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PROTOCOL FOR MOOTHLY SLIDES September, 1958 TOKOR TISSUB REGISTRY

LOS ANGEW COUNT'{ HOSPITAL CAG!i: t:O. 3 September, 1958 ACCESSION NO. 9976 OUTSIDE NO . 1603-58 NAME: Mrs. M.W. AGE: 32 SEX: Female RACE: Cauc:.

COOTRIBUTOR: John J. Gilrane, M.D., St. ~te's Hospital, Pasadena, California.

TISSUE PRCM : Right ovary. CLINICAL ABSTRACT: HISTORY: Soreness· in the right lower quadrant of the abdomen had been present for one and one-half years. She had been examined at intervals by an internist who found that the right ovary had been enlarging and be­ coming more tender. She was referred to a gynecologist for examination and possible surgery. Physical examination disclosed right lower quadrant tenderness. The right ovary was tender and larger than when examined before on January 11,1957. SURGERY: On May 26, 1958, an exploratory laparotomy with right aalpino-oophorectomy and incidental appendectomy was performed. GROSS PATHOLOGY: The solid ovari an I:UIIIor weighed 39.5 grams and measured 4. 7 x 4 x 3.5 em. It had been shelled out from the right ovary. The exte.ual surface was lobular in outline except for over 3/5 of the sur­ face where there was a smooth glistening serosal aspect of the ovary. It was composed of gray-white glistening tissue which on cut section was divided into compartments by fibrous trabecula.

The 5 x 0,6 em. right oviduct had a clean fimbria and an adherent cuff of ovarian tissue that measured 4.8 x 3.4 x 1.2 em. This ovarian tissue as well as the vermi form appendix and a portion of broad ligament were free of tumor. CASE NO. 4 Septembe~, 1958. ACCESSION NO , 9356 OUTSIDE NO . 57-A-115

NAME: E.S. AGE: 54 SEX: Female RAC11 Nean.

Can'lliB~I Grace II. Ryde 1 M. D., Hiahland-Alameda County Boepital0 Oakland, California.

TISSUE PRCI(: Uterus.

CLINICAL ABSTRACT:

HISTORY; Int ry vas ude to the hospital on February 27th , 1957 , be­ cauee of vaainal spotting of three weeks duration, which gradually became more profuse. In January, 1957, her private physician was consulted because of fatigue and listlessness for the previous two months. She was told that abe had a tumor which should be removed. Her abdominal girth had gradually increased for one to tw~ years, but she attributed this to obeeity. Blood pressur e wts 190/110, the heart wee enlarged and the lower legs showed 2 plus edema. BIG revealed a possible old healed myocardial infarc­ tion. The pelvi c mass was the she of a full term pregnancy. X-raya diiiDOD• etrated calcium deposits in it. 't'he hemoglobin was 6.7 sral!l.l, llbc 3.97 million and the packed cell volU1D! 26'1.

SURGB!Y: Surgery was perfot'Ule·l on March 26th, 1957 . Because of cardiac status, only a subtotal hyste: ~ct~ was done. The risht tube and ovary were aleo r~ved and omental a~besions were lysed ,

GROSS PATHOLOGY: The larae, lo~ular, diatended uterue weighed 13 pounds and contained many fibroid&, some of which ware calcified. A large 12 x 4 em . bemor rhasi c, polypoid mass projected into the uterine cavity. It seemed to arise from the myometrium and prolapse down into the cavity.

POLLOW•UP : Following surgery the patient was prog~e.. i ng aatisfae­ torily until March 29th, 1957 , wben she auddenly conwlaed and expired. At autopey there waa evidence of recent suraery and dilatation of both uretere to 1 em . The heart weighed 480 grams and contained a 811411 1 em. arayilh area in the ventricular myoc ardium. The . peri-aortic nodes ware enlarged, but were infl-tory only after eect1ontna. CASE NO. 6 September, 1958 ACCESSION NO. 9499 OUTSIDE NO. S·2963·57

NAME: E.N. AGE ': 21 SEX: Female RACE: Cauc .

