CALIFORNIA TUMOR TISSUE REGISTRY

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California Tumor Tissue Registry c/o: Dep:utmentofPathology and Human Anatomy

Lorna Unda University Scllool of Medicine 11021 Campus Avenue, AH 335 Lorna Undo, California 92350

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

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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 diagnose.~ from participating pathologists. Usting of selected references from the medical literature.

Prlnc.ipnl faculty: Weldon K. Bullock, MD Donald R. Chase, MD

CMECredit: Th~ 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.

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

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CONTRIBUTOR: Mark J. DeMeo, M.D. CASE NO. 1 • MARCH 1997 Santa Rosa, CA

TISSUE FROM: Rlght lung ACCESSION 27940

CLINICAL ABSTRACT:

This 75-year old Caucasian female smoker presented with a one year history of a chronic persistent cough. A ch~t x-ray revealed a large wedge-shaped alveolar opacity in the posterior basilar segment of the right lower lobe. In addition she was noted to have abnormally enlarged mediastinal lymph nodes at the level of the carina and below. Following biopsy, a right lower lobe resection was performed.

GROSS PATHOLOGY:

The 260 gram lobe of lung was 16.0 x 115 x 95 em. In the lateral posterior aspect was a 7.5 x 8.0 x 4.5 em firm area which appeared to be consolidated lung tissue. The involvement extended to the periphery of the lung, stretching but not grossly invading the pleura.

CONTRIBUTOR: Thomas Heinz, M.D. CASE NO. 2 • MARCH 1997 Orange, CA

TISSUE FROM: Rlght lung ACCESSION #28106

CLINICAL ABSTRACT:

This 2 112-year old girl presented with mild cough and wheeze. Following two albuterol treatments she developed a tension pneumothorax with total collapse of the right lung. After stabilization, workup revealed cystic change in the right lung and a right upper lobe lobectomy was performed for presumed lobar emphysema.

GROSS PATHOLOGY:

The 46 gram portion of lung was 12.5 x 7 5 x 2.0 em. Serial sections revealed multiple saclike structures up to 11.5 em in greatest diameter. There was no grossly normal lung parenchyma.

SPECIAL STAINS: Vimentin: HHF35:

positive positive

Desmin: LCA:

positive negative

CONTRIBUTOR: F. Azizi, M.D. CASE NO. 3 - MARCH 1997 Fontana, CA

TISSUE FROM: Rlght lung ACCESSION #27883

CLINICAL ABSTRACT:

This 39-year-old non-smoking female was known to have had a positive PPD skin test for many years. Her employment program included yearly chest x-rays. Her most recent x-ray showed a mass on the right side. A cr scan of the chest demonstrated a well-circumscribed homogenous solid right upper lobe mass abutting the lateral aspect of the superior vena cava. A wedge excision was performed.

GROSS PATHOLOGY:

The 55 gram wedge of lung was 6.0 x 3.5 x 3.0 em. It included a 3.0 em diameter yellow-tan well-circumscribed nodule.

CONTRIBUTOR: Robert Reichmnnn, M.D. CASE NO. 4 - MARCH 1997 Covina, CA

TISSUE FROM: Left lung ACCESSION #28037

CLINICAL ABSTRACT:

This 59-year old female started smoking at the age of eight and has continued to smoke for the last 51 years, up to 4 packs daily. She presented with a three year history of recurrent bouts of pneumonia. She denied hemoptysis or weight loss. Chest x-ray and cr scan revealed an obstructing endobronchial lesion of the left mainstem bronchus with post-obstructive bronchiectasis. A left sided pneumonectomy was performed.

GROSS PATHOLOGY:

The 340 gram left lung was 18.0 x 13.0 x 6.0 em. The mainstem bronchus was virtually occluded by a 2.0 em diameter, sessile, well-circumscribed, firm, round, pink-tan mass.

CONTRIBUTOR: Nelson J. Quigley, M.D. CASE NO.5 - MARCH 1997 Anaheim, CA

TISSUE FROM: Left lung ACCESSION #27825

CLINICAL ABSTRACf:

_ _ This 55 year-old asymptomatic non,smoking.female had_achest x-ray.as part of-a .routine_ physical examination. This showed a chest mass originally interpreted as an aorti.c arch aneurysm. Excision of the left lung mass was performed.

GROSS PATHOLOGY:

The 17 gram lung wedge was 5.0 x 4.5 x 2.3 em. Within it was a 3.0 x 2.0 em gray-white turner which produced a depression of the overlying pleura. Approximately 40 grams of focally hemorrhagic tumor-involved lymph nodes were submitted separately.

SPECIAL STAINS: Chromogranin: CAM5.2:

positive positive

CONTRIBUTOR: Marigold Ardron, M.D. Keesler AFB, MS

TISSUE FROM: Mediastinum

CLINICAL ABSTRACf:

Synaptophysin: focal positive

• CASE NO. 6 - MARCH 19.97

ACCESSION #27873

This 26-year-old white female presented with dull chest pain radiating to the left shoulder and a two year history of intermittent decreased strength in the left hand with left arm paresthesias. A chest x-ray showed a: large(> 10 em) superior posterior mediastinal mass, which was resected.

GROSS PATHOLOGY:

The specimen consisted of a 14.5 x 7.5 x 7.0 em oblong red-tan tumor with a smooth external surface. Serial sectioning revealed a solid, firm, pale yellow cut surface.

SPECIAL STAINS: Vimentin: S-100:

weakly positive positive

Cytokeratin: Neuron specific enolase:

negative negative

CONTRmUTOR: Alexandra Reichman, M.D. CASE NO. 7 - MARCH 1997 Marysville, CA

TISSUE FROM: Mediastinum ACCESSION #27846

CLINICAL ABSTRACf:

This 62-year-old male had progressive dysphagia over a ten month period. Work-up showed Barrett's esophagus with a lower esophageal stricture. There was also displacement of the upper cervical esophagus and trachea towards the left. CT scan confirmed a 9 x 6 x 5 em mass in the upper anterior mediastinum and lower neck. A thyroid scan was normal. Past history included a right orchiectomy for testicular cancer (type unknown) 25 year earlier and radical prostatectomy for adenocarcinoma 9 months earlier. The mass was excised.

