california tumor tissue registry los angeles county

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CALIFORNIA TUMOR TISSUE REGISTRY

LOS ANGELES COUNTY - UNIVERSITY OF SOUTHERN CALIFORNIA

PROTOCOL

FOR

MONTHLY STUDY SLIDES

FEBRUARY 1987

GENERAL PATHOLOGY - PART II

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COKTRIBUTOR: Jozef Kollin, M. D. FEBRUARY 19B7 - CASE NO. 1 Long Beach, California

TISSUE FROM: Right testicle ACCESSION NO. 25623

CLINICAL ABSTRACT:

History: This 59-year-old Caucasian man reported a 2 month history of pain and swelling of his right testicle following minor trauma to the scrotum. He deni ed fever or chills. Antibiotic therapy fai led to relieve his symptoms. The patient underwent a retropubic prostatectomy for hypertrophy on 3/8/85. .

Physical examination: The -right testicl-e was enlarged and finn. The overlying scrotum was erythematous.

Radiographs: An ultrasound revealed an echogenic mass in the right testicle. ·

SURGERY: (June 21, 1985)

A right radical orchiectomy was performed.

GROSS PATHOLOGY:

The specimen consisted of an entire right testicle and attached spermati c cord. The testicle measured 6.5 .x 3.5 x 2.5 em. and weighed 58 grams. The tunica vaginal is and tunica albuginea were· adherent to one another. The testicular parenchyma was homogeneous tan and moderately firm with a thin peripheral rim of soft, light yellow tissue. A distinct tumor was not present . The epididymis was white and firm.

CONTRIBUTOR: Jozef Kol ,1 in, ~1. D. FEBRUARY 1987 - CASE NO. 2 Long Beach, California

TISSUE FROM: Right. lung mass ACCESSION NO. 25747

CLINICAL ABSTRACT:

History: This 55-year-old Mexican-American man had a long history of cigarette smoking, alcoholi~m and diabetes mellitus. He presented to the emergency room with epistaxis. A chest x-ray taken in the E. R. showed an 11 x 5 em.· mass in the right . lower chest cacity.

SURGERY: (February 29, 1984)

A thoracotomy with resection of the mass was performed. An apparently encapsulated, 10 x 10 x 12 em. mass was attached to the pleural surface of right middle lobe by a short pedicle. The tumor did not involv.e any other thoracic structures. The remaining pleural surfaces were unremprkable.

GROSS PATHOLOGY:

Received was an enca'psul at.ed, 15 x 13 x 10 em. , 700 grams firm mass. Cut surfaces were tan7white and bulging. Small fragments of lung tissue were attached to the periphery of the mass.

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CONTRIBUTOR: Jozef Kollin, M. D. Long Beach, California

FEBRUARY 1987 - CASE NO. 3

TISSUE FROM: Right neck mass ACCESSION NO . 25746

CLINICAL ABSTRACT:

Historf: This 43-year-old man had a 3 month history of gradually enlarging r ght neck mass. There was no history of dysphagia, weight loss, fever or chills. No mucosal lesions were identified.

SURGERY: (April 11, 1983)

A right neck exploration with resection of the mass was performed. An elongated, cystic, 6 em. mass was found beneath the sternocleidomastoid muscle. A slender portion of the. tumor could be followed to where it penetrated between 2 cervical ·vertebral bodies.

GROSS PATHOLOGY:

The specimen consisted of a cylindrical, 3 x 3.5 x 1 em. thin-walled cystic structure. The external surface was smooth and grey pink and the inner surface was nodular and yellow white. The interi9r was fille with yellowish fluid. The cyst wall was yellow to white and firm with focal calcifications.

CONTRIBUTOR: Jozef Kollin, M. D. FEBRUARY 1g87 - CASE NO. 4 Long Beach, California

TISSUE FROM: Appendix ACCESSION NO. 25744

CLINICAL ABSTRACT:

History: This 51-year-old quadraplegic Caucasian man had a history of intermittent right lower quadrant pain for many years. He sought medical attention because of nausea and vomiting, without associated diarrhea.

Radiographs: A barium enema showed an extrinsic mass in the area of the cecum.

SURGERY: (March 16, 1983)

An exploratory laparotomy with right hemicolectomy and mesenteric lymph node dissection was performed.

GROSS PATHOLOGY:

The specimen consisted of a 150 em. length of distal small bowel and an attached 30 em. length of right colon. The small bowel measured 5 em. in circumference and the large bowel 10 em. in circumference. At the .terminal ileum, the mesenteric fat was creeping along the serosal surface, ·and the bowel wall was thickened up to 1.0 em. The mucosa of the proximal small bowel showed ulceration with mul tiple pseudopolyps in the intervening areas. Near the ileocecal valve, a 2.5 x 2 x 1. 5 em. finn yellow tumor mass was noted. The overlying mucosa was ulcerated. The tumor extended through t he entire thickness of the wall and the serosa , and involved the base of the appendix.

