma (13).

LONG BEACH - Neurofibroma (6). BAY AREA - Neurilemmoma (3). SANTA ROSA - Neurofibroma (3). OAKLAND (Kaiser\ - Neurofibroma. NEVADA <Reno\ • Neurofibroma (I); Myxoid neurofibroma (I). WYOMING - Neurofibroma. MICHIGAN - Benign peripheml nerve sheath tumor. NEBRASKA (Creightoo University) - Neurofibroma. FLORIDA (Tallahassee\ • Neurofibroma (4).

MARYLAND @ethes4a Naval Medical Center) - Myxoid neurofibroma (13). MARYLAND (Sinai Hospital) - Scbwannoma NEW HAMPSHIRE (Manchester\ • Myxoliposarooma, IO\V grade. NEW YORK (lmpa!h\ - Neurofibroma (4).

NEW YORK (Northport) - Neurofibroma. NEW JERSEY <Overlook Hospital Summit) - Neurofibroma (3).

MAINE • Neurofibroma. CONNECTICliT Nniv CT Health Ctr\ • Neurofibroma. AUSTRALIA (Sydney) - Neurofibroma .

. DIAGNOSIS:

NEUROFIBROMA, LEFT PARAPHARYNGEAL REGION TX8680,M95400

RCFERENCES:

FEBRUARY 1998

Magalted M. Histopathological VariantS ofNturofibromn. A Study of 114 lc3ions. Am J o[Dermatopatho/1994; 16(5): 486-495.

Takata M. lmai T and Hirooe T. Fac:1or-XIII4·Positive Cells in Normal Periphetal Nerves and Cutan<:ous Neurofibromas ofTypt>l Neurofibromatosis .. AmJofDermatopatho/1994; 16(1): 37-43.

!'onder B. Hwnan Genetics. Neurofibromatosis Gene Cloned. Natore 1990; 346: 703-704. Riccardi VM. Neurofibromatosis. Past, Present and future. N Eng/ J Med 1991; 324: 1283. Peltooen J, Jaakkola S, Lebwohl M. RenvaU S. ct al. Cellular Oiffen:ntiation and Expr<S!ion of Matrix Genes in Type I

Neurotibromalosis. L<zb lnvw 1988; 59(6): 760-771. Rubenstein A. BungeR WJd Housm;m D (eds). Neurofibromatosis. A Review of the Clinical Problem in

Neurofibromatosis. Ann MY A cod Sci 1986; 486: 1-13. Fountain JW. Wallaet MR. Bruce MA, Seizinger BR, e1 al. Pb)~icaf Mapping of aT ranslocation Brcakpoinl in

Neumfibromalosis. Science 1989; 244: 1085-1087. Hwnza A. Fason JJ, WeiS-<man JL and Myers EN. Neurilemomas of lhc Paraphtlryngeal Space. Arc/• Otolaryngollfead

and Neck Surg (United Slates) 1997; 123 (6): 622-626.