IIC,J
CALIFORNIA TUMOR TISSUE REGISTRY
"GASTROINTESTINAL TRACT PATHOLOGY"
Study Cases, Subscription A
March 2000
California Tumor Tissue Registry c/o: De1mrtment of Pathology and Human Anatomy Loma Linda Univcr.;ily School ofMcd.icine 11021 Campus Avenue, AH 335 Lomn Linda, California 92350 (909) 558-4788 FAX: (909) 558·0188 E-mail: [email protected] Case oftbe Month: www.llu.edu/Uu/cttr/cotm Target audience: Practicing pathologists and pathology residents.
Goal: To acquairu the participam with the hiswlogic featu res of a variety of benign and malignant neoplasms and tumor-l ike conditions.
Objectives: n1e participant will be able to recognize morphologic features ofa variety of benign and malignam neoplasms and tWllOr-like conditions and relate those processes to pertinent references in d1e medical literature.
Educational methods and media: Review of representative glass slides v.ith associated histories. Feedback on consensus diagnoses lt·om participating pathologists. Listing of selected references from the medical literature.
Principal faculty: Weldon K. Bullock, Ml) Donald R. Chase, MD
CME Credit: Lorna Li.nda University School of Medicine designates this continuing medical education·activity for up to 2 hours of Category I of the Physician's Recogn ition Award oft he· American Medical Association. CME credit is offered for d1e subscription year only.
Accreditation: Loma Linda University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing medical education for physicians. Contributor: James A. Henry, M.D. Case No. 1 - March 2000 Woodbridge, VA
Tissue from: Terminal ileum Accession #28502
Clinical Abstract: This 37-year-old black female presented with several weeks' history of right lower quadrant abdominal pain radiating to the right side of the back and right inguinal area. There was no associated fever, leukocytosis, nausea, vomiting or diarrhea. A pre op CT scan revealed a 6.0 em solid mass oft he lower quadran!. A laparotomy with a partial bowel resection was performed.
Gross Pathology: The 11.0 em portion of ileum included a4.0 em portion of cecum, the appendix and attached mesenteries for an overall dimension of 18.0 x 18.0 x 7.0 em. The ileal mesentery contained a 9.0 x 6.0 x 4.5 em friable yellow-tan mass and several separate enlarged lymph node~ measuring up to 2.0 em in greatest dimension. The appendix was adherent to this mass.
Contributor: Mark Lones, M.D. Case No. 2. - M:trch 2000 Ornnge, CA
Tissue from: Rectum Accession #28148
Clinical Abstract: Whi le being evaluated for rectal bleeding, thi s 73-year-old male patient was found to have a 2-3 em firm area i.o a thickened rectal wall. l:ollowing a colooscopic biopsy. an abdominal perineal resection of the rectum was perfom1ed.
Gross J>atholo!!Y: In the mid portion of a 39 em length of bowel WclS a 3.0 x 1.5 x. 0.8 em centrally ulcerated red-tan tumor. The mass grossly extended into and through the bowel wall.
SPECIAL STAINS (outside facil ity): Chromogranin focal positivity Synaptophysin focal positivity CAM 5.2 diffusely positive Contributor : Philip G. Robinson, M.D. Case No. 3 - March 2000 Boynton Beach, FL
Tissue from: Small bowel Accession #284 79
Clinical Abstract: At surgery for an acute abdomen, a nodule was nOled in the bowel o f this 43-year-old fe male.
Gross P athologv: A segment of small bowel showed a 4.5 x 2.8 x 3.2 em nodule projecting into the lumen. It had a light yellow to tan cut sur lace and extended to the serosa.
Contributor: J im Hannah, M.D. Case No.4 - March 2000 San Luis Obispo, CA
Tissue from : Colon nod small bowel Accession #28153
Clinica l Abstract: This 36-year-old male presented with abdominal fullness. An exploratory laparotomy fo und a multiloculated cystic mass involving the serosal surface o f the colon a nd small bowel.
Gross P athology: The tumor was approximately 20 em in greatest dimension and appeared to be multifocal. Contributor: Farooq Ali, M.D. Case No. 5 - March 2000 Vcntum, CA 93003
Tissue from: Appendix Accession #28680
Clinical Abstract: Because ofcomplaints of right sided flank pain. this 86-year-old Hispanic female bad a CT scan, which showed a simple cyst of the right kidney and a 2 em cyst in the right lobe of t he liver. About two years later, she presented with repeated episodes ofri ght sided pain. Radiographic studies showed the cysts to be unchanged but gallstones were noted and she underwent a cholecystectomy. At that time, a perforated appendix was found, with multiple adhesions and mucus-filled cysts confined to the appendix and mesoappendix. Ovaries were normal ror age. -
Gross P:llhology: The 5 em long appendix was up to 1.5 em in external diameter. It had hemorrhagic red adhesions and multiple mucin-tilled cysts up to 1.5 em in diameter on the mesothelia l surface.