CONTRIBUTOR: E. Wasef, M. D. FEBRUARY 1987 - CASE NO. 5 Los Angeles, California

TISSUE FROM: Pancreas ACCESSION NO. 25769

CLINICAL ABSTRACT:

Hi storf A 68-year-old Oriental male was admitted for right upper quadrant ab aminal pain, .associated wi th nausea and vomiting of 2 weeks duration. A CT scan performed one year prev·iously revealed a large mass in the right mid-abdomen. An exploratory laparotomy was recommended, but refused. Past medical hi story was significant for a right hemicolectomy 3~ years previously for colon carcinoma followed by 5 FU chemotherapy. He also had hypertension , but no history of alcoholism.

Physical examination: There was tenderness in the right upper abdomen without a pal~abl e mass.

Radiographs: CT scan revealed a mass measuring 10 x 7 em. in the r ight middle abdomen , anterior to the kidney and without liver, spleen, kidney or retroperitoneal involvement. A barium enema and upper G.I. series were negative.

Laboratory data: CEA was normal


A modified Whipple's procedure . was performed.

GROSS PATHOLOGY:

A large mass involving t he body and head of the pancreas was found. The liver appeared smooth without nodules and the rest of the abdominal exploration was unremarkable.

CONTRIBUTOR: Jozef Ko 11 in, M. D. FEBRUARY 1987 - CASE NO. 6 Long Beach, California

TISSUE FROM: Left breast ACCESSION ' NO . 25761

CLINICAL ABSTRACT :

History: and nausea.

This 84-year-old woman presented with complaints of back pain '

. . Physical examination: A large mass W?IS discovered in the left breast.

When questioned about the mass, the patient reported that she had noted the mass gradu~lly enlarging to this size over ·a period of 4 years • . There was no history of ni.pple di.scharge or skin dimpling .

SURGERY: (September 13, 1984)

A modified radical mastectomy with axillary lymph node dissection was performed.

GROSS PATHOLOGY:

The specimen consisted of an entire left breast including nipple, surrounding skin ellipse and pectoral fascia, with an attached portion of axillary .fat. The skin superior to the nipple had a translucent appearance and was stretched by an underlying 11.0 x 13.0 x 8.0 em. lobulated mass. On section, the tumor appeared to be encapsulated. The cut surfaces were gl i stening, tan and divided into lobules by fibrous septae.

CONTRIBUTOR: Jozef Kollin, M. D. FEBRUARY 19B7 - CASE NO. 7 Long Beach, California

TISSUE FROM: Lung ACCESSION NO. 25753

CLINICAL ABSTRACT:

History: This 65-~ear-ol d white man presented with a 6 month history of abdominal pain and a 40 lb. weight loss.

Radiographs: Chest x-ray showed an interstitial nodular pattern.


A wedge biopsy of the right upper lobe was performed.

GROSS PATHOLOGY:

The specimen consisted of a 4 x 4 x 3 em. wedge-shaped portion of lung with a smooth, glistening pleural surface. The cut surfaces showed mu-ltiple glistening grey-tan parenchymal nodules measuring up to 1 em. in diameter .

CONTRIBUTOR: J. Koll1n, M. D • FEBRUARY 1987 - CASE NO. 8 . . Long Beach, California

TISSUE FROM: Thyroid ACCESSION NO. 25741

CL INICAL ABSTRACT:

History: A 23-year-old Caucasian male was admitted with a one year h'1story of palpitations, irritability,. headaches, tremors, ill fitting contact lens~s, frequent hard stools, a six month history of heat intolerance, 20lb weight loss, occasional epistaxis, a two month history of dizziness without loss of consciousness and "Bug" eyes.

Ph~sical examination: BP 140/60; pulse 90/min. Physical findings include exopthalmos, fine motor tremors, brisk deep tendon reflexes bilaterally and a questionable mass in the left lobe of the thyroid.

Radio~raphs.: Radionucl ide tracer study of the thyroid with I 123 . showed a d1ffuse increase in tracer uptake throughout an enlarged thyroid gland with 77% uptake (nl:l0-20%) at 24 hrs. No focal hot nodules were seen.

Laborator~ data: The serum T4 was greater than 24Jfg/dl (N=5.5-11.5), and the TSH an · T3 resin uptake were normal.

SURGERY: (April 24, 1986)

A subtotal thyroidectomy was performed.

GROSS PATHOLOGY:

The right lobe of the thyroid weighed 41 grams and measured 7 x 4.5 x 3.1 em.; the left lobe weighed 46 grams and measured 6.5 x 4.5 x 3.2 em. Both lobes had a homogeneuous, beefy red, bulging appearance.