GROSS PATHOLOGY:

The 78 gram bosselated tan mass was 8.5 x 6.0 x 3.2 em. Cross sectioning revealed variegated, vaguely nodular firm white or light tan tissue.

SPECIAL STAINS: S-100: Actin: CD-34: CAM 5.2:

negative negative diffusely positive negative

CONTRIBUTOR: K. Greg Peter son, M.D. Sioux Falls, SD

TISSUE FROM: Mediastinum

CLINICAL ABSTRACf:

Actin: CD-68: CD-34:

negative negative positive

CASE NO. 8 - MARCH 1997

ACCESSION #26935

This 58-year-old white male had a three year history of polyneuropathy and chronic diarrhea with marked weight loss, both of unknown etiology. About 2 weeks prior to admission a muscle biopsy showed polymyositis. In the 48 hours before admission he developed acute venous obstruction with edema of the left upper extremity. CT scan of the chest showed a 6 em diameter anterior mediastinal mass. At surgery the mass was attached to and involved the left phrenic nerve and the superior vena cava, completely obliterating the left innominate vein. About 90% of the tumor was removed.

GROSS PATHOLOGY:

A 70 gram, 6.0 em diameter specimen consisted of three fragments of firm, homogenous, tao­white tissue with focal necrosis but no hemorrhage.

CONTRIBUTOR: Raymond Lesonsky, M.D. CASE NO. 9 - MARCH 1997 Northridge, CA

TISSUE FROM: Mediastinum ACCESSION #26541

CLINICAL ABSTRACT:

This 69-year-old female presented with a 5 month history of interscapular pain and increased shortness of breath on exercise. A thoracic cr scan revealed an 8.0 x 8.0 x 6.0 em anterior mediastinal mass. A venogram showed complete obstruction of the left subclavian vein at the level of the axilla. At surgery, the mass involved the innominate vein, the pericardium, phrenic nerve and tip of the lung.

GROSS PATHOLOGY:

The 405 gram specimen was 18.0 x 12.0 x 6.5 em and contained a 10.0 x 6.5 x 9.5 em, well­circumscribed, nodular, homogeneously gray white, firm tumor.

CONTRIBUTOR: E. DuBose Dent, Jr., M.D. CASE NO. 10 - MARCH 1997 Glendale, CA

TISSUE FROM: Right lung ACCESSION #26782

CLJNTCAL ABSTRACT:

This 69-year-old Caucasian female presented with a well-circumscribed mass just beneath the pleura. A wedge resection of the right upper lobe was performed

GROSS PATHOLOGY:

The 3.5 em diameter specimen was of pale red-brown with a soft consistency.

SPECIAL STAINS: Lambda: l.r26:

positive positive

Kappa: negative

CALIFORNIA TUMOR TISSUE REGISTRY

SUGGESTED RF.ADING (Gener.tl Topics from Recent Uterature):

Pulmonary Carcinoid Tumors. cr Assessment. Davis SO, Zem JR, Govoni AF, et al. J. ComputAssist Tomggr 1989; i3.(4): 244-247.

The Clinical Outcome of Needle Aspiration of the Lung When Cancer is not Diagnosed. Calhoun P. Feldeman DS, Armstrong P, et al. Ann Tflorac Sllrg 1986; 41: 592-596.

Reproductibility of Major Diagnoses in a Binational Study of Lung C;lncer in Uranium Miners and Atomic Bon1b Survivors. Kuhn R, Auerbach 0, Nambu S, Carter D, et al. AmJ Clin Pallw/1994 (Sup!); 101: 478-482.

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

Lorna Linda University School of Medicine 11021 Campus Avenue, AH335 Lorna Linda, California 92350

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

CASE NO. 1, ACCESSION NO. 27940 1\fARCH 1991

IN !.AND CRJYBRS!DB'SAN BERNARDINO\ • Small lymphocytic lymphoma (low grade lymphoma of BALT) (1); Lymphoma (2); Well.(liffuentiatcd lymphocytic lylnphoma (1).

BAKERSFIElD (Central Valley Study Group) · Diffuse large cell lymphoma. CAMARIU p (Aivjso Gmupl • Small cell lymphoma VENJliRA (Unil•bl • Lymphocytic interstitial pneumonia (2). P!..EASANTON/FBEMONT - Low grade (small lymphocytic) lymphoma. LONG BFACH • Malignant oon-Hodgkin's lymphoma, low grade (7). OXNARD CSt.lohns Rerional Qr) • Lymphomatoid granulomaiC>Sis. SAN DIEGO <Naval Medical Ctrl • Low grade lymphoma. uvor extranodal marginal zone lymphoma (15); Mantle

cell lymphoma (1). SANIA BARBARA (Cottaae Hosoilall • Malloma. SANTA CIARACLoma Prieta Grouol · Malignantlymph0ma (mantle cell lymphoma) (S). SANTA ROSA - Lymphoma, "diffuse", m·IXed large .;,d small cell. (2); Diffuse non-Hodgkin's lymphoma, mixed (1). BAY ARPA • Lymphoma, probably non-Hodgkin's with? pulmonary alveolar proteinosis (3). SACRAMENTO CUC Davis) • Small lymphocytic lymphoma of BALT,Iow grade. ARIZONA CVA Med Qrl · Small cell lymphoma (Mallowa). NEBRASKA (Creighton Univer.<ityl • Malignant lymphoma of small lymphocytes, probable MALT type. MISSISSIPPI CBaptjsl Hoopilall - Low grade lymphoma. FLORIDA <Ta!!ahAS<eel • Lymphoma (3). MARYLAND (Bethesda Naval Mcd Qrl · Malignant lymphoma, low grade (small lymphocytic with plasmacytoid .

differentiation vs Maltoma) (13) CONNECTICtrr CUnjv O>nn Health Ctrl • Malignant lymphoma, diffuse, intermediate cell type. CONNECIJCUT <Yale Univl - 8-celllymphoma of MALT type. MASSACHUSETIS {BerkshjreMod Qr) · Malignant lymphoma, small cell type.

