' l '''tt CALIFORNIA TUMOR T ISSUE REGISTRY
"ENDOCRINE PATHOLOGY"
Study Cases, Subscription A
February 1999
California Tumor T issue Registry c/o: Department of Pathology a nd Human Anatomy Loma Linda University School of Medicine 11021 Campus Avenue, AH 335 Lorna Unda, California 92350 (909) 824-4788 FAX: (909) 478-4188 E-mail: [email protected] Target audience: Practicing pathologists and paU1ology residents.
Coal: To acquaint the participant witll the histologic features of a variety of benign and malignant neoplasms and tumor-like conditions.
Objectives: The participant will be able to recognize morphologic features of a variety of benign and malignant neoplasms and rumor-like conditions and relate those processes to pertinent references in the medicalliferature.
Educa tional methods and media: Review of representative glass slides with associated histories. Feedback on consensus diagnoses from participating pathologists. Listing ofselec ted •·eferences from the medical literature.
Principal faeultv: Weldon K. Builock, MD Donald R. Chase, MD
CM"E Credit: Lorna Liuda Uoivc•·sity School of Medicine designates this continuing medical education activiiy for up to 2 hours of Category I of the Physician 's Recognition Award ofthe American Medical Association. CME crodit is offered lor the subscription Y"il' on ly.
Accreditation: L.oma Linda University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing medical education for physicians. CONTRIDUTOR: Peter Morris, M.D. CASE NO.1 - FEBRUARY 1999 Santa Barbara, CA
TISSUE FROM: Pancreas ACCESSION 1128388
CLINJCAL ABSTRACT: A 48-year-old female Caucasian fe male complained of progressive muscle weakness, intermittent diarrhea and a 14 pound weight loss. CT scan revealed a 4.0 em, partially calci fi ed, irregular mass in the area of the left adrenal. At surgery the mass was found to be arising from the tail of the pancreas.
GROSS PATHOLOGY: The 139 gram specimen consisted of tail of pancreas, spleen, and a 4.5 x 4.2 x 4.0 em neoplastic mass on the anterior surface of the pancreas at the hilum of spleen. The JlUISS was encapsulated, oval and somewhat nodular, with focal areas of calcification. The cut surface was firm, mottled gray-white and red.
SPECIAL STUDIES: Chromogranin strongly positive Synaptophysin strongly positive Neuron specific enolase strongly positive Glucagon positive Amyloid negative Congo Red negative Vimentin rumor negative Alpha-I antitrypsin tumor negative Gastrin, insulin, soilUitostatin and pancreatic polypeptide negative
CONTRIBUTOR: Lorna Linda Pathology Group (kt) CASE NO.2 - FEBRUARY 1999 Lorna Linda, CA
TISSUE FROM: Pancreas ACCESSION #28393
CLINICAL ABSTRACT: This 58-year-old female presented with a four month history of intractable diarrhea. Work-up found a high vasoactive intestinal peptide level. CT showed a tumor in the tail of the pancreas.
GROSS PATHOLOGY: The 143 gram, 10.0 x 5.1 x 3.5 em portion of pancreas included two adjacent lobular tan masses, one 7.0 x 4. 5 x 3.0 em, the other 3.5 x 2.5 x 2.0 em. Both masses were necrotic with areas of hemorrhage. CONTRIDUTOR: Lorna Lind11 Pathology G•·oup (kt) CASE NO. 3 - FEBRUARY 1999 Lorna Linda, CA
TISSUE FROM: T hymus ACCESSION 28044
CLINICAL ABSTRACf: This 81 -year-old male was found to have an anterior mediastinal mass. This was noted during follow up for colon carcinoma, resected three years earlier.
GROSS PATH OLOGY: The specimen consisted of a 7.5 x 5.5 x 3.5 em tan ovoid, well-circumscribed mass with a thin fibrous capsule. The cut surface was homogeneous, soft, tan, without hemorrhage or calcification.
CONTRJBUTOR: Loma Linda Pathology Group (mra) CASE NO. 4 - FEBRUARY 1999 Lorna Linda, CA
T ISSUE FROM: Right adrenal ACCESSION #28392
CLINICAL ABSTRACf: This 38-year-old Black female had a history of virilizing syndrome with bilateral adrenal masses. A left adrenalectomy was done and the right adrenal mass had been followed conservatively for several years. Recent evidence of enlargement of the right adrenal gland and return of the virilizing syndrome Jed to a right adrenalectomy.
