CALIFORNIA TUMOR TISSUE REGISTRY
California Tumor Tissue Registry c/o: Department ofPatbology and Human Anatomy Loma Linda University School ofMedicine 11021 Campus Avenue, AH 335 Loma Linda, Califomia 92350 (909) 824-4788 FAX: (909) 478-4188 Target audience: Practicing pathologists and pathology residents.
Goal; To acquaint the participant with the histologic features of a variety of benign and malignant neoplasms and tumor-like conditions.
ObJective: The participant will be able to recognize morphologic features of a variety of benign and malignant neoplasms and tumor-like conditions and relate those processes to pertinent references in the medical literature.
Educational methods and medl n: Review of representative glass slides with associated histories. Feedback on consensus diagnoses from participating pathologists. Listing of selected references from the medical literature.
Principal faculty: Weldon K.. Bullock, MD Donald R. Chase, MD
CMECredit: The CTTR designates this activity for up to 2 hours of continuing medical education. Participants must return their diagnoses to the CTTR as documentation of participation in this activity.
Accreditation: The California Thmor Tissue Registry is accredited by the California Medical Association as a provider of continuing medical education. CONTRIBUTOR: Guillermo Acero, M.D. CASE NO. 1 • APRIL 1997 Santa Paula, CA
TISSUE FROM: Retroperitoneum ACCESSION #27853
CLINICAL ABSTRACT:
This 63-year old Hispanic female presented with a history of frequent bowel movements and some pelvic discomfort. Examination found a rectal mass. cr scan revealed an 8.0 em retroperitoneal .mass displacing the rectum and vagina to the left side. The mass was resected.
GROSS PATHOLOGY:
The specimen consisted of portions of yellow-gray, focally hemorrhagic soft tissue from 0.5 to 3.4 em in diameter.
SPECIAL STAINS: Vimentin: positive in spindled elements/rare positive in polygonal elements Keratin: positive in polygonal elements/negative in spindled' elements Desmin: negative HCG: negative
CONTRIBUTOR: Ernesto Rivera, M.D• CASE NO.2 - APRIL 1997 . Delano, CA
TISSUE FROM: Right hip ACCESSION #27844
CLINICAL ABSTRACT:
This 71-year-old female presented with a one year history of an enlarging mass in the right hip. She Clenied any history of traum.a. cr scan showed a subcutaneous mass without invasion of muscle or underlying tissue. The mass was excised.
GROSS PATHOLOGY:
The 41 gram specimen consisted of a 6.0 x 4.8 x 3.0 em smooth surfaced oval mass with an overlying 4 em long elliptical piece of skin. The cut surface was soft, gelatinous, pale brown without areas of hemorrhage or necr~ sis. CONTRIBUTOR: Philip G. Robinson, M.D. CASE NO.3 - APRIL 1997 Boynton Beach, FL
TISSUE FROM: Thigh ACCESSION #27845
CLINICAL ABSTRACf:
This 86-year-oid male presented with a six month history of a mass in his distal left thigh. An excisional biopsy was perfonned.
GROSS PATHOLOGY:
The specimen consisted of a 4.2 x 2.5 x 2.5 em elliptical fragment of pale tan skin through which could be seen a biuL~h finn area which measured 3.S x 2.0 x 2.3 em. Cut sectioning through the underlying tissue revealed a gelatinous center.
SPECIAL STAINS: S-100 negative
CONTRIBUTOR: Mark Janssen, M.D. CASE NO.4 - APRIL 1997 Anaheim, CA
TISSUE FROM: Sigmoid colon ACCESSION #27856
CLINICAL ABSTRACf:
This 50-year-old obese female presented with a two year history of crampy abdominal pain, diarrhea, occasional decreased bowel movements, and occasional clot-like blood per rectum. She denied any nausea or vomiting. Barium enema studies showed a filling defect in the distal sigmoid colon which was felt to be an extraluminal process. Colonscopy showed a 5.0 em diameter mass at 15.0 em, producing severe luminal narrowing. A low anterior colon resection was perfonned.
GROSS PATHOLOGY:
The 14.0 em long segment of colon had a 5.0 em long region where the mucosa was thickened and distorted. The wall in this area was up to 2 em thick and indurated. CONTRIBUTOR: Mark Janssen, M.D. CASE NO.5 - APRIL 1997 Anaheim, CA
TISSUE FROM: Supraclavicular ACCESSION #27857
CLINICAL ABSTRACT:
This 51-year-old male smoker presented with a ten week history of a growing supraclavicular mass. The mass was firm, moveable, and non-tender. A left supraclavicular biopsy was performed.