NEW HAMPSHIRE IManeh~:<le.t\ - Malignant lymphoma, small cleave eelllype (1); Lymphoma (1). NEW JERSEY (Over!ooJs Hospital Summit) • Lymphocytic lymphoma· well-differentiated (Baltoma) (4). NEW YORK <Metrooolitan Hospital) - B~lllymphoma.

NEW YORK Ompathl • Malignant lymphoma, small B·cell, marginal zone, probable BALT{4). WYOMING • Small cell lymphocytic lymphoma/CLL MAINE (Bangor) • All, Grade 1. JAPAN (Shjmada-Kyotol • Small lymphocytic lymphoma.

DIAGNOSIS: MAUCNANT LYMPHOMA, SMALL LYMPHOCYTIC CELL TYPE, lUCHT LUNG

T28000/M96203

CONSULTATION: Thomas V. Colby, M.D., Mayo Clinic Soottsdale, Arizona: "Features of small lymphocytic lymphoma."

REFERENCES: Zukerberg LR, Mederios UL, Ferry lA, and Harris~!'lL Diffuse Low-Grade B·Cell Lymphoms. Four Clinically

Distinct Subtypes Defined by· a Combination of Morphologic and lmmunophenotic Features. Am J Clin Patho/ 1993; 100: 373-385.

Grogan 1M (O>mmcntary). The Low Grade B-Cell Lymphoma Polyglot. Is Ii a Step Forward or Backward? AdvAnat Pat/w/1995; 2(1): 39-42. .

Koss MN, Hocholzer I., Nichols·PW, et al. Primary Non-Hodgkin's Lymphoma and Pseudolymphoma of Lung. A Study of 161 patients. Hum Patho/1983; 14: 1024-1038.

Segal GH. (Commentary) Marginal Zone B:Cell Lymphoma. An Agreeable Union of Several Recently Desaibed Entities. Adv in Anal Patho/·1991; 4{1): 44-50.

Leith CP, BChir MB, Mangalik A and FQUC3r K. A B-Celi"Olameleon•. Stri~ing Clinical, Morphological, and lmmunophenOiypic Diversity of a Single Low-Grade B Cell Clone. Hum Patho/1991; 28(1): 104·110.

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CASE NO. 2, ACCESSION NO. 28106 MARCH 1997

!NIANQ (BIVERS!DfJSAN BERNARDINO\ - Cystic pulmonary blastoma of dllldhood (1); Embryonal rllabdomyosar00nla(1); Coogenilallabar emphysema (I); Pulmonary blasiOIDa (1).

BAKUBSF!ElD (Central Val lev Study Grooo> - Coogenilll cystic adenomatoid malformation. Ci\MAR!I J Q CAI'"so Grooo> - Cyslic hamartoma with lciomytomoois. VE!flYBA CUnilabl - Cyslic pulmonary blostoma of dlildhood (1), Cystic pulmonary blastoma of dlildbood (1). PlEASANTON/FREMONT • Cystic pulmonary blastoma of childhood. -LONG B!!AC!:I - Olildbood pleuro-pulmonary cystic blastoma with rllabdomyosarcomatous elements (1). OXNARD (St, Johns Regional Orl - Pulmonary blastoma, cystic. SAN DIEGO CNaval Mcdjcal Center) - Cystic blastoma or childhood with rltabdomyooarcomatous differentlatioo (16). SANIA BARBARA (Cottage Hoonjtoll - Embryonal rhobdomyooarcoma. SANJ'A ClARA (!..om a Prieta Gmup) - Cystic pulmonary blastoma or childhood (5). SANTA ROSA - Embryonal rbabdomyooarooma (2); Rhabdomyosarcoma (1), BAY AREA - Rhabdomyosarooma (3). $ACRAM ENTQ CUC Davis) - Embryonal rllabdomyosarOoma. ARI7.0NA tvA Me<! Qrl - Congenitaladenc>matoid malfonnllion. NEBBASI<A (Creighton University! - Pleuropulmonary blastoma/embryonal rhabdomyosarcoma. MJ$SISS!PPI CRaptist Hosoitoll - Cystic blastoma (rhabdomyosarcoma) of childhood (see fig 21-17 in blue fascicle) npRIDA Cial!abwee) • Pulmonary blostoma (3). MARYlAND CBethesda Naval Med Orl - Cystic pulmonary bl .. toma (13). CONNECDC!lf CUniv Conn Health Or) - Embryonal rltabdomyosarooma risi"8 in lype I adenomatous cystic

mal £ormation. CONNECDC!lf <Yale Univl • Cystic mC$Cnchymal hamartoma/embryonal rllabdomyosarcoma. MASSACHUSETTS (Berkshire Med Orl • Embryonal rhabdomyosarcoma. NSW HAMPS!:URECManchesterl • Rhabdomyosarcoma (I}; Plllmonal)' blastoma vs rhabdomyosarcoma (1) N8W JBBSBY (Overlook Hospjtal Summit) • Rhabdomyosarcoma rising in adcnomatoid malformation (2); Pulmonary

cystic blastoma with rhabdomyosarcoma (1); Rhabdomyosorooma (1). NEW YORK IMetronolitan H~pilall - Pulmonary blostomo. NliW YORK Omp•thl • Cystic pleuropulmonary blastoma. WVOMING • Pulmonary blastoma. MAINE CO.,ng(l[l · Mesenchymal cystic hamartoma. JAPAN CSbjmada-Kyotol • Pulmc>nary blastoma of dlildhood.