CONTRIBUTOR: E. Wasef, M. D. FEBRUARY 1987 - CASE NO. 9 Los Angele~, California

TISSUE FROM: Right breast ACCESSION NO. 25771

CLINICAL ABSTRACT:

History: A 29-year-old woman was admitted for a right breast mass. She had had a previous exci~ion of a right breast mass in 1982 which was interpreted as a cystosarcoma phyllodes without evidence of malignancy. About three months prior to this admission, she noted a mass in the upper inner. part of the breast. This mass increased rapidly in size. The mass now measured approximately 7 em. in diameter.

SURGERY: (Apri 1 15, 1985)

A right simple mastectomy wa.s performed.

GROSS PATHOLOGY:

A partially opened, well circumscribed, smooth walled cystic structure measured 5.5 x 4.0 x 3.5 cni. A lobulated, multinodular mass of firm grayish white tissue with focal hemorrhage measuri ng 4 x 3.5 x 2.8 ems. was attached to the wall by a 2.5 x 2 em. base. Cross section through the mass reveals glistening grayish white. tissue.

CONTRIBUTOR: Gary C. Ponto, M. D. FEBRUARY 1987 - CASE NO. 10 Santa Barbara, California

TISSUE FROM: Breast ACCESSION NO. 25478

CLINICAL ABSTRACT:

History: A 68-year-old Caucasian female ,was admitted for a progressively enlarging left breast mass for at least·3 year. At the time of presentation, the patient had signs of sepsis. A fluctuant cavity was drained and a large · mass remained.

Physical examination: The left breast was massively enlarged. The overlying skin showed some edema simulating peau d'orang. No axi llary adenopathy was palpable.

Radiographs: Bone scan and chest x-ray were normal.

SURGERY: (June 26, 1985)

A simple mastectomy was performed. The initial incision .expressed a large volume of reddish-brown necrotic appearing material. The lesion (mass) dissected easily with a minimum of sharp dissection.

GROSS PATHOLOGY:

The mass with attached skin elipse and minimal surrounding fat weighed 650 grams and measured 15 x 10.5 x 6.0 em. The mass was sharply circumscribed, oval, minimally lobulated, and surrounded by a thin rim of unremarkable fatty breast parenchyma. Cut surface showed an irregular, thick capsule-like bano of fibrous tissue surrounding a thick shaggy layer of soft, yellow-tan, lobulated tissue and a large collapsed central cavity. The tumorous tissue measured up to 4 em. in thickness and showed myxoid areas, scattered calcification, and bands of fibrosis in a soft fleshy tumor. An adjacent cyst cavity measured 6 x 6 x 3 em. and was lined by a necrotic hemorrhagic, shaggy tissue layer free of any obvious bulky tumor.

CONTRIBUTOR: W. M. Talbert, M. 0. FEBRUARY 1987 - CASE NO. 11 Long Beach, California

TISSUE FROM: Pancreas ACCESSION NO. 25640

CLINICAL ABSTRACT:

History: An 86-year-old .caucasian female was admitted with an acute myocardial infarction and died several hours after admission. Incidental autopsy findings included a mass in the tail of pancreas. She had a history of arthritis.

GROSS PATHOLOGY:

At autopsy, an ovoid, well-circumscribed mass measuring 7 x 6 x 4.5 em. was found in the tail of the pancreas. Cut surface revealed numerous small cysts ranging .from 0.1 to 2 em. indiameter, filled with thin , clear fluid, separated by grey-white fibrous connective tissue .

CONTRIBUTOR: James D. Collins, M. D. FEBRUARY 1987 - CASE NO. 12 Waterloo, Iowa

TISSUE FROI1: left thigh ACCESSION NO. 23683

CLINICAL ABSTRACT:

History: A 30-year-old Caucasia~ female was admitted with a left thigh mass first noted 6 months previously. The mass did not interfere with her walking and was not painfuL.

Physical examination: A S.cm., firm, mobile, nontender, subcutaneous mass was found in the inner aspect of the left thigh, without overlying skin changes or palpable regional nodes.

SURTERY: (November 17, 1986)

An excisional biopsy was performed. A well-defined vascular pedicle was noted, and the tumor was easily removed from between two muscles in the thigh .

GROSS PATHOLOGY:

An oval, apparently encapsulated mass measuring 5.3 x 4.0 x 2.1 em. was received. Cross section reveal ed bulging lobulated tissue composed of fairly solid greyish pink tissue that had focal areas of increased vascularity. Another specimen submitted as a pedicle consisted of a cylindrical greyish yellow- pink soft tissue fragment.

