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CALIFORNIA TUMOR TISSUE REGISTRY

Study Cases, Subscription A

January 2000

California Tumor Tissue Registry d o: Department of Pathology and H uman Anatomy

Lorna Linda University School of Med icine 11021 Campus Avenue, AH 335 Loma Linda, California 92350

(909) 558-4788 FAX: (909) 55~188

E-mail: cttr@linklinc.com

II ft. I

Target audience: Practicing palhologists and pathology residents.

Cool: ""'Th'8cquaint the participant with the histologic features of a variety of benign and

malignant neoplasms and tumor-like conditions.

Objeetives: The participant will be able to recognize morphologic features of a variety of benign

and malignant neoplasms and twnor· like conditions and relate those processes to pertinent references in the medical literature.

Educational methods and media: Review of representative glass slides with associated histories. Feedback on consensus diagnoses from participating pathologists. Listing of selected references from lhe medical literature.

Principal tileulty: Weldon K. Bullock, MD Donald R. Cbase, MD

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

education activity for up to 2 hours of Category I ofthe Physician's Recognition Award of the American Medical Associat ion.

CIVIE credit is offered for the subscription year ooly.

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

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

. :

Contributor: Robert E. Riecbmann, J r., M.D. Case No. 1 - J anuary 2000 Glendale, CA

Tissue from: Left Atrium, Heart Accession #28289

Clinical Abstract: During work-up for weight loss and fatigue in a 67-year-old female, aCT showed left atrial

mass. A transthoracic echocardiogram confirmed a 3 x 4 em left atrial mass, which was resected.

Gross Pathology: The 3.9 x 4.1 x 2.4 em polypoid tan to dark red tissue had a gelatinous red tan cut surface.

Contributor: Robert E. Riechmann, M.D. Case No.2 - January 2000 Glenda le, CA

Tissue from: Gastric polyp Accession #28470

Clinical Abstract: A 76-year-old male was discovered to have a large gastric polyp, which was surgically

removed.

Gross Pathology: The soft glistening pink-tan polypoid tissue measured 6.0 x 4.2 x 3.7 em. The surface was

bosselated and covered with mucus and had a slightly papiUary appearance.

CONTRJBUTOR: Nelson Quigley, M.D. Case No.3 - January 2000 Anaheim, CA

TISSUE FROM: Sigmoid colon Accession #28205

C linical Abstract: After four months of fatigue and a 20 pound weight loss, this 25-year-old male was found to

have severe iron deficiency anemia requiring transfusion. A colonoscopy revealed an obstructing lesion in the left colon with CT scan verifying a mass. A left hemicolectomy with side to side anastomosis was performed.

Gross Pathology: The 253 gram, 15.0 x 8.0 x 6.5 em segment of large bowel contained a rock hard mass in the

midporlion.

SPECIAL STAINS: Chromogranin positive in solid, nested regions

negative in cells of"mucinous" areas

Contributor: Arthur L . .Koehler, M.D. Case No. 4 - January 2000 Pasadena, CA

T issue from: Mediastinum Accession #28236

Clinical Abstract:

'

During a routine physical examination, this 51-year-old femaie was found, on chest x-ray, to have a large prominent right hilar mass. A well-encapsulated anterior mediastinal mass was removed.

Gross Pa tbology: The 88 gram specimen was 8.0 x 6.0 x 5.0 em. The parenchyma was dense with a slightly

gritty texture, but calcifications and cystic degeneration were not grossly identified.

Contributor: Peter Chen, M .D. Case No. 5 - January 2000 Sylmar, CA

Tissue from: Right kidney Accession #28319

Clinical Abstract: Severe right flank pain brought this 49 year old female to medical attention. Radiologic

workup revealed a renal mass. A radical nephrectomy was performed.

Gross Pathology: The resected kidney with perirenal fat weight 1400 gm. In the upper pole was a 12.0 x I 0.5 x

10.0 em spherical mass composed of variegated, cystic and solid, soft to firm, hemorrhagic and tan-red to tan-white tissue.

Contributor: Farooq Ali, M.D. Case No.6 - January 2000 Ventura, CA

Tissue from: Right ovary Accession #28598

Clinical Abstract: Because of a family hlstory of ovarian carcinoma, this 40-year-old El Salvadorian female

expressed concerns after experiencing increased abdominal girth, discomfort and intermittent nausea and emesis. Physical exam showed a palpable abdominal mass and Cf scan revealed a large mass in the right ovary, which was removed.

Gross Pathology: The 2636 gram cystic ovarian mass was oval and measured 35.0 x 20.0 x 8.0 em. A 32 em

diameter main locule contained 2.5 liters of serous and mucoid fluid. Tbere were red-tan papillary islands covering approximately 30% of the internal surface.

Contributor: LLUMC Pathology Group (we) Lo rna L inda, CA

Tissue from: Bilateral Ovaries

Clinica l Abstract:

Case No.7 - Jan uary 2000

Accession #28562

After complaining of abdominal pain and increasing girth. this 32-year-old female was found to have a palpable 32 em diameter soft abdomina-pelvic mass. CT show-ed bilateral solid and cystic masses in the pelvis, extending to mid-abdomen.

Gross Pathology: The multicystic, multinodular right ovarian.mass weighed 2740 grams and measured 23.0 x

14.0 X 10.0 em. The yellow-tan nodules were up to 7.0 em in greatest diameter, some with central hemorrhagic areas. The left ovary was 1500 grams and 19.5 x 13.5 x 7.0 em and was also multicystic and multinodular.

Contribu tor: LLUMC Pathology Group (drc) Lorna Linda, CA

Tissue from: Right ovary

CLINICAL ABSTRACT:

Case No.8 - January 2000

Accession #28452

This 50-year-old female presented with an abdominal mass. A total abdominal hysterectomy wjth bilateral salpino-oophorectomy was performed.

GROSS PATHOLOGY: The 1940 gram multilobulatcd ovarian mass was 23.0 x 14.0 x 10.0 em. The parenchyma ,.,.as

composed of light tan, generally necrotic, tissue with foci of hemorrhage. There were also multiple smooth-walled hemorrhagic cysts up to 2.4 em in greatest diameter.

Contributor: Arno A. Roscher, M.D. Case No.9 - .January 2000 Valencia, CA

Tissue from: Left pelvic mass Accession #28349

Clinical Abstract: A large pelvic mass \\<as palpated during a routine examination of this 85-year-old Caucasian

female. The mass was fixed but found to be unassociated with adjacent ovary, oviduct and bladder.

Gross Pathology: The 238 gram mass was I I .0 x I 0.0 x 8.0 em. The parenchyma was gelatinous yellow-gray

witb cystic areas.

SPECIAL STUDIES: S-100 CD34

strongly positive negative

Contributor: K. Greg Peterson, M .D. Sioux Fall~, SO

Tissue from: Left thigh

Clinical Abstract:

Case No. 10 - January 200()

Accession #28619

This 83-year-old male complained of an enlarging mass on his left thigh.

Gross Pathology: This well encapsulated oval mass measured 7.0 x 4.0 x 3.5 em and was composed of variegated

whorled fibrous yellow-tan tissue.

CALIFORNIA TUMOR T ISSUE REGISTRY

GENERAL PATHOLOGY

Minutes - Subscription A

January 2000

SUGGESTED READING (Goncrul Topics from Recent literature):

Molecular Determinants of Outcome in Bladder Cancer. Cote, RJ, et al. The Cancer Journal From Scientific American 1999: 5( I ):2· 15.

An Unappreciated Discoverer of !he Cause and Treatment ofPeptic Ulcer Disease. Rigas 13, ct nl. I .ancet 1999; 354: 1634-1635.

Prognostic Factors in Urothelial Renal Pelvis and Ureter Tumours. A Multi centre Rare Care Study. Ozsahin M, ct al. Eur J Cancer 1999; 35(5):738-743.

Neoplasms Composed of Eosinophilic Polygonal Cells. An Overview with Consideration Cytomorphologic Pnuems. Nappi 0, et al. Semin Piagnl'atho/1999 16(2):82-9<).