DIAGNOSIS: CYSTIC PLEUROPULMONARY BLASTOMA, LUN~

1'28000/M

CONSUJ,TATIONS: Jon M. Rowland, M.D., Ph.D., Childrens Hospital, Los Angeles, "Consistent with pleuropulmonary blutoma with

predominantly myogenic phenotype." Stephen I. Qualman, M.D., Intergroup Rhabdomyosarooma Study, "Cystic Pulmonary blastoma."

FOLI,OW·IJI'i The patient is currently reocivlng dlemothcrapy with no recurrence (follow period of 9 montllS.)

REFERENCES: Minniti Cl', Tsokos M, Newton WAir, and Helman U. Specific Expression oflnsulin-Uke Growth Factor II in

Rhtbdomyosarooma Tumor Cells. Am J Clin Pat/oo/1994; 101: 198-203. Henry K and Keal EE. Pulmonary Blastoma with Striated Muscle Component Br J Di$Cirest1966; 60: 87-92. Sousa RC. Elm us DP, Takaro T. Plllmc>nary Blastoma. A Distinctive Oroup of Carcinooarooma Lung. Am Tho=

Surg 1965; 1: 259-268. Asmar 1.. Gehon EA. Newton W A. Webber Bl, et ol. Agreement Among and Within Groups of Pathologist in the

Ousiflatioo of Rhabdomyosan:oma and Related Childhood Saroomas. Report of an lntematioo>l Study of f'OIU Pathology Oassifications. Canur 1994; 74(9): 2579·2588.

CASE NO. J, ACCESSION NO. 27883 MARCH1997

INl.ANP CR!YERSIDE/SAN BERNARDINO> - Pulmonary histiocytosis X.{l); Poorly differentiated bronchoalveolar carcinoma with marked histiocytic response {1); Sclerosing hemangioma (2).

BAJ<ERSF1ELD (Central Valley S!l!dy Group) - Metastatic clear cell carcinoma. CAMARILLO (Alviso Groun) • Papillary adenosquamous carcinoma. VENTURA CUnilab) - Broncboalvcolar carcinoma (2)

PLBA$ANTQNJFREMONT • Adenocarcinoma, NOC vs bronchoalvcolar. LONG BEACH - Adenocarcinoma with bronchoalveolar spread (7) .

. O)(NARD (St.Iobns Regional Ctr) - Broncboalveolar carcinoma.

SAN DIEGO <Naval Medical Center) - Sclerosing hemangioma (13); Papillary adenoma (3). SANTA BARBARA (CQttage Homj!aO - Adenocarcinoma with clear cell fea!l!res. SANTA CLARA CLoma Prieta Groun) • BroncJ>oalveolar tumor (S). SANTA ROSA - Adenocarcinoma, papillary with clara cell component (2); Papillary adenocarcinoma {1). BAY AREA - Broncboalveolar carcinoma {3).

SACBAMENTO cue Davis) - Papillary bronchoalveolar adenoma VS adenocarcinoma, well-differentiated, papillary broncbioalveolar type.

ARIZONA CVA Med Or) - Broncboalveolar carcinoma.

NEBRASKA (Creighton University) - Adenocarcinoma, bronc.boalvcolar type {rule our metastasis). MISS!SSlPP! @aprist Hospital) - Sclerosing hemangioma. flPRIQA CTallahassee) - Sclerosing hemangioma (3).

MARXLANP @ethesda Naval Med Or) - Sclerosing hemangioma (13).

CONNECTICUT CUniv C<Jnn He•lth Qr) • Sclerosing hemangioma (4); Bronchoalveolar tumor ( 4). CONNECTICUT !Yale Univ) - Sclerosing hemangioma (papillary pneurnocytoma) dd: papillary

mesothelioma. MASSACHYSEJJ"S @erksbire Med Qr) - Broncboalveolar carcinoma, non-mucinous type. NEW HAMPSHIRE (Manchester) - PapiUary adenocarcinoma with clear cell features (2). NEW JERSEY (Overlook Hospit•l Summit) - Sclerosing hemangioma {4). NEW YORK CMetrooolitan Hospital) - Papillary adenocarcinoma, lung. NEW YORK Qmpath) • Sclerosing hemangioma (4).

WYOMING • Metastatic renal cell carcinoma MA!NECBnngor) - Sclerosingbemongioma of lung.

JAPAN (Shimadn-Kyoto) - Adenosquamous carcinoma.

DIAGNOSIS: SCLEROSING HEMANGIOMA, LUNG

TZ8000/M8&320

REfERENCE$: Katun.stein AA, Gmelicb IT and Carrington CB. Sclerosing Hemangioma of the Lung. Am Surg Patlw/1980; 4: 343-

356.

Chan KW, Gibbs AR, LoWS, et at. Benign Sclerosing Pneumocytoma or tho Lung (Sclerosing Hemangioma). Tllorax 1982; 37: 404-412.

Semcraro D and Gibbs AR. Pulmonary Adenoma. A Variant of Sclerosing Hemangioma? J C/inPatho/1989; 42: 122Z.l223.

Yousem AA, Hoc:hbolzer L Alveolar Adenom1. Hum Pollw/1989: 1066-1071.