STUDY GROUP CASES FOR

FEBRUARY 1987

CASE NO. 1 ~ ACCESSION NO. 25623

LOS ANGELES: Granulomatous orchitis - 13

MARTINEZ: Granulomatous orchitis - 8; chronic orchitis - 4

LONG BEACH: Idi·opathic granulomatous orchitis - 10

VENTURA: Chronic gr.anulomato'us orchitis - 7

FRESNO: Non-specific granulomatous .orchitis - 12

INDIANA: Granulomatous orchitis - 2

BAKERSFI·EL:o: Granulomatous .orchitis - 8; ' infla11111atory pseudo tumor- 1; ~lasma cell orchitis - 1

SAN FRANCISCO: Granulomatous orchitis ~ 7

SAN BERNARDINO (INLAND): Granulomatous orchit"is- 7; infla11111atory pseudotumor - 1

OAKLAND: .Chronic granulomatous orchitis, right testicle - 13

SEATTLE: Orchitis, plasma cell rich, ? granulomatous - 4

OHIO: Granulomatous orchjtis - 3

FOLLOW-UP: .

Not aYailable.

SPECIAL STAINS:

Stains for acid fast bacilli and fungi were negative.

FILE DIAGNOSIS:

Granulomatous orchitis, testicle

RE-FERENCES:

Elicken, E. R., Evans, A. T.: Granulomatous Orchitis. J. Urol. 113, 199-200, 1975. Report of 3 cases.

Lynch, V. P., Eakins, D., Morrison, E.: ·Granulomatous Orchitis. Br. J. Urol. 40:451-458, 1968. Report of 19 cases.

CASE NO. 2 - ACCESSION NO. 25747 FEBRUARY 1987

LOS ANGELES: Localized fibrous mesothelioma , 13

MARTINEZ: Benign fibrous mes9the11oma - 12

LONG BEACH: Benign localized fibrous mesothelioma- 10

VENTURA: Localized fibrous mesothelioma (~leural fibroma) - 7

FRESNO: Fibrous mesothelioma- 10; neurofibroma- 1; sequestration with fibrosis - 1

INDIANA: Fibrous mesothelioma- 2

BAKERSFIELD: Benign localized fibrous mesothelioma- 10 . .

SAN FRANCisc·o: Benign fibrous mesothelioma (localiZed s,ubpleural fibroma} - 7

SAN BERNARDf.NO (INLAND): Benign fibrous .mesothelioma of pleura - 8

OAIQAND: Local benign fibrous mesothel.ioma, pleura, right middle lobe - 14

SEATTLE: Subpleural fibroma - 4

OHIO: Fibrous mesothelioma - 3

FOLLOW-UP:

On December 10, 1985, a second thoractomy was performed for a suspected recurrent mass, which turned out to ~e the pericardial fat pad. No evidence of recurrence was discovered at that surgery. As of December 1986, the patient remained without evidence of recur.rent tumor.

FILE DIAGNOSIS:

Localized fibrous mesothelioma, pleura

REFERENCES:

Hernandez, F. J., Fernandez, B. B.: ·Localized and Fibrous Tumors of the Pleura: A Light and Electron Microscopic Study. Cancer ·34, 1667-1674, 1974. Report of 2 cases.

Dalton, W. T., Zolliker, A. S., McCaughey, W. T. E., Jacques, J., Kannerstein, M.: Localized Primary Tumors of the Pl eura: An Analysis of 40 Cases. Cancer 44:1465-1475, 1979. Hi stologic patterns, frequency of malignant behavior.

Scharifker, D., Kaneko, M.: Localized Fibrous Mesothelioma of P~eura (Submesothial Fibroma): A Clinicopathologic Study of 18 Cases. Cancer 43: 627-635. 1979.

CASE NO. 3 - ACCESSION NO. 25746

LOS ANGELES: Cystic neurilemmoma (schwannoma) - 13

MARTINEZ: Neurilemmoma - 12

LONG BEACH: Cystic schwannoma - 10

VENTURA: Cystic schwannoma - 7

FEBRUARY 1987

FRESNO: Congenital cystic axi~l neural tumor - 2; cystic schwannoma ~ 10

INDIANA: Schwannoma - 2

BAKERSFIELD: Benign cystic ~chwannoma - 7; meningomyelocele sac - 3 ·

SAN FRANCISCO : Cystic schwannoma - 7

SAN BERNARDINO (INLAND): Neurilemoma- 7; ectopic-brain tissue- 1

OAKLAND: Benign schwannoma; right neck - 14

SEATTLE : Cystic schwannoma - 4

OHIO: Neurilemmoma - 3

FOLLOW-UP:

The patient was well, without recurrence 3 year.s after surgery.

SPECIAL STAINS:

Immunohistochemical stains for S-100 protein were positive.