CaUfornia Tumor Tissue Registry c/o: Department or Pathology and lluman Anatomy

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

(909) 558-4 788 FAX: (909) 558-0188

E-mail: cttr@linklinc.com Case of the Month: www.llu.edu/l lu/cttr/cotm

Case. No. I, Accession No. 28289

Mounrain View (ffi Camjon Hospital) - Atrial myxoma Ornn!!C CUCJ Medical Center Rcsic!entsl - Atrial myxoma (8) Ventura !Unilnb) - CardillO myxpma (2) Sunl!l Rosa - Myxoma (J) Valencia (licnp• Mavo Newhall M~;morial I IQSDital> • Myxoma l.ong Beach - Myxoma (7) Santa llarbom !Cotta!!C I l!!;!pj!i~l - Angiomyxoma Qo!cland !Knjoor> - Atrial myxoma.(2) Bay Arcn • Myxoma (3) ~1onterev lCommunitv HospjtW of MONcrcy Pc.."Tiin~ulal - Myxomn of:nrium San Piero INa, .. t Mcdi••l Cmerl - Myxoma (12) Nevada fRcno) - Myxoma (2) Utah !APAl • Atrial myxomu Ncbmskn <Creighton Universjlyl . Myxo1nn, leflatrlum Texas. HI Pa.<;p ITe~as Tee!! Medical I I!Jb C'!r) • Myxixnn Illinois. ~lin•dale rouool!e Prubo!osv J\s!roc.) - CerdillC myxoma l.ouisjano CShn;veportl - Myxoma Michigan CEsxue l lo.•milaD - Cardiac IU)'XOma Michiglln !St Jo.epb Mcrcv llosnillll) • Myxoma (2) florida O'allnha=cl - Myxoma (3) 111orida (Maru!lc Regional Medical CC!!!o:il • Myxoma North Curo!ina(Ashervillcl • Atrial myxoma (3) Washjow.on, pc CWahcr Rs:cd Army Medical Ccmcr) .. Alrial myxoma l,enn.~vlvnnja CRcsidems Concmaueh Mcmorjal liOipitnl\ ~ Myxom:1. left atrium

January 201!0

Pcnn<>iwnjo (!&high VallcyHospilall - Cordiac myxoma (4): A1rial myxoma wilh mnri<ed he~.jc •'COOUSI<'tlng.:slioo of wall and many hcmosiderphnscs 3Dd hemooidcrin deposits noted.( I): Myxoma ( I); Atri1d myxoma (I)

New York ClA nG ls)and J~Cwj*h MediC<JI Ccmcr) - Cvcllac myxomn New York CNonhoort) • Atrinl myxom:s Marvland !UnjvtJSily o(Mwvlendl - AI rial myxoma M31VIand <Nulional Navol Medical Ccn1cr> - Alrin1 myxoma Marylnnd ( Woo<lhinc) • Myxoma (2) New JerseY IOvcrlook l·losp.lll!!l • Atrial 1nyxoma (14) Connediw! CVnjveqirvofConn Hl!h Or) · Atrial m)'XOill3 with cxcessi"c fibrin deJK'5ition and oraunizing thrombus (I) New Yods CNMhoonl • Atrial myx001o Maino lllanll!l!} • Myxoma Canada tf!oo!hj!l Hosnitul) - Cardi~tc •nyxoma Canada CV(i!l Anatomic Pmhologv) • I .ell atrial myxoma 131!311 CKun1$hjki) • Cardiuc n1yxoma (3) Saudi Arnbio !Kino Kb.1ljd University H!llnjlllll - Myxoma. left atrium Australia (S)'dne>·> - Cardiac rnyxoma

DIAGNOSIS: Cardiac Myxomu, Left Alrium

T-32300, M-88950

REFERENCES: MlllSui Y. et ol. Myxoma of the Mitral Vohc Prolapsin& into Left Atriu111 w1d Ycntriclo. Report of 11 Ot~c. Surg Today 1998;

28(10):1105-1107. Ko PJ. et ul. Video-Assisted Minimal A~Xlt» in Excision of Left Atrial Myxoma_ Amt 71wroc Surg 1998: 66(4):130 1-1 3(15. Ramphal PS. et a!. Myxoma oi'Righ• Femoral Vein Ori~in Present in& ns a Right Atriul Mass with Syncope. J Thorac Cardiwm:

Surg 1998: 116(4):655-656. Nakano T. cl ol The Relationship Between FuocLionaiJ•utmonary Artery Pressure and Size in Lett Atriul Myxo•nn. Cardiovasc

Surg 1996: 4(3):320.323.

Case No. 2, Accossion No. 28470 January 2000

Mountain Vjcw !Iii C-amino HosPi!91l - llyperplastic pol)-p Orongc IUCI Mcdjq!l Centq Residen~) • Adenomatous polyp (5): hypcrplasaic polyp (3) Vem!J!l! Cl/ni!obl - H)lXIpla.tic polyp (2} Santa Rosa • Hypcrp13Stie polyp (2); Tllbovilloo.< polyp. benign (I) Vnlcncia (Henry Mayo N<;whall Memorial H<><nilllll - Hypcrpl .. lic polyp (r/o Pcutz-Jeghers syndrome) lm• Bench - Villous odcnoma (S}; and hypcrpht<tic polyp (2) Sanutllurbma CCouagc l lospitall - Tubulovillous polyp Oakland <Kn!~gr) • llyperplostic polyp (2) lli!~ · l'opillnry (tubulovillous) adenomatous polyp (3} Mnnts.-rcy <Couununitv Hosoital of Monterey PenjnSllll\) · /\ntMI IOvcolnr polyp San Dictw (Nuyal Mcdj.:al Center) - Hyperpl1mic 1><>lyp ( II ): r•cutz·Jcghcr polyp (I) Nevudn <R\'no) - Gnstrl,c adenoma (2) Utah (J\JJA) - Tubulo"illous adenoma Ncb!l!Ska CCrcit:hton Uni,-er.;ityl - Hypcrplaslic polyp Tcx!!S. f.! l'il5o CTcxa< Ted1 Medlen! Hlth Ctrl • Adcnornu llliooi•, llin•d!llc !!>uPW!e l'lllhoiOI!V Assoc.) - H)')>CrpiiiStic polyp. :>deoomotoo.< changes J.oui•iunu CShrcyspgsjl - Tubulovillous adenoma Miebjgup lfoocc llospitnll - Pcmz.Jegher polyp Mjchjmm !St. Joseph Mmv Hosnitnll • Tuhulovillou.< adenoma (2): ll)perpiDSlic polyp (I) Flclrida !Tolloho.<SC~:l • Adcnomatous polyp (3) Flori<fa <Monroe Rcciooal Medical Cemerl - Tubulovillous adenoma North Cnro!inn (Asheryille) - Villous adenoma (2); Tubulovillous ndenomo ( I) W!Lihjngton, !)C <Wvl!er Reed Armv Medienl Center) - llyperplostic polyp Pcnn:wlvqnia (Rcsjdcnts Concmaush Memoriall lo.o:;ni&al) ~ Wcll~diffcrcnthucd OOenocarcinoma., :nomach ecmJ>vlyoui!l.f.1&hiQh Vullev Hosoitall • Gastric villous udcnOrna (I): Vill(flJS (papillury) adenoma of the >tOmnch (3): Polypoid

gllltric udcnocureinomu ofintestinn.l type ( I); Neoplnstic polyp ( I); Adcnornarous polyp(!) New York Clong l$(und Jewjsh Medit¢11 Center) - Hypcrph,~t ic polyp New Yorli(Northpl)r!l • Hamartomatous pol~p (l'cut.o-Jcj\hcr"s type) Morvlnod (!Jnjvcrsjtvoi"Marvlandl - Hyperplastic polyp with focul dysplusia Marvlood <National Naval Medical Center) - Tubulovillo..- adenoma Moryl:md IWoodbjncl - Villoos udenoma with low grade dysplusiu ( 1): I l)l'erplnstic polyp ( 1) New Jj:rncy !Oyqlook l!o:mitllll ·Villous adenoma (3): llypcrpl!l$1ic flll<trlC polyp (I) Coonce!jcut CUnhmit'' of Corm Hlth C!r} - llypcrplastic/rcgencr.uh·e polyp indctcrmin:ne for d)'Splasia New YodlfNO!!hOO!!l - Hamllrtomatous poi}J> (Peutz-Jcgl>cr"s type} Maincl!luowr.} - Villous adenoma Ciuw!a lfOO!hm I loopital) - II)'J'Crpiast.ic ga;tric pol)]> Ciuw!a CVGI I t\nOtomic l'llthology} - ~I)')>Crplastic polyp Jam!D !Kun<'hjkil • Fov<:olar epithelinl hypcrplasia (2); Hyperplastic polyp (I} Saudi Arnbio CKjng Khalid lJnivcrsitv Hosoitol) - Villoglnndular pol~p. $lomuch AUHCJII j11 CSydncv) • Villous odcnomu (2); llamoriomotous pol}]> ( I); Pcui<-Jcghers polyp ( !)