GROSS PATHOLOGY:
A 4.0 x 3.5 x 2.0 em portion of soft tan tissue contained a tan slightly nodular area measuring up to 2.0 em. The mass "shelled out" at the time of biopsy.
CONTRIBUTOR: Douglas A. Kahn, M.D. CASE NO. 6 - APRIL 1997 Sylmar, CA
TISSUE FROM: Thyroid ACCESSION #27842
CLINICAL ABSTRACT:
This 34-year-old Hispanic female presented with a suspicious thyroid nodule. Following an FNA, a total thyroidectomy was performed.
GROSS PATHOLOGY:
The.left and right lobes of thyroid were submitted separately. The 18 gram left lobe was 4.0 x 4.0 x 3.0 em. Sectioning revealed almost complete replacement by homogenous gray-tan, firm tumor with only a thin rim of brown thyroid parenchyma. The. right lobe was grossly unremarkable. CONTRIBUTOR: Lorna Unda Pathoiogy Group (ric) CASE NO. 7 • APRIL 1997 Lorna Linda, CA
TISSUE FROM: Rlght chest wall ACCESSION #27836
CLINICAL ABSTRACT:
This 50-year-old male had a liposarcoma in the right thigh, diagnosed 6 years earlier. It had been treated with radical excision of tbe quadriceps, intra--arterial Adriomycin and 6500 rads of radiation. Four years later he had a left flank mass excised. He now presents with a 5 em diameter right lower lung/chest wall mass. An excisional biopsy was performed.
GROSS PATHOLOGY:
The 93.5 gram, 9.0 x 5.0 x 4.0 em specimen included a central 3.5 x 3.0 x 3.0 em firm white-tan well-circumscribed mass. The cut surface was somewhat nodular.
CONTRIBUTOR: Lorna Unda Pathology Group (ric) CASE NO. 8 • APRIL 1997 Lorna Linda, CA
TISSUE FROM: Rlght kidney ACCESSION #27837
CLINICAL ABSTRACT:
This 49 year-old male presented with an episode of hematuria. KUB, IVP and cr scan revealed a 7-8 em diameter renal mass in the-lower pole. A radical nephrectomy was performed.
GROSS PATHOLOGY:
The 783 gram, 7.0 x 5.0 x 5.0 em kidney had a 8.0 x7.0 x 6.0 em soft brown and white-tan partially necrotic mass involving the lower pole. CONTRIBUTOR: Lorna Undo Pathology Group (ao) CASE NO. 9 • APRIL 1997 Lorna Lindo, CA
TISSUE FROM: Small bowel ACCESSION #28040
CLINICAL ABSTRACf:
This 51-year-old male presented with bowel obstruction. A partial small bowel resection was performed.
GROSS PATHOLOGY:
The specimen consisted of a 270 gram,17.0 x 4.0 x3.0 em segment of small bowel with an attached 15.0 x 4.0 x 3.0 em portion of mesentery. The bowel wall was diffusely thickened to 0.7 em.
CONTRIBUTOR: Douglas Kahn, M.D. CASE NO. 10 • APRIL 1997 Sylmar, CA
TISSUE FROM: Omentum ACCESSION #27822
CLINlCAL ABSTRACf:
This 69 year-old female presented with increased abdominal girth, weakness and fatigue. The CA-125 was 825. Cytology on ascitic fluid showed malignant cells. Work-up for a primary was negative. Hysterectectomy, bilateral salpingo-oophorectomy and omentectomy were performed.
