I I'll CALIFORNIA TUMOR TISSUE REGISTRY

"ULTRASTRUCTURAL PATHOLOGY"

Study Cases, Subscription A

November 2000

Editor's Note: We hope you enjoy this slight departure from the usual format of the CITR momhly slide series. While !he use of ultrastructure as a diagnostic aid is waning, its importance is still considerable. The imem of this particular swdy set is to correlate the ultrastructural features of the cases with the characteristic histologic findings. This momh 's set was put together by former Loma Linda Pathology Resident Dr. Dennis O'MaiiL'Y. His commentary 011 the electron micrographr will appear i11 the "Miuutes. " .. . DRC

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

Lorna Linda University School of Medicine 11021 CampusAvenue, AH335 Lonm Linda, Californ ia 92350

(909) 558-4788 FAX: (909) 558-0188

E-mail: gtr@linklinc.com Web Pnge: www.cttr.org

Targd audiente: Practicing patholosists and patholosy residents.

Goal: To acquaint the participant with the histologic features of a variety of benign and

malignant neoplasms and tumor-like' conditions.

Objectives: The participant will be able to recosnize morpbologic features of a variety of benign

and malignant neopi9Sllls and tumor-like conditions and relate those processes to pertinent references in the medical literature.

Educati.onal metbods and media: Review of representative glass slides with associated histories. Feedback on consensus diagnoses from participating pathologists. Listing of selected references from the medical literature.

Principal faculty: Weldon K. Bullock, MD Donald R. Olase, MD

CME Credit: Lorna Linda University School of Medicine designates this continuing medical

education activity for up to 2 hours of Category I of the Physician's Recognition Award oftlte American Medical Association.

CME credit is offered for the subscriplioo year only.

Aec:rtditarion: Lorna Linda University School of Medicine is accredited by the Accreditation

Council for Continuing Medical Education (ACCME) to sponsor continuing medical education for physicia.ns.

Contributor: G. Phillip Mansur, M.D. Case No. 1 - November 2000 Merced, CA

Tissue from: Lung Accession #24978

Clinical Abstract: While being evaluated for minor injuries in a motor vehicle accident, this 75-year-old male was

found to have a large solitary peripheral mass in the left lung. He smoked up to I to l 1/2 packs of cigarettes a day and was a retired welder, mechanic and shipyard worker. He had a history of carcinoma of the bladder, resected 12 years earlier. A left lobectomy was performed.

Gross Pathology: . The 280 gram lobe of lung had a 6 em diameter bare surface with central cavity, apparently

corresponding to an accompanying 55 gram aggregate of white fleshy tumor fragments.

SPEClAL STUDIES: Cytokeratin EMA CEA CD IS

positive positive negative negative

Contributor: Robert T. Dalzell, M.D. La Mesa, CA

Tissue from: Right testis

Clinical Abstract:

Case No. 2 - November 2000

Accession #24553

After two weeks of left groin pain and swelling, this 72-year-old Caucasian male underwent bilateral inguinal hernia repair and bilateral orchiectomy.

Gross Pathology: The 90 gram right testis contained a 5.0 em diameter yellow-tan lobular mass with focal

hemorrhage.

Cootn"butor: James P. Kaye, M.D. Case No. 3 - November 2000 Riverside, CA

Tissue from: Right axilla Accession #24377

Clinical Abstract: About I year earlier, this 55-year-old female brought to the attention of her family physician a

lump in her right ax.illa Over the year of observation, the mass grew slowly larger. Her breasts bad no palpable masses and mammograms were negative. An axillary dissection was performed.

Gross Pathology: Most of the 46 resected lymph nodes, ranging from 2 to 4 em in greatest diameter, contained

firm tan tumor with apparent focal hemorrhage . .

SPECIAL STUDIES (Outside facility): Fontana-Masson positive

Contributor: Mark Janssen, M.D. Case No. 4 - November 2000 Lorna Linda, CA

Tissue from: Pancreas Accession #24421

Clinical Abstract: This 54-year-old Caucasian male experienced jaundice and slight RUQ abdominal tenderness

with dark urine and futty stools. Ultrasound revealed an echogenic mass in the head of the pancreas witb obstn,lction of the common bile duct.

Gross Pathology: Included in the resected portion of the pancreas was 3 x 2.5 x 2 em firm, white to pale yeUow

mass with foci of hemorrhagic necrosis.

Contributor: Arthur L. Koehler, M.D. Case No. 5 - November 2000 Pasadena, CA

Tissue from: Right wrist Accession #27363

Clinical Abstract: This 81-year-old Caucasian female had noted a large cystic mass in the volar aspect of her right

wrist for about a year. The mass was hard and almost immovable.

Gross Pathology: The 4.5 x 3.0 em oval mass was firm and non-encapsulated.

Contributor: Mark Janssen, M.D. Case No. 6 - November 2000 Lorna Linda, CA

Tissue from : Thyroid Accession #24121

Clinical Abstl'llct: Over a period of a year, this 35-year-old Hispanic male experienced. a 35 pound weight Loss and

a gradually enlarging neck mass. A 2 em diameter mass was palpable in right lower lobe of his thyroid, along with a 6 em supraclavicular mass and 3 em right cervical mass. He also had multiple small submucosal nodules, later found to be neurofibromas. Family history a papiUary thyroid carcinoma diagnosed 2 years earlier in his father. A thyroidectomy with right radical neck dissection was perfo[Jlled.

Gross Pathology: The 7.5 gram right lobe of thyroid contained a 3.5 x 2.0 x 2.0 em light tan nodule.

SPECIAL STUDIES: CAM5.2 Chromogran.in NSE Calcitonin

4+ 3+ 4+ I+

Contributor: Mark J . DeMeo, M.D. Case No. 7 - November 2000 Santa Rosa, CA

Tissue from: Kidney Accession #27670

Clinical Abstract: For six months, this 61-year-old Caucasian male had been experiencing difficulty voiding.

Sonography disclosed a solid mass near the pole of the right kidney. A right radical nephrectomy was performed.

Gros.~ Pathology: The 500 gram resection specimen included the right kidney with a 4.0 em brown-tan bosselated

mass in its upper pole.

Contributor: E. M. Courier, M.D. Case No. 8 - November 2000 Fullerton, CA

Tissue from: Left thigh Accession #18888

Clinical Abstract: Following a one-year history of a mass in her I ell thigh, this 69-year-old Caucasian female

underwent a resection ofthe anterior portion of her rectus femoris muscle. A radiograph had revealed that the mass did not involve adjacent bone.

Gross Pathology: The encapsulated 10.0 x 7.0 x 6.0 em fusiform tumor had a variegated yellow-tan cut surface.

Contributor: Mark Janssen, M.D. Case No. 9 - November 2000 Anaheim,CA

Tissue from: Lung Accession #28311

Clinical Abstract: After suffering a fall, this 70-ycar-old female presented with chest pain. She had a 90-pack­

year history of smoking. Chest x-ray and CT scan revealed a mass in the right upper lobe. A right upper lobectomy was performed.

Gross Pathology: The 16.0 x 13.0 x 4.0 em lobe of lung had a 2.5 em diameter white, firm gray mass with ill­

defined borders, extending to but not involving, the pleural surface.

Contributor: W. M. Talbert, M .D. Case No. 10 - November 2000 Long Beach, CA

Tissue from: Left lung Accession #27244

Clinical Abstract: When she developed a low grade fever, progressive fatigue, and weight loss, this 4-year-old

Brazilian girl was treated for pneumonia Breath sounds were markedly diminished on the left. Chest x-ray showed 'white-out' of the left lung field. Symptoms persisted and further work-up led to a left pneumonectomy.

Gross Pathology: The 1660 gram, 25.0 x 19.0 x 8.0 em left lung was almost completely replaced by a focally

necrotic tumor with a fish-flesh cut surface.

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CALIFORNIA TUMOR TISSUE REGIST RY

ULTRASTRUCTURAL PATHOLOGY

Minutes - Subscription A

November 2000

SUGGESTED READING (~oeral Topics from Recent Literature):

Metastasizing Fibrous Histiocytoma of the Skin, A Clinicopathologic and Immunohistochemical Analysis ofThree Oases. Guillou Land Gebhard S. Mod Patho/2000; 13:654-660.