GROSS PATHOLOGY: The adrenal gland was largely replaced by an 80 gram, 7.5 x 5.5 x 4.0 em wel l-circumscribed, red brown nodule with faintly lobular, firm, orange-red parenchyma. CONTRIBUTOR: Roger McFadden, M.D. CASE NO. 5 - FEBRUARY 1999 Stockton, CA
TISSUE FROM: Left adrenal ACCESSION #27950
CLINlCAL ABSTRACf: A 47-year-old male developed abdominal pain. CT showed a large left adrenal mass. There was no clin ical evidence of hormonal activity.
GROSS PAmOLOGY: The 177 gram, 9.0 x 7.3 x 6.8 em irregularly oval mass was gray to red-tan with a central 5.0 em hemorrhagic cystic area.
SPECIAL STUDIES: CAM 5.2 rare positivity Chromogranin posirive NSE positive Ewings ' marker 0 13 negative
COl\'TRIBUTOR: Nora Ostr7.ega, M.D. CASE NO.6 - FEBRUARY 1999 Sylmar, CA
TISSUE FROM: Adrenal ACCESSION #27861
CLINICAL ABSTRACT: This 33-year-old Hispanic female was found unconscious while at work. Work-up showed a cerebral hemorrhage and malignant hypertension (2401160). CT of the abdomen revealed a 4 em right adrenal mass.
GROSS PATHOLOGY: The specimen consisted of a 7.0 x 5.0 x 2.0 em adipose mass. Sectioni ng revealed normal yellow adrenal cortex compressed by a red-brown mass. CONTRIBUTOR: E. R. J ennings, M.D.. CASE NO.7 - FEBRUARY 1999 Long Beach, CA
TiSSUE FROM: Thyroid ACCESSION #12056
CLINICAL ABSTRACT: A 51-year-old male had noticed a lump in the right lobe of the thyroid fo r about three to four months. Jt had not increased in size but became slightly tender in the last three-four weeks. A total thyroidectomy was perfo rmed.
G ROSS PAmOLOGY: The 15 gram thyroid had a 2.5 em nodule in the right lobe. The nodule was soft with a tan granular cut surface.
SPEC IAL STAINS: Calcitonin strongly positive Chromogranin trace positive
CONTRIBUTOR: Gary Moekli, M.D. CASE NO. 8 - J ANUARY 1999 Manchester, NR
TISSUE FROM: Thyroid ACCESSION #28215
CLINICAL ABSTRACT: This 54-year-old female presented with a large mass in the vicinity of the thyroid.
GROSS PATHOLOGY: The thyroid was removed in multiple fragments. The lefl thyroid lobe included a 7.0 em diameter tan gray nodular mass. The right lobe consisted of a 6.0 x 4.0 x 2.0 em multinodular tissue fragment.
SPECIAL STUDI ES: CAM 5.2 strongly positive Synaptophysin positive Calcitonin negative Thyroglobulin negative Chromogranin negative S-100 negative LCA negative CONTRIBUTOR: Guillermo Acero, M.D. CASE NO. 9 - FEBRUARY 1999 Santa Paula, CA
TISSUE FROM: T hyroid ACCESSJON#26313
CLrNICAL ABSTRACT: This 30-year-old Caucasian male was found to have a non-functioning nodule in the right lobe of his thyroid gland.
GROSS PATHOLOGY: The 4.0 x 3.5 x 1.8 em nodular thyroid included a 2.3 em gray-brown area with surrounding hemorrhage.
CONTRIBUTOR: Alexandra I. Reichman, M.D. CASE NO. 10 - FEBRUARY 1999 Marysville, CA
TISSUE FROM: Left thyroid ACCESSION 28450
CLINICAL ABSTRACT: This 47-year-old male had a slowly enlarging mass in the left neck for five months. The area was somewhat tender and he experienced intermittent hoarseness but had no difficulty swallowing. Physical examination showed a 2 em nodule in the left thyroid as well 3S a 5 em palpable node in the left posterior triangle. Serum calcitonin was 2731 (reference range 0-1 00). There was no personal or family history of endocrine disease.
GROSS PATHOLOGY: The 53 gram, 13.5 x 5.0 x 2.5 em thyroid included a well-demarcated 3.5 x 3.0 x 6.0 em variegated hemorrhagic light or yell ow-tan mass in the left lobe with only a small residual rim of red thyroid tissue.