GROSS PATHOLOGY:
The omentum was a 30.0 x 20.0 x 3.0 em irregularly-shaped portion of yellow and red-brown finn libroadipose tissue. The ovaries and fallopian tubes showed atrophic changes. The uterus had atrophic endometrium and benign adenomyosis. CALIFORNIA TUMOR TISSUE REGISTRY
SUGGESTED READING (General Topics from Recent Literature):
Apoptosis. Cwnntings MC, Wintcrford CM and Walker NI. Am J. Surg Pat110l 1997; 21(1): 88-101. An Infectious Etiology for Wegener's Granulomatosis? Adv in Anatom Pathol 1997; 4(1): 52. Empiricism and Wegener's Granulomatosis (Editorial). DeRemcc RA. N Eng! J Med 1996; 335: 54-SS. Trimethoprim Sulfrunethoxawle (Co-Trimoxawle) For the Prevention of Relapses of Wegener's Granulomatosis. (Dutch Co-Trimoxawle Wegener Study Group) Stegeman CA, Travaert JWC, DeJong PE nnd Kallenbcrg CGM N. Eng J Med 1996; 335: 16-20. Unbuffered Fonnalin Negates HPV DNA Detection by Polymerase Chain Reaction in Laryngeal Papil.lornas. Adv in Anat Pat1Joll997; 4(1): 53. Detection of Human Papilloma virus in Routinely Processed Biopsy Specimens from Laryngeal Papillomas. Evaluation ofReproducibility of Polymerase Chain-Reaction and DNA in situ Hybridization Procedures. Acta Otolaryngol1996; I 16: 627-a32. Tumor Angiogenesis as a Predictor ofTumor Aggressiveness and Metastatic Potential in Squamous Cell Carcinoma of the Head and Neck. Carrau RL, Barnes EL, Snydermru1 CH, Petruzelli G, ct al. Invas Metas 1996; 15: 197-202.
California Tumor Tissue Registry c/o: Department ofPathology and Human Anatomy Lorna Linda University School ofMedicine 11021 Campus Avenue, AH 335 Lorna Linda, California 92350 (909) 824-478 FAX: (909) 478-4188 CASE NO. 1, ACCESSION NO. 27853 APRIL 1997
INLANQ CRIVERSIDE/SAN BERNARDINO> - Chondrosarcoma, possible malignant chordoma (I); Carcinosarcoma (1). BAKERSFIELD DTAGNOS IS: CARCINOSARCOMA, RETROPERITONEUM T¥4600/1\189803 FOLLOW-UP: The paticm was treated with radical pelvic exenterotion followed by local radiation iherapy, colostomy. One year later the patient was found to have a duct carcinoma of the breast Tumor morphology was different from the retroperitoneal neoplasm. REFERENCES: Laucltlan SC. Concep!Ual Unity of the Mullerian Tumor GrOU(l. Cancer 1968; 22: 60 1 ~10. McGmlh PC. Retroperitoneal Sarcomas. Semin Surg Oucol1994; 10: 364-368. lshil;ura H. Kumag;U F, Yoshika T. cartinos:lrtoma of tile Ur«cr "ith UllllSUIII Histologic Features. Jpn 1 Clin Oneal (Japan) 1994; 24(3): 175-180. (Pn:scnted as a reuoperitoneal tumor). Binaman P, Chum B. and Kunnan RJ. Significance of Epithelial Differentiation in Mixed Mesodermal Tumors of the Uterus. A Clinicopalltologic and Irrunw1ohistocl>emiCIII Study. Am J Sutg Patho11990; 14: 317-328. Dictor M. Alpha !- Antitrypsin in a Mllligmmt Mixed Tumor of the Ovary. Am J Surg Pathol1981; S4l-SSO. CASE NO. 2, ACCESSION NO. 27844 APRTL1997 INLAND CRTVERSIDEISAN BERNARDTNOl • M:llignant fibrous histiocytoma (I); Pleomorphic liposarcoma (1). BAKERSFIELD DIAGNOSIS: • DEDIFFERENTIATED LIPOSARCOMA (MIXED LIPOSARCOMA WITH WELL DIFFERENTIATED AND PLEOMORPIDC COMPONENTS); RIGHT HIP TYlS00/1\188513 RllfERENC£.