CONTRIBUTOR: George J. Hummer, M.D., St. J ?br.'r• Hospital, Sm1•a Monica, California. n SSUE FROM: Right ovary. CLINICAL ABSTRACT: HISTORY: This patient was admitted to the hospital for the first time on June 21st, 1957, because of en enlarging tumor mass in the cul-de-sac. She was first seen by her referring physician on April 8th,l957, because of missed periods of three months duration, nausea and vomiting, frequency and low back pain. Eighteen months previously, she had been told that abe had a right ovarian tumor. The laet menstrual period was January 7th, 1957. Upon admies ion, she was 23 weeks pregnant. A firm, exquisitely tender maea in the cul-de-sac, measuring 6 to 7 em. in diameter, was believed to be in the right ovary. The uterus was enlarged to a level consistent with a 20 weeks geetation. SURGERY: On June 22nd, 1957, a pelvic laparotomy was performed with a right oophorectomy .

GROSS PA'l'HOLOOY: The ovary weighed 110 grams and measured 9 x 5 x 4 em. The exterior surface was smooth, white and glistening for the mos t: part, except for several smell focal areas covered by a thickened, grey-pink mem· branous material measuring several millimeters in diameter. One small 1 em. red-brawn nodule protruded 0.4 em. from the surface. On sectioning, the specimen was composed primarily of very firm, uniform, yellow-white tissue. A few small focal areas of softer and more granular nonencapsulatad tan-gray tissue were found . CASE NO. 8 September, 1958

ACCESSION NO. 9398 OUTSIDE NO. 57·1288. NAME: M.B. AGE: 60 SEX: Female liACE: Cauc.

CONTRIBUTOR: Thos. F. McKellar, M.D., 124.~ Garden Street, San Luis Obispo, California.

TISSUE PROM: Right ovary.

CLINICAL ABSTRACT:

HISTORY: The patient l·tas well until April, 1957, when lower abdominal pain and a sense of heaviness were noted. Examination reveaied a right ad- nexal mass.

~..!l::f: A right cystic ovarian tumor was removed in April, 1957.

_

FOLLO~I-UP: Patient receiverl X-ray ther8py and remained well until the middle of Ju;;., 1958. At that time she was hospitalized for weakness and dySp:ll'A. ll.'ld was founti to have a massive bloociy ple•nal effusion. Cell bloc!< sho~1~d aum.oroua malignar.t syncy •~ia. She >TaS tre.1t ed ~lith thorac.entesis and 20 mgms. of nit:X'ogen mustard tilixed with 100 mls. of fluid, ~~ere injected into the pleural sac. Patient expired on August 12, 1958. C .~SE NO 9 September, 1958 ACCESSION NO. 9439 OUTSIDE NO. S 57-60.

Nt\ME : S.C. tiGE: 63 SEX: Female RACE: Negro. CONTRIBUTOR: Eva M. Haumeder, M.D. , City of Hope Medical Center, Duarte, California. TISSUE PRCM: Right ovary,

CLINICAL ABSTRACT:

HISTORY: This patient was a gravida 6, para 5, aborts 1, whoee last menstrual period had occurred in 1935. Approximately one and one-half years prior to admission to the hospital, she had begun periodic vaginal bleeding which had occurred approximately monthly up to the time of admission. This had become somewhat heavier over tbe last few months, until the last epi­ sode of bleeding which had begun two days prior to admission and resembled a normal menstrual period. Over the course of the last one and one-half years, she had been advised by several physicians that she had " tumors" and that they should be removed but she had refused. Other than this, she had no specific abnormalities and the systemic review is within normal limits. Physical examination was within normal limits, with the exception of the pelvic examinati on, which revealed a large, firm, mobile, approximat ely 10 x 10 x 12 em. mass in the area of the r i ght adnexa. It could not be deter­ mined whether or not this was connected to the uterus. SURGERY: On January 15th, 1957, D & C and laparotomy with removal of a large ovarian neoplasm, both tubes, left ovary and uterus was done .