DIAGNOS IS: Hyp~qllastic Polyp, Stomach

T-63000, M-72040

REFERENCES: Lewin KJ and Appclml!!! HD. AJo7P Tumor Fascicle 18, 3,. S.:rics 19'J6: 201-207. Elster K. Histologic Classification of Gastric Pol~l'S· ln:Milr"<On HC. cd. !'athol oft he Gaslroimestinnl Tract. Oerl/n:Springer­

l"erlll!l 1976:77-93. Ming SC. ct al. Epithelial Polyps of the Swmach. In: Ming SC. GoldnlWlll. eds. Pathology of the Gastruinte:<~inal Truct.

Phllntklpl~trWB Saunden 1992:547-569. Krishshnam.-.hy. S. lmmunohi&ochemienl Expm;.'lion Tronsforming Growth Factor. Alpha and Epidermal <'•rowlh Factor

Reccp1or in C"""rointestinal Carcinoids. AmJ Surg Patho/1997: 21(3):327-333. Miller Jll. ct Ill. Upper Gastrointestinal Tr.ICI Villous Tumol"$. AJR Am J Roemge~w/1980; 134(5):933·936.

Case No. 3, Accession No. 28205 January 2000

Mounrain View (BJ Camjno Hosoitall - Composite tumor·mucinous ack:nocarciooma and neuroendocrine carcinoma <l<ange !UC! Mcdjcal Ceo!..- Rc.idontsl · bwasive adenocan:incma with focal ~ne diffcrmtiation (8) Venl!!!l !lJnjlobl • Composite adenocatcinoma-carcinoid tumor (2) Santa R053 • Combined adenocarcinoma carcinoid (2); Invasive adenocatcinoma. <Wcinoid (I) Valcncta CHcrxv Mo>·o Newhall Memoria) HogKtall - Poorly differentiated am;inomn with neumroe"""cKioc<ln<rinc feutures Long !leach • Com(ll)Sitc mucinous and neuroendocrine =cinomu (7) Santa Oarbma ceou.._i: !!osni.lill) - Neuroendocrine carcinomo with mucinous differentiation Oakland !K~ • Poorly difTcrcntiltlcd carciooma with neuroendocrine features (2) Buv Arc!l • Mnlignwll tldcnocarciooid (mucinoto.;) (3) Mc)Qtcrc .... <Cpmmunhy Hpspjtal ofMnnterev Peninsula) • Mucin pr()ducing ud..:nocarciooma San Dicoo (Nuygl Medical Center> .. High grade adcnocurciuomn with neuroendocrine 1~'1llUres (12) Nevada £Reno) • Ad~noncuroendocrinc carcinoma (2) I hab lAPA> - lligh-aradc carcinoma \\~lh mucin<>us nnd neuroendocrine '-'iOCrentiotion Ncbm.,ka !Crcightpn Uojvcrsjlyl • Composite tumprs or udc:nocarcinomn and carcinoid 1umor Texas. El Pat;n <Tyxms Tech Medical Hhh Ctrl - Adenocarci1\0ma whh neuroendocrine features !lljnois. lljosdale cpunugc Pathology A$§9C) - Mucinous adcnocarcinoid tmor Louisiana CSJm;,,cponl • Ade(IQC'atcinoid Michigan Cfoou; llmpj1all .. Mucinous adc:oocarcinoma with n...~--ndoc:rinc: differentiation Michigan 1St Joser>b M..-c" Uospitall · Adenocarciooma "ith n<Urocndo<Tioc dillC:rentiation (2) Florida ffillljlhMs) · l'oorly diffcnniated adenocatcinoma with neuroendocrine difti:n:ntiarioo (3) ~1orida !M!l!!tOC Regional Medical C...Uer) • Adcnoam:inoid tumor 'lar!h Carolina lt\J!IIlr-jllc) - Goblet cell c.u~inoid (I); Campooitc tumor (comm>id with mucinous ad<OOCUrtinoma) ( 1): Carcinoid

rumor with mudnQtl$ diO~rcntiation ( I) WtL'\hingtQn. J)C CWuhcr Reed Army Medical Csmer} - Mixed cnrcinoid·adcnO<."arCinorna l'cnnsvlvililia CRcJjdcnts Comrmaugh Memorial Jlospit.all .. Ptxlrly dim:rcntiutcd adenocarcinoma. colon with foci ot'ncurocmJo~.:rine

>U>d ~lgncl ring e<:ll lutnor l''consvlvanjn (l&hjgb Vullcy I!usnjtal) • Adenocarcinoid (1): Pnorly dim:rcntiutcd ndc.nocnrcinoma wD1h lOcal neuroendocrine

ditlCrcntiution (2)i Mulignant carcinoid tumor of oolon ( I); Mixed carclnmnu with areas of mucinous nnd .:ndocrine di iTcrcnti(lli<)n (3)

New York tt.ong lslund J.,;wish Medical CenLer) . PoorlydifTercnritdcd ~dcn~trcinoma with -a neuroendocrine c..·vclnomatous component

New York CNorthJ)ON) • Adcnoc::trdnoma with neuroendocrine nnd mucinous ICatures Maryland <Unjvs:rshv ofMaryiWJd) - Mucinous adenocarcinoma wilh endocrine differentiation M""lnnd <Natjonnl NB\'BI Medical C<ntcrl • POO<Iy differentiated adcO<laln:inoma with neuroendocrine features (composite) M;n1and !W!l!!dl>jot:) • Mixed nc:uroendocrine-mu<inoos carcinoma (2) New Jmev !O,'C!Iog!c I !ospj!all • Adenocarcinoma. poorly diffcrcntiotcd with ncurocndccrinr feau.-.s Cooooc:tia!l IUnh<Qhy of Conn Hlth Qrl · AdeOC)(lltCinnid "'· n<UroendcxTinr C81Cinoma, high grade N<"" York INOClblll!£l) • Adcno<:areiooma with neuroendocrine and mucinous features Maine CpaoGO!) • Adcnoc:m;inorna with neuroendocrine di tfercnchation Canada IFootbj!l HIISQilill} • l ligh grade colloid adenocarcinoma with neuroo:ndO<.Tine and focal squamous di 111.-n::mi:~tion Canada <VOl t Anatomic Pathology) · Poorly-di tTcrentimcd C'Jrdnoma (mixed adenocarcinoma and neuroendocrine curcinoma) JJlniUl <Kum~hjkil • J\donO(.'arcinoma with possible n~.,.·u rO(IHiocrine ditlt:rentiation Sm1di Arahjn <Kinu Kh~1lid l!njve1-sitv Hospital) - Mucinous ndenocnr<:inoma with focal neucoendocrine difn.:n.:111imion. si,g,moid

colon Aw;tralia <Snl.n£l1 .. Combined adenocarcinoma iUld C~lrcir,oid

DIAGNOS IS: Composilr Mucin-&eret;ng Adenocarcinoma willt N<urocndocrine Differentiation, Colon

T -67000, M·84813

REFF.RENC!jS; l'earsoo ER. et ill. A Genetic Model fOt Coloredal Tumorig..-oosis. Cell t990; 61(5);759-767. Greco JLI. Ct ol. Mucinous Carcinoma-JUSt AnotheT Colon Conca1 Dis CoiO<r Recr11nr 1993; 36(1);49·54. Zrn·lrillr!e WI . ctol. Si81'ct Ring Ouciooma in llyp.'rplastic Polyp. ScarKIJ Gastr<Jentero/1995; 30(6):60-t~S. Bunsal M. et nl .. 1\n: Metnplasias in Colorcaal AdciiClmll> Trul)' M<11lplasia? tlnr J Patlrol 1984: 115(2) ;253·265. Pascal RR, ctol. Consistency in the Tenninol"llY ofCotnrcCtal D)~plasi<L H11m Patho/1988: 19(11):1249·1250.