SPEC IAL STUDIES: Congo red stain Focal ly positive CALIFORNIA TUMOR TISSUE REGISTRY
ENDOCRINE PATHOLOGY
Minutes- Subscription A
February 1999
SUGGESTED READING (General Topk5 from Re A Maligllant Small Cell Twnor in a Child. Four Wrongs Do Not Make a Right. Dehner LP. Am J ofC linic Patho/1998; 662-667. R~omm endations for the Reporting of Pancreatic Specimens Comaining Malignant Tumors. Jorge Albores Saavedra, Heff'ess C, Hruban RH, Klimsrra D and Longnecker D. Am J Clin Patho/1999; 304-307. Ten· Year follow-Up ofOvarian Cancer Patients After Second-Look Laparotomy with Negative Findings. Rubin SC, Randall TC, Armstrong KA, Chi OS, and Hoskins WJ. ObstetandGyneco/ 1999; 93(1):2 1- 24. Differentiating Vulvar lnlrtlepithelial Neoplasia From NonneoplaSiic Epilhelial Disorders. The Toluidine Blue Test. Joura EA, Zeisler H, Alexander L, Sator MO and Mullaucr·Ertl S. J Reprod Med 1998; 43:671.074. California Tumor Tissue Registry c/o: Department of Pathology and Human Anatomy Lorna Linda University School ofMedicine 11021 Campus Avenue, AH 335 Lorna Linda, California 92350 (909) 824-4788 FAX: (909) 558-0188 E-mail: [email protected] CASE NO. 1, ACCESSION NO. 28388 FEBRUARY 1999 INLAND (Riverside/San Bemw-dino) - Pancreatic endocrine carcinoma (I); Alpha cell twnor (pancreatic adenoma) (!);.Sclerosing carcinoid (I); Olucagonoma (I) BAKERSFIELD (Central Valley Study Oroupl - Adrenal cortical adenoma with sclerosis BAKERSFIELD {San Joaquin Commtmity Hospjtall - Islet cell twnor ORANGE • Olucagonoma . VENTURA (Unilabl - Pancreatic endocrine neoplasm with hy41inized stroma (2) MONTEREY • Islet cell twnor BAY AREA • Islet cell tumor - glucagonorna (3) LONG BEACH - Carcinoid (5) HAYWARD (St. Rose Hospi!llll - Pancreatic endocrine neoplasm, alpha cell type SAN DIEGO CNaval Medical Center) • Glucagonoma (12) NEVADA (Reno) - Pancreatic Islet celltumoc (glucagono111a) (2) COLORADO (North Colo Medical Ctrl · Pan~Teatic endocrine tumoc (glucagonoma with hyalinized stroma) TEXAS CTexas Tech Med Hlth Ctrl · Endocrine tumor ofpancreas (glucagooorna) IDAHO ClDXl • Glucagonorna NEBRASKA CCreightoo University) • Olucagonoma MICHIGAN (Foote Hospital) • Neuroendocrine (islet cell) tumor, glucagonom a MICHIGAN (St. Mary's Hospital) • Adenocarcinoid twnor MICHIGAN (St. Joseph Mercy Hospital) - Islet tumor (glucagonorna) (2) FLORJDA DIAGNOSIS: PANCREATIC ISLET CELL TUMOR ("GLUCAGONOMA") TS9000,M81520 REFERENCES: Heitz PU, Kasp<.'f M, Polalc JM, c:t ul. Pancrcalic Endocrine Tumors. Immunohistochemical Analysis of 125 Tum<>r$. H11m Pmho/1981(3); 13:263-271. Kruscman CAN, Knijnenburg G, de !u Riviere G, ct al. MorpholoSY and lmmunohlstochemicol!y-Dclined !Jndocrine Function ofP1111creatic Islet Cell Tumours. llistopotho/1918(6); 389·399. Mukai K, (Jrouing JC. Greider MH and Rosai J. Retrospc<:tive Srudy of 77 P1111crea1ic Endocrine Tumors Using the lmmunopen» INLAND (Riverside/San Bernardino) • Pancreatic YlPoma (3); Atypical =cinoid tumor ( I) BAKERSFTELD {Central Valley Study Group) • Pancreatic VlPoma BAKERSFTELD (San Joaquin Community Hospital) • Atypical carcinoid tumor ORANGE • VIPoma VENTURA CUoilab) • YIPoma (2) MONTEREY - YIPorna BAY AREA - Neuroendocrine carcinoma with YIP syndrome (3) LONG BEACH • Islet cell tumor (YIPoma) (5) HAYWARD (St. Rose HQ!;pital) - Pancreatic endocrine neoplasm (YlPoma) SAN DIEGO (Naval Meslical Center) • VIPoma ( 12) NEVADA CRenol • Pancreatic islet cell tumor {VIPorna) (2) COLORA DO (North Colo Medical Ctrl • Malignant pancreatic endocrine tumor (YfPoma) TEXAS (Texas Tech Med Hllh Ctrl • Islet cell tumor (VlPoma) IDAHO (I OX) · VlPoma NEBRASKA CCTeighton Universirv) • VTPoma MICHIGAN (Foote Hospital) · Neuroendocrine (islet cell) tumor MICHIGAN CSt. Mary's Hospital) • Islet cell tumor MICHIGAN {St. Joseph Mercy Hospitql) • Islet cell tumor {VIPoma) (2) FLORIDA DIAGNOSIS: LOW GRAOE PANCREATIC ENDOCRINE NEOPLASM ("VIPOMA ") T59000, M8240 I REFERENCF..S: BloomS, Polak JM, PeM INLAND (Riverside/San Bernardino) • Thymoma (3); Mixed ? and spindle celllhymoma BAKERSFIELD {Central Valley Study Group) • Lymphocytic thymoma BAKERSFIELD (San Joaquin Commynity Hospital) • Thymoma ORANGE - Thymoma, epithelial cell predominant VENTIJRA {Unilab) • Epithelial1hymoma (2) MONTEREY • Thymoma BAY AREA · Thymoma{3) LONG BEACH · Thymoma {5) HAYWARD DIAGNOSIS: THYMOMA T98000, M85800 REFERENCES: SeiJO INLAND (Riverside/San Bernardino) • Virilizing adrenal cortical adenoma (2); Cortical adenoma, adrenal (2) BAKERSFIBLD (Central Valley Study Group) • Adrenal cortical adenoma BAKERSFIELD (San Joaquin Communitv Hospital) • Adrenal conical tumor. favor beoigJt ORANGE • Adrenal cortical adenoma VENTURA (Unilab) • Adrenal cortical adenoma (2) MONTEREY • Adrenal hyperplasia BAY AREA • Adrenocortical tumor. fractional, with virilizing syndrome (3) LONG BEACH • Adrenal cortical hyperplasia (5) HAYW ARP (St. Rose Hospital) · Adrenal cortical adenoma (virilizing) SAN DIEGO (Naval Medical Center) • Adrenocortical carcinoma (3); Adenoma (6); Adrenocortical virilizing neoplasm (I) NEVADA (Reno) · Adrenal cortical carcinoma (2) COLORADO (North Colo Medical Ctrl . Virilizing adrenal neoplasm. probably adenoma TEXAS DIAGNOSIS: ADRENAL CORTICAL ADENOMA (VIRI LIZING) 1'93000, M83700 REFERENCES: Week EE Jr.. Shaliton U llJld J INLAND {Riverside/San Bernardino) • Pheochromocytoma (4) BAKERSFIELD (Central Volley Study Group} · Adrenal cortical carcinoma BAKERSFIELD (San Joaquin Community Hospital) • Pheochromocytoma ORANGE • Pheochromocytoma VENTURA CUnilabl • Pheochromocytoma (2) MONTEREY · Adrenal cortical carcinoma BAY A REA • Paraganglioma/pheochromocytoma (3) LONG BEACH • Paraganglioma {3); Pheochromocytoma (2) HAYWARD (SL Rose Hosoitall • Pheochromocytoma SAN DIEGO (Naval Medical Center) • Pheochromocytoma ( 12) NEVADA CRenol · Pheochromocytoma (2) COLORADO (North Colo Mes!icgl Ctrl ·• Pheochromocytoma IE){AS ITexas Tech Med Hllh Ctrl • Pheochromocytoma IDAHO (£0)() • Pheochromocytoma/paraganglioma ? NEBRASKA (Creighton Universjtvl • Pheochromocytoma MICHIGAN (Foote Hospital) • Atypical