The Location and Frequency of Intestinal Metaplasia at the Esophago!!Mtric Junction in 223 Consecutive Autopsies. Implication for Patient Treatment and Preventive Strategies in Barrett' s Esophagus. Ormsby AH and Kilgore SP Mod Palho/2000; 13:614-620.

Indeterminate Fibrobistiocytic Lesions of the Slcio. Is There a Speeuum Between Dermatofibroma and Dermatofibrosarcoma Protuberans? Horenstein MG, Prieto VG, et aJ. AmJ Surg Patho/2000; 24:996-1003.

Lymphovascular Invasion as a Predictor of Disease Pwgression in Prostate Caocer. Herman CM, Wilco;< GE, et al. Am J Surg Patho/2000; 24:859-863.

Electron Microscopy in Tumor Diagnosis. Indications for Its Use in the Immunohistochemical Era. Ordonez NG and Mackay B. Hum Patho/ 1998; 29(12): 1403-14ll .

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

Lorna Linda University School of Medicine 1102 1 Campus Avenue, AH 335 Lorna Linda, California 92350

(909) 558-4788 fAX: (909) 558-0 188

E-mail: cttr@linkline.CQm Case of the Month: www.lly e!lu/Uu/cttr/ootrn

Web Page: www.cttr.org

File Diagnoses

Editpr'a Note: We hope you mjoyed this slight departllre from the usual format oftbe crfR monthly slide series. While the use of ultrastructure as a diagnostic aid is waning, its importance is still considerable. The intent of this sUde set is to serve as a reminder of tbe correlation of ultrastructural features with the charatieristic histologic findings. 'Residents might also like to review this mote rial for their boards.

The commentary is given by Dr. Dennis O'Malley, currently a hematopathology fellow at Duke University. Dennis recently graduated from the residency program at lAma Linda, and has been a Co-Director oftbe crfR's web-based Case of the Month (ettr.org, or www.llu.edu/Jiulcttrlcotm). .. .. DRC

CaJe No. I Aeemion No. 14978 Diagnosi" Malignant mesothelioma, lung T -28000, M-90503 •

Commeomcy: Mesothelioma is still considered to be a difficult diagnosis, especially when it is poorly ditrerentiatcd. Its distinction from adenocarcinoma can be difficult. Recent developments in immunohistochemical stains have made this difficult task easier, but ultrastruC1ure can still help. The key feature for ultrastructural differentiation is the density, length and branching of. the microvilli. Classically, mesothelioma has numerous, long slender microvilli, with dichotomous branching. These characrers are not seen in adenocarcinoma.

Cue No.2 Accession No. 24553 Diagnosis: Leydig cell tumor, testis T-78000, M-86503

Copsu!rarjpn: {AFlP) "Malignant Leydig cell rumor." Commemacy: This tumor falls into the category of steroid-secreting neoplasms. The Reinke's crysralloids in a normal ~ydig cell are also present in a Leydig cell tumor, and are an ultrastructural hallmark of the tumor. In longitudinal section (pictured here), the crystals usually present as long rod-like structures. (n transverse section. they have a polygonal shape, with each side of the crystal being parallel to the corresponding opposite side.

Case No. 3 Accession No. 24377 Diagnosis: Metastatic melanoma, ax.illa T-Y8100, M-87203

Commepuu:y: Melanin production is a characteristic of the melanoc)lle and this function is best defined by the presence of premelanosomes. These organelles are the only truly diagnostic ultrastructural feature of melanoma. (A caveat, other non-melanoma entities such as angiomyolipoma, sugar tumor, etc. may also contain premelanosomes). The premelanosome is characterized by an internal, lattice-like structure which is seen before the organelle becomes fully pigmented. As the melanowme matures, through well-detined stages, the melanin pigment obscures the internal slnacture. Melanin pigment may be present in cells through phagocytosis (melanophages) and lhese pockets of melanin may masquerade as more advanced slages of melanosomes.

Cas• No. 4 Accession No. 24421 Diagnosis: Pancreatic neuroeodocrint tumor (islet cell tumor) T-59000, M-81500

Consuhatjon. (AFIP) '1slet cell tumor, pancreas.'' Commcntao:: This is a neuroendocrine-derived tumor that is subjec~to some hi$tQlogic variability, The ultrastructure is characterized by the presence of neurosecretory granules, in this case filled with pancreatic hormones. By uhrasli'\ICture, it is possible to derermine if the granules contain insulin versus other types of pancreatic honnones (glucagon, etc.). The insulin granules have a membrane coat with a central 'popcorn' or angulated crystal appearance. Or her honnones are often homogeneous and electron dense.

CTTR, November 2000 "MmuU:s" (Suboocrip<Jon A) ..

CueNo. S Accession No. 27363 DiagnosiJ: Granular ceO tumor, wrist T-Y8600, M-8620 I

Commentarv: This tumor falls into the general category of the 'large pink cell tumors', whose differential is perhaps not so well defined as its counterpan the 'small blue cell tumors.· Granular cell tumor has a very characteristic ultrastructural appearance, which directly correlates to its light microscopic appearance. The cells are packed with numerous secondary lysosomes. These lysosomes impan the granular pink character to the cytoplasm. The histogenesis of these tumors has been clearly resolved: they are of Schwann cell origin.

Case No. 6 Accession No. 24121 DiagnOJis: Medullary carcinoma, thyroid T-96000, M-85103

Commemary: It is known that endocrine-derived rumors have a marked propeosity for varied and sometime bizarre appearances. Medullary thyroid carcinoma is certainly no exception. Its histologic appearance can vary widely and its pleomorphism can lead to wild speculation about possible-diagnoses. To parallel the immunohistochemical presence of calcitonin are the presence of neurosecretory granules. The presence of these granules in a tumor of thyroid origin is proof of its neuroendoctine nature and hence the diagnosis of medullary carcinoma of the thyroid. l.fthere is amyloid in the histologic sections. its ultrastructural appearance can also be confirmed by the classic ' pick-up-sticks' appearance of the fibrils. Further, true to its name, it is a carcinoma and has well-developed cell junctions.

Case No. 7 Accession No. ·27670 Diagnosis: Oncocytoma, kidney T-71000, M-82900

Commentary: The pink, granular light microscopic appearance oftbese cells is quite distinctive. The ultraStructure is also quite characteristic. The cytoplasm of the cells is virtually always packed with ntitochondria. The mitochondria may be normal in appearance, but can be bi1.arre or misshapen. It is unclear what their functional capacity is.

Case No. 8 Accession No. 18888 Diagnosis: Alveolar soft part sarcoma, thigh T-Y9100, M-95813

CommeD)arv: An unusual tumor of unknown origin. Theories of the derivation for alveolar sofl pan sarcoma abound. These also fall into the category of the large pink cell tumors. There is linle that is memorable about predilection for age or location. As such they may be pan of the differential for many tumors. By light nticcoscopy, the characteristic cytoplasmic crystals can be sparse or inapparent. PAS stains will accentuate their appearance and they are diastase resistant. Electron nticroscopy will often find crystals that are not apparent or visible by light nticroscopy.

Cnse No. 9 Diagnosis: Small cell carcinoma, lung T-28000,M-80413

Accession No. 28311

Consu!taJjon: (Mayo Clinic) "Resection of right upper lobe mass showing features of small cell carcinoma." Commentary: Yet another neuroendocrine carcinoma, with the characteristic neurosecretory granules. In fact, chromogranin. a commonly used immunostain for neuroendocrine differentiation, actually stains a component of the neurosecretory granules. Again. because it is a carcinoma, cell junctions are also present.

CaseNo. 10 OiagnO!is: RhabdomyosartOiliJI witb pleomorph ic features

("pl~omorphic rbabdomyosarcoma") T -28000, M-89003

Accession No. 2 7244

Commentary: The histologic variability of rhabdomyosarcoma can make this a difficult diagnosis. Its histologic appearance can be classic, with pink cells with cross striated fibers, or it can present as a small blue cell rumor. As sucb, the findings of muscle spindle differentiation on electron microscopy can make the diagnosis straightforward.

