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,, ., 1312.. CALIFORNIA TUMOR TISSUE REGISTRY "GENERAL PATHOLOGY" Study Cases, Subscription B October 1998 California Tumor Tissue Registry c/o: Department of l'nthology and Ruman Anatomy Loma Lindn Universily School'oflV.lcdicine 11021 Campus Avenue, AH 335 Lomn Linda, California 92350 (909) 824-4788 FAX: (909) 478-4188 E-mail: cU [email protected] CONTRIBUTOR: Philip G. R obinson, M.D. CASE NO. 1 - OcrOBER 1998 Boynton Beach, FL TISSUE FROM: Stomach ACCESSION #28434 CLINICAL ABSTRACT: This 67-year-old female was thought to have a pancreatic mass, but at surgery was found to have a nodule within the gastric wall. GROSS PATHOLOGY: The specimen consisted of a 5.0 x 5.5 x 4.5 em fragment of gray tissue. The cut surface was pale tan, coarsely lobular with cystic degeneration. SPECIAL STUDIES: Keratin negative Desmin negative Actin negative S-100 negative CD-34 trace to 1+ positive in stromal cells (background vasculature positive throughout) CONTRIBUTOR: Mar k J anssen, M.D. CASE NO. 2 - ocrOBER 1998 Anaheim, CA TISSUE FROM: Bladder ACCESSION #28350 CLINICAL ABSTRACT: This 54-year-old male was found to have a large rumor in his bladder. GROSS PATHOLOGY: The specimen consisted of a TUR of urinary bladder tissue, forming a 7.5 x 7. 5 x 1.5 em aggregate. SPECIAL STUDfES: C)1okeratin focally positive Vimentin highly positive MSA,Desmin faint positivity CONTRIBUTOR: Howard Otto, M.D. CASE NO.3 - OCTOBER 1998 Cheboygan, Ml TISSUE FROM: Appendix ACCESSION #28447 CLINICAL ABSTRACT: This 73-year-old female presented with acute appendicitis and at surgery was felt to have a periappendiceal abscess. GROSS PATHOLOGY: The 7.0 x 1.5 x 2.0 em hemorrhagic appendix showed a 3.0 x 2.0 em area of hemorrhagic discoloration and possible perforation. Multiple cross sections showed a mucinous growth extending from the lumen onto the serosal surface. CONTRIBUTOR: Chisa Aoyama, M.D. CASE NO.4 - OCTOBER 1998 Sylmar, CA TISSUE FROM: Appendix ACCESSION #28231 CLINlCAL ABSTRACT: This 10- year-old morbidly obese male was fow1d to have an abdominal tumor during surgery for suspected acute appendicitis. GROSS PATHOLOGY: The resected appendix was replaced by a 14.0 x 8.5 x 7.0 em ovoid mass. The cut surface was homogeneously white-tan with focal nodularity and a 1.0 em area of white chalky necrosis. SPECIAL STUDIES: CD3 Negative in neoplastic ceUs CD20 Positive in neoplastic cells CONTRIBUTOR: Douglas Kahn, M.D. CASE NO.5 - OCTOBER 1998 Sylmar, CA TISSUE FROM: Right testicle ACCESSION #28029 CLINICAL ABSTRACT: This 26-year-olcl Hispanic male presented with an enlarged right testicle. An orchiectomy was performed. GROSS PATHOLOGY: The gray- tan testicular tumor weighed 133 grams and measured 12.0 x 6.0 x 5.0 em. CONTRIBUTOR: Robert Riccbmann, M.D. CASE NO.6 - OCTOBER 1998 Covina, CA TISSUE FROM: Left submandibular gland ACCESSION #28229 CLINICAL ABSTRACT: This 80-year-old femole presented with a gradually enlarging neck mass involving the left submandibular gland. GROSS PATHOLOGY: The 6.0 x 2.0 em submandibular gland had a 3.5 em dian1eter well-circumscribed flflll tan­ white nodule at one pole. CONTRIBUTOR: Lorna Linda Pathology Group (kt) CASE NO.7 - OCTOBER 1998 Lorna Linda, CA TISSUE FROM: Left paravaginal r egion ACCESSION #28252 CLINICAL ABSTRACT: This 40-year-old female presented with a left paravaginaVparaeervieal mass discovered on pelvic exam. This was excised at the time of a hysterectomy and bilateral salpingo-oophorectomy. GROSS PATHOLOGY: The specimen was 3.2 x 2.5 x 2.5 em firm, well-circumscribed mass of white soft tissue. SPECIAL STUDIES: Desmin positive S-100 negative CONTRIBUTOR: Laura Williams, M.D. CASE NO.8 - OCTOBER 1998 Stanford, CA TISSUE FROM: Ovary ACCESSION #28199 CLINICAL ABSTRACT: This 85-year-old female presented with lower abdominal pain. On pelvic ultrasound