FILE DIAGNOSIS:

Cystic neurilemmoma (schwannoma), neck

REFERENCES:

Kragh, L. V., Soule, E. H., Masson, J. K .. : Benign and Malignant Neurilelll!lOmas of the Head and Neclc. ·Surg. Gynecol. Obstet. III, 211-218, lg6o. Review of 148 cases.

Oberman, H. A., Sullenger, G.: Neurogenous Tumors of the Head and Neck. Cancer 20:1992-2001, 1967. Reports 15 cases of neurilemmoma .

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CASE NO. 4 - ACCESSION NO. 25744

LOS ANGELES: Carcinoid tumor - 13

MARTINEZ: Carcinoid - 12 .

FEBRUARY 1987

LONG BEACH: Carcinoid in association with Crohn's disease- 10

VENTURA: Carcinoid - 7

FRESNO: Carcinoid - 12

INDIANA: Carcinoid tumor - 2

BAKERSFIELD: Carcinoid tumor, appendix - 10

SAN FRANCISCO: Carcinoid tumor - 7

SAN BERNARDINO ( INLAND): . Carcinoid - 8

OAKLAND: Carcinoid with granulomas suggestive of Crohn's disease, G.I tract - 14

SEATTLE: Carcinoid tumor - 4

OHIO: Carcinoid - 3

FOLLOW-UP :

Three years post-operatively, the patient suffered from intermittent bouts of diarrhea, but had no evidence of recurrent tumor.

FILE DIAGNOSIS:

Carcinoid tumor, appendix, arising in a patient with Crohn' s disease.

REFERENCES:

Brown GA, Kollin J. , Kannan Rajan R.: The Coexistence of Carcinoid Tumor and Crohn's disease. Gastroenterol 8:286-289, 1986. (Case report of this patient) .

Moertel, C. G., Dockerty, M. B., Judd, .E. S.: Carcinoid Tumors of the Vermiform Appendix. Cancer 21, 270-278, 1968. Seri es of 144 cases; pathology, incidence of metastasis.

Lewtn, K, et al: The endocrine cell of the G.I. Tract: Tumors, part II. Path. Annu. Vol. 21 (part 2): 181-215, 1986.

Syracu se, D. C., Perzin, K. H., Price, J. B. , Wiedel, P. D., Meas-Tejeda, R.: Carcinoid Tumors of the Appendix: Meso-appendiceal Extension and Nodal Metastases. Ann. Surg. 190, 58-63, 1979. Report of 92 cases.

Glasser, C. M. Bhagavan, B. S.: Carcinoid Tumors of the Appendix. Arch. Pathol. Lab. Med. 104:272-275, 1980. Report of 46 cases; ~eatures of metastasizing tumors.

CASE NO. 5 - ACCESSION NO . ~5769 FEBRUARY 1987

LOS ANGELES: Mucinous adenocarcinoma (either pancreatic or metast atic) - 14

MARTINEZ: Adenocarcinoma, mucinous , probably arising from pancreatic duct - 8; adenocarcinoma , metastatic from colon- 1; adenocarcinoma , mucinous, NOS - 3 ,

LONG BEACH: Mucinous adenocarcinoma of pancreas - 10

VENTURA: Mucinous secreting adenocarcinoma, primary site not dete~ined - 7

FRESNO: Primary carcinoma pancreas- 10; carcinoma of duodenum- 1; primary adenocarcinoma - 1

IHDIANA: Adenocarcinoma , poorly differentiated - 2

BAKERSFIELD: Mucinous adenocarcinoma ,- pancreas- 8; metastatic carcinoma- 2

SAN FRANCISCO: Adenocarcinoma of pancreas - 6; adenocarcinoma metastatic from colon - 1

SAN BERNARDINO (INLAND}: Muc inous adenocarcinoma (primary - 4, secondary - 2, undecided - 2)

OAKLAND: Adenocarcinoma, moderately differentiated, most likely of pancreatic or igin - 14

SEATTLE: Adenocarcinoma - 4; malignant neuroendocrine carcinoma - 1

OHIO: Mucinous adenocarcinoma - 3

FOLLOW-UP:

Postoperatively the patient developed intra-abdominal bleeding. Repeat exploratory laporatomy showed a mesenteric artery occlusion . A bowel resection was performed. The pati ent dev~loped renal failure, hyperglycemia, and continued G.I. bleeding. He died on March 23, 1986 with metastatic carc1 noma.

FILE DIAGNOSIS:

Mucinous adenocarcinoma, pancreas (primary versus metastatic)

. .