GROSS PATHOLOGY: The uterus was enlarged to two plus times the usual size. The tumor, (right ovary), was coarsely bosselated, very firm, measuring 10 x 7.5 x 6 em. and weighing 320 grams. The right tube, stretched over the upper circumference of the tumor, was dilated in its distal third with mild hydrosalpinx. n1e tumor, on sectioning, presented a light yellow­ tan, firm surface which was coarsely lobulated by interveni ng gray-tan fibrous trabecles. Hormonal Assay: (On 6 grams of tumor tissue) : Estrogen: 75 microgm/gm; 17 ketosteroid&: 0.24 mgm/gm .

FOLt.mi-UP: As of May 21st, 1957 , the patient was well, no al>domi­ nal masses or tenderness. Pelvis and rectum: negative. CASE NO. 10 September, 1958

ACCESSION NO. 9473 OUTSIDE NO . D-728-57

NP..l>IE : B • B • t.GE: 28 SEX: Female RACE: White

CONTRIBUTOR: Seymour B. Silverman, M.D., Memorial Hospital, Phoenix, Arizona. TISSUE FROM: Ovaries.

CLINICAl ABSTRACT: HISTORY: The only available history was that the patient had en­ largement of' lymph nodes, liver and spleen. The WBC was approximately 200,000 with mainly lymphocytes. No information available regarding a pregnancy.

SURGERY: Circa ~une, 1957. I ~ l'ATHOLOGI.:. "The main part of the specimen consisted of a tran­ sected portion of uterus that was enlarged and appeared to have been removed suprace~vically . It measured 11 em. in ita greatest dimension. The endo­ metrial cavity was greatly' increased in size and was seen to be filled with placental tissue covering a maximum diameter of 8 em. Attached at one place was a 20 em. narrow normal appearing umbilical cord. A fetus was not present. The remainder of the endometrial lining sho~1ed typical thickening of decidua. The wall itself was intact and of firm structure with a max,imum thickness of 2.3 em."

"Received separately were o~o tubo-ovarian complexes. ~acb of the fallopian tubes were up to 8 em. in length and 6 mm . in diameter . Outwardly and on section, they do not appear to be unusual."

"Each ovary had a mximum measurement of 5 em. The surfaces were smooth but the ou,tline was bosselated. Section showed a number of smoothly rounded 2.8 em. pale-gray tumor-like struct ures. One of the ovaries con­ tained a 2. 5 em. hemorrhagic cyst."

FOLLOW•UP: Shortly after the specimen was received, the patient expired. No autopsy was performed. CASE IiO. 12 September, 1958

ACCESSION NO. 9460 OUTSIDE NO. S57-2950 NAME: J.M. AGE: 41 SEX: Female RACE: Cauc.

CONTRIBUTOR: Paul Michael, ~LD., 450-JOth Street, Oakland, California.

TISSUE FROM: Labia majora.

CLINICAL ABSTRACT: _tl!g]ORY: Entry was made to the hospital on May 27th, 1957, because of a painless mass in the labia majora for two months. The mass was first noticed as a small painless lump which had gradually increased in size. There were no other complaints except for the right lower extremity varicosities which caused discomfort just prior to and during menstruation.

SURGZRY: On May 28th, 1957, a soft, friable tumor located in the Bartho~gl!Hid area and not adherent to the surrounding structures, was removed.

GROSS PATROT~GY: The 5.0 x 3.5 x 3.0 em. mass had a lobulated exter­ nal surface and was entirely sur.rounded by a very thin, semi-transparent capsule. Tbe cut section revea led mushy, soft tissue with a glaring, almost gelatinous surface.

FO~~-UP: The patient was seen by her attending physician the latter part of July,l950 at which time she was "well and healthy", with no local re­ currence and no evidence of metastases. At the time of diagnosis in May, 1957, a radiologic metastatic survey was negativa. Following surgery, she had a complete course of irradiation. RBPOiiT ON '1'UB

S'l'UDY GllOOP CASBS JOR September, 1958

CASE NO. 1, ACCESSION NO. 9992, E. M. Hall, M.D., Contributor.

LOS ANGELES : Tbe vote was unanimous for adenocarcinoma, en4ometrium, with metastases to ovary and uterus.

OAKLAND: Adenocarcinoma of the uterus, metastatic to ovary and invading the cervi'lt, 11 votes; priulary endometrial carcinoma, &doing in the uterus and prtmary papillary adenocarcinoma of ovary, 1 vote; prtmary adenocarcinoma of endocervix and priulary papillary adenocarcinoma of fallopian tube, invading ovary, 1 vote.