CTTR.Janual}' 2000 .. Mjnul~:s"' (St~bscription A)

Case No. 4, Accession No. 28236

Mountain View <EI Camino llospitan · Thymoma. lymphocpithelia1 typ<: Orange I!ICJ Medical Center Residents) • Thymoma (8) Ventura iUnilab) • 11tymoma (2)

.January 2000

Sama Rosa - Need lPOX. Hodgkin's disease vs. Hon-lfodgkin's lymphoma (2); Lymphoma (hnmunostains needed) NHL vs. I·JL Valencia (Uenry Mayo Ne\"'h·aiJ MemoriaJ Hospital> .. Thymoma Long !leach - Thymoma (7) - .. Th}moma Oakland CJ:;:aiscr} - Thymoma (2) Bay Area - Thymoma. lympl10C)1ic predominant (3) Monlcrcv (Community Hospital of Monterey Peninsula) p Thymoma. l)mphocytic San Diego (Naval Medical Cen(erl - Lymphocyte predominant thymoma ( 12) Nevada (Reno) - Thymoma (2) IJ!ab I APt\) - 'illymoma-lymphocyte rich Ncbrru;ka (Cr<:i!!hton University) - Thymoma Texas. El Paso ITcx!!s Tech McdiGPI Hljh Ctrl - Thymoma Illinois. Binsdale !Duooge Pathoi~Assoc.) - Lymphoma Loujsjanu CS!g$vcoort) - 'fltymoma, lymphoc)1C predominant Michiean <Foote Hospital> - ·nl)'ltlorna Mi£bjgan (St. Joseoh M<r<:v Hospital) - lhymoma (2) Florida Crallaha<~see\ • ThY.Jlloma (3) Florida. (Monroe Regional Medical Ccrncrl - ·n l)'lllOma North Carolina CAshervillc} · Tbymoma (J) Wa<hington. J)C (Walter Reed Army Medical U:nterl - Thymoma Pennsvlvnnia £Residents Concmaueh Memorial Hospital) - ]1tymomu Penfl'vlvania !Lehigh Valley Hospital) • Thymoma (4): Lymphocytic thymoma (2); l,>•nphoc)tic lymphoma (diffuse) "itb

scattered larger pale-slalning histiocytes ( I) New york (4mg lslnnd Jewish Medical Center) • Thymoma, predominantly cortical New York (No[!hp(lrt) - Lymphocyte rich th}moma Maryland (Univer.;ity of M!)[yla.ru!) -1ltymoma, predominantly lymphoc)1ic Mw-yland <National Naval Medical Center) - Lymphocytic thymoma, favor invasive Marylattd ( IV(Xxlbine) - Thymoma ( I); Thymic hyperpla<ia ( I) New Jcrscv (Q, .. crlook Hospital> - 1l1yrtlorna Connecticut· HJni"cr;sjtv ofCnnn H1Lh Ctrl - Mixed epithelial and lymphoc}1ic th)'moma New York <Northoortl - Lymphocyte rkb.thymoma Maine (Bangor) - Thymumo Canada <.Eoothill HosojHJI) - Thymus-'ntymoma l)'l)lphoc}tc predominant with 7 cell areas (medullary di Oi:rentiation) focally

invasive and fOilictJiar thyrnilis Canada (VGH Anatomic Patltologvl - Thymoma (lymphocyte-rich) Janan (!(ura<hiki\ • Thymoma, invasive (3) Saudi Arabia <King KhaJid University Hospital) - 11lymoma. predominantly cortical Australia (Sydney> • Encapsulated thymoma

DIAGNOSIS: Thymoma, Predominantly Lympb~ylic, Mediastinum

T-Y2300, M-85800

REFERENCES: Whoolcy BP, ct al. Primary Tumors of the Mcdi.,.tinurn. J Surg Oncol 1999; 7(!{2):95-99. KU(' T'r. Thymoma. A Study of the Pathologic Clu.ssHictltion of71 Casi!S wilb Uvah.1atioo of the Mulle•·-Hermclink System. Num

Pat hoi 1993: 2<1(7):766-771. Pcscarmona E. ct al The Prognostic Implication orThymoma Histologic Subtyping. A Study of80 Consccutiw Cuses. Am J of

Clin Pathol 1990; 93(2):190-1 95. Nussbaum M .. et al. Management of Myasthenia Gr~wls by Extended 'llt)'mectomy with Anlc:rior Mcdiost.inal 11issection. Surg 1992;

I 12(4):681-687. Andersson T, t.1 al. Ultrasound Guid(..-d Tumour Biopsy in the Anlcrior MediaSlinum. An Alternative co Thoracotomy and

Mediastino.•copy. A era Radio/ I 992; 33(5):423-426. Juttncr F'M, Cl al. Pirfhlls in lmraQpcmtfvc J::"ro7.en Set.1ion Histology of MediasLinaJ Neoplasms. Eur J Cardiothoroc~urg 1990;

4( 11):584-586.

Case No. 5, Ac~essiun No. 28319

';fountain Vjcw lEI Camino llosoilall • Clear cxll corcitl0013. muhicyslic t)'P" Orange CUCI Medical Ccncq Resident•) • Ro:nal cell <=;incma (8) Ventura U!ni!ab) ~ Renal cell carcinomu (2) Santa Ros11 • Renal cell carcinoma, clear cell iypc (3) Valencia (' ltrtn' J\·1ayo NcwbaU MemorjolllospiUtU · Renal cell carcinoma l.oo• Bead! • Oear cell udcnocarcinom> (7) Santa Rarl!gm fCof!age !IO<pitall • Renal cell carcincmn. grad;) II, clear ccllcype Q:.tkland IKni:;<:rl · Reo., I cell carcinomt~ clear cclllype (2) Bay Aren • Renal cell carcinoma, clear c.;llcype (3)

January 2000

MO!JI.:rey IC'.ommunity I!O<nital of Momcrey Peniot<ulnl • Renal cell <arcinomo. clear cell San DicgofNaval Medical Center) - Renal cell carcinoma, grade II (12) NcYada tRcnol • Clcnr cell. renal cell carcinoma (2) Utah lAP A) • Renal cell C(orcinoma Nebraslu! CCrcigh!on \Jnjyernity) • Renal cell carcinoma, clear cell type Taas. El Pllsg IT exa< Tsxb Medica! I !lib Ctrl • Renal cell carcinoma Illinois. niMdalc fDnJl!li!C l'ntholog,-As50C,) • Renal cell carcinoma, clear a.-11. lo-- srn<1c J,guisiruli\ ( $hrcvcoort) • Kcnat cell carcinoma Michigan tFomc llospital) - Clear cell •·c113l cell carcinoma Michigan ISL Jooeoh Mercy liospitall • Rcrutl cell carcinoma. clear ccll l)pc (2) Florida {Ta!!!!ha<sce) • Renal oel! carcinoma Florida fMgnroc Regionnl Modica! Co,IICJ') • Renal cell corcinoma, clc-•r <'Ciil)'J)< North Carolina fA<hef'il!cl - Clear cell rom~ edt carcinoma (3) Washi•lB1nn. DC lWaJt.::r ltlrCd Ann\' Mcdjcql Center> - Renal cell curcinoma Pertn::ovhMia lResick:nls Coocmaueh Memorial Hosni!n!) - Renal oOC~cinoma. clear cell type Pcnnsv1,11nia !!&high Valley UospiJal) • Rem! cell cun:inoma, c!c:ur ccl!t)-pe; Renal c:c:ll carcinomo-<:hromophohc: •11riant { 1):