• Cl1'R. Nonn>bc< 1.000 •MIOuw.• (Subscriprim ."J

STuDY GROUP DIAGNOSES and REFERENCES

Calle No. 1, Accession No. 24978

LLUMC Patbologv Residents • Mali~'llant mesothelioma M2lml!!i!! view CEI Camjno Pathology CJTOiljll . Malignant mesothelioma Riverside . Transitional cell carcinoma, metastatic Bakqsfic!d - Fibrous mesothelioma OranAA • Malignant mesothelioma (sarcomatoid type) Ventura (Unilabl • Mesothelioma (2) Oilkland (Kaiser) • Mesothelioma (4) i.ong Beach · Malignant mesothelioma (long micrO\•illi) (9) Boy Area · Malignant mesothelioma (3) Monterev ·Mesothelioma Santa Ros9 · Mesothelioma San Diego • Bipbasic malignant mesothelioma Santa Barbara • MesolheHoma Monterev l'ark - Malignant fibrous mesothelioma • li!U1•ood/Ftemont . Mesothelioma with long microvilli (3) Nevada (Wcstcm Pathology Consultan!.i) · Mesotheli.oma Nebraska <Creighton Unh•ersityl · Mesothelionta

November 2000

Kan,<a.< (Coffeyville Regional Medical Center) • Sarcomatoid carcinoma (by light) vs. mesothelioma (bv EM) Kansas <Unjversjtv of Kamas Medicaf Center) • Mesothelioma ( 16) · Indiana <Fort Wavncl • Sarcomatoid carcinoma, lelllung Louisiana CLouisiana State University Medical Center) • Mesothelioma, sarcomatous Wisconsin (Meriter Hospital\ · Malignant mesothelioma, biphasic type, r/o metastatic tumor if solitary mass Illinois <Duoasc Patbs>.!Qgy A<.IQciates) · Solitary fibrous tumor of pleura-malignant (AKA localized maligoant mesothelioma-

spindle cell type) (.!); .Fibrous mesothelioma (1) Michigan (Oakwood Hospital) • Mesothelioma .Michigan 1St Joseoh Mercv Hospital) • Spindle cell (metaplastic) squan>ous carcinoma Kentucky IUniversjtv of Louisville Residents) • Spindle cell mixed mesothelioma Florida (Tallahassee) • Malignant spindled cell mesothelioma Florida (Munroe Regional Medical Center) · Sarcomatoid mesothelioma f lprida !Winter Haven) . Mesothelioma (3) North Carolina {Walle Forest Unjvec;jtv) · Malignant mesothelioma Pennsvlvania/Conemaueb Medical Center Residents) • Mesothelioma Peru>svlvania (Lel>igh Valley Hosoitall • Spindle cell carcinoma (2); Malignant mesothelioma (I) Marvland IWooc!bjne) · Mesothelioma (2) MarYland <National Naval Medical Cttl • lv!esothelioma MaN land !University of Maryland) • Malignant mesothelioma New Jersev /Overlook Hospital) • Malignant mesothelioma, epithelial type(4) lv!~ssaehuse!ls <New England Medical Center) . Malignant mesothelioma Connecticut IUnivcrsity·or CoWlectjcut Health Center) · Malignant mesothelioma New'vork !Beth Israel Medical Center Residents) • Malignant mesothelioma New York <Northport) . MesotheJioma New Yor~ <New Hyde Park) · Mesothelioma Alaska (Anchorage) • Malignant sarcomatous mesothelioma !';:an ada (Foothills Ho:;pital\ • Sarcomatoid carcinoma ~ - Sarcomatoid malignant mesothelioma Japan <Kvoto) · Molignant mesothelioma (3): Spindle cell carcinoma (I) Japan Kurashiki !Kawasaki Medical School\ • Malignant mesothelioma (4)· S!naapof£ . Mesothelioma Saus!i Arabia <King Kha!id !Jpivcrsity Hospital) . Mesothelioma

References: Koss M, Travis W, Moran C. et al. Pseudomesotheliomatous Adenocarcinoma. A Reappraisal. Sem Diagn Patho/ 1992; 9(2): 117·

123. Bro\\n RW, Clark GM, Tandon AK, et ul. Multiple-Marker lmmwiohistochemicarPhenotypes Distinguishing Malignant Pleural

Mesothelioma from Pulmonary Adenocarcinoma. H11m Palho/ 1993; 24(4):347-354. Comin CE, de Klerk NH and Henderson DW. Malignant Mesothelioma. CmTent Conundrums Over Risk Estimates and Whith.cr

Electtou Microscopy for Diagnosis? Ultra.wmct Patho/ 1991; 21(4):315·320. Omy TD, Hammar SP and Roggli VL. Ultrastructural Features of Diffuse Malignant Mesotl•e1iomas. H11m f>atho/1998; 29

{12): 1382.-1392.

c'M1{, November 2000 ''Minutes .. (Sub~cription A)

Case No. 2, Atcession No. 24553

LLUMC Pi!!hology Residcnu • Leydig cell tumor Mounliin view IE! Camino fJtboloey Group> - Leydig cell twnot Rixcaic!c - Histioeytoma? Bakro6c!d - Leydig cell tumor ~ • Leydig cell tumor VcntW! CUnilabl - Leydig cell tumor (2) Oak!ancHKaiserl • Leydig cell tumor (4) Long Beach • Leydig cell rumor(Reinkc' saysta!s)(9) Bav AWl • Leydig cell tumor (3) Monterey - Leydig cell tumor Sanlll Rosa • Leydig cell tumor (Reinke crystalloidS) (I); Leydig cell tumor (l) San Die&<> • Leydig cell rumor Simta Bad:!ara • Leydig cell rumor Monterey Park - Leydig cell tumor Haywood/fremont - Leydig cell tumor with Reinke crystalloids (3) Neyada (Western PA!holoc;y Consultants> - Leydig cell tumor • Nebraska CCrcjsh!AA Ugjvcgjtyl • Leydig cell tumor

November 2000

Kansas CCo!IcxvWc RcsjQ04l Medical Center) • Interstitial cell (LeydiS) tumor (by light) with Reinke crystals (by EM) KansM CUnjycrsjty of Kanw Medical Centerl • Leydig cell tumor (16) lndiaaa (foil Wavncl • Leydig cell tumor, right testis Louisiana <Louisiana StOIC Univcrsitv Medical Center) • Leydig cell rumor Wisconsin !Mcritq Hospjtal) - Leydig cell tumor Illinois fDupoge P11holoey Associates> - Leydig cell tumor (N.B. Reinke crystals on EM), teStis (I); Leydig cell tumor (I) Michisan CO)Ikwooc! Hosoi!all • Leydig cell tumor Michigan ($t Joseph Mqcy Hospital) - Leydig cell rumor Kentyeky CUnivCJ'SiiY of Lou[svmc Residen!S) - Leydig cell tumor f lorida ffillnhass"l • Leydig cell tumor Florida fMunrpe Regional Medical Center) • Leydig cell tumor Florida !Wjntcr !iaycnl - Leydig cclllUmor (2); Sertoli cell tumor ( I) ~orth Cru:olinn (Wake Eo<est University) · Leydig cclllurnor ~nnsylyanjo <Concmauch Me<liCJil Center Rcsidon!Sl - Leydig cell tumor PcWlSylyW!i• <LcbjJ!h volley Hospital) • Leydig eel! tumor (3) MarvlW!d <Wooc!bjno) - Leydig cell tumor (I); Ma!ignont Lcydog cell tumor (!) Marvland (National Naval Medical Ctrl • Leydig cell tumor Mruyland CUojyqsjty of Mruylandl • Leydig cell rumor New Jersey (Qyq!ook HO<pitall - Leydig cellt~~mor (4) Mamchuse!L! CNew Enslans! Mgljeal Center) • Leydig cell tumor Connectjcyt fVniycajty of Co!l!ll<C!icot Health Center) • Leydig cell tllmor with AIWi• New Yor!s <Beth !mel Medical Center Residents) • Leydig cell tumor New York INorthponl - Leydig cell rumor t:~ew \'oris, CNew Hvdc Pirkl - Leydig ocU tumor Alaska CAnel!oa!li:C} • Leydig cell rumor Canada (foothills HosnitAI) • Leydig cell tumor ~ • Leydig cell tumor (probably benign) Jppau IKyoro) - Leydig cell tumor (4) Japrut Kucashjkj (Kawas!lki Medical Schooll • Leydig cell tumor (4) Singaoorc • Leydig cell tumor Saydi Arab in fKjng Khol jd l lniyersjty Hosoi!llll · Leydig cell tumor

References: Bertram KA, BrotloiT B, Hodges GF, et al. Treatment of Malignant Leydig Cell Tumor. Cancer 1991; 68( I 0):2324-2329. CbcYille JC. Scbo TJ. Lager OJ. ct a!. Leydig CcU Tumor of the Testis. A Clinicopa!hologic, DNA Content and MlB-1 Comparison

o£ NonmctiiStOSWlli and Metastasizing Tumors. Am J So~Fg Pmhol 1998: 22(11): 1361-1367. Assi A, Sironi M, eta!. Leydig Cell Tumor of the Tesus. A Cytohistologica!, lmmunohistoehcmical, and Ultrastru<:tural Case Study.