Contributor: Fr.tncis S. Buck, M.D. Case No.6 - March 2000 Los Angele.s, CA
Tissue from: Liver Accession #17251
Clinical Abstract: A live month girl failed to thrive, developed chronic anemia and hydrocephalus, and then expired in her filth monlh of life. She weighed 2 po unds 4 ounces at birth and measured 38 em. Both the mother and baby were 0, Rh positive. The child received exchange transfusions on her third and fourth day of life because of hyperbilirubinemia of undetermined etiology.
Gross Pathology (Autopsy): The liver weighed I 02.5 grams and was yellow-tan and contained many small. pearl-like. b,-ay-white tumors measuring up to 0.4 em in diameter.
I Contributor: Tom Schmidtkecht, M.D. Case No. 7 - March 2000 Oakland, CA
Tissue from: Abdomen Accession #26302
Clinica l A h~trn ct: During a hysterectomy for mu ltiple leiomyo mas, a large pcdw1culatcd hepatic moss was noted on the inferior surface of the liver ofthis 49-year-old female. Other simi lar appearing masses were noted within the hepatic parenchyma but were not removed.
Gross Pathology: T he 174 gram mass was 10.0 x 9.0 x 4.0 em. Sectioning revealed a spongy red-purple tissue with scattered gray-tan nodules measuring up to I. 7 em.
Contributor: LL Pathology Group (drc) Case No. 8 - March 2000 Loma Linda, CA
Tissue from: Liver Accession #28489
Clinical Abstr.tct: Du ring a routine phys ical examination, a large mass was found in the upper abdominal quadrant of this 58-year-old temalc. Questioning revealed that she had experienced a 70 lb weight loss over the past two years. CT of the abdomen showed a soft tissue density posterior to the stomach adjacent to the pancreas.
Gross Patholo gy: The2480 gram. 30.0 x 19.0 x l i.Ocm spccimen consisted ofa 17.0 x 15.0 x 10.0 linn multinodular tan encapsulated tumor with attached distal pan.creas, spleen and a segmcm of colon. There was no gross invasion of these structures by the tumor. The cut surface of the tumor was firm, tan, whorled and nodular. Contributor: David Lawrence, M.O. Case No. 9 - March 2000 Santa Maria, CA
Tissue from : Rigbt liver Accession #28553
Clinical Abstract: This 82-year-old female presented with a right liver mass, which was resected.
Gross Pathology: T he 6.0 em mass had numerous sate ll ite lesions extending over an additiona15.0 cm area.
Contributor : Isabel Salcedo, M.D. Case No. 10 - March 2000 Fontana, CA
Tissue from: Pa ncreas Accession #26335
Clinical Abstr-.tct: After complaining ofimem1ittcnt epigastric pain for two months. tllis 39-year-old fema le was found to have a cystic mass arising from the body of the pancreas. At surgery, a thin walled, mucin-filled mass was attached to the pancreas and pushed tbe stomach to the rigbt.
Gross Pathology: The 850 gram. multilocular cystic mass was 16.0 x 12.0 x I 0.0 em. CALIFORNIA T UMOR TISSUE REGISTRY
GASTROINTESTINAL TRACT PATHOLOGY
Minutes- Subscription A
March 2000
SUGGESTED READING (General Topic.1 from Recent Literature):
Redefining the Role ofAntiarrhyt hmic Drugs. P(>drid PJ, et al. The New England Journal ofMedicine 1999; 340(24):1910-1911. tumor Suppressor Genes. A Short Review. Yeo, CJ. Surge1y 1999; 125(4):363-366, Post-Tral)splant Lymphoprolifetative Disorder. A Practical Approach. Swerdlow SH. Scm Diag Patlwl 1997; 14:2, Is Intensive Follow-Up Really Able to Improve Prognosis of Patients with Local Rccun·ence after Curative Surgery tbr Rectal Cancer? Secco GB, et al, Annals ofSurg Oneal '1999; 7(1):32-37. Neurologic complications of the Reactivahon of Varicella-Zoster Virus. Gilden DH, et al. New England Joumtrl of Medicine 2000; 342(9):635-645. Diagnostic Problems in Surgical Pathology of the Adrenal Glands. Lack EE, et al. Mod Pathol 1995: 8(3):3 12-33;!,