there was a large, complex and panially cystic mass in the pelvis. The CA125 level was elevated at 845. GROSS PATHOLOGY: The specimen consisted of a multilocula!ed intact cystic mass weighing 230 grams and measuring 14.5 x 12.0 x 6.0 em. The outer surface was intact. Cross sections of the cyst wall showed somewhat mucoid, gelatinous, gray-white surfaces. CONTRm UTOR: Sheldon Miller, M.D. CASE NO. 9 - OCTOBER 1998 Ventura, CA TISSUE FROM: Thigh ACCESSION #28320 CLINICAL ABSTRACT : This 48-year-old male presented with a lesion deep in the upper thigh/buttock area, just above the muscle at the gluteal fold. An exeisional biopsy was performed. GROSS PATHOLOGY: The specimen consisted of a finn, nodular, fatty tissue mass measuring 4.0 x 2.7 x 2.0 em. Sectioning revealed a 1.5 em nodular area. CONTRmUTOR: Arthur L. Koehler, M.D. CASE NO. 10 - OCTOBER 1998 Pasadena, CA TISSUE FROM: Right labia ACCESSION #282 26 CLINICAL ABSTRACl': This 75-year-old female presented with a 4.0 em mass in the right labiwn. An excisional biopsy was performed. GROSS PATHOLOGY: This 8 gram 2.9 x 1.9 x 2 .1 em portion of light tan-brown soft tissue was hemorrhagic and nodular. On sectioning there was a hemorrhagic cystic zone and zones of white-yellow nodularity. CALIFORNIA TUMOR T ISSUE REGISTRY GENERAL TUMOR PATHOLOGY Minutes - Subscription B October 1998 SUGGESTED READiNG (General Topics from Recent Literature): The Cellular Basis of Metastasis. Urology 1996. 141-150. Ruiz, P and Gunthert U. Expression ofMyogenic Regulatory Proteins (Myogenin and MyoDI) in SmaU Blue Round Cell Tumors of Childhood. AmJ Pathoii99S; 147: 1799-810. The CDKN2A Tumor-Suppressor Locus-A Tale of Two Proteins. New England.!ounUJ! ofMedicine 1998; 338: 910-912. Clwman, Band Groudinc M. Malignant Small Bowel Neoplasms. Histopathologic Determinants of Recurrence and Survival. Annals of Surgery 1997; 223(3): 300-305. California Tumor Tissue Registry c/o: Department ofPathol ogy and Human Anatomy Loma "Linda University School of Medicine 1102 1 Campus Avenue, AH 335 Lorna Linda, California 92350 (909) 824-4788 FAX: (909) 478-4188 E-mail: [email protected] ., CASE NO. 1 ACCESSION NO. 28434 OCTOBER 1998 CALIFORNIA <G lendale) - Epithelioid GIST CALIE'ORNIA (Oakland) - Gastric stromal tumor ofunce.rtain malignant potential (STUMP} (2) OHlO (Columbus) - Gastrointestinal stromal tumor MICHIGAN (Foote Hospital. Jackson) - Benign stromal tumor TEXAS (Houston) - Gastrointestinal stromal tumor (GIST) of undetermined malignant potential TEXAS (Waco) - Malignant gastrointestinal stromal tumor FLORIDA (Winter Haven Hospital) - Gl stromal tumor, borderline malignant MARYLAND (Baltimore) - Gastric stromal tu mor (leiomyoblastoma) MARYLAND (National Naval Med Ctr. Bethesda) - GIST (uncertain malignant potential) (10); Epithelioid GIST (2). PENNSYLVANIA (Philadelphia) - GI ST, malignant MASSACHUSETfS (Longmeadow) - Gastrointestinal stromal tumor (GIST) undetermined type, potentially malignant MASSACHUSETIS (Medfield) - Malignant hemaogiopericytoma of stomach. MAINE CBangor) - Leiomyoblastoma (GIST) JAPAN (Shimada Citv Hospital) - Leiomyoblastoma, stomach DIAGNOSIS: GASTROINTES TINAL STROMAL TUMOR (GIST) OF UNCERTAIN MALIGNANT POTENTIAL, STOMAC H Director's Note: Before immunostains and the concept of GIST's this tumor was know n as a "Ieiomyoblastoma." T63000, M80 I 03 REFERENCES: Appelman HO. Smooth Muscle ofthe Gastrointestincxal Tract. What We Now Know That Stout Didn "t Know. AmJSurgParhol, Suppll, 1986; 10: 83-89. Van De Rijn, M, Hendrickson MR and Rouse RV. CD-34 Expression in Oasrrointestinul Tract Stromal 1\unors. Hum Pat/101 1994; 25: 766-771. Newman l'L., Walden C. and Fletcher CD. Gastrointestinal Sltomal Tumors. Correlation of lromunophenotype with Clinicopathologic Features. J Patho/1991; 107-117 Lauv.'CfS OY. Erlandson RA. Casper ES, et al. Gastrointestinal Autonomic