Dlagn C}'toptJtlw/1991: 16(3):262-266. BilbJ18S SO. Roth LM and Ulbright TM. Microoystic Leydig Cell Tumors Momicking Yolk Sac Tumor. A Repon of Four Cases.

Am J S..rg Patlw/1999; 23(5):546-551.

6 CTTR November 2000 .. Minutca"' (Sul~plion A)

Case No. 3, Accession No. 24377

LLUMC Paihology Residents - Melanoma MoUntain View <EI Camino Pathology Group) · Metastatic melanoma wilb saroomatoid features Riverside - Melanoma, metastatic Bakersfield - Melanoma ~ - Malignant melanoma Ventura (Uni!i!U - Met:.1Stlltic melanoma (2) Oakiand !Kaiser) - Melanoma (4) Long Beach -Metastatic malignant melanoma (melanosomes) (9) Bay Area - Malignant melanoma (3) Montcrcv - Metastatic melanoma Santa Rosa - Melanoma (melanosomes) SM Diego - Metasta6c melanoma Santa Barbara - Metastatic melanoma Monterey Park - Mci:lullary carcinoma Haywood!Fremonr - Metastatic melanoma wiih melanosomes (3) Neyada (Western Paihology Consultants) - Metastatic melanoma Nebraska <Creighton Universitvl - Metastatic melanoma

November 2000

Kansas (Coffeyyillc Regional Mcdjcal Center) - Malignant melanoma (by light) with melanosomes (by EM) Kansas (University of Kansas Medical Center) - Melano= (16) !ndjana (fan Wavne) - Metastatic malignaot melanoma, right axilla Louisiana (l.;ouisiana State )!niversitv Medical Center) • Malignant melanoma Wisconsin (Meriter Hospital) - Metastatic melanoma iJijnois fDunage Pathology Associotc§) - Metastatic malignant melonoma (NB stage II aberrant melanosomes on EM) (I);

lvl"alignant melanoma (mets) (1) Michigan (Oakwood Hospitall - Metastatic melanoma Michigan (St Jose{!h Mercy Hospital) - Metastatic melanoma Kentucl.:v CUniversitv of LouisviHc Residents) - Melanoma Florida (Tallahas~ee) - Melanoma Florida {Munroe Regional Medical Center> - Metasta.tic melanoma Florida (Winter Haven) - Metastatic melanoma (3) !ionh Carolina (Wake Forest Univcreitv) - Metastatic malignant melanoma Pennsylvania !Conemaugh Medical Center Residents) - Malignant melanoma Pennsylvania (Lehigh Volley Hospital) - Metastatic malignant melanoma (2); Mefanoma (I) Marvlang fWoo!lbinel - Melanoma (2) Man· land !National Naval Medical Ctrl - Melanoma Mar.· land (Uoiycrsit"' of Marvland) - Metastatic melanoma New Jersey (Overlook Hoopitall - Metastatic melanoma ( 4) Mossafhuset!S !New England MedicaJ Center) • Malignant mclononm Connecticut Cllnjycrsitv of Connecticut Health Center) - Metastatic maljgnanl melanoma New York CBelh Israel Medical Center 'Residents) - Melanoma New York CNonhportl - Melonoma New York (New Hyde Parkl - Melanoma Alaska fAnch9rage) - Metastatic malignant melanoma C=da (foothills Hospital) - Metastatic melanoma ~ - Malignant melanon1a, metastatic Jaoan (Kyoto) - Malignant melanoma (3); LNgeceU carcinoma (I) Japan . Kuri!Shikj <Kawasaki Medical Sc.hooll - Malignant melanoma (4) Singaoorc .. Mctascatic melanoma Saudi Arabia (King Khalid Univcrsitv Hospital) - Amelanotic melanoma, metastatic

Refer•= Norman J, Cruse CW, ESpinoso C, ctal. RcdoliliiuOil ofCutaHeous Lympbatlc Otaiuage wi~t the Use ofLyMph~tintigraphyfor

M:atignant Melanoma. Am J Surg 1991; 162(5):432-437. Heller R, King B, Baekey P, ct al. Identification of Submicroscopic Lymph Node Metastases in Patients with Malignant Melanoma.

Semin Surg Oncology 1993; 9(3):285-289. Hocbwald SN an~ Coil DG. Role of Elective Lymph Node Dissection in Mclanom•. Semln'Surg Onco/1998; 14(4):276-282. Nakhleh RE, Wick MR, Rocamora A, Swanson PE, et al. Morphologic Diversity in Malignant Melanomas. Am J Clin Pathol 1990;

93(6): 731-740.

Cl"'rR, November 2000 "_l...iinutes» {SuOOcription A) 7

Case No. 4, A<<=ion No. 14421

LLI!MC Palholosv Residents • Pancreatic ncutO<Ddocrine tumor (islet ecllnunor) Moyntain View !El Camino Pathology Grouol • lslctcelltumar Riyqsjdo - Islet cell tumor Bakersfield . Islet cell tumor Q!lma~ • lnsulinoma vemur• /Unilobl • Acinar cell carcinoma (2) Oekl!!!!d IK!!jser\ • lslct cell tumor (4) l.ons BeAch • Ncurocndocrine carcinoma (DCUOS<U®f)' g11111ulcs) (9) Bay Area • Islet cell nunor (? insulinoma) (3) Montqcy · Islet cell tumor SantA RoM · Islet cell tumor (secretory vesicles) (I); Islet cell tumor, alpha cell type(!) SiiU Diego • Insulinoma Sgnta Borbara - Pancreatic endocrine neoplasm (insulinoma) Monterey Park - Malignant tumor • ? melanoma