Clear-cell carcinoma of kidney ( !); Renal oell carcinoma (2); Clear cell type of renal cell carcinorna (2) New York U6)JlG Island Jcwjsh Medknl Ccntcrl - Rcnnl cell carcinoma, clear cclltyp.:, low nuclt:.11r grade New York CNurthoortl • Renal cell carciooma. clear cell variant M!!O'land (1/nh..,,.icyofMwyland} • Renal cdl carcillMia. cl=ceiii>JlC Marvland CN;ujonal Naval Medical Cemq) · Reno! oell carcinoma (clear cell type) Mo.rvland (Woodbine) • Rctuol cell cnrd noma. c!eor cell type. grudc II (2) New Jersey (Overlook llQspiw!) ·Reno! cell carcinoma. clear cell type, purtly cystic (4) Conncctia.n (Unjrersitv of Coon Uhh Ctrl - O car cell n.:nal cell carcinoma :-.lew YO!!< I Northport) • Rer.,! rei! carcinoma, cl'"" cell variant Maine CUangurl - Clca.r cell carcinoma Canada lfOOJbilll lmnimD - Multi cystic renal cell carcinoma, grade 2/4 Canada cy011 Anatomic l1ulholoov) .. Rennl cell carcillOrna. conventionul cl~ cell type Jaoon CKumshikil • Rem~ cell carcinoma, clear ..:ell, cys!ic (3) Si!udi Arabia !King Kbalid \Jnivcrsitv !lospitall • Renal cell carcinoma, clear ccllt)'J)<. right kidney

Australia !Sydnc•) • Renal cell carcin<>ma

DIAGNOSIS: Rtnal Cell Cucinoma, Con,·eotiooal Clt:~r Cell Type, Grade II, Kidney

T-71000, M-831 23

REFERENCES: Cohen C. Cl a!. llistogcncsis ofRennl Cell Carcinomu and Rcru~ Onooc)tomo. An lmmunobistocl>emical Study. Cancer 1988;

62(9):1946-1951. FulumM SA. ct at l'rogJtoo.tic Signifi<':lnc:e ofMorphQIOgic Paramct<t$ in Renal Cell Carcinomo. AmJSurg l'at/ro/1982: 6(7):65S.

663. Hoehn IV, ct a!. !nv-.sion of Vein In Rcnu! Cell Carcinoma-Frequency. Correlation l' rognosis. 1-:ur Ck o/ 1983: Y(S):276-280. Prcsli JC, Cl ul. Histopathological, Cyto~tcnctic and Molecular (llarncto-rizatiOfl ofRcnul Cortical Tumors. Cant:cr Ros 1991;

51(5):1544-I SS2. Frohmullcr 110. <1 a!. Comp:r.nh'O Voluc ofU!tr.>SOOOgn>phy. Computerized Tomop-.spby, AogiogJllphy and f:xa.:t()f)' Urogn\phy

in the Stn~:ing of Rennl Cell Cnrciuoma. J Uro/ 1987; 138(3):482~184.

Ca.st No. 6, Accession No. 28598 Marth 2000

Mountain View fEI Camjoo tlosmitull - Muci•1ous odcnocarcinoma. {:rrade I Orungc c LJCI Medical Ct!mcr Residents) - Papillary ndcnocarcinoma (5); Mixed $CI'Ous and mucinous cr.~ lie tumor of low mali~1111111

ll<>lcntial (3) Vcmura CUnilab) · Scro1.- ~u~illwy tumor of borderline molignancy (2) Saow Rosa • Muoinoos tume< of low malignant ~tcnti fil (2); Mucinous tumor (bordc:1"1ine) (I) Valencia <Hem• Mavo Newhall Memorial Hosoitull • "'ucinous I .. '-1P. high JVUdc l&lf)a !leach • Pnpillury cystic tumor oflow malignant polcntial (7) Santj!.flarbarn {Couage llooohall • Mucinous adcnocnn:inoma. low grade (>akhwd (Kaiser) - Mucin()US :.tdcnocarcinoma ( 1 ): MucillQUS tumor of low mali&nnnt potential ( l) Uav ArCII · Scromucinous papillw-y oystictumor orlow molignant ~tcntial (3) Monterey CCommunjtv l losni.Jnl of Monterey Peninsula) - Papillary carcinomo. mucinou5 Snn l)icgo fNaval Medjcal Center) - Mucinous bordcl'line tumor with intra<.j)hhcHal carcinoma (8); Mucinous carcinoma (4) Ncvgda CRcnol · Serous hordcrllnc cystadenoma of ovary (2) l!tah CAP AI · Cystadcnocurcinomu-muoinous Ndnska CCrci!!lt1on Unh:eaityl • Serous tumor ofbO<dcrlioo malignancy TcxQ.'!, El Paso Cfexa.< Ted! Mrdiall Hlth Ctr) • Serous tumor of low malignnrl! polcntial (serous bO<clerlioc tumor) ll!joojs. Hjnsd;)le (l)uoage f';uhology Assoc.) - Muci1101JS cys!Jldenocarcinorna Loujsjana CShrevenort) .. Mucinous t.;.ystadeflOtn~ borderline malignancy (imcstinoJ type) Mkhican <foote Hosnitul) • Muc-inous tumor of low mulignanl potenl ial with inrrncpithclittl carcinoma MjchiL•,ah (St. Joseph Mlrc>• Uosphal) - Serous tumor ol' low maliguant petcntiul (2) Flpridn <Tallahassee) - llupillnry turnor of low maligmuu potenl.inJ. papillary serous tumor of LMI' rlorjdQ (Monroe Reclonal Mcdjcol Center) - llapiii:'U')' mucinous C..'}'Stadcnocarcinomu 'otlh \.oro! ina CAshcrvillel • Mucinous tumor of kl<•• malignant polcntial ( I); Mucinous tumor·I.MI' •>itb focal inlracpitholial

c:artiooma ( I); MuciriOU$ tumor ofbO<clcrline malignuncy ofendocervic:aii>"Jl<~areas of intracpithc:linl CllfcillOOia (J) W!!.>hinoloo. !2C CWahc-r Reed t\nnv MrdjeaJ C-en1er) • Mucinous low maliwmnt polcotial twnor (<dypicnlly ~rolifcruting mucinous

tumor) P£nnsvlvunin <Resident~ Cnocmnugh Memorial f.losrhull • PapiHary serous cysrnder•ocarcinoma. ovtllry ~l vania fLchigJr Vnllcy l:losnital) ~ Mucinous corcinorna offow (or borderline) mulig:nant potcn1i:11 (3): Serous

cystadenocarcinoma of O\•ur·y with mucin-secreting c.:ys.tuden.oma in the wotll nl'1hc tLdcnocurcinomu: Serous p(rpillary mmor or bonl<:<line type ( I); Tumor of low malignant ~teotiul. ondomolrioid (I); Paplllwy C)>tadcnO(.'ilrcinomu ( I)

New York fLong Island Jcwjsh McdiQll Cemerl - Jlordcrlinc scromucinous tumor in u background of mucinous cystadenoma (ulso endomctrioid dilfcrcn~iation)

New York (NortbOOf!) • Scromucinoos borderline tume< "ith inttocpitheliru cnrcinoma Moo1ood <lJni\1:rsitv of MPr)!laod) • Mucinous intc::ninol tumor oflow·maligrmnt ~tential Mncylund fNational Naval M¢dical Center) · Scrou$ f.I')':Uadcnoma of low malignant potcruinl Maryland (Woodbine) - SCTt)U!) papillw-y cystndcnocurcinomo tiJl d mucinous cyswdcnoma ( l ); St'fous p~tpillary cysmdcnocarcinomu

(Uid ltlllcinous adenollbrnmo ( 1) ~Jersey (Overlook Hospj!o!) - Mucinous carcinoma ( 1): Borderline muJign~uu 1nucinous tumor ( 1 ): Pupil1nry