SAN PRI\NCISCO: Primary endometrial adenocarcinoma with metastasis to ovary, 7 votes; primory endometrial end primary ovarian adenocarcinoma, 2 votes; primary ovarian carcinoma with metastasis to uterus, 1 vote.

cmmw. VALLEY: Discussion on thb case centered about one tumor versus two. It vas agreed that a definitive concluoion might be impossible. Tbe microscopic pattern was compatible with one tumor. Tbe vote; Endometrial adenocarcinoma with matastasb to the ovary, 9 votes; primary carcinoma of both ovary and endometrium, 1 vote. Tbe dissenter based his intransigeance on the apper• ently early and localized status of the endometrial carcinoma. He felt it unliltoly ( though not impossible), that such a carcinoma would exhibit this pattern of metastasis. The possibility of origin of the ovarian tumor in pre-existing endometriosi s was suggested,

SAN DIEGO: Discussion as to whether this vas originally an endometrial growth, or two independent primary tumors. Votes: Two tumors, 4; endometrial adeno• carcinome,2; granulosa cell, 2.

WEST LOS AN9BLBS: Adenocarcinoma of the endometrium with metastasis to the ovary, 8 votes; primary ovarian carcinoma with metastasis to the uterus, 1 vote.

PILB DIAGNOSIS: Adenocarcinoma of endometrium with metastases to OV!lty, Cross-index: 1. Adenocarcinoma of ovary with metastases to endometrium. 2. Primary adenocarcinoma of ovary and of endo· 1111! t dum. -2- CASB NO• 2. ACCBSSIOO NO. 9160, D, R. Dickson, M. D., Contributor, LOS A!IGBUtS: the vote was unanimous for mixed mesodermal tumor of uterus.

OAKLAND: Malignant mixed mesodermal tumor of uterut, unantmoua,

SAH Pl!ANCISCO: OVarian carcinoma metastatic to perirectal region, 1; the rest voted for two separate malignant tumors or carcinosarcoma and requested informa­ tion as to nature of "cancerous tiasue"from extornal os removed in November, 1955.

CBNTRAL VJ!I.JRY: It was felt that a s lide from the 1954 surgery would have bean help• ful in evaluatins this case, 'lhe ps81l11101l1& bodies tended to support the hypo· thesis of ovarian origin of the neoplasm found at autopsy. Its extremely sarcomatoid pattern and the polypoid structures in the uterus would have been compatible with uterine ~llerian) origin.

SAN Dpqn; Leiomyosarcoma, 3 votes; mixed mesodermal tumor, 3 votes; unclaaeified sarcoma, 2.

WI!S T LOS AHGELES i Mixed mesodermal tumor ( carcinosarcoma)6 votes. carcinoma of ovary with radiation changes, 1 vote. Coaoent: Tbe Committee feels that it would lil«~ to see sections of the original ovarian tumor. We doubt that. the tumor was primary in the ovary s ince thia type of tumor would be rare in. that l ocation. Majority of the coanittee believes it is primary in the uterus,

FlUt DIAGNOSIS: Malignant mixed mesodermal tumor ( carcinosarcoma).

CAS! NO. 3, ACCESSION NO, 9976, John J. Gilrane, M.D. , Contributor.

LOS Al'!CBUtS : Members agreed that this was a liiUCin secr etinG tumor of ovary. the vote: Mucinous carcinoma. flAI.WfD : Adenomatoid tumor of ovary, 12 votes; meaonephroma, 1 vote,

SAH PBANCJ§CO; Adenomatoid tumor, 3; lympbansi.OIIIIl, ovary, 2; liposarcoma, ovary,l; no votes , 5, cpmw. VALLBY: Tbia cue evoked considerable diacoelion of the chemical nature of the clear cytoplaSil of the tumor cella and of the interpretation of the arebi· tacture. Dr, Millar •ussaated the diagnoaia of adenomatoid tumor. Although he wa1 unable to cite any reports of 1ucb a ledon in the neighborhood of the ovary, he sav no reason wby such thinsa shouldn't occur, Ble ars-nt Continued• ·3· Oaae lio, 3, Acceuiou No.9976 • continued. waa so peraualive that four others as reed with him. The vote: AdenOin&toid tumor, 5 votes; clear cell carcinoma ( probably of adrenal nat origin), 3 votes; liposarcoma, 2 votes, Follow-up on thh caae will be awaited with much interest.