November 2000

Haywood/Fremont - Pancreatic endocrine carcinoma with secretory granules (2); Medullary carcinoma wilh secretory granules (I) Nsyada CWcstan Patholooy Consultants) - Pancreatic endocrine jUIDor Ne'nsko lCreighton Ugiymjtv> - Noo-fu.nction.al islet cell tumoc Kansas (Colfcyyille Reoional Medjca! Center> • Islet cell rumor (by light; by EM: g11111ulcs with crystalline cores, insulinoma?) K;osos CUni\'crsitv of Kansas Mcdjcal Center> - Jnsulinoma (16) lndjono (fort Wayne) - Oncocytie islet cell carcinoma (neuroendocrine CA), bCACI of pancreas [,gyjsjana (Louisiana Slate Unjycrsitv Medical Centcrl - Beta cell tumor Wjsconsin CMcriter Hospital> .. Panereatk neuroendocrine neoplasm ll!jnojs !Dupage Palhology Associntos} - Pancreas·ncu.rocndocrinc carcinoma ( I); Islet cellnunor ( I) Michie;m COa!cwooc! HQSpilAil - Pancreatic eodocrinc tumor Michjgnn !St Joseph Mercy HO$Pita0 - Neuroendocrine carcinoma Kcptuckv CUnh•ersitv of !.oYisyjllc Residents) • lnsulinolllll E!orjdal!allahossee) - Ncuroc:ndocrine carcinoma Floric!a CMunroe Regional Mc;dical Center) - Islet cell tumor f !orjdn (Winter Haven) - Pilllcreatie neuroendocrine clli'Cinoma (3) North Cftl'olina CWake Forest Uniycrsity) · Acinar cell cnrcinoma PJ;nnsylvania (ConemaQch Medical Center Resjdcp\.1} - Islet cell tumor (insuliooma) Pennsylyaoia (Lehigh volley HoopitaO - Neuroendocrine eorcinoma (2); Islet cell tumor ( l) Mqrvlnnd !Woodbine) - lnsulinomn (2) M;yylMd !National Nays! Medjcal Ctrl - Islet cell tumor (insulinoma) M;yy!and runivmiw or Mmylandl . Islet cell tumor New Jersey (0\'alook Hospjta)) • Islet cell tumor (4) MamciluSC!tS !New Ensland Modica! Center) - Islet cell rumor of the pancreas Connocticul (University of Connecticut Health Ccntctl · Beta cell carcinoma.. possibly of a component of acinic cell carcinoma New York (Beth Israel Mcdjcgl Center Residents) - PaJtcrcatic acinar cell carcinoma New York fNorthoortl - lnsu!inoma New York !New Hvde Park) - lnsulinoma Alg<ka (Anchorage> · lnsuliooma (islet cell tumor-beta cell type) Cwn!da lfoo!hi!!s HO§J!itall • Islet cell tumo<, in.sulinoma ~ • lnsulinoma Japan CK vcxo) - Islet cell tumor (3); Endocrine tumor (insulinoma) with uncertAin malignant pOtential (I) Japgn Kurasbiki()(awasa]d Mc;djcal Scbooll • AcinAr cell carcinoma (3); Islet cell tumor (I) Jiinlla~m · Pancreatic endocrine rumor Sgudj Arnbia CKing KhoJid Uniyersity Hospital) - Islet cell tumor

References: Kruscman PC, Knijncnburg 0, del Ia !Uviere GB, ct al Morphology and lmmunohistochemieally-Delincd Endocrine Function or

Pancreatic 1$1~ ~Tumors. Histopalhology 1978; 2(6):389-399. Etlandsen SL, HegreOO, Ponons JA, ct al. Pancreatic !£let Cell Hormoocs. DiStribution or Cell Types 1n the lsle1 and EVldcnec for

the Presence ofSomiiiQStalln and Gastrin in the D Cell. J Histochem Cytoch1m 1976; 24:&83-897. Mllnghom DC and Isaacson PO. A Novcllmmunobistochcmieal Detection Srstem Using Min-or Image Complementary Antibodies

(MICA). Hlsroparlwl 1?99; 35(2): 129-133.

8 CTIR, November 2000 "Mm .. cs" (S<>bscnptjon A)

C.ase No. 5, Accession No. 273~3

LLUMC Pathology Residen!S - Granular cell tumor Mountain View fEI Camino Patholosv Grouol - Granul~r C<OII tumor Riverside - Granular cell tumor Bakersfield - Granular cell twnor Orange - Granular cell tumor Venrura <Unilab) - Granular cell tumor (2) Qaldand (Kaiser) - Granular cell tumor (4) Loug Beach - Granular C<OII tumor (lysosome) (9) Bav Area • Granular cell tumor (3) Monterey - Granular cell tumor Santa Rosa - Granular cell tumor (dense budics) San Diego - Granular cell tumor Santa Barbara - Granular ecll tumor Monterey Park - Granular cell tumor Haywood/Fremont - Granular cell tumor with I}'Sosomcs (3) Nevada (Western PaU!Sllogy COnsulllVJ!Sl - 9rnnular tell tumor Nebr.Ska (Creiehton University) - Granular cell tumor Kansas CCoffevvjlle Regional Medical Center) - Granular cell tumor (by light) with lysosomcs (by EM) Kansas CUniY•rsit~ of Kansas Medical Center) - Granular cell tumor (8); PVNS (8) Indiana CFort Wayne} - Granular cell tumor, right wrist Louisiana (Louisiana State Univcrsitv Medical Center) - Granular cell tumor Wisconsin rMeriter Hos1liill) - Granular oell tumor

November 2000

Illinois fDupage Pathology Associates) - Granular cell tumor (NB secondary lysosomcs on EM) (I); Granular cell tumor (I) Micbinan (Oakwood Hospital) - Granular scbwaMoma Michigan <St losenh Mercv Hospit.all • Granular ccU twnor Xentuckv <University of L..ouisyj!le·RcsidenlSl - Granular cell tumor Florida (Tallahassee) - Granular cell tumor · Florida (Munroe Regional Medical Centerl - Granular cell tumor florida (Winter Haven) - Granular cell tumor (3) Nor!h Carolina £Wake Forest University) - Granular ~II tumor Pcnnsylyania <Cogem·aug'h Medical Cenrer ResidentS) ~ Granular cell tumor Pennsvlvania {Lehigh Vallcv Hospital) - Granular cell tumor (3) Mnrvhmd !Woodbine) - G!Mww ~!I \U!DO< (2) Marvland fNational Naval Medjcal Ctr\ - Granular cell tumor Maryland (University of Maryland) - Granular cell tumor New Jersey (Overlook Hosoitall • Granular cell tumor (4) Mw~husO[ts (New England Medical Center) - Granular cell tumor Conncc.ticul (Univcrsitv of Coonectjcut Heall)t Center> - Granular cell tumor New York (Beth Israel Medical Center Residen~) - Granular cell tumor New York (Nor!hportl - Granular eel! rumor New York (New fude Park) • Granular cell tumor Alaska fAnchornge) • Granular cell tumor Canada (foothills Hospital) - Granular cell tumor )'ortugal - Granular C<:lltumor h!Jlan (KvolO) - Granular cell tunJOr (4) Japan Kurashiki (Kawasaki Medical Scbooll - Granular cell tumor (4) Singapore • Granular cell tumor Saudi Arabia O<ina Khalid Uni .. ·ersilv Hospital) • Granular cell. tumor

References: Apisarnthanaray P. Granular Cell Tumor. An Analysis of 16 Cases and Review of the Literature. JAm Acad /JermatOplllho/ I 981 :

5(2): 17 I -182. Kbansur T, Balducci Land Tavassoli M. Identification ofDesmosomcs in the Granular Cell Tumor. Implications in tlistologi<:

Diagnosis and Histogenesis. Am J Surg Pot hoi 1985; 9(12): 898-904. Bhawan J, Malholra R and Naik DR. Goucher-Like Cells in a Grnnular Cell Tumor. Hum Palho/ 1983; 14(8):730-733. Lelloit PE, Bart RJ, Sural! S, et aJ. Primiti1•e Polyploid Granular-Cell Tumor and Other Cutaneous Granular-Cell Neoplasms o.f

Apparent Non Neu(a! Origin. Am J Surg Patholl99l: I 5(1):48,58. Kurtin P J and Bonin OM. lmmunohistoch~mical Dcmon.stration of the l-ysosome-Associated Glycoprotein CD68 (KP-1) in

Granular Cell Tumors ana Schwlinnomas. Hum !'athol 1994; 25( I I): I I 72- I 178.