carcinoid MJCHIGAN (St. Mary's Hospital) • Adrenal cortical carcinoma MICHIGAN (SL Joseph Mercy HO!S!!itall · Pheochromocytoma (2) FLORIDA DIAGNOSIS: PffilOCBROMOCVTOMA T93000, M87000 REF!lRENCES: Kr11nc NK. C~nically Unsuspected Pheochromocytomas. E: INLAND (Riverside/San Bernardino\ - Pheochromocytoma (4) BAKERSFfELD (Central Valley Studv Group) - Adrenal cortical carcinoma BAKERSFIELD (San Joaquin Community Hospital) - Pheochromocytoma ORANGE - Pheochromocytoma VENTURA CUni lab) - Pheochromocytoma (2) MONTEREY - Pheochromocytoma BAY AREA - Pheochromocytoma (3) LONG BEACH - Pheochromocytoma (5) HAYW ARP (St. Rose Hosoita!l - Pheochromocytoma SAN DIEGO (Naval Medical Center) - Pheochromocytoma {12) NEVADA (Reno) - Pheochromocytoma (2) COLORADO (Norib Colo Medical Ctr) - Pheochromocytoma TEXAS DIAGNOSIS: PH EOCHROMOCYTOMA T93000. M87000 REFERENCES: Correa P and Chen V. Endocrin< Oland Cancer. Concrr 1995: (I Suppl) 75:338-352. (Phcochromoc)toma Adrenal Med11lla pp350·351). Greene JP. and Guay AT. New l'<'l'spcciives in Pheochromocytoma. Uro/ Cli~ric N ,fm 1989; 16(3):487-503. Shapiro Bond fig t.M. Mana~:Cment ofJ>heochromocycoma. F:ndocrina/ Metab Clinic N Am 1989; 18(2): 443-481. Shcps S.llong NO and Kee GG. J)i8.fpl()Stic E\•aluatlon of PheochromoCytoma. F:ndocrino/.1/etab Clinic N Am 1988: 17(2):397-414. Epelbaum J, el al. Molecular and Phannaoological Characterizatioo of Somatostatin Rcoepcor Subtypes in Adrenlll, Extraadrcnal. and Malignanl Pheocl\romoe~toma.•. J C/in Endocrinol Mttab 1995; 80(6):1837-1844. CASE NO. 7, ACCESSION NO. 12056 FEBRUARY 1999 INLAND CRivenide/San Bernardino) - Medullary thyroid carcinoma (4) BAKERSFIELD (Central Valley Studv Group) - Medullary carcinoma of th~roid BAKERSFfELD CSan Joaquin Community Hospital) - Medullary carcinoma ORANGE - Medullary carcinoma VENTURA CUnilabl - Medullary carcinoma of thyroid (2) MONTEREY - Medullary carcinoma BAY AREA - Medullary carcinoma of the thyroid (3) LONG BEACH - Medullary carcinoma (5) HAVWARD (St. Rose Hospital) - Medullary carcinoma, thyroid SAN DIEGO (Naval Medical Ct'llterl - Medullary thyroid carcinoma (12) NEVADA (Reno) - Medullary carcinoma of thyroid (2) COLORADO (North Colo Medical Ctr)'- Medullary carcinoma of the thyroid TEXAS ITexas Tech Med Hlth Ctrl - Medullary carcinoma IDAHO (IDXl - Medullary carcinoma NEBRASKA CCreightoo University) - Medullary carcinoma ofthyroid MICHIGAN Cfoole Hospital) - Medullary carcinoma MICHIGAN (St. Mary's Hospital) - Thyroid medullary carcinoma MTCHJGAN (St. Joseph Mercy Hospital) - Medullary carcinoma (2) FLORIDA (Tallahassee) - Medullary carcinoma (4) OHIO CMcCullough-RWe Memorial Hosoital) - Medullary carcinoma KENJUCKY (Woodbine) - Medullary carcinoma (2) MARYLAND DIAGNOSIS: MEDULLARY CARCINOMA OF THE THYROID WITH AMYLOID STROMA T96000, M85!03 REFERENCES: Alborc:s-Saavedra J, LiVolsi VA nnd Williams EO. Medullary Carcinoma. Semi11 Diagr~ Parhol 1985; 2:137- 146. LiVolsi VA and Feind CR. Incidental Medullary Th)roid Carcinoma in Sporadic Hyperparnthyroidism. An Expw15ion of the Concept ofCCell Hyperplasia. Am J C/in Patho/1919; 71:595-599. Mendelsohn G, El!l!lc:stoo JC, Wcisburger WR, GoM OS, ct al. Calcitonin and Hiswninase in CCcll H)llCtplosia and Medullary Thyroid Carcinoma. A Light Mit=oopic and lmmunohistocllcmical Study. Am J Parho/1918; 92:35· 52. Schmid KW, Fischer.