SMf D~j e resemblance to a Kruckenburg aod to lipoid tumor• waa diecueeed. The vote: Benign mesench)'IDCID&,

W§ST LOS ANG£U3S j Aclenomatoid tumor, 8 votes; (cross reference lympbangicma), No opin· ion, 1 vote. CCIIllllent: This type of tumor 1e rare in the ovary. According to Dr. Young a recent review of 123 cases only one was described in the ovary,

FILE DIAGNOSIS: Aclenomatoid tumor, ovary, Croaa·index: 1. LymphaDg{cma, ovary, 2. Muc~ous carcinoma, ovary.

CASB NO, 4, ACC!SSION NO. 9356, Grace M. Hyde, M.D., Contributor.

LOS ANGELES i The vote was unanimous for leiomyosarcoma.

OULAND: Leiomyosarcoma, unanimous.

SAH FRANCISCO: Leiomyosarcoma, uterus, 11 votes.

CBNTRAL VALI&X; Leiomyosarcoma, 10 votes.

SAN DIBGQ; Leiomyosarcoma, B votes.

WBST LOS ANGELES: Myosarcoma of the uterus, 10 votes.( Leiomyoaarcoma 3, rbabd~ear· coma 3, no opinion 4 . )

PIU! DIAGNOSIS : Leiomyosarcoma, uterus, Cross•index: Myosarcoma, uterus.

CASE NO• 5. ACCESSION NO. 9415, Grace M. Hyde, M.D., Contributor, LOS ANGELES; Tbe a ssi gned discusaor's diagnosis: Androblaatoma or gynandroblaatoma. The vote wae unanimous for granulosa cell tumor, t o be cross-indexed under hiler synandroblastoma. continued· -4-

ta§e Ne. ~. Aecesaion No. 9415 - continued.

OAKLAND: Granulosa cell tUQQr, unanimous, SAN FRANCISCO: Gynandroblastoma, ovary, 6; granulosa cell tumor, 3; arrhenoblastoma,2.

CENTRAL VALLEY: Granulosa cell tumor, 7 votes; arrhenoblastoma, 3 votes. SAN DIEGO: Dr. DeSanto discussed this as a variant of the Sertoli·Leydig cell tumor, noting the sex cords in some slides. Granulosa cell tumor, 5 votes; gynandroblastoma, arrhenoblastoma, 3 votes. WEST LOS ANGELES: Arrhenoblastoma of the ovary, 3 votes. Granulosa cell tumor of the ovary, 4 votes, gynandroblas~oma, 2 votes. PILE DIAGNOSIS: Granulosa cell, ovary. Cross-index: Gynandroblastoma, ovary.

CASE NO. 6, ACCESSION NO. 9499, George J. Hummer, M.D.,Contributor.

LOS ANGELES : Assigned discusser's diaenosis: Arrhenoblastoma. There were 13 votes for this diagnosis, one vote for Brenner tumor.

OAKLAND: Atypical cystic Brenner tumor, 10 votes, cell rest tumor, 3 votes. SAN FRANCISCO: Granulosa cell tumor 6 votes; Brenner tumor, ovary, 2 votes; probable Brenner tumor, l; arrhenoblastoma, 1; adenocarcinoma, metastatic from gastro· intestinal tract, 1.