LOS ANGELES: Mucinous carcinoma - 14

MARTINEZ : Colloid carcinoma - 12

LONG BEACH: Colloid adenocarcinoma of breast - 10

VENTURA: Mucinous adenocarcinoma (colloid carcinoma) - 7

FRESNO: Colloid carcinoma - 12

INDIANA: Adenocarcinoma, mucinous (colloid carcinoma) - 2

BAKERSFIELD: Mucinous (col loid) carcinoma, left breast - 9; mucinous carcinoid tumor of breast - 1

SAN FRANCISCO: Colloid carcinoma of breast - 7

SAN BERNARDINO (INLAND): Colloid carcinoma of breast - 8

OAKLAND: Mucinous carcinoma, left breast - 14

SEATTLE: Adenocarcinoma with excess mucin and carcinoid features - 5

OHIO: Mucinous adenocarcinoma - 3

FOLLOW-UP:

The patient was treated with tamoxifen post-operatively. In January, 1986, a mass in the left lower lobe of the lung was di scovered during a routine follow-up visit. Four months later, she was hospitalized for weakness and dyspnea. She expired on July 17, 1986. At autopsy a 10 em. adenocarcinoma was discovered in the left lower lobe of the lung. This had metastasized to hilar lymph nodes. No other tumor was identified. The lung tumor was felt to be a 2nd primary, since it was not histologically similar to the breast lesion.

FILE DIAGNOSIS:

Mucinous carcinoma, breast

REFERENCES:

Silverberg, S. G., Kay, S., Chitale, A. R. , Livitt, S. H.: Colloid Carcinoma of the Breast. Am. J. Clin. Pathol. 55:355-363 , 1971. Report of 42 cases.

Rogen, P. P., Wang, T-Y.: Colloid Carcinoma of the Breast: Analysis of 64 Patients with Long-Tenn Follow-up. Am. J. Clin. Pathol. 73:304, 1980. (Abstract). Thirty-year follow-up of patients with colloid and mixed ductal/ colloid carcinoma.

Rasmussen Br, et al: Prognostic factors in Primary Mucinous Breast Carcinoma. Am. J. Clin. Path. 87:155-160, 1987.

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LOS ANGELES: Mucin producin, adenocarcinoma, (either primary or metastatic) - 14

W\RTINEZ: Adenocarcinoma, bronchioloaveolar type - 3; adenocarcinoma, bronchloloaveolar type, r/o metastatic tumor - 9

LONG BEACH: Bronchioloalveolar carci noma - 10

VENTURA: Adenocarcinoma consistent with bronchoalveolar carcinoma, cannot rule out metastases - 7

FRESNO: Bronchoalveolar cell c·arcinoma to rule out primary abdominal carc1noma - 12

IND IANA: Adenocarcinoma, well differentiated {bronchiolo-alveolar vs. metastatic) - 2

BAKERSFIELD: Bronchiolar-alveolar carcinoma - 10

SAN FRANCISCO: Metastatic carcinoma to lung - 3; bronchiolo-alveolar carcinoma - 4

'SAN BERNARDINO (INLAND): Bronchioloalveolar carcinoma- 8

OAKLAND: Adenocarcinoma, right upper lope, lung, favor metastatic lesion R. 0. bronchiole-alveolar type - 10; bronchia-alveolar carcinoma - rule out metastatic carcinoma - 4

SEATTLE: Mucinous adenocarcinoma, favor metastatic - 5

OHIO: Bronchoalveolar carcinoma - 3

FOLLOW-UP:

Post operative bone scan showed multiple areas of increased activity in the right and left humerus, right clavicl e, ribs and spine. The patient' s bilirubin began to increase, reaching 20 mg/dl. An endoscopic retrograde cholangiopancreatograph revealed a mass· in the pancreatic head. Aspiration biopsy showed atypical cells. The patient died 6 weeks after surgery. No autopsy was performed.

FILE DIAGNOSIS:

Mucin producing adenocarcinoma, lung (primary versus metastatic)

REFERENCES:

Rosenblatt, M. B., Lisa , J. R., Collier, F.: Primary and Metastatic Bronchiole-Alveolar Carcinoma. Dis. Chest. 52:147-152, 1967. Report of 34 cases in which metastases to~ung mimicked primary bronchiole-alveolar carcinoma.

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Greenberg, s. 0., Smith, M. N. , Spjut, H. J.: Bronchiolo-alveolar Carcinoma -Cell of Origin. Am. J. Clin. Pathol. 63:153-167, 1975. Light and electron microscopic study of 5 cases, suggesting 2 different cells of origin.

Tao, L. C., Delarue, N.C., Sanders, D., Weisbrod, G.: Bronchioloal.veolar Carcinoma: A Correlative Clinical and Cytologic Study. Cancer 42: 2759-2767, 1978. Comparison of fine needle aspiration and cytology of sputum or bronchial washings for diagnosis.