CASE NO. 4, ACCESSION NO. 28037 MARCH19?7

INlAND CRIVERSIDE!SAN BERNARDINO) • Adenoid cystic carcinolllll of bronchus (4). BAKERSFIE!.P CCcntn1l Valley Study Group) • Adenoid cystic carcinoma CAMARILLO (Alviso Grouol • Cylindroma. \IENTIJRA CUnilab) • Adenoid cystic carcinoma (2). PLEASANJQNIFREMONT • Adenoid cystic carcinoma. LONG BEACH - Adenoid cystic carcinoma (7). OXNARD CSt. Johns Regional Ctrl - Adenoid cystic carcinoma. SAN DIEGO (Naval Medical Center) • Adenoid cystic carcinoma (16). SANTA BARBARA (Cottage Hospital) • Adenoid cystic carcinoma. SANTA Cl.ARA (Lorna Prieta Grouol • Adenoid cystic carcinoma (5). SANTA ROSA - lntralumcna! polypoid adenoid cystic carcinoma (1); Adenoid cystic carcinoma (1);

Adenocystlc carcinoma of the polypoid type(!). · BAY ARM • Adenoid cystic carcinoma (3). SACRAMENTO CUC Davis) • Adenoid cystic carcinoma. ARIZONA CIA Med Orl - Adenoid cystic carcinoma. NEB BAS !(A (Creighton University) • Adenoid cystic carcinoma. MISSISSIPPI (Baptist Hosoit:aD • Adenoid cystic carcinoma. FLORIDA CTallabasseel • Adenoid cystic carcinoma (3). MARYI,ANQ (Bethesda Navel Med Ctrl • Adenoid cystic carcinoma (13). CONNECTJCV[ CUniv Conn Health Ctrl - Adenocystic carcinoma. CONNECTICUT (Yale Univl - Adenoid cystic carcinoma. MASSACHYSETIS <Berkshire Med Ctrl - Adenoid cystic carcinoma. NEW HAMPSHIRE (Manchester) • Adent>id cystic carcinonia.(2). NEW JERSEY (Overlook Hospital Summit) - Adenoid cystic carcinoma (4). NEW YORK (Metrooolitan Hospital) • Adenoid cystic carcinoma. NEW YORK <rmpathl - Adenoid cystic carcinoma. WYOMING - Adenoid cystic carcinoma. MAINE (Bangor) • Adenoid cystic carcinoma, endobronchial. JAPAN (Shimada-Kyoto) • Adenoid cystic carcinoma.

J>IACNOSIS: ADf-.NOID CYSTIC CARCINOMA, LUNG

TZ8000/MS2003

llEfERENCFS: Moran CA, Sustcr Sand Koss MN. Primory Cystic Carcinoma of the l..llng. A Clinicopathologic and

lmmunohistocbcmieal Srudyofl6 Cases. Cancu1994; 73: !390-!397. Mleuinon M and RapolaJ. Immunohistochemical Spoctrum Rhabdomyosarcoma and Rbabdomyosarooma-Uicc 1\&mot.

Expression of CytokCnltin and rhe 68 kD Neuro£ilamcnt l'rotcin. tim J Surg Patlw/1989; 13(2): 120-132. Lawrence J B, Mazur MT. Adenoid Cystic Carcinoma. A Comparative Pathologic Study of Tumors in Salivary Oland,

Brcas~ l..llng and C.lyx. Human Pathol1982; 13: 916-924. Roggli VI... Editorial. Histologic Classification of l..llng CaOCC<S. Factors Affecting irs Vari•biliry. A.mJ Clin Pallwl

1994; 100(3): 411-412. Monn CJt., Suster S, Kess MN. Primary Adenoid Cystic Carcinoma of rhe lung. A Oioioopathologic and

Immunohistochemical study of 16 Cases. C.ncer 1994; 73: t390-t397.

CASE NO. 5, ACCESSION NO. 27825 MARCH1997

INLAND <RIVERSIDE/SAN BERNARDINO) • Large cell neuroendocrine carcinoma (1); Carcinoid tumor (mitotic activity not high enough for atypical carcinoid) (1); Neuroendocrine carcinoma (1); Alypical carcinoid (1).

BAKERSFIELD (Central Vallev Studv Group) • Neuroendocrine carcinoma. CAMARILLO (Alviso Grouo) · Adenocarcinoma, VENTURA CUnilab) • Atypical carcinoid (1); Spindle cell carcinoid (1). PLEASANTON/FREMONT • Atypical carcinoid. LONG BEACH • Neuroendocrine carcinoma (7). OXNARD (St. Johns Regional Center) • Pulmonary paraganglioma (chemodectoma). SAN DIEGO (Naval Medical Center) • Atypical carcinoid (6); Well-differentiated neuroendocrine

carcinoma (10). SANTA BARBARA • Neuroendocrine carcinoma. SANTA CLARA !Lorna Prieta Group) • Large cell neuroendocrine tumor (atypical carcinoid) (5).

SANTA ROSA • Carcinoid tumor {2); Neuroendocrine carcinoma (1). BAY AREA • Neuroendocrine carcinoma (3).

SACRAMENTO CUC Davis) • Spindle cell (atypical carcinoid). ARIZONA (VA Med Or) • Peripbical, spindle carcinoid tumor .

. NEBRASKA (Creighton University) • Malignant paraganglioma. MISSISSIPPI (Baptist Hospital) · Atypical carcinoid. FLORIDA ITallahassce) • Neuroendocrine carcinoma, atypical carcinoid (3).

MARYLAND (Bethesda Naval Med Or) • Atypical carcinoid (13).

CONNECTICUT illniv Conn Health Or) - Neuroendocrine carcinoma (5); Atypical carcinoid (1).

CONNECT! CUT CVale Univ) • Malignant carcinoid/atypical carcinoid. MASSACHUSETTS (Berkshire Med Orl - Atypical carcinoid. NEW HAMPSHIRE <Manchester) • Malignant carcinoid (2). NEW JERSEY • Atypical carcinoid ( 4). NEW YORK (Metropolitan Hospital) - Atypical carcinoid. NEW YORK Ompatb) • Atypical carcinoid tumor (4). WYOMING - Poorly differentiated squamous cell carcinoma. MAINE (Bangor) • Large cell carcinoma with neuroendocrine featureS (atypical carcinoid, grade III). JAPAN CSbimada-Kyoto) · Atypical carcinoid.