California Tumor Tissue Registry c/o: Department ofPatho lo&,'Y and Human Anatomy Lorna Linda lJniversity School of Medicine l )(l21 Campus Avenue, AH 335 Loma Linda, California 92350 (909) 558-4.788 FAX: (909) 558-0188 E-mail: cttr@linkline com Case oftl1e Month: www. llu.edu/llu/cttrlcotm Case No. 1, Accession No. 28502 1\>IR n:b 2000
~rs fi eld - Inflammatory pscudotumor (x1mthogranuloma) Riverside - Inflammatory pseudotumor Mountain View (EJ Camino Hosl!iW) - Rosai-Dorfinan disease Qrange DIAGNOSIS: E:d ranodnl Rosai-Dorfman Dist'nse, terminal ileurn T-65520, M-77810 CQNSULIAT10N: Dr. Elaine Jaffe, National Institute of Health, Belhesda, Maryland. "Rosai-Dorfinan disease " REFERENC&S: Foucar E, eta!. Sinus Histioc)10S1S \\ith Massive l,.ymphadcnopath)· !Rosai-Dorlinon Disease). Review ofthe Entity Scmin Diag Ptuho/ 1990; 7(1).17-73. Montgomery EA. ct ol. R05oi·Oorfmon Disease of Soft Tissue. AmJ Surg Pothol 1992. 16(2):122·129 Bcrsamaschi G. Ct ol. Evidence for a Po1yc1ono1 Noturc of the Cc!11nfiltratc in Sinus ~hstiocytosis with Massive L)mph•denopathy (Rosai.Dorrmnn Disease). Br .I Naematal 1995; ')1 (2):415·4 18. Vcinol JP, ct at Son Tissue Rosoi Dorfmno Disease Mimicking fnOanunotocy P.seudotumor. A Dia0onostic Pitfall. PIIIM/ 1998: 30(1).14-16 Case No. 2, Accession No. 28148 March 2000 Bakerslield - Nwroendocrine carcinoma Riversids - Malignant carcinoid Mountain Yiew lEI Camino Hospital) • Small ccll neuroendocrine carcinoma Orange IUC! Medical Center l!.esidemsl · Small cell carcinoma Havward - Basa!oid carcinoma (I}; Small cell carcinoma (2} Ventura (Unjlab) - Carcinoid (2) Santa Rosa - Neuroendocrine carcinoma (2); Small cell carcinoma (neuroendocrine) (I} Santa Barbara (Co!IJ!SC Hospi(QI) - Neuroendocrine carcinoma Momerex (Community Hospital of Monterev Penin ~u la l • Small cell carcinoma San PieJ?.Q !Nayql Mcdi.c;ll Cell!ID - Net•roendocrine carcinoma ~ - Cat·cinoma with neuroendocrine features (6) Michigan {Dearborn) -Invasive carcinoma with neuroendocrine and squamous features bigb grade Texas O'exas Tech Medical Health Center\ - Poorly diflerentiated carcinoma with neuroendocrine difrcremintion Nebraska {Crejghton University) - Poorly differentiated carcinoma with neuroendocrine features Florida (Monroe Regional Medical Center) - Neuroendocrine carcinoma Mro!lan DIAGNOSIS: Smull Cell Carcinoma (Neuroendocrine Carci nom•), rectum T-68000,M-80413 REFERENCES: Gould VE.ct ol. Neuroendocrine Carcinoma of tho Colon. Uh l'>struelur>tand Btocl>enucalEvidcncc of their Secretory Function AIO!.I Smog l'ntholt978; 2(1):3t-38. Wick M R, or al Smoll Cell Neuroendocrine Carcinoma of the Colon ond Rcc.tum. Ctinicol, Histologicnl. ~nd Ultrnstruclurol Comparison with CtoncogenicCorcinomo. Studyof lnmllmohisiochcmicnt Comparison. Hum l'orho/ 1987: 18(t):9-2 1. Mills SE, ct ol. Small Cell Undiffcre.utiatcd Carciuomo of ~1c Colon. A Ctinicoparhotogieal Study of Five Cases and Their Association wi~t Colonic Adenomas. Am .IS urg Pathul 1983; 7(7):643-65 I. Sorsr.cld P, cL nl Smoll Cell Undiffcre.nLiatcd (''NC Bakersfield • inflammatory fibroid polyp Riversjde • lnfiammatory fibroid polyp Moumajn View lEI Camino Hospitnll • Inflammatory fibroid polyp Qranw=. CUCI Medical Center Rcsjdcms) • Inflammatory myolibroblnstic tumor (inflammatory pseudotumor) (4); Liposarcoma. myxoid ( 4) Hayward • lnflammato.ry fibroid polyp (3) Vemyrn IUnjlab) • Myxoid liposarcoma (2) Sama Rosa · Gastrointestinal stromal tumor {3) Santa