C'J1R November 2000 ''Minute, ·• (Subscription A) 9

Cue No. 6, Accession No. 24121

LLUMC Pa!llology Re3jdents · MeduUary carcinoma, thyroid Mountain View CE! Cmino Pathology Group> • Medullary tan:inoma Rivmis!e • Medullary c:an:inoma Bakmfie!d · Medullary .:arcinoma Orange • Medullary .:arcinoma Ventyra CUnjlabl • Medullary eareinoma (2) Oa!<lans! IKajsgl • Medullary c:arciooma (4) Long Bcoch • Medullary eareinoma (neuroseeretol)• granules) (9) Bay Area • Medullary carcinoma of !be thyroid (3) Monle!ey . Carcinoma with glandular and neuroendo<rine features Santa Rosa · Medullary carcinoma (consistent with} (2) San Dicco • Medullary thyroid carcinoma Samp BarbJWt • Medullary cnrcinomn Monton;y Park • Moclullary carcinoma Haywood!Frcmgnt · Small cell variant of medullary carcinoma with type II granules (dense core} (3) Nevad!! (Western Pathology Consultants) • Mctasllltic medullary carcinoma Nebooka !CrejKhton Unjvc:nitvl • Medullary c:arcinoma of thyroid

November 2000

K!!l!Sas !Coffcyyjlle Re!!ional Medical Ceutq) · Medullary tarcinoma (by light}, neurosecretory granules (by EM) Kansas !Uniycrsjtv gfKansas Medical Cent<:£) • Medullary carcinoma of the thyroid (16) Indiana Cfort Wpyncl • Medullary carcinoma, right lobe of thyroid Louisiw !Louj!jw State Univmity Medjsa! Center) · Medullary carcinoma WlS>OOilSin (MqjJq Hosoi!lll • Medullary eareinoma D!inois lDuoaae Palhology Associates) • Mcdullaty carcinomo. thyroid (2) Mimi OM !Oal:wgod HO$pitall • Mcdullaty thyroid carcinoma, smAll cell type Michigan !St Jgoenb Mqcy Hosllillll · Medullary carcinoma Kentucl:y !UniversiiV gf Loujsvillc Residents) • Medullary thyroid carcinoma f loridaiTh!lahmec) • Medullary carcinoma Florida {Mugroc ReKjgna! Modica! Center) · Moclullary carcinoma FlOrida (Winter Hayen) • Medullary carcinoma (3) North Coroljoa (Wake forest Uoiversitv) • Medullary carcinoma Pennsylynnjn (Conemaugh Medical Center Residents) - Modullory cnrcinoona, thyroid Pcngsylyania CLebjcb Valley Hoscitall · Medullary carcinoma of thyroid (3} MIDland (Wgodbjoel • Medullary carcinoma, M.E.N 2b (2) fv!;uyhmd ilirujongl Ngval Medical C!rl • Medullary carcinoma Mmland (Uojycaj[y gfM!U)'Iand) . Medullary carcinoma ofth)TOid New Jawy !Ovqlook Hosoiton · Medullary thryoid carcinoma (4) Mossachuseltt <New Ens!and Medical Center) • Insular careioomJI Connec:!jcut CVmversity of Co""""riCU! Health CC!JJtt) · MeduUary thyroid carcinoma New )'ocls !Belh !mel Medical Center Residents> · Medullary carcinoma New York !Nonhpgn> • Medullary carcinoma New Yock <New HydePprkl • Mcdullaty carcinoma A Iasko IAncmacl • Medullary carcinoma of thyroid Caoi\da (FOQ\bjl!s Hgsoilall • Medullary carcinoma, thyrnid ~ • Medullary carcinoma of the th)Toid, in a conte.xt of M, E.N 2b Japan fKyglO) • Medullary carcinoma of thyroid (4} Japan. Kurosbikj !Kawasaki Medical Sebooll · Medullary carcinoma (4) Singaoore . Mcdu1hsry carcinonta Saudi Arabia (Kins Khnlid Unjymitv Hospil1lll • Medullary carcinoma

References: Saad MF, OrdonCJ< NG, Rashid RK, et al. Medullary Carcinoma of the Thyroid. A Study of the Clinical Features and Progl105U<>

FattOf'S in 161 Patients. Medicine (Baltimore) 1984: 63(6):3 19·342. Bergholm U. Adami HO, BergstrOm R. et al. Clinical Characteristics in Sporodic and Familial Medullary Thyroid Carc.noma. A

Natiom•ide Study of249 Patients in Sweden from 19S9lhrough 1981. Can<>!r 1989;63(6):1196-1204. DeLellis RA and Bologh K. Histochemical Charncteristics of Parofo!heular Cell$ and Medullary Thyroid Carcinoma. Am J Sr~rg

Porho/1913. 72(1);119-128. A1~-Soavodra J, LiVo!vi VA, et al. Medullary Carr.inoma. S.mlnon in Dtagnosnc Parho/ogy 198S; 2(2):137-146. Haraeh HR and Williams ED. Glandular (Tubular and follicular) Variants of Medullary Carcinoma of the Thyroid Hlstopot!wl

1983; 7(1):83-97.

10 C'ITR, No\'emhcr 2000 .. Mlnutc1" (Subscription A)

Case No. 7, A<<e$$ion No. 27670

LLUMC Pathology Residents - Oncocytoma, kidney Mountain View CBI Camino Pathology Group) - Ononcytoma Riverside - Oncocytoma B!!l;ersfield - Oncocytoma Orange - Oncocytoma Ventura ClJnilah) - OnCOC)'toma (2) Oakland (Kaiser) - Oncocytoma (4) Long Beach - Oneocytoma (mitochondria) (9) Bav Area - Oncoe~1oma (3) Monterey - Ononcy1oma Santa l!,!l§a - Oncocytoma (mitochondria) San Diego · Oncocytoma Santa Barbara - Oncocytoma Monwev Park - Oncocytoma Haywood/Fremont - Oncoc}1oma with fat mitochondria (3) Nevada (Western Pathology Consultants) - Oncocytoma Nebraska (Creighton Unh•ersityl - Oncoc)1oma Kansas (Coffewmc Begiooal Medical Center) - Ononcy1oma (by light), mitochoodria (by EM) Kansas CUniymitv of Kansas Meqi~l Center) - 0nCOC)10n>a (16) Indiana (Fort Wavnel - Onooc}1oma, right kidney Louisiana'(LoujsianaStateUniversity Medical Center) · Oncocytoma Wisconsin (Mcritcr Hoopi!Jill - Oncocytoma Dlinois (Dupagc Pathology Associates) - Renal oococ)10ma (2) Michlgan (Oakwood Hospital\ - Oricocy1oma Mjcbigan CSt Joseph Mercy Hospital) - Oncocytoma Kentucly fUnivcrsiw of Louisyille Residents) - Oncocytoma Florida ITallahassccl. - Oncoc)toma Florida (Munroe Regional Medical Center) - Oncocyto!Da Florida (Winter Hayen) - Oricoc)tOma (3) Nortli Carolina <Wake Forest Univmitvl - Oncocytoma Pcnnsvlvania (Conemaugh ~edical Center Residents) - Oncocytoma, Kidney Perin.<vlvania (Lehigh Vallev Hospital) - Renal onCOC)1oma (3) Marvland <Woo<fbjne) - Oncocytoma (2) Marvland !National Naval Medical Ctrl · - Onc~ytic renal neoplasm Marvland CUni\1ersily of Marvlandl · Oncocytoma New Jersey (Overlook Hospi!Jill - Oncocytoma (4) Massachusetts CNew England Modica! Cen!¢cl - Renal cell carcinoma Connecticut (University of COnnecticut HCalth Center) · Oncocytoma New York (Beth Israel Medical Center Residents) - Oncocytoma New York CNor!hpo!ll - Oncocytoma New York !New H.ydo Pa£kl - OncoC)10ma ,\la~ka (Anchciragcl · Renal oncocytoma Canada !Foothills Hospital) - Renal oncocytoma ~Ill - Renal oncocytoma Japan fKvotol • Renal oncocytoma (4) Japan Kurasbiki (Kawasaki Medic"! School) - Oncocytoma (4) Singapore - Renal oncocytoma Saudi Arabia <King KhaJid lJni\tef$1tv Hospital) - OneocyLOmq

References:

November 2000

Marshall FF, Stewart 1\K and Menek HR_ The National Cancer Data Base. Repori on Kidney Cancers. The American College of Surgeons Commission on Cancer and the American Cancer Society_ Cancet· L997; 80(ll):2167-2174.

Eble JN and Hull MT. MOf]Jhologic Features of Renal Cell Oricoc)1oma. A Light and Electron Microscopic Study. Hum /'athol 1984; 15(11):1054-1061.

Amin MO, Crotty TB. et al. Renal Oncocytoma. A Reappraisal ofMorpbologic.Features with Ctinicopathologie findings in 80 Cases. AmJ Surg Plltho/19<)3; 22(2):2.71-272.

Tickoo SK, Reuter VE, et al. Renal Oncoc)1osis. A Morphologic Study of Fourteen Cases. Am J Surg l'athol 1999; 23(9): 1094-ltOI.