CENTRAL VALLEY: It was agreed that the tubular structures had a decidedly Brennerisb appearance. However extra-tubular cells resembling interstitial cells were pointed out in some areas of some slides. The vote: Tubular arrhenoblastoma, 7 votes, Brenner tumor, 2, malienant Brenner tumor, 1 vote. · SAN DIEGO: Further discussion led by Dr. DeSanto on masculine appearing tumors without male hormone secretion, described by Pick and Sc)liltele(tumors Masson calls "rarissimes"); macrofollicular granulosa cell tumors with balance be· tween the Sertoli and Leydig components. Non-functioning tubular adenoma, Pick, 9 votes. WEST LOS ANGELES: Arrhenoblastoma, 1 vote. Adenofibroma ( adenothecoma) ovary, 6 votes. Atypical Brenner tumor, 1 vote, Sertoli Leydig cell tumor, 2 votes. PILE DIAGNOSIS: Arrhenoblastoma. Cross-index: 1. Adenothecoma. 2. Brenner tumor. 3. ~on-functioning tubular adenoma. -s- CASE NO. 7. ACCESSION NO. 9370, D. A. DeSanto, M.D., Contributor. LOS ANGEIBS; 1be vote was unanimous for lutenized grilnulosa cell tumor.

OAK!.AND: Benign lipoid cell tumor, type undetermined, 6 votes. Medullary car­ cinoma, hypernephroid type, 6 votes, adrenal-like tumor of ovary, l vote. SAN FRANCISCO: Luteoma ( luteiniz~d aranulosa cell tumor), 11 votes.

CENTRAL VALLEY: ntis provolted the anticipatable discussion on clear cells of adrenal or.igin versus clear cella of granulosa! or thecal origin. 1be vote: A4reqal rest tumor, 1; luteinized granulosa or theca cell tumor, 8 votes.

S@ DIEGO: Luteinized granulosa ce-ll tumor, 9 votes,

WEST LOS ANGELES: Adrenocortical rest tumor, S votes; interstitial cell tumor, 2 votes; luteoma, 1 vote; no opinion, 1 vote. FILE DIAGNOSIS: Luteinizing granulosa cell tumor. Cross-file: Adrenocortical rest tumor.

CASE NO. G, ACCESSION NO. 9396, Thos. F. McKellar, M.D., Contributor, LOS ANGELES: The assigned discussor's diagnosis: Papillary cystadenocarcinoma. 13 members agreed with this diagnosis with one member voting for choriocarci• noma.

OAK!.AND: Papillary cystadenocarcinoma, 9 votes; teratocarcinoma, 3 votes; no vote, 1. SAN FRANCISCO·: Adenocarcinoma, ovary, 11 votes. CENTRAL VALLEY: All agreed that this represented an essentially teratoid malignan,cy. Five preferred the term ovarian choriocarcinoma, While four favored the desig• nation adenocarcinoma. SAN DIEGO: Papillary adenocarcinoma, 5, teratoma with choriocarcinoma, 1, ana• plastic adenocarcinoma, hypernephroid type, 2.

WEST LOS ANGELES: Papillary (hypernephroid ) clear cell carcinoma of the ovary• unani- mous. FILE DIAGNOSIS: Adenocarcinoma, ovary. Cross-index: 1, Teratocarcinoma, 2. Papillary cystadenocarcinoma. · 6·

CASE NO, 9, ACCESSION NO. 9439, Bva M. Ba-der, M. D., Contributor.

U)§ ANGELES : Assigned discussor1s diagnosis: Feminizing meaenchymoma ( granulosa cell tumor), of ovary. Alternate diagnoses: Adenocarcinoma of ovary with secondary hyperplasia of thecal atroma, 7 votes.. Secondary adnocarcinoma of ovary, 7 votes.

QAKIAND: Granulosa cell tumor , tubular type, 1 vote. Endometrial carc:in01118 in ovary, 11 votes, No vote, 1.

SAN FRANCISOOi Granulosa cell tumor, ovary, 7 votes; Sertoli cell tumor with theca cel l stroma, 2; no vote, 1.

CBNTRAL VAIUY: Tubular granulosa cell tumor , 9 votes. SAN D1EGO: Adenofibroma ovary, 1, Benign endometrioma 4, Granulosa cell tumor, 1. Arrhenoblastoma, 2.

WBST LOS AN9EU!S: Androb1aatoma ( gynandroblastoma, Sertoli Leydig cell tumor), 4 votes, Adenothec:oma, 4 votes, adenofibroma of Mbllerian origin, 1.

Fl U! DIAGNOSIS: Granulosa cell tumor, ovary. Cross- index: 1. Adenocarcinoma, ovary with hyperplasia of thecal stroma. 2. Adenothecoma.