<')'SH<dcnocarcinoma (2) Cooi!c<1jcu! CUnh•ersirvofCono I lith Q rl · SerollS papillw-y C)"adeoomn of borderline malignancy New York <Northponl • SerolnuciltOIIS i>or<k<line tumoo- with intracpitheliru corcin0013 Mains £Bangor) - Papilltvy mucinous carc...;oomo Caruoda !FO<Mhilllloonitall • Ovary mucinO<IS cystic tumor of borderline moliS"ancy. cndO()OfVicallikc. nile out amyloid stroma nod

mucinous cyst.ad\.-nomn QJJUtda ( VGH Anatomic l,ulb~ - Borderline mucinous tumoc Jil.PllU CKurashiki) · Mucinous h()rdcrlinc tumor with c;ll'ciiiCJina in~situ

Snudj Arabia (Kine Khalid \ !njyg"Ritv Hospital) - lnt<:stimi1 mucinous borderline tumor, right ovary Australia CSvdnev) - Proliferating mucinous tumour (bordet'line/Jow maJignnn1 f'()tcntial)

DIAGNOS IS: Papillary S..romudnous Tumor (Borderline/Low Malignant Potential), 0.-ary

T-87000, M-8<1 113

RIWii llloNCI'.S: Cndun'RF'. et al. Comparison of Mutations ofKi·RAS und p531mmunorcacti vity in Borderline ~md Mulignuut Epithelial Ovarian

Tumors. Am J Swg Putlwl 1999; 23(3):323·328. Kupryjaoczyk J. ct al. pS3 Gene Analysis of Ovarian Borderline Tumors :ond St•sc I Carcinomas. 1/um l'mlw/!995: 26(4):387-392. Priolcuu J. e1 al. 1'53 Ao1ill"n Loss in Stored ParuOin Slides (Lcuer). N Eng/ J M"/1995; 332(''1:1521·1522. Vlltl Hoaftcn-Day C. ct ul. li.xprossioo of Cell Rcj~ulmOt)' l'ro!eins in Ovarian Bordo:rlinc Tunxn. C111~er 1996: 77(10):2092·2098.

C'rrR. Janu.ary 2000 -Mlnules·• (Sub:icription A) 7

•

Case No. 7, Accession No. 28562 ,Junuary 2000

Mountain View CEI Camino llospitall - Atypical prolifcrt1ting cndomctrioid rumor Qrange CliCI Mcdi(;!ll Ccntq Rcsidcn!.•l - EndCJmC!.rioid c:vcinoma "ith squamous diffcn:tllilllion (3) Yemura lUnilab) - Ovar,ian cndometl'ioid Ct'lt'Cinoma (2) ~anta Rosa · Endomeoioid carcinoma (2): l'upil!ury carcinoma, ondomclrioid type (I) Vakpei:a lllcruy Ma"o Newhall Memorial llnspitaU - E.ndomctrioid adenocarcinoma 1.<!!!& BeaGh - Endometrioid odcnocarcinoma (7) Sunta narhara lCouag~ Ho:mhuJ) - Endomctrioid carch1oma, low grnde. wilh extensive squamol.IS metnpla<iia Qakland <Kaiser\ - Endomctrioid adenocarcinoma, grade I, with squnmou• metaplasia (2) !lav Arcu - l!ndomctrioid pupillary udcllOalfcinOilll!, cannot rule out s<roo< type) (3) Monttre\ CCM!munih·ll(t<citnl of Mcnen..~ PcniflSUla) - Endomctrioid auciooma Son l)iego fNuvol Medical Cemcrl - Endometrioid carcinoma ( 10): Yolk sacmmor (2) Ncvada fRenol • Endomctrioid carc.inoma wiLh squamou$ dillC!rcntiation (2) UJM fAPA) • Cndomctrioid carcinoma with squamous di1Tcren1iation Ncbm<ka CCrsjshton !lnhmjM - Endometrial ~ooma with squamous mc1llplusia (adeooacanthoma) rcxat 1'.1 Pa.w ITexas Tech McdiC\)f llllh Cto - AdellOC!tCiooma, JXlBSibly metastatic Jllinois Hinsdnh: (l>upanc Putho!ogv Assnc.) - Well~dill'Crentiated cn<k)mClrioid carcinon1o r/o met$ I&Juisiaoa (Shroycpord - Adcnoaca.mhomu Mjd1igan <F'004c HmmitaJl - Endometrioid :Wcnocarcinoma Michigan lSt Jmph Mercy I twnim!l - Enoometrioid ~noma (low mali!ll'ant pot<'lltial?) (2) f lorida <Tullaha..\..~cl - Endomctrioid udenocarcinomil Florida <Monroe Rc&iOnfll Medical Ccnlcr> - Scrtoli-Le)'dlg cell lumor, wcll-difibrculintcd Ns>nh Caroljnil !Aslu:nillc) - \Ve!l-dilfcrani01ed cndomctrioid adcnocorcinoma (3) Washineton. DC !Wolter Rccs! Amw Medical C,"11ta") - Endomctrioid can:inoma l'cnnsvlvaniu !f$esidcnts Com:muugh Mcmorial l-lospi1a1> .. [~ndometrioid OOenoca.rcinoma. O\<ary

J'cnnsvh•anin (Lehigh Vaii~Jy IIQSJ>ita!) - 8ndometrioid corcinoma (I); l ~ndomctrioid udt:nocarcinomn wilh abundlln1 5quarnuus dillercntialion (2); AdcnoaCilJllhoma of ovary (possible cndornetriotiadly dcvelo1>cd)(l): Proliferating Brenner ttnnor and mucinom odcnocarcinomu (I): Ovarian udcnocarcinomu.. s:OOometrioid ( I): Papilhllyudcnocarcino<na 'cnoomctrioid lypc{l)

New York C!,oos Island Jenjsh Medical Ccnt<T) - Endometrioid adenocon:inoma "itb ~difl'en:ntiotioo New YorkfNor~ - P.ndomctrioid cnrcinoma_with squumous diflCr~nLiation (morulcs} Mmrland (Uniycpdtv ofMnD'h111d} · Endorncu·ioid can.:inoma, grade l 1.1rising in otypicul emlometrinsis Mnrvland lNfltional Naval McdjOO C..cntcr) .. l~mc1risl adenocarcinoma with squamous differentiation M!I!Yiand CW(!(!()bine) - Ensloml:trioid adcnoc;arcinoma (2) fjcw Jerscv COycrlook Hn.~pitoll - f!:ndorncltioid carcinoma (4) Connecticut <Unh•crsity of Conn I !1Ll1 Or) - Endomcuioid adenoacanthoma. grade Ill probobly arising in cndomdrio~is

New York CNOf1hport) • Endomeuioid carcinoma with .squamous dirrcrc.nliation (moru!cs) Maine Clbngorl - Endomctrioid adcuocatcinoma with squwoous ditlCrerui~iOCl and t.~u:1rtosis Cd!nu<la Cfoothjl! Uoonital) - S.rtoli-le)'dig tumors. intcrrncdillle grade Curmda !VG! I Anutomic Pq.tboJogy) - Gndomc1rioid adcnocnrcinoma, grndc I, with squamous diftbrcnliation Japan CKura.l\hjkil - l~domc1rioid tarc:inomn Saudi Arabia <King Khafid Unh"S:!Sitv Hn<nha!l - Fndorncoiuid carcinoma. ovary Australia <S"dncvl - Well--ditlCrcntiatcd cndomctrioid BdellOC".ucinoma

OIAGNOS IS: Endometrioid Carcinoma witb Squamous Uifl'crentiation, Associated with an Endomelriotic Cyst

T-Y6235. M-83803

1\1\fERENC!lS: llowsh MS, Cl a!. The Occmrcnce orSqunruous Epithelium in Lhe E,ndomctrium. OIJSICI Gynecol Sur" 1967: 22( 1):69-115. '>ih·crilcrg SO. •1 a!. Adeno.'ICanthoma nod Mixed Adenosquamous Otrcinoma oflhc !;ndomcsrium. A Clinicop:uhologjc Study.