~: Fletcher CD, Ackcnnan M, Dol Cin P, de Weaver L, et al. Correlation Between Clinicopnthologieal Features and Karyotype: in Lipomatous Twnors. A rcpon of 178 Cases from Chromosomes and MorpboiO@Y (CRAMP) Colla'bonlth·e INLAND CRJVERSIDEISAN BERNARDINO> • Myxoid malignant fibrous histiocytoma (I); Carcinosarcoma (I). BAKERSFIELD CCenttal Valley Study Group! - Myxoma.. CAMARILLO {Alviso Group) - Liposarcoma VENTURA DIAGNOSIS: l\fi'XOMA, THIGH TY9JOO/M88400 REFERENCES: Hasltimoto li, Tsuneyoshi M, Daimaru Y, et al. Intramuscular Myxoma. A Clinicopathologic, brununohlstochemicol and Electron Microscopic Study. Cancer 1986; 740-747. MieUinen M, Hockerstedl K, Reitamo J and Tollermari S. lnlrftmuscular Myxom.,...A Clinicopatbologicol Study or Twenty· Tl\ree Cases. Am J Clin Patltol 1985; 84 : 265-212. Allen PW. Myxoid Tumor orSoft Tissue. Patbol AnnUAl I, Part 11980; 133-192. CASE NO. 4, ACCESSION NO. 27856 APRJL 1997 INLAND CR!VERSIDE/SAN BERNA@!NOl - Endometriosis (2) BAKERSFIELD DIAGNOSIS: ENDOMETRIOSIS, COLON T67000/M76SOO FOLLOW-UP: In !he year following surgery, she has had episodes of pyelonephritis, secondary to endometriosis associated ureteral obstruction and endometriosis of the liver, identified tl~rough ultrasonography. REFERE)':K:ES: Panpnilnn W, Coronog JL. Endometriosis ofUle Intestines and Vamiform Appendix. Dis Colon Rectum 1912; 15: 253-262. Gray LA. l11e Management of EndomelriO$iS Involving !he Bowel Clin Obstet Gynecol 1966; 9: 309-330. CASE NO. S, ACCESSION NO. 27857 APRIL 1997 INLAND CRIVERS!DEfSAN BERNARDINO> • Myxosarcoma (1); Lipoma wilh myxoid change (myxolipoma). BAJ DIAGNOSIS: MYXOID LIPOSARCOMA, LEFT SUPRACLAVICULAR REGION TY0620/88523 FOLLOWUP: Additionalliposarcomatous masses were found to inYolve tlte lei\ ;-etroperitoneum and right submandibular region. REfERBNCES: Gollege J, Fisher C and Rhys-Evans PH. Hand and Neck Lipo=ma. Can~r 1995; 76(6): 1051-105&. MeCulloeh TM, Malielski KR. McNuu MA. Head and N«k Liposan:oma. A Histopathologic Re-Evaluation of Reponed cases. Arch Otolo.t)ngol Head Neck Surg 1992; 118(10): 1045-1049. (76 cases since 1911}. Stewart MG, Schwattz MR, Alford BR. Atypical and MaliSMJtt Lipomatous Lesions of the Head and Neck. Arch Otolaryngol HeadNeckSurg 1994; 120(10): 1151-11 55. CASE NO. 6, ACCESS ION~O. 27842 APRIL 1997 INLAND DIAGNOSIS: PAPILLARY CARCINOMA, THYROID T96000/M80503 REfERENCES: Gilliland FD, Hunt WC, Monis OM, Key CR. Progn<»1ic Factors for Thyroid Carcinoma. A Popu13tion Based Study of 15,698 ca.es from the Surveillance, Epidemiology ond End Resulrs (SEER) Prognun, 1973-1991 -Cancer 1997; ?9(3): 564-573. . Cody 8, Rossi R. An Expandod View or Risk- INLAND (RIVERSIDE/SAN BERNARDINO) - Metastatic liposarcoma (I); Dedifferentiated liposarcoma (I). BAKERSFIELD CCemral Valley Studv Group) ·Malignant fibrous histiocytoma. CAMARILLO CAlvi so Group) • Malignant fibrous histiocytoma. VENTURA CUnilabl - Fibrosarcoma (2). PLEASANTON/FREMONT • Metastatic liposarcoma. LONG BEACH • Malignant fibrous histiocytoma (3); Sarcoma, NOS (3). OXNARP (St. Jobns Regional Ctrl - High grade sarcoma clw fibrosarcoma. SAN DIEGO CNawl Medical Cemerl - Oedilferentiated liposarcoma (20). SANTA BARBARA (Con agel - Malignant soli~1ry fibrous tumor. SANTA CLARA DIAGNOSIS: DEDIFFERENTIATED LIPOSARCOMA (MFH PHENOTYPE), CREST WALL TY2150/M88513 