CASE NO. 10, ACCESSION NO. 9473, Se}'lliOUr B. Silverman, M.D. ,Contributor,

LOS ANGBLBS: Leukemic infiltration of ovary, unanimous.

OAICLAND: Presence of corpus 1uteum of pregnancy, 13 votes; presence of leukemi c: infiltrate of some type also, 8 votes; concurrent dysgerminoma 5 votes, granu· loas call tumor, 3 votes.

SAN FRANCISCO: Leukemic infiltrate, ovary, 9 votes; malignant tumor in ovary, 1 vote.

CENTRAL VAI,t.§X; The paucity of dat a on this case was regr etted. The vote: Malignant lymphoma, 5; dysgerminoma, 1; no vot e, l. Those Who favored dysgerminoma considered the blood picture "leukemoid".

SAN DIEGO: Dysgerminoma and l eukemic cell infiltrate, 4 votes; leukemic infil· trate, 4 votes.

continued- -7- Case No. 10, Accession No.9473 - continued. WEST LOS ANGELES : Malignant lymphoma of the ovaries, unanimous, PILE DIAGNOSIS: Malignant lymphoma, ovary,

CASE NO .• 11, ACCES·SION NO. 9487, Seymo~ B. Silve'rlDlln, M.D. ,Contributor. lOS ANGEIBS : The vote was unanimous for ovarian dermoid with struma.

OAKLAND· Teratoma of ovary with struma ovarii, unanimous. SAN FRANCISCO: Teratoma, with functioning thyroid tissue, ovary, 11 votes.

CENTRAL VALLEY: The vote was unanimous for teratogenous thyroid (struma ovarii).

SAN DIEGO: Dern:oid with stroma ovarii,

WEST LOS AN(!!LES : Struma ovarii arising in a teratoma - unanimous of the ovary. FILE DIAGNOSIS: Struma ovar:l.i arhina in a teratoma, ovary.

CASE NO. 12, ACCESSION NO. 9460, Paul Michael, M.D.,Contributor.

LOS Mi9ELI!S : Malignant mesenchymal tup10r, suggestive of neuro-epithelial origin, 9 votes; adenocarcinoma of Bartholin's gland, 4 votes.

OAKLAND: Malignant vascular tumor, 10 vtites; hemangiopericytoma, 3 votes. SAN F!\ANCISCOj Glioma, 5; mesothelioma, canal of Nuck, 2; mesothelial sarcoma, angio-endothelioma, no vote, 1 each. ( A PTAH stain was to be made at the request of those voting for glioma.)

CENTRAL VALLEY: This was so puzzling that the group decided to defer a vote, Possi­ bilities considered included vascular tumor of erectile tissue, Botryoid sar­ coma, and mixed type tumor of adnexal glands,

SAN DIF.CO; Mesothelioma 1; benign adenomatoid tumor, 4; degenerated papillary mucoid adenoma, 1; no opinion 3. continued· -a-- Case No. 12 - Accession No. 9460 - continued.

WEST LOS ANGEUS; Peripheral neuro-epithelioma ( (llioblaetoma, glioma), 2 votes; Adnexal malignant tumor, type undetermined, 5; hemangiosarcoma, 1 vote; unclassified ma 1i(l11an t tumor, 1.

FILE DIAGOOSIS : Adenocarcinoma, Bartholin's gland. Cross-index: 1. Adnexal malignant tumor. 2. Hemangiosarcoma.

The following corrections have been received from the secreta~ies of the Oakland and West Los Angeles Study Groupe on the diagnoe.. and dis­ cussions submitted for the August, 1958 casesa

Oeltland: "In reference to case No. 8, Accession No.9406, the unani­ mous opinion of the group was also osteo(lenic sarcoma, not chondrosarcoma." West Los Angeles: " Case No . 9 should have included an interesting eto.tement made by Dr. Lichtenstein who pointed out that 'the appearance of a chondroblastoma in an older person is unusual but might be accounted for in this patient by the fact that his bone age was under 20 years' • " "Case No, 11 should have read - reparative granu­ loma, including hyperparathyroidism."