DIAGNOSIS: ATYPICAL CARCINOID TUMOR, LUNG

T28000/M82401

REFERENCFS: Modlin IM and Sandor A. An .Analysis of 8305 c.seS of Carcinoid TumorS. Canet:r 1997; 79: 813·829. Wise LS, Bonder D, Aikawa M and Hsieh CL. Carcinoid Tumor of Lung with Varied Hlstology. AmJ Sui'g PaJhcl

1982; 6: 261-267. EI-Naggar AI<, Ballance W, Abdui'Karin FW, et al. Typical and Alypical Bronchopulmonary Carcinoids. A

Oinicopathologic and Flow Cytometric Study. AmJ Clin Potlro/1991; 828-834. Valli M, FaJ>ris GA. Dewar A, et al. Atypical Carcinoid Tumor of the Lung. A Study of33 C,ses with Prognootie

Features. Histopatlro/24: 363-369. . Ranchod M and Levine G. Spindle.Cell Carcinoid Tumors of the Lung. A Clinicopathologic Study o(35 Cases. Am J

Surg Patlro/4: 315·322.

CASE NO. 6, ACCESSION NO. 27873 MARCU1?97

INLAND CRIVERS!J)EJSAN BERNARPINO) - Granular cell tumor (1); Degenerated neurilemoma (ancient schwannoma) (1); Malignant schwannoma (2).

BAKERSfiELD <Central Valley Study Group) - Spindle cell san:oma. CAMARILLO (Aiyi~:<> Group) - Neurofibroma VENTURA CUnilab) - Neurilemoma. (2). PLEASANT/FREMONT - Schwannoma. LONG BEACH • ScbWllnnoma (7).

OXNARD (St. Johns Regional Or) - Neurilemoma SAN DIEGO <Nav•l Medical Center) - Ancient scbwannoma (16). SANTA BARBARA - Schwannoma. SANTA C!.ARA CLoma Prieta Group) - Lipidized schwannoma (5).

SANTA ROSA - Neurofibroma, r/o neurofibrosarc:onia (1); Cellular neurofibroma] neurilemmoma with xanthomatous change (1); Neurofibroma, r/o neurofibrosarcoma (1).

BAY AR!?A • Schwannoma (3). SACRAMENTO CUC Davis) - Scbwannoma (neurilemoma). No histologic evidence of malignancy. ARfZONA (VA Med Or) - Schwannoma. NEBRASKA (Creighton University) • Schwannoma. MTSSJSSTPPJ CB•ptist Hospital) - Scbwannoma. FLORIDA ITallahasseel - Schwannoma, low grade malignant scbwnnnoma (3).

MARYLAND {Bethesda Naval Mcd Or) - Pign1ented scbwannoma (13).

CONNECTICUT CUnjv Conn ffealtb Qr) - Sebwannoma. CONNEC'fiCUT (Yale Univ) - Neurofibroma. MASSACHUSEJTS CBerlc<hire Med qr) - Cellular schwannoma. NEW HAMPSHIRE (Manchester) - Cellular schwannoma (1); Malignant schwannoma (1). NEW JERSEY (Overlook Hospitnl Summil) - Scbwannoma (4). NEW YORK (Metronolitan Hospital) - Ancient sebwannoma. NEW YORK Ompath) - Scbwannoma (4). WYOMING - Schwannoma. MAINE{Bangor) - Scbwannom• (with roam cells). JAPAN (Shimada-Kyoto) - Scbwannoma.

DrAGNOSIS: SCHWANNOMA WITHDEGENERATIVECHANGES("ANCIENTSCHWANNOMA"),

MEDIASTINUM TY2300/M95600

REFERENCES: Oberman HA and Abell MR. Neurogeoous Tumors oft be Mediastinum. Canc.u 1960; 13: 882-898. Ackerman LV and Taylor FH. Neurogenous Tumors within the Thorax. A Oinioopatholoaic Evaluation of Folly-Eight

Cases. Cancer 1951; 4: 669·691. Swanson PE. Soft Tissue Neoplasms oft he Mediastinum. Semin Diagn Patho/199l; 8: 14·34. Sustcr Sand Rosai J . Thymus. Chapter 12. lfistol for Potllol (Ed) StephenS. Sternberg. Raven Prus 1992.

CASE NO. 7, ACCESSION NO. 27846 MARCH1997

INLAND CRJVERSTDE/SAN BERNARDINO) • Solitary fibrous IUmor of the mediastinum (2); Sclerosing mediastinitis (1); Solitary fibrous tumor (1).

BAKERSFIELD (Central Valley Study Group) - Spindle cell thymoma. CAMARILLO (Alviso Grounl - Neurofibroma. VENTURA CUnilabl - LO~ized fibrous IUmor of childhood (1);"1::ocaiized fibrous tumor of pleura (1). PLEASANTON/FREMONT - SolitAry fibrous tumor of pleura; Treated (remote genn oell tumor (1). LONG BEACH - Solitary fibrous tumor (7). OXNARD {St. Johns Regional Ctrl - Solitary fibrous IUmor. SAN DIEGO (Naval Medical Center) - Solitary fibrous tumor (16). SANTA BARBARA - Solitary fibrous tumor. SANTA CLARA <Lama Prieta Group) - · Solit~ry fibrous tumor (5). SANTA ROSA - Solitary fibrous tumor, r/o hyalinized bemangioperieytoma (1); Hemangiopericytoma vs

solitary fibrous tumor (2). BAY AREA - Fibrous histiocytoma (2); SolitAry fibrous tumor(? angiofibroma) (1). SACRAMENTO CUC Davis) - Solitary fibrous tumor (localized mesothelioma). ARIZONA CVA Med Ctrl - Solitary fibrous tumor. NEBRASKA (Creighton University) - Solitary fibrous tumor. MISSISSIPPI (Baptist HosniLil) • Solitary fibrous tumor. FLORIDA <Tallahassee) - Solitary fibrous IUmor (3). MARYLAND (Bethesda Naval Med Or) - Solitary fibrous tumor (13). CONNECTICUT (Univ Conn Health Or) - Solitary fibrous tumor. COJ::<N&CTICUT (Yale Univ) • Solitary fibrous tumor ofthe·pleura. MASSACHUSETTS (Berkshire Med Or) - SolitAry fibrous tumor. NEW HAMPSHIRE (Manchester) • Benign lesion , favor fibromyosarcoma vs desmoid tumor (1);

Myxofibroma (1). NEW JERSEY (Overlook Hospital Summit) • Solitary fibrous tumor (3); Benign stromal tumor (1).

NEW YORK CMetrooolitau Hospital) - Solitary fibrous tumor. NEW YORK Ompath) - Solitary fibrous tunior. WYOMING - Solitary fibrous tumor. MAINE (Bango;) - Solitary fibrous tumor JAPAN (Shimada-Kyoto) - Localized fibrous tumor of pleura.

DIAGNOSIS: SOLITARY FIBROUS TUMOR, ANTERIOR MEOIASTlNUM

TY2300'/M90510

REFERENCFS: Good lad AR and Fletcher CD. Solitary Fibrous Tumor Arising at Unusual !lites. Analysis of a Series. Hislopalho/

1991; 515-522. Wilkins GB and Rooai J. Solitary Fibrous Tumor of the Mediastihum. A Report of 14 Cases. Am l Surg Patho/1989;

13: 547-557. (See Case 6-.Swanson)

CASE NO. 8, ACCESSION NO. 2693S MARCB1997

INLAND ffiJ\IERSIDEISAN BERNARDINO) - Thymoma, malignant (1); Thymoma (3). BAJ(ERSFJELD (Cenlnll Valley Sl\Jdy G!9!!pl - Malignant lymphoma, la.ge oelltype. CAMARILLO (Aivjso Group) - Lymphocytic thymoma. VENTURA <Unilnb) - Thymoma (2).

PI.EASANTI?N/FREMONT - Thymoma, mixed (probably malignant based on history). LONG BPACH - Malignant thymoma (1). OXNARD (St. Johns Region> I Ctr) - Thymoma.

SAN DIEGO <Naval Medical Center) - Malignant thymoma (9); Thymic carcinoma (7). SANTA BARBARA - TbynUc carcinoma. SANTA CLARA <Lorna Prieta Group) - Thymic carcinoma (5). SANTA ROSA • Malignant thymoma (1); Thymic carcinoma (malignant thymoma, type I) (I); Thymic

carcinoma vs.Jymphoma (1). · BAY ARPA - Invasive tbymoma {3); (? se.runomatous type cells)

SACRAMEN1'Q CUC pavis) • Thymoma, malignant clinically. ARIZONA (VA Med Ctr) • Malignant thymoma. NEBRASKA (Creighton Univernity) - Thymic carcinoma MISSISSIPPI <Baptist HospitaO - Thymoma.

FLORIDA CTallbasseel - Thymoma (3). MARYLAND <Bethesda Navnl Medical Center) - Invasive thymoma (13). CONNECTICUT CUniv Conn Health Ctr) - Thymoma. CONNECI1CUT <Yale Univ) - Malignant thymoma, type I. MASSACHUSETJS <Berkshire Med Ctr) - Malignant thymoma, type I vs seminoma.

NEW HAMPSHlRE (Manchester) • Malignant thymoma (2). NEW JERSEY (Overlook Hospital Summit) - Invasive thymoma (3); SenUnoma (1).

NEW YORK CMetrooolitan Hospital) • Thymic carcinoma probably non-keratinizing. squamous cell. NEW YORK Ompnth) - Invasive (malignant) thymoma (4). WYOMING • Thymic carcinoma MAINE (Bangor) • Thymoma. JAPAN CSbimado-Kyoto) - Malignant thymoma

DIAGNOSIS: INVASIVE THYMOMA, MEDIASTINUM

TY2800/M8S800

FOLLOW-UP: There bas been no tumor recurrence (8 year follow period).

REJ'gRENCE$: Kuo 1T and Lo SK. DNA Flow CytomctrieStudy of Thymic Epithelial TumOit wilh Evaluotion of its Usefulness ill the

P1tho!ogic Oauifocotioo. Hum Patho/1993; 24: 746-749. Lewis JE, Wick MR and Sbeihaur BW, et al. Thymoma. A Clinicopathologic RevieW. Cun<:erl987; 60: 2727-2743. Pich A, OJiarle R and Chlura Land Palestro G. Argyrophilic Nuclear Orgsniu r Regic>n, Counts Predict Sui"\/ ivai ill

Thymoma. Canet:r 1994; Sustc:r S ond Rosai J. Thymic Carcinoma. A Oinicopalhologic Study of 60 Cases. C<urur 1991; 67: 1025-1032. Pescarmona E, Rendina EA, et al. The Prognootic lmpli<:ation olThymoma HistologicSubtyping. A Study alSO

Consooutive Cases. AmJ ClinPatllo/1990; 93: 193-195.

. . .

CASE NO.9, ACCESSION NO. 26541 MARCH1997

INLAND (RJVERSIDB§AN BERNARDINO - Thymoma (1); Thymoma with prominent fibroblastic component (1); Malignantthymicepitbc!ial neoplasm (1); Seminoma (1).

BAKERSFIELD (Central Vallev Study Group) - Metastatic P/0 carcinoma. CAMARILLO (Alviso Group) - Large cell immunoblastic sarcoma. VENTURA CUni!ab) - Thymoma (2).

PLEASANTON/FREMONT - Thymic carcinoma. LONG BEACH - Malignant thymoma (4); Carcinoma showing thymus-like elements (CASTLE) (3). OXNARD (St. Johns RegionAl Qrl - Thymoma r/o undifferentiated carcinoma, r/o germ cell tumor. SAN DIEGO CNaval Medical Ce111erl - Thymic carcinoma (16). SANJA BARBARA - Thymic carcinoma. SANTA CLARA CLoma Prieta Group) - Thy~c carcinoma (5).

SANTA ROSA - Malignant germ cell tumor (2); Dysgem1inoma (1). BAY AREA - Thymic carcinoma (2); Adenooarcinoma (?seminoma/genu cell tumor) (1). SACRAMENTO CUC Davis) - Thymic carcinoma (2); Malignant thymoma (2).

ARIZONA (\lA Med Or) - Malignant thymoma. NEBRASKA (Creighton University) - Thymic carcinoma. MISSISSIPPI CBaptist Hospital) - Thymic carcinoma. FLORIDA Cfall~hassee) • Thymoma (3). MARYLAND CBethesda Naval Medical Center) - Thymic carcinoma (13).

CONNECTICUTCUniv Conn Health Cr) - Metastatic cardnoma (5); Thymoma (1).

CONNECfiCliT (Yale Univ) - Maligna111 thymoma, type 1/Well-differentiated thymic carcinoma, MASSACHUSETTS (Berkshire Med Cr) - Malignant thymoma, type II. NEW HAMPSHIRE (Manche•ter) - Malignant thymoma (2).

NEW JERSEY (Overlook Hospjtal Summit) - Thymic carcinoma (NOS--large cell type) (4). NEW YORK (Metropolitan Hospital) - Poorly differentiated thymic carcinoma with clear cells. NEW YORK Ompathl - Tbyrnic carcinoma (4). WYOMING - Carcinoma ?ncuroendoorine. MAINE@angor) - (?thymic) carcinonu, r/o dysgenninoma/mcl. JAPAN (Shimoda-Kyoto) - Germinoma.

PIAGNOSIS: THYMIC CARCINOMA, MEDIASTINUM

T28000/M85803

REFERENCES: See References for Case #8.

CASE NO. 10, ACCESSION NO. 26782 MARCH 1m

INLAND <RJVBRSIDE!SAN BEBNARDINO} - Low grade B-celllympboma (1); Pulmonary lymphomo (1); Lymphoma, small cleaved cell (1); Well-diffcrenliated lymphocytic lymphoma (I).

BAKERSFIELD (Central Valley Study Group) - Pseudolymphoma.

CAMARilLO Wviso Group) • Lymphoma Qeukemia?). VEJIITURA (Unilab) • Malignant lymphoma, small lymphocytic (2).

PLEASANTON/FREMONT • UP (small cell lymphoma). LONG BEACH • Malignant non-Hodgkin's lymphoma (plasmacytoid) (1). OXNARD (St. Johns Region•! Ctr} • Malignant lymphoma, small cleaved cell type. SAN DIEGO (Naval Medical Center) • Extnlnodal marginal zone (MALl) lymphoma (16). SANTA BARBARA - Small lymphocytic lymphoma witb plasnucytoma features. SANTA CLARA CLoma Prieta Group) - MaligJtantlympboma (5).

SANTA ROSA - Malignant lymphoma, r/o malloma (1); Maltoma (1); Small lymphocytic lymphoma of tbeMALTtype. '

BAY AREA - Lymphoplasmaeytic lymphoma (2); extra medullary plasmacytoma (1).

SACRAMENTO CUC Davis) • Snulllymphocylic lymphoma,low gnde.

ARIZONA (VA Med Clr) • Small B-cell lympboma of MALT. NEBRASKA (Creighlon Univefl'ity) - Malignant lymphoma of smalllympbocy1cs, probable MALT type. MISSISSIPPI CBaptist Hospital) • Low grade lymphoma.

FLORIDA CTallh•<-<eel - Lymphoma (3). MARYLAND (Bethesda Naval Medical Center) • Malignant lymphoma, low grade (13).

CONNECTICtiT CUniv Conn Heallh Ctrl • B-celllympboma, low grade. CONNECTIC![[ <Yale UnivJ - B·celllymphoma of MALT type. MASSACHUSETTS <Berkshire Med Ctr} - Malignant lymphoma, small cell type.

NEW HAMPSHIRE <Manchester) • Malignant lymphoma (1); Lymphoma with plasmacytic features (1). NEW JERSEY (Overlook Hospitol Summit) - Low gnde lymphoma (4). NEW YORK CMetrooolitan Hospital) • B-celllympboma. NEW YORK Ompath) - Malignant lymphoma, small B-cell, marginal zone, probable BALT.

WYOMING • Low grade MALT lymphoma. MAINB(Bangor) • Lymphoma ofBALT. JAPAN (Shimada-Kyoto) - Low-grade lymphocytic lymphoma of BALT.

J)JAGNOSTS: CONSISTF.NT WID! LYMPHOPLASMACYTIC LYMPHOMA, LUNG

T:z8000!M96113

CONSULTATION: Bbarat N. Natbwani, M.D., USC Medical Center, Los Angeles, "Strongly Suggestive ofLymphoplasmacytic

L>:tnphoma."

REfERENCES: Bienenstock J and llcfusAD. Gut and Bronchus-Associated Lymphoid Ti$SUC. /lmJ Anat 170: 437-445. Salzstein SL Pulmonary Malignont Lymphomas oncll'$eudolympbomas. Owir~e~tion, Therapy and Progoosis.

Cancer 16: 928-9$5. Turner R, Colby T and Oogget R. Well-Differentiated Lymphocytic Lymphoma. A Study of 47 Cases with Primary

Manifestation in the Lung. Cancor 1984; 54: 2088-2096. Kobuk L. Benign Pulmonary Lesions That May De Misdiagnosed as Malignant. Semin Diagn Pothol 1990; 7: 129·

138.