AmJ Obstl!l Gyn<co/1912; 30(5):1307-1314. Reyes cv. Cl nl. Anaplassic Cwcinoma of the Coloo. Oiniwpathologie StudyofEigJtl Cass:s ora l'oorly Recognized Lesion. Ann

Diagn t'mhn/ 1991; 1{1):19-25. (Co<e< ldemified from2650 Colonic MaliS~~ancics)

I CT1'1t Jamuuy 2000 .. Mmules'' (Subscnplion .A)

Case No. 8, A(tession No. 28452

MO!!OI&in Vjew CEI Camino Hospital! - Granulosa a:!! tumor Ornnec O!C! Mc'lljg!l Ce!llct Residents! - Granulosa a:ll tumor (8) Vcntl!!ll C\Jnjlubl • Granulosa c:cll rumor (2) Santa ROS!I - Cnnulosa cell tumor

March 2000

yuJendn tlleory Mayo Newhall Manorial I fos:oitaO - Gnmulosa cell tumor n. carcinoid Lpns !leach - Oranulooa cell tumor (7) Santa llarbam CCoun~ llo~nitaO • Granulosa cxll tumor Oaklfllld (Knj~ - Gmnul= ccU tumor (2) flny Areg - Co<:nu <"<:II tumor. p<Odominantly yolk SllC type (3) Monterey (Communjty l lospjtal of Monterey J)cnin.~iulu) .. Grnnulur ccll lumor San Dicoo fNqyul Medical Center> .. Gr-.mulosa ccll lumor ( 12) Ncyndo <Reno> - Granulosa cell tumor (2) !.!.u1l!..!.A£A - Granulosa cell tumor Ncbra~kn CCrcjgbton Unjvcrsi1v> · Granulosa cell tumor Texa.<. El Puso C rcxa• Tech Medical Hlth G'trl - Gmnul<>«1 c:clltumor Ill innis. Hjn@als fOuoogt: Pptholoov A.~.) .. Granulosa -thccu celt tumor Louisiana (Sba;,·cport) - Granulosa oeU tumor Michi!ll!ll WOO!ollospitall - Adult granulosa c:cll rumor Michi!tl!l !S1. Jmoh Mew· Hospital! - Granulosa cell tumor (2) Fkwi<b <TWLW;r:vcl - Granulosa ceU rumor Florida !Monroe RC1!jonal Medical Center) - CJ!"tic I!IMUiosa cell tumor Nor!h Coroljnu (A.,h;Tvillcl - Gr.mulosa cell nunor (3) Waihington. DC <Wnhcr Reed Amw Medical Center) · Gnmulosu ocH tumor Pcnnsvlo,•uojn <Rssjdents Conemaugh Mcmorial l-losnitnl) - S<:_x oord stromal tumor. ·1 Sertoli-Lcydig t'CII tumor.? pure Scrtoli ocll

uunor Pcnnsvlvw>in /L.ohieh Ynlley Hospital\ - Sex oord-stromultwnnl'-poosibly gnumlosa cell ( I); Granulosa cell tumor (4); Grunulosa

cell curcinon1u with C)'Stic area·~ of massive hemorrhagic dcgcm:rntiun ( I); Malignant granulosa cell tumor ( I) New York <Long Js!qnd Jewish Medical Ccntc..'T) - Grtmulosn C'-'llturnor New York /NQobll!l!l) - Adult gr•mulosa cell tumor MlltVIaod (!Jnjvc[;!j!Yoi' Mm!tmd) - Granulosa cell tumor. odull-tYJ>C Mruyland !N!Uinnnl Novul Medical Center) - Grunuloso eo!! uunnr (7): Scrtoli cell tumor (6)

Mao•land /Wc•xlbjnc) - Grnnulosa c:clltumor (2) New Jern;v !Oyt.'rlook Hospital) - Granulosa cell tumor (3): Sertoli-t.cydig cell tumor (I) Conneaicut !Vnhmjty of Conn H!th Clrl - Grnnulosa cell tumor

N<m York CN211h1!2!1) - Adult granulosa cell tumor Mninelll.1n&<J[) - Gnlllulooa cell tumor Canp (fOOJbj!IIIOl!l!.iJlll) - Adult granuloou cell tumor Canada CVGII AnP!omic Pothoi<M!vl - Grnnulosa cell tumour. ad11lt type Japan lKuna..1hjkD • Granulosa cell tumOf" Saudi Aruhiu O<iny Kbulisl University Hospital) ~ Sex cord stromullumor. mosl likdy adult granulosa a:lllumor, right ovury Australia (Svdm;y) .. Sertoli cell rumour/udult gronulosa t.:l.'llllunour

DI AGNOS IS: C ranulosa Cell Tumor, Ovary

T-87000, M-95800

REFERENCES; Fox H. cl o!. A Clinioopa~10logic Studyof92 Cases ofGrfllluiO>la Coli Tumors of1he O''aJ)'with Special Relc.,noc to ~•c F<~eW>

lnOucncing ~'"Prognosis. Cancer 1975: 35(1 ):231-241. Costa MJ, ct ul. lmmunoltistochemical Phen!ll)pc of0,'3J'iao Gr•nulosa Cell Tumors. Abs..-nce ofF.pithelial Membrane Antigen

1!83 Dilljjll(l:>tic Value. Hum Patho/1994; 25(J);6(UM•. Sub K e1 nl. Granulosa Cell Tumor of the Ovary. Histopalhologic and Flow C)1ometric Anal)~i$ "ith Oinical Com:lation. Arch

Pmholl.ab M td 1990: 114(5):496-501. Pricx A. e1 al. Composite Mucinous and Grnnulosa-Cclltumor of0Vlll)·. c..., Rqx>n of a Unique Noopla'irn. lnl J Gyrwcol Pa1llol

1990: 9(4):372-378. Costa MJ, cc uJ. Trurt$lbrt1lation in Recurrent O"·arian Granulo;.o Cell Tumors Ki67 (MIB-1) and p53 lmmunohi$tochcmislr')'

Demonwul<'s u PoMiblc Molecular llasi< tor f'oor Histologic Pr«liction of Clinical Behavior. /fum l'atlrol 1996; 27(3):27<1-287.

crrR, Jnnunry 2000 .. Minutes"' (Subscriptu:m A) 9

Ca~ No. 9, Accc~ion No. 28349 March 2000

Mountain Vjew CEI Cnmjno Hospjuol) - $ch\\tuU10Clla "ith -"""ient change" (~inantly Antoni type-B) Oran!!C CUC! MediC!!! Ccruq RC1ijdc!ltsl - Myxoid ncurorobromu (8) Ventura IUoi!ah\ • Ancient Schwaonomn (2) Santa RO!!i• - Neurofibrosarooma (2); Malignant Schwanooma(l) Valencia !Henry Mqvp Nc:Whall Memorial IIMQjtull - Satooma. probably lipcoarromn I.Qng Ocuch - !khwnnnoma {7)

l)Mta flarhara !Cotwoc Hosojl!!ll • Schwan noma Qa!cland CKaisql - Ancient Sch"'UMOOia (2) Bav Artl) - Tcrotoma (with focal neural clements) (3) Moolw;y <CornmuniJy Hospital of Montcruy l)eninsula) • Mulignant PNST San Djeoo !Naval Modica! Center) • Ancient Schwrumomu ( 12) Nevada !Reno) - Schwannoma (1111Cicm) (2) Utah !/\PAl • Schwannoma Ncbru.~kaCCreighton Uni\'ersitil • Liposarcomn:myxoid typc Te:xus Ell'll<a Cfcx&<]'ccl! Modjg!l l lith Ctr\ • Myositis O$si6cans Illinois, I fin<dalc !Duro(!C f'alhology A<S<>C.\ • Schwamoma with degc~>~.'fllti'" fe:.ru,., l .nui<ianu !Sbreveoort\ - Malignw1t peripheral nCTvc shcwh tumor (MI'NS1) Michigan (Foote Hospital) - Schwanuoma with unciem change Michirum !SL Joscnh Mqcv HmPital) - Schwanooma (2) florida ll'n!lahassee) - SchWllDnoma (3) r:Jorida (Monroe RcgiwHI Mcdit1d Center} - l)lcxi rorm ncurofibroLna No!1h C.1rolina CAshcryi!lel' - Myxoid neorofibl\lma ( I); Neurofibroma ( I); Plexiform ncuror,bromu (I) Wasbjnmon. OC <WAlter Reed Aany Medical C..cnicr) - Ancient Sdlwa.nnoma Pcnnsylyania CRcsidcnt'i Concmqugh McmoriallfospitaD - Malignant peripheral ncr-.e sheath tumor PcnOS\+Jyuniu (L;bjgh YaUCy l-lrumitul> - Nerve .sheath sarcoma - low grodc (I); N~;urilcmmomtl with scnesocnl change "anci(...'Tll

schwanoma"" ( I): Myxomarous lciomyostll'OOtna ofutcnJs wirh giant c.:clls ofsymr lusmictypc ( I): Neurofibroma vs. ancient schwrumoma (!); Gaoglioneurob!astoma (I): Neurilemmoma with scn<.'SQCot dWlgt "ancient Scltwannoma'' ( !): Schwunnoma with nnciem fcarures ( I)