(;olbrie R, Hngn C. Jasani B. ct ul. Chromogranin A and ll wtd Sccreto[lranin n in Mooullary Can:inomasofthcTh)TOid. AmJSurgParho/1981; li:SSI-556. Sikri KL, Vamdell IM, Hamid QA. et ul. Medullary Carcinoma oftbe Thyroid. An lmmllnOC)1ocbemical and llistochemical Studyof2S Cnscs UsingEigllt Sepal11te Mllrl INLAND !Riyeajdc!San B<:m;rdjnol · Parathyroid carcinoma (I): Nodular hyperplasia (I): Medullary card noma ( 1): Poorly differentiated "insul.,... carcinoma (1) BAKERSFfELD CCenlnll Ynllcy Study Group) • Large cell l)mphoma BAKERSFIELD CSM Joaquin eommupity Hospital} • Neuroendocrine carcinoma O&ANGE • Neuroendocrine c:an:inoma VENTURA Cllnjl;lbl - Small cell undifferentiated carcinoma (2) MONTEREY · Small cell carcinoma flAY AR!.\A • Neuroendocrine carcinoma (3) LONG BEACH • Neuroendocrine carcinoma (S) HAYWARD DIAGNOSIS: ANAPLASTIC THYROID CA RClNOMA WITH NEUROENDOCRINE FEATURES T96000, M85l03 CONSULTATIONS: Queen £limbeth Hospital-John K.C. Chilll. M.D. "Anaplastic carclno•na (with a small cell and a large cell component)." REFERENCES: Agruwal S, Rao RS. Parikh DM, Purlkh HK, Borge~ AM, et (~ . Histologic Trends in Thyroid Ccnte.-1969-1993. A CUnioopathologic Analysis of the Relative Proportion of Annpla. INLAND (Riverside/San Bemar!ljno) • Papillary carcinoma of thyroid (4) BAKERSFIELD !Central Valley Study Group) · Papillary carcinoma ofth)Toid BAKERSFIELD CSan Joaquin Cornmunitv Hospital) · Papillary carcinoma ORANGE • Papillary carcinoma VENTURA (Unilabl · Papillary carcinoma ofthyroid (2) MONTEREY • Papillary carcinoma BAY AREA • Papillary carcinoma (3) LONG BEACH • Papillary carcinoma (5) HAYWARD (St. Rose Hospital) • Papillary carcinoma, thyroid SAN DIEGO fNaV"JI Medical Center) • Papillary carcinoma of thyroid (12) NEVADA IRenol • Papillary carcinoma of thyroid (2) COLORADO !North Colo Medical Ctrl : Papillary carcinoma of thyroid TEXAS DIAGNOSIS: PAPILLARY CARCINOMA, THYROID T961 00. M80503 REFERENCES: Cildy Band Rcosl R. An Expanded Review ofRisk Group Definition in Dilfcrcntialed Th)TOid Carcinoma. Surgery 1988; 104(6):947-953. Cunningham Ml', Duda RB, Roorun W, e1 ol. Survival Discriminants for Ditl'crentirued 11>yroid Cancer. Am J Surg 1990; 160(4):344-347. Hay ID, Grant CS, Taylor WF, et al. lpsila!cral Lobeaomy Versus Bilateral Lobar Resection in Papillary Th)TOid Carcinoma. A Reuospcaive Anal)'1is of Surgical Outcome Using a Novel Prognostic Scoring Sy>tan. SUTg'ry 1987; 102(6}:1088-1095. Shaha AR and Jaffe BM. Completion Thyroide<:tOm:t-A Critical Appmisal. Surgery 1992; 112(6): 1148·1152. Shaha AR, Love TR and Shah JP. Intermediate Rlsk Group for Differentiated Carcinoma of Thyroid. Surgery 1994; 116(6): I 036· I 041. CASE NO. 10, ACCESSION NO. 28450 