CASE .NO. 8- ACCESSION NO. 25741 FEBRUARY 1987

LOS ANGELES: Diffuse hyperplasia (clini cal ly toxic goiter) - 14

MARTINEZ: Primary hyperplasia of ·t hyroid in Grave's Disease - 12

LONG BEACH: Primary thyroid hyperplasia - 10

VENTURA: Diffuse hyperplasia of thyroid (Grave's disease) - 7

FRESNO: Diffuse thyroid hyperplasia - 12

!NOlANA: Hyperplasia (Grave'S" disease) - 2

BAKERSFIELD: Toxic goiter - 10

SAN FRANCISCO: Hyperplasia of thyroid - 7

SAN BERNARDI NO (INLAND): Diffuse hyperplasia of thyroid - 8

OAKLAND: Hyperplasia , thyroid (Grave's disease) - 14

SEATTLE: Hyperplastic thyroiditis - 5

OHIO: Hyperplastic thyroid - 3

FOLLOW-UP:

The postoperative course was uneventful, and thyroid function tests were within normal limits .

FILE DIAGNOSIS:

Diffuse hyperplasia, thyroid

REFERENCES:

Eggen, P. C., Seljelid, R.: The Hi.stological Appearance of Hyperfunct ioning Thyroids Following Various Preoperat ive Treatments. Acta Pathol. Microbial. Scand. (A)81:16-20, 1973.

Gossage, A. A. R., Munro, D. S.: The Pathogenesis of Graves' Disease. Clio. Endocr inol. Metab. 14:299-330, 1985 . Review of immunology of Grave's Disease .


LOS ANGELES: Cystosarcoma phyllodes - 4; cystosarcoma phyllodes, histologically malignant - 10

MARTINEZ: Cystosarcoma phyllodes, potentially malignant- 1; cystosarcoma phyllodes, malignant - 11

LONG BEACH: ·.Cystosarcoma phyllodes, (malignant) - 10

VENTURA: Aggressive phyllodes tumor (cystosarcoma phyllodes) - 7

FRESNO: Malignant cystosarcoma phallodes- 12

INDIANA: Cystosarcoma phyllodes, probably malignant- 2

BAKERSFIELD: Malignant cystosarcoma phyllodes, right breast - ..1 0

SAN FRANCISCO: Recurrent cystpsarcoma phyllodes, i ntermediate ·grade - 1; recurrent cystosarcoma phyll odes, rna 1 ignant - 6

SAN BERNARDINO (INLAND): Phyllodes t umor- 8 (intermediate- 4, malignant- 4).

OAKLAND: Malignant cystosarcoma phyllodes, recurrent, right breast - 14

SEATTLE: Phyllodes tumor - 4 ; cellular fibroadenoma - 1

QHIO: Malignant cystosarcoma phyl1odes - 3 .

FOLLOW-UP:

The patient was seen .bY her physician 3-4 months ago and there is no evidence of recurrence.

FILE DIAGNOSIS:

Phyllodes tumor, malignant, breast

REFERENCES:

Norris, H. J. , Taylor, H·. B. : Relationship of Histologtc Features to Beha_vior of Cystosarcoma P.hy-llodes: Analysis of N'inety- four Cases . Cancer 20:2090-2099, 1967. Correlation of microscopic features .and malignancy.

Rhodes, R. H., Frankel ., K. A. , Davis, R. L.. 'latter, D.: Metastatic Cystosarcoma Phyllodes: A Report of 2 Cases Presenting with Neurological Symptoms . Cancer-41:1179-1187, 1978. Review of literature on metastatic cystosarcoma phyllodes.

Hart, W. R., Baner ,. R. C. , Oberman, H. A. : Cystosarcoma .Phyllodes: A Cl'lnicopC\thologic Study of Twenty-six Hypercellular Periductal Stromal Tumors of the Breast. Am. J. Clin. Pathol . 70:211-216, 1978. Distinction between benign and malignant forms. ·

Ward R. M. , Evans: Cystosarcoma phyllodes: A studry of 26 cases (Importance of ·Stroma·l Overgrowth). Cancer 5~:2282-2289, 1986.

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LOS ANGELES: Intracystic carcinoma - 8; mixed tumor, borderline malignancy - 3; sebaceous carcinoma- 1; lipid rich carcinoma 2

·MARTINEZ: Subareolar duCt papillomatosis with infl'diTillatory carcinoma· - 6; . sweat gland tumor of b'reast , 1; intraductal papi.llary carcinoma with lymphatlc invasion - . 3; papillomatosis with infarction~ 2

LONG BEACH: Intraductal and . infilt~ating ductal adenocarcinoma- 10

VENTURA: Atypical intraductal: papi lloma, benign - 1; infiltrating ductal can:inoma - 6

FRESNO: Sebaceous gland carcinoma- 1; sweat gland carcinoma- 5; adenocarcinoma - 6

INDIANA: Adenocarcinoma - ? BAKERSFIELD: Florid ductal papillomatosis, left breast - 6 ;. ·adenosi s - l; ·cystic adenoca rc.i noma - 3

SAN FRANCISCO: Lo.w grade skin adnexal tumor - 2; giant adenoma of nipple - 1; low grade ducta 1 carcinoma - 3 .