REFERENCES: DeitosAP, Mentzel T, Newman CD. Spindle Cell Liposarcoma. A Hitherto Unrecognized Variant ofLiposarcoll14. An Analysis ofSix Cases. Am 1 Surg Pathol1994; 18(9): 913·921. Kale AC, Nciberg OE, Von Oink! RJ, el nl. Detection ofl.ooll Recurrence of Sofi Tissue Sarcoma with Positron Emmission Tomography Using (!SF) Fhaodeoxy Glucooc. Surg Oncol 1997; 4(1): 57~3. Faber LP, SomenJ,and TempletonAC. Chest Wall TllmO<$. Current Prob in Surg 1995; 32(8): 661-756. Hendricks WH, Chu YC, Goldblum JR and Weiss SW. OedifTen:ntia!Ed Liposarnoma A Clinicopathological Analysis of ISS Cases with Proposal for an Expanded Definition ofOedifTen:ntiated. And Surg Pathol 1997; 21(3): 271-281. Brennan MF. Presidential Addr~s. TI>e Enigma ofl..ocal Recurrence. Ann Surg 1997; 4(1): 1-12. CASE NO. 8, ACCESSION NO. 27837 APRIL 1997 INLAND CR!VERSIDEISAN BERNARDINO> • Renal cell carcinoma (I); Papillary renal oeU catcinoma (!). BAKERSFIELD • Renal cell adenocarcinoma CAMARILLO DrAGNOSTS: PAPILLARY RENAL CELL CARCINOMA, RIGHT KIDNEY T7l010/M83123 REfERENCES: Jwlkcr K, Schliclucr A, JWlkcr U, Knofel B, ct al. C)1ogcnic, Histopathologic and hmnWlologic Studies of Mullif()Cj!J Renal Cell Carcinoma. Cancer 1997; 79: 97)-981. · GuinM P, Fronk W, SMTrwn R w1d Rubenstein M Staging wtd Survival of Patients with Renal Cell Carcinoma. Scmin Surg Oncol1 994'; 10: 47-50. Fulltln:tn SA, lAsky LC and Limas C. The Prognostic Significance ofMorpl1ologic Parameters in Rennl Cell Cateinoma. Am J Surg PuOtol 1982; 6: 655-663. CASE NO. 9, ACCESSION NO. 28040 APRIL 1997 lNLAND CR!VERSIDEISAN BERNARDINO • Ganglioneuroma (I); Diffuse ganglioneuromatosis (1). BAKERSFIELD CCentml Valley Study Group) • Diverticulwn willl ulcer. CAMARILLO (Alviso Grouo> • Ganglioneuroma. VENTUM CUnilabl • Crohn's enteritis (2). PLEASANIONIFREMONT • Ganglioneuroma. LONG BEACH • HypelJllasia of myenteric plexus(? Neurofibromatosis? MEN 28) (6). OXNARD DIAGNOSIS: ' INTESTINAL GANGLIONEUROMATOSJS, DIFFUSE TYPE, SMALL BOWEL T640001Ms.1600 REFERENCES: • Montresor E, Tacano C, Nifosi F, et ul. Retroperitoneum Pargangliomt>$. Role oflnununochcmistry in U1e DiBgnosis of Malignancy and Assessment of Prognosis. Eur ofSurg 1994; 160-162. Shulman 01, McCierothan OT, Hanncl RP, et at. OangliOC1ellro!Jialosslnvolving the Small Intestine andPanataS or a Child and Causing Hypcn;cactioo of Vasoactive Intestinal Polypeptide. J RediarOaslroenterol Nwr 1996; 22: 212- 218. Emanu!e S, D'Amorc 0, Manivel IC, et at. Intestinal Oanglioneuromatosis. Mucosal and Transmural Types. A ClinicopaU1ologicand Inunwlohistochcmicol Study ofSix Cases. Hum Palhol t991; 22: 276-286. CASE NO. 10, ACCESSION NO. 27822 APRIL 1997 INLAND CRiyERSIDEISAN BERNARDINO) • Metastatic c:arcinoma (1); Extraovarian serous carcinoma (1). BAKERSFIELD !Central Valley Study Group) - Papillruy adenocarcinoma. CAMARILLO DTAGNOSTS: PAPILLARY SEROUS ADENOCARCINOMA OF PERITONEUM TY4400/l\184603 REFERENCES: LieehlanSC, TheSccondaryMullcrianSystem-Revisitod. In!JOnccolPatholl994; 13{1): 73-79. Miyaishi 0, Kcnvcl>i I, SagaS and Sato T. Autopsy Case of Serous Pnpillruy Carcinoma of Peritoneum "i!ll Distant Metastases but No Peritonc:aJ Disscminlltion. ~I Oncol 1994; 55(3) : 44&-452. Battifora H. M