FEBRUARY 1999 INLAND (Riverside/San Bem!lJ'dinol • Medullary thyroid carcinoma (4) BAKERSFIELD (Central Valley Study Group) • Medullary carcinoma of thyroid BAKERSfiELD (San Joaquin Coromurutv Hospital) · Medullary carcinoma ORANGE • Medullary carcinoma VENTURA Nnilabl . Medullary carcinoma of thyroid (2) MONTEREY • Medullary ca.rcinoma BAY AREA • Medullary carcinoma of the lhyroid (3) LONG BEACH · Medullary carcinoma (5) HAYWARD !St. Rose Hosoirall • Medullary carcinoma, thyroid SAN DIEGO (Nava!Medical Cen!erl • Medullary !hyroid carcinoma (12) NEVADA (Reno) · Medullary carcinoma oflhyroid (2) COLORADO DIAGNOSIS: MEDULLARY CARCINOMA, THYROID T96200, M85 I 03 CONSULTAtiON: Diag11ostic P111hology Medical Group, Inc. Gwen MlllDujian, M.D. "Medullary Carcinoma with lmmunoreaclivity for Calcitonin and CEA.~ REFERENCES: Frac B, Roscnl>l:rg·Bourgjn M, Carllou R Dutricux-Bcrgcr N, et al. Medullary Th}Toid Carcinoma. Search for Histoloslcal Predictors of Survival (109 PI'Qb:md Ca.les Anal ~• i s). flwn Pat/rot 1998; 29(!0):1078·1084. Modigliani E. Cohen R, Cnmpo.• JM, cl al. Prognootlc I' actors and for Biochcmic:al Cure in Medullary Thyroid Carcinoma. Results in 899 POiients. Clin End()Cr/no/ 1998; 48(3}:265·273. llergholm U, Oerptrom Rand Ekbom A. Long Tenn Follc"'"UP ofPMients with Medullary Carcinoma of the Th)TOid. Cancer 1997; 79(1}:132-138. Alb Note: l)pon deeper sectioning of tbi~ case, the patient was found to have two tumors. Phyllodes Tumor and Infiltrating Duct Carcinoma were both presented. CASE NO. 2, ACCESSION NO. 28140 J ANUARY 1999 INLAND CRi\"ersidt!Sgn Bernardin(!) · Fibroadenoma with introductal au-cinomn in·situ (I); Benign cyl:IOW'OOrna phyllodcs (I); l'hylkldcs tumor, benign (2); Pscudosarcomatosis s1l'OIIlBI h)-pctplasia (I) BAKER$FIELD ICcotral Valley Study 01911(!) • Phyllndes tumor ORANGE • Active pseudoangjomatous hyperplusin MONTEREY · Infiltrating ductal curcinom11, &rnde 3/3 BAY ARilA • M)'Ofibroblastoma (I): Benign phyllodes wmor (I); Benign fibrous tumor (I) SANTA ROSA: Duct c:an:inoma. invasi-·e ( i): Carcinosarooma (2) LONG BEACH • l'oorly dilfertnti:lled ductal enrcinorna (6) - (In a second set we have case N2 showing only benign breast tissue SUI!Scstive ofbenian phyllodcs tumor without cvid of malig. SAN DIEGO (Nayul Modica! Cemerl • Benign l'hyllodes tumor (I); Borderline phyllodcs tumor (8); Juvenile fibroadenoma (2) SACRAMENTO OJC Paris) · Phyllodes nunor, lo"' grade HAYWARD 1St Rose Hospi!!!ll • Fibroadenoma (cellular and fibrosi ng) (6) NEVAPACReno\ • Phyllodcstumor (2) TEXAS (Tsx•< Teclt Regional Aensl Hlth C!rl • 13cnign phyllodes tumor NEIIRASJ(A ICI'doblon Univ) · Fibroadenoma with features ofjuvenile giant libroadcnoma ILLINOIS DIAGNOSIS: Pl:lYLLODES TUMOR AND TNFTLTRATINC DUCT CARCINOMA, BREAST 1'040 10, M90203 T04010, M85003 /!996; 20(12):1469-t480. Kuo TT. Thymoma. A Study of the PathoiQ&ic Classifie31ion of71 Cases with (;valuation of the Mullcr-Bc:rmcrlink Systent. Hum Pathol 1993: 24(7):766-771. CASE NO. 4, ACCESSION NO. 28392 FEBRUARY 1999