CTIR November 2000 "1\.!inutes" (Subscription A) I I

Case No. 8, Accession No. 18888

LLVMC Pillho!oav Rcsidrots - Alveolar son part SIU'OOIIla

MOWJtain Vjcw IE! Camino Pathology Group) • Ah·eohv soft port~ R.ivcnide - Alveolar son part san::omJ1

BalseafieJd - Alveolar son part san:oma Orange - Alveolar soft part san::omJ~ Ventura CUnilab) - Alveolar sol\ part san:oma (2) Oakland !Kaiser) - Alveolar sol\ part san:oma (4) Lon& Beach - AlvcoliV son pi!J\ san:oma (crystAlline grid) (9) Bay Area - Alveolar son part Slli'COIDB (3) MOn!Cfll~ - Alveolar son p•r1s SiVCCma

Santa Rosn - Alveolnr soft pftr1 sarcoma (70-angslrom inclusions) (2) Snn Diego .. Alveolar sot'\ tissue sarcoma Santa Bnrbnro • Alvoolnr soft part sarcoma .M.2ll1£ntl(.fAl); • Alveolar soft part sarcoma tlamoodiFJl;mont • Alveolar soil pan sarcoma with rhomboid crystals (3) Nevada CWcs!Cm Pathology Consultants\ - Alveolar soft part sarcoma NebraskA CCn;jgb!On University\ • Alveolar soft part sarcoma Kansas !Coffcyyjl!e Regional Medical Center> - Alveolar soft parts tumor (by light) with aysta1s (by EM) Kansas (UniymiwofKansas Medjeal Center\ • AlveoliV soft pllll sarcoma (16) Indiana (fort Wavoel - Alveolar soft part sanxxna, reclll$ femoris muscle Looisjw CLooWw Slate Uoivenity Medjgl Center) • Alvoolar son part sarcoma Wisconsin (Mqjlq Hospj!Ail - Alveolar soft pan san:omo Dlinois IDuppgg Pllho!ogy Associates\ - Alveot.r soft part sarcoma (I); Al•·eolar rhabdomyosarcoma (I) Michi•M COallwood Hospi!l!l) - Alveolar soft pllt sarcoma Mjcbi&M !St Joseph Mercy Hospj!AI\ - Alveolar soft pi!J\ sarcoma Kcntud.y CUniyqsitv oC Louisvjlle Residents) · Alveolar soft part sarcoma Florida !Tallaho.ssec) - Alveolar sol\ part san:oma Florida !Munroe Rcgjonal Mediclll Center\ - Alveolar soft part sarcoma florida CWjntcr Ho~cn\ - Alveolar soft part sarcoma (3) North Carolina (Woke forest University) • Alveolar son port sarcomo PcrulSyJyanjq <Conemnugh Medica) Center Residen~) - Ah•tolot son plllt stu'OOma

November 2000

Pennsv!yanio Cl.ehjgh Valley Hospi!Jl!) - Rru.bdomyosarcoma ( I); Cmbryonal rhabdomyosarcoma ( 1): Alvcolar soft port sarcoma (I)

Mazyland CW09dbjncl - Alveolar soft pllll sarcoma (2) Mazyland /NAtional Ngvol Medical Ctrl - Alveolar soft part sorcoma Marvland ruojycrsjw gfMwyland) - Alveolar soft part sarcoma New Jcqcy CO>er!ook Hospital) • Alvcot.r son part sarcoma (4) MIIS!fi!Chwe\)5 rNcw England Medical Ceotcr> - Alveolar soft part san:oma Coonectjsut Nnh·crsjsy of CoMectieut Hea][h Caller) - Alveolar soft part san:oma New York !Beth Israel Medical Centq Residents) - Alveolar son pan wcoma New York CNO!!hDQ!!l • AI\'COlar son port sarcoma New Y or!; CNew Hvdc Pad;) - Al'·eolar son part san:oma Alaska (Apeborucl • Alvcoll!l' son pi!J\ sarcoma Canada CFoot!Jj!la Hgsojll!tl - Alveolar soft part Slli'COma Portugal - Alveolar son part sarcoma Japan (Kyoto> • Alveolar soft part sarcoma (3); RhabdomyosarcomA (I} ,!j!pan Kurru;hikj lKawas!lki Medical School\ - Alveolar son part sarcom~ (4) Singaoore · Alvcohu son part sarcoma Saudi Arabia !Kjng Khu!id Universitv HgsJl.i!ill} - Alveolar son l)llrt snroomo

Rcferenccsi Gomez JA, A min MB, ct a!. lmmunohistochemieal Profile ofMyogcnin and MyoD I Does Not Support Skclc!Jll Muscle Lineage in

Alveolar Son Part Sarcoma. Arch Pathol Lob Med 1999; 123(6):503-507. Joyama S. Veda T, et al Chromosome Reammgcmeotot 17q25 and •P II 2 in Alveolar Soft-Part Sarcoma. A Case Rcpor1and

Review of !he Literature. Cancer 1999; 86(7):1246-1250. Ordonez NG. Alvcolor Son Part Sarcoma A RC\-icw and Updote. AdvAnat Patlro/1999; 6(3):125-139. Husain M and Ngu}eo GK. Alveolor Soli Part Sarcoma. Rcpor1 or a Case Diagnosed by Nccdle Aspiration C)1ology and Electron

Microscopy. Acta Cyto/1995; 39(5):951·954. d'Amorc ES and Ninfo V Tumors of the Soft TISSUCS Composed of J.arse Eosinophilic Cells. Semin Diagn PoJho/1999; 16(2):178-

189.

12 ClOt .November 2000 "Minutes-. (Su~,ption A)

Case No. 9, Accession No. 28311

LLUMC Pathology ResidcoiS • Small cell ncuroc~ <:atCinoma Mountajn View lEI Camino Pathology Qrouol - Small cell neuroendorcrinc carconoma. intermediate tfl)e Riyeajde . Neurocdocrine carcinoma Bakersfield • Neuroendocrine carcinoma (small cell careinoma) Orangy - Small cell carcinoma Yenijl£a (Unilnb) - Large cell neuroendocrine carcinoma (2) Oaklnn4 CKaiscrl - Small cell neurocndocrioo carcinoma (4) Long Beach • Neuroendocrine carcinoma (ocLm>Sccrctocy granules) (9) Bay Area - Neuroendocrine carcinoma (2): Malignant carcinoid (I) Montqsy - Neuroendocrine (small cell) carcinoma San11 RQ!A - Neuroendocrine carcinomo (scact«)• vesicles) (2) San Diegg - Small cell lung carcinoma San!A Barbara • NcwoeMocrine carcinoma Mooterey !'!Irk - Oat cell carcinoma Haywood/Fremont - Large cell neuroendocrine careinoma (dense core granules) (3) Neyoda(WQStern Pathology Consultants> • Small cell carcinoma NebraskA CCrojghton University) - Small cell carcinoma IVith neuroendocrine differentiate