New York (I .png lshmd Jewish Medical Ccntt.tl - Schwannomu wilh dc~enemtive changes New York (Noohoorl) • Ancient Sclm·-annomo Marvland lllniversiry o[Marvland\ - Malignont periphernl nme shead1 tumor b'larvland fNQ!ional Naypl Mediwl Cwter\ • Schwannoma Maryland CWoodhinc\ - Plexili>rm ncuroflbromu (1); Neurofibroma ( I) New Jc[l!cy CQ,•erlook Hoopiml) • Schwannoma (4) Conneqjcut 1UniP::J1ljJv of Conn I lith Orl - P!c'OillO<phic pigmented neurofibroma New york CNonh~ - Ancient Scbwannoma Maine 0\nncor) - Mulignant perit>hcraJ nerve sheath tumor Ganado !Fs!O!hill l l0$pitall - LiJXlS"'WWDO. myxoid with p!oomorpbic foci Canada <YGH Analornjc PathologY) - Schwunnoma Japan <Kur.t."hikil - Schwannomll, dcgcncnued Saudi t\robia (King KIUllid Uoivernity l losn!J.n!} • Ancietll Schwannomtl Ausmdia !Sydncvl • Schwanooma with ancienr change

DJACNOSIS: l'eripbtrQ! Nerve Shenth Tumor with Otgener.ltive Change (" Ancient Schwa.nnuma"), Pelvis

T· Y6000, M-95600

REFERI\NCES: Dahl I, et ul. Ancien I Neurilemmoma (Schwnnnoma) Acta l'atlro/ Microbiol Scand ( tl) I 977; 85(6):812-81 &. l>as Guplll TK. ct al. llenign SoliULr)' Schwannoma.~(NetD'ilcmomas). e<mcer 1979:24:355.

Case No. 10, Ae<ession No. 28619 11-lareb 2000

Mountain View ( E1 Crunino Hosoitnll · Malignant llbrous histiocytoma, ~mriform/ploomorphic lypc lli!wgc {\JCI Mcdjcu! Center Rcsidc"Otsl • Sclerosing epithelioid tibrosarooml• high grade (4); Mallsn:ull fibrous histiocytonut (4) Vcmuta !Unilabl • Malignant peripber.tl ncn·c shcalh tumor (2) Santa Rosa • Malignant mesendl)maltumor, possibly muli8J"nl fibrous hiSiiOC)1Qf11a (need IPOX) ( 3) Yulen<ia !lleruy Mavo Newhall Memorial llo:;pitall • lliah grudc sarooma l.png Beach · San:oma. NOS (1} Sunta Barbnm. CCouagc HosniUlll • Mo.lignon1 peripheral ncrw sheath lumor Qilkland (Kaiser) • Malignant fibrous histiocytoma (2) !Jay Area • Moli8J>ant fibrous histiOC)10ma (2); Sarcoma. NOS("/ neural ? triton) (I)

Montcrc'' CCornmuohy Hospital ofMOQ(crcv Peninsula> · MFH San Dje!l!l !Na--nl Mts!iSlll Center) • Molil!llant fil¥ous histiOC)1oma (12) Nevada rReno) • MPH (pleomorphic >toritorm type) (2)

Utah lAP A) • High·gtade sarcoma (MFII vs. MPNS1) Ncbmska (Creighton LJniverSiLv) - Mcscnch)•mal chondrosurootna or pleomorphic liposarooma Texas. 1!1 Paso !Tcs!IS Tech Medicalllhh Ctrl - LifJC)llarcomo Illinois. I ljnsdale !Ouoore Patholog,• t\>WC.l - Myxoid MFII Louisiana !Shren:QQ!)} • Ma!il!llant fibrous hislioc)10111a Michigan ([:ooic !lo~pitall - Malignant fibrous hi!=iliocytom:t Michigan IS! . .loocnb Mcrcv tl<><r>itnl) • l.ciom)·osnrcomn (2) F!nrida fTaJiahusscc> • Pleomorphic liposuroomalmnligllOI\t spindle cell sarcoma Florida !Monn>e l!cgionnl Medical <&mer) - High grade wwmu favor MI'NT vs. MFI-I Nroh C.amlina (A>hqri]W • Maligruont fibrous histioc)1om• (3) Washiwon, DC (Walter Reed Anny Medical O:n!CT) · Malignant fibrous hiStiOC)1oma Pcuns\'lvania !Rcsid!iJ!ls Conemaueh Memorial HospitaU - Malignant fibrous hi:Hiocytoma '! pt~morphit: rhabdomyosurcomo )'enn<ylvania (l .cl)jgh Vullev HospituO • l-l igh·gradc son:omu (MFH '"· nerve sht<~Lh) ( I); Molil!llunt librous hi<tiocyH>mu (4):

Malignant periphcrnl ne1·vc sheath tumo1· ( !);Sarcoma ot' nerve sheath origin ( I) ~cw York (Long ls!W)d Jewish Medical Ccn!er) · Millignunt librqus histioc)tomo Nk·w York !NmOOii!:!} - Sarcoma fa\or r.;om)osarcomB Marvland !Uni>qsi!y of Man-land) ·Sarcoma. malignant periphmll nerve shc:~~h ltllnO< vs. dediffcn:ntioted liposarcoma Maryland <Nuti(H1n! Nnva1 Medical Ccntl.r) - Malignnrlt fibrot1s histiocytomn (7): Muligraam peripheral nt'1'\'e sheath tumor (6) Mno•land (WoodhiwJ.l • l.eiomyosurC(Imo ( I): Muligmun periphcrnl nerv~ shcmh tumor (I) N£W Jcrsev (Ovct!ook Hospital) · MFII (4) Connecticut (Uojycajlv of Conn I Jhh Or) - Malignant iibrous hiMiOC)1oma ~ew York fNorthooa) • Sarcoma favor ltiom)~tl\3 Mninc !Ban!!!l!l • \111'11 Cunudn <Foothill Ho;pitql) - Leiomyosarcoma Canada ( VGII Amuomjc l'atho1ogvl - Mnlignan1 fibrous histiocytoma J.;man (Kuntshiki> - L<:iomyosarooma StnuJj Arabia <Kjng KhaJjd l Jni\'crsiiV llo,oi1al l - Spindle cell sarooma. mosc likely mulignruu pcriphcml uerve sheath lumor~ left

thigh Au•trolia (S,dnC>) • Unditfcr(nlinted wooma (I); MFH (3)

!)IAGNOSIS: M11lignan1 Fibrous Histiocytoma, Thigh

T· Y9 1 00, M-88303

REFERljNCf.S: Flctd><TCD. l'loomorphic Malil!llant Fibroosl fostiOC)1oma. Fact or Fiction? A Critical Rcapprni•lllllo>ed on 159 Tumor>

Diagnoocd as Pl«>morphic Saroomu. Am JSurg P(llho/1992; 16(3):2 13·228. lln7jnger FM. Mnlignm>t Fibroos lli!lliocytoma 2(1 Years 1\Jlcr Stout. AmJ Sur!! l'who/1986; IO(Suppl):43·53. l>ydcn BP. et ol. A Study of Spindle Cell SarcMlns Showing Myofibroblastic Di n"rcntiation. Ultrnwuct l'atho/1991 ; 15:367-378. IIi rose 1'. ct a!. llxpn:ssion of Intermediate Filaments in Malignmu Fibrous lli,.ioe)1ornas. Hum P(lt/Jo/ 1989; 20(9):87.1-R77.