Nerve Tumors. A Clinicopathological Immunohistochemical and Ultrastructural Study of 12 Cases. Am J Surg Pathol 1993; 17: 887-897. Suster S, Saracen and Moran CA. Oas~rointestinal Stromal Tumors with Prominent Myxoid Matrix. Cl.inicopathologic, Immunohistochemical, and Ultrastructural Study of Nine Cases of a Distinctive Morphologic Variant ofM yogenic Stromal Tumor. Am J Surg Pathol 1995; 19(12): 59-70. Owen CH, Madden JF, and Clavien P-A. Spindle Cell Stromal Tumor of the Pnnaeas. Treatment by Pancreatoduodenectomy. Surgery 1997 122: 105-lll. CASE NO. 2 ACCESSION NO. 28350 OCTOBER 1998 CALIFORNIA (Glendale) -Inflammatory fi bromyxoid tumor CALIFORNIA (Oakland) - Pseudosarcomatous fibromyxoid tumor (2) OHIO (Columbus) - Reactive stroma nodule MICRlGAN (Foote Hospital, Jackson) - Inflammatory myofibroblastic tumor TEXAS (Houston) - Inflammatory myotibroblastic tumor TEXAX (Waco) - Inflammatory pseudotumor FLORIDA (Winter Haven Hospital) - Leiomyosarcoma MARYLAND <Baltimore) - Leiomyoma of urinary bladder vs post-operative spindle cell nodule MARYLAND (National Naval Med ·ctr. Bethesda) - Inflammatory pseudotumor (I I); Sarcomatoid carcinoma ( I) · PENNSYLVANIA (Philadelphia) - Inflammatory pseudotumor MASSACHUSETTS (Longmeadow) - Low grade leiomyosarcoma, bladder MASSACHUSETTS (Medfield) - Inflammatory pseudotumor of bladder MAINE (Bangor) - Pseudotumor JAPAN (Shimada City Hospital) - Pseudosarcomatous fibromyxoid tumor, bladder DIAGNOSIS: PSEUDOSARCOMATOUS FIBROMYXOID TUMOR, BLADDER T74000,M80043 REFERENCES: Nochomobitz LE and Orenstein JH. Inflammatory Pseudotumor of the Urinary Bladder. Possible Relationship to Nodular Fasciitis. Two Case Reports Cytologic Observations and Ultrasrructural Observations. Am .I Surg Patho/1985; 9: 366-373. Proppe KH, Scully RE and Rosai J. Postoperative Spindle Cell Nodules of Gen itourinary Ttact Resembling Sarcomas. AReportof8Cases.
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  • Estrogen-Producing Endometrioid Adenocarcinoma Resembling Sex

    Estrogen-Producing Endometrioid Adenocarcinoma Resembling Sex

    Katoh et al. Diagnostic Pathology 2012, 7:164 http://www.diagnosticpathology.org/content/7/1/164 CASE REPORT Open Access Estrogen-producing endometrioid adenocarcinoma resembling sex cord-stromal tumor of the ovary: a review of four postmenopausal cases Tomomi Katoh1, Masanori Yasuda1*, Kosei Hasegawa2, Eito Kozawa3, Jun-ichi Maniwa4 and Hironobu Sasano5 Abstract: The 4 present cases with endometrioid adenocarcinoma (EMA) of the ovary were characterized by estrogen overproduction and resemblance to sex cord-stromal tumor (SCST). The patients were all postmenopausal, at ages ranging from 60 to 79 years (av. 67.5), who complained of abdominal discomfort or distention and also atypical genital bleeding. Cytologically, maturation of the cervicovaginal squamous epithelium and active endometrial proliferation were detected. The serum estrogen (estradiol, E2) value was preoperatively found to be elevated, ranging from 48.7 to 83.0 pg/mL (av. 58.4). In contrast, follicle stimulating hormone was suppressed to below the normal value. MR imaging diagnoses included SCSTs such as granulosa cell tumor or thecoma for 3 cases because of predominantly solid growth, and epithelial malignancy for one case because of cystic and solid structure. Grossly, the solid part of 3 cases was homogeneously yellow in color. Histologically, varying amounts of tumor components were arranged in solid nests, hollow tubules, cord-like strands and cribriform-like nests in addition to the conventional EMA histology. In summary, postmenopausal ovarian solid tumors with the estrogenic manifestations tend to be preoperatively diagnosed as SCST. Due to this, in the histological diagnosis, this variant of ovarian EMA may be challenging and misdiagnosed as SCST because of its wide range in morphology.