November 2000

Knns!\S CCoffcnille Rcgiogal Medical Center\ - Neuroendocrine (oat cell) carcinoma (by tigbl), neuroendocrine granules (b)• BM) Kansas IUnjvcrsity of Kansas Medioal Cemctl • Smnll cell carcinoma (16) Indiana (fort Wayne) - Large cell neuroendocrine carcinoma, right upper lobe, lung louisiw <Louisiana State Unj\'crsity ModjcAl Cenler) - Neuroendocrine carcinoma Wimnsin CMeriter Hospital) - Neuroendocrine careinoma (LNEC, grade 3 vs. atypical carcinoid, grade 2) Dlinojs IPupage Pathology Associates) • Small cell carcinoma, lung (2) Micbi•M IO!!kwooc! Hospital) - Small cell carcinoma Mjcbjson CStloseph Mercy HosPital> - Small cell carcinoma Kentuckv <UojycrsiiY of louisville RcsjdeniSl • Small cell carcinoma, mixed type Florida CTol!ahasseel - Small cell undifferentiated carcinoma Florjdo <Munroe Regjonal Medical Ccnlctl ~ Neuroendocrine carcinoma f!oLislo CWjntcr Haven) - Small cell carcinoma (2); Atypical carcinoid (I) NortJt Cprolinq (Wakc .Forcst. Univcrsil,yl • Small cell carcinoma Pcrum)'lynnja (Conemaugh Medical Cemcr RcsjdcnLV .. Small ceil carcinoma, lung PeJUJSvlynnja Cl.cbjsb Valley Hospital) • Undifferentiated small cell corcinonlll (I); Small cell carcinoma (I): Neuroendocrine

carcinoma (1) M!!!Yitmd CW!lOdbinel • Small cell ca"inotna (2) M!!!Yiand £Notional Naval Medical CtiJ - Small cell carcinoma ( 12); Large cell neuroendocrine carcinoma (6) MOQ'Iand <Uni•·cmty ofMao~and\ - Small cell carcinoma New leaey IOvcrlook Hosoi!PI\ • LarQC cell newoendoainc carcinoma (4) M!WOtbuWis (New En!!land Medical Ccntql - Small cell (neuroendocrine) carcinoma Conncctjcut CUnjyersitv of CoMcx:ticyt Heq!th Center) · Neuroendocrine carcinoma, intennediate eell New York IBcth Jsrnel 'Medical Center Rcsjdcntsl - Carcinoid tumor Nc\V York INortlmort) • Neuroendocrine tumor New York CNcw Hvde Park) - Smnll cell carcioomn Aloska IAnshOTIIJW) - Small cell carcinoma of lung Cn!\jldA (foothills HospiLAI) - Neuroendocrine carcinoma, large cell type f2!:U!IIDI • Small cell lung carcinomo Jap;m (Kyoto) - Small cell carcinoma (3): l.argc cell neuroendocrine carcinoma (1) Jao;m KurashiJ;,j IKawesal:i Medical Schoo!! - Small cell carcinoma (4) Sjn!!JII!O!!l • Small cell <arcinoma, ontermcdialc ceU type Saudi Ar!lbja fKin• Khnlid University H"'l!iW) • Small ceO careinoma

References: Khuder SA. Dayal HH, ct al. EITect of Cignrctw Smoking on Major Histolog•col Types of Lung Canccr in Men. Lomg Cancer 1999:

24(1):45. Travis WO, Gal AA, et al Reproducibility of Neuroendocrine Lung 1'u1n0r Classification. Hum P(llho/1998; 29(3):272-279. Carter D. Small Cell Carcinoma oft he Lung. Am .I SllrgPatho/1983: 7(R).787-795.

CTI'R. November 2000 "Mmutes" (Subscrlpuon A) !3

Case No. 10, Ae<ession No. 27244 November 2000

LLUMC Pathology Resjdeo!S - Rliabdomyosarcoma, embryonal Moun!i!in view (EJ Camino Pathology Group) - Pleomorphic rhabdomyosarcoma {primary) V$ pleuro-pulmonary blastoma Rjyqside - Neurofibroma Bak=ficld - Rhabdomyosarooma ~ -Rhabdomyosarcoma Ventura <Uojlob} - Embryonal rhabdomyosarcoma (2) Oakland !Kaiser) - Rhabdomyosarcoma, pleomorphic (3); Jnfanlilc fibrosarcoma (l) Log•lkiGb - Embryonal rhabdomyosarcoma (Z-band material) (9) BavA=- Rhabdomyosarooma(3) MO!llcrev - Rhabdomyosarcoma, pleomorphic Santa Rosq - Blastoma (rhabdomyoblastie) (2) San Diego - Pleuropulmonary blastoma Sao\!! 8atbaca - Rhabdomyosarcoma MCI!l!erey Park • Embryonal rhabdomyos.vcoma Haywoodlfttmonl - Leiomyosarcoma (~1in myofilamcnts l!l1d dense bodies) (3) Ncyoda (Western Patho!at'Y Consultants) - Rhabdomyosarcoma Nebraska (Creighton Univeailyl - Embryonal rhabdomyosarcoma Kansas (Coffeyville Regional Medical Center) - Rhabdomyosarcoma (by !igbt), fi!amcn~ attm~ Z lines (by EM) Kansas <Uni>·ati!v of Kan!ls Medical Ccntql • Rhabdomyosan:orm (I 6) Indiana (fort Wayne) - Pulmonary blastoma, left IW18 (pleuropulmonary blastoma or childhood) L4uisian.1 (Louisiana State University Medjcal Center) .. Rhnbdomyosnrcoma Wisconsjn (Mqiter HospjtoO · Rhabdomyostu'COma Illinois !Dupage PA!bolo"Y tltwdates) - Likely metaplastic (san:omatoid) careinoma, lung(!); High grade sarcoma (rhabdo ,.s.

carcinosarooma) ( I ) Michi!!lm COaJ,·wood Hgspitn!l - Pleomorphic rhBbdomyosarcoma Michl !!1m CSt Joseph Mercy Hospital) - Pleomorphic rbnbdom)·osarcomn KentuckY <Unjyeajtv or Loyjsyj!le Rcsidcn)S) - Rhabdomyosarcoma Florida (lallahnsscr) .. Pleomorphic rhabdomy05arcoma florida <MuurocRegiopaJ Ma!ical Ccn)ql - Gonglioncurobl$orna Florida <Winter Havepl - Leiomyosarcoma (2); Rhabdom)·osarcoma (!) North Carolina (Wake Forest Upiywilyl - Mci!!Static alveolar rbabdomyooarooma Pcnnsylyaoja (Conemaugh Medical Ccn)cr Residents) • Alveolar rhabdomyosarcon1a Pconsv!vania CLehi•h Valley !fwlitall - Rhabdomyosarcoma (2); Leiomyosarcoma(!) M!l!)'land CWqqdhine) - Giant cell carcinoma (2) Mmiand (National Na,·al Mcdiea! Ctrl • Rbcbdomyosarooma Maryland (University o( Marvlandl - Embryonal rhabdomyosarcoma Now Jersey COyqlook Hospitall - Rbnbdomyooarcoma ( 4) Massacbuset!S £New Eo gland Medical Ccn!ctl - Rhabdomyosarcoma COI!!ledicut <Uniyc:rsitv of Connecticut Heahh Center) - Rbabdomyosarcomt1 New YO!k !BcJh Israel Medjca! <'..enter Residents) - Rhabdomyosarcoma New York CNoW>oortl - Rhabdomyosarcoma t~cw York (New HydcP!!!kl - Rhabdomyosarcoma Alaska (Ancborn•e) - Pleomorphic rhabdomyosarcoma CMf!!a !FOO!hjlls Hosnitall - Embryonal rhabdomyosarconu Portu!!al - Pleuropulmonary blastoma ~.l'210) • Embryon•l rhabdomyosarcoma (3); Pleuropulmonary bloS!orna (!) .l!YlM. Kumbjki !Kawosaki Medical Scbool\ - Leiomyosarcoma, metastatic (4) Slngaoore .. PleomOf])hic sarcom:t Saudi Arnbta (Kin• Khalid Unjvc:rsitv Hgsojta)) • Rhabdomyosarcoma

RefetC!Jccs: Lee SH, Rcguuchary SS and Pammcsb J. Primary Pulmonary Rhabdomyosarcoma. A Case Report and Review oftl>c Litcrnturc.

Hum /'athol 1981; 12(1):92-95. PI'Z)ogodVo RM. Moran CA, et nL Prinuuy Pu!monasy Rhabdomyosarcomas. A C!inieopathologic and !nununobistoehcmica! Study

oflll= Cases. Mrxl Pat hoi 1995: 8(6):658-661. Wesche WA. Flctebcr CD, Oias P, ct a!. lmmtmobistochemisuy of MyoD! in Adult Pleomorphic Son Tissue Sarcom•s. Am J Sr~rg

Pmhol 1995: 19(3):261 -269. Dagher Rand Helman L. RhabdomyosorcoOlJI. An Overview. Oncologm 1999: 4( I ):34-44. Atabao S, Aksu 0 nod Ekinc> C. C)10iogic Diagnosis and Subtyping ofRhobdomyosarcoma. Cytopotho/ 1998: 9(6):389-397.

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