OAKLAND: Benign intraductal papilloma, left breast - 7; necrotizing carcinoma, ductal, sweat gland type- 7

SEATTLE: Low-grade carcinoma - 3; nipple adenoma - 2

OHIO: Adenoma - 2; adenocarcinoma- 1

FOLLOW-UP:

Not available .

FILE DIAGNOSIS:

L·ow grade carcinoma, NOS, breast

CONSULTATION:

William R. Hart, ·M. ·D., Cleveland Cl inic Foundation Favor benign intraductal papilloma or adenoma with secondary infarction resulting in cellular atypia and a pseudofnfiltrative growth pattern.

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REFERENCES:

Kraus, F. T., Neubecker, R. D.: The Differential Diagnosis of Papillary Tumors of the Breast. Cancer 15:444-455, 1962. Distinction between papilloma and papiJlary carcinoma.

Murad, T. M. , Swaid, S. , Pritchett, P.: Mal ignant and Benign Papillary Leisons of the Breast. Hum. Pathol . 8:379-39D; 1977. Criteria for Diagnosi s of Papillary Breast ~esions.

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LOS ANGELES: Serous (microcystic) cystadenoma - 14

MARTINEZ: Serous cystadenom·a (lliicroc,ystic adenoma) · - 12

LONG BEACH: . Serous cystadenoma (microcystic adenoma) . - 10

VENTURA: ·Benign serous cystadenoma of pancreas - ·7 ·

FRESNO: Serous cystadenoma pancreas - 12

I~OIANA: Microcystic (glycogen rich) adenoma - 2

BAKERSFIELD: Pancreatic serous cystadenoma - 10

SAN FRANCISCO: Microcystic adenoma - 7

SAN BERNARDINO (INLAND):· M1crocystic cystadenoma - 8

OAKLAND: Microcystic adenoma, tail of pancreas - 14

SEATTLE: Microcystic cystadenoma - 5

OHIO: Glycogen-rich cystadenoam - 3

FOLLOW-UP:

Autopsy case.

FILE DIAGNOSIS:

Serous (microcystic) cystadenoma, pancreas

REFERENCES:

Campago, J . , Oertel, J. E.; Microcystic Adenomas of the Pancreas (Glycogen-rich Cystadenomas): ·A clinicopathologic Study of 34 Cases. Am. J. Clin. Pathol. 69:289-298, 1978. Histopathology, diagnosis, clinical course.

Shorten SO, Hart WR, Petras RE: Microcystic adenomas {serous cystadenomas) of Pancreas. Am. J. Surg. Pathol. 10:365-372, 1986.

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LOS ANGELES: Hemangiopericytoma - 14

MARTINEZ: Hemangiopericytoma - 12

LONG BEACH: Hemangiopericytoma - 10

VENTURA: Hemangiopericytoma - 7

FRESNO: Malignant hemangiopericytoma ~ 12

INDIANA: Hemangiopericytoma - 2

BAKERSFIELD: Hemangiopericytoma . - 10

SAN FRANCISCO: Hemangiopericytoma, low· grade malignancy - 7

SAN BERNARDINO {INLAND}: Hemangiopericytoma - 8

OAKLAND: Hemangiopericytoma, left thigh - 14

SEATTLE: Hemangiopericytoma - 5

~: Hemangiopericytoma - 3

FOLLOW-UP:

As of January 1987 the patient is doing fine with no evidence of recurrence.

FILE DIAGNOSIS:

Hemangiopericytoma, left thigh

REFERENCES:

McMaster, H. J. , Soule, E. H., Ivins, J. C.: Hemangiopericytoma: A Clinicopathologic Study and Long-term Follow-up of 60 Patients. Cancer 36:2232-2244, 1975. Pathology, clinical findings, radiology, treatment, follow-up . .

Enzinger , F. M;, Smith, B. H.: Hemangiopericytoma: An Analysis of 106 Cases. Hum. Pathol. 7:61-82, 1976. Clinical findings, histology, differential diagnosis.

Angervall, L., Kindblum, L. G., Nielsen, J. H. Stener, B., Svendsen, P.: Hemangiopericytoma: A Clinicopathologic Angiographic and Microangiographic Study. Cancer 42:2412-2427, 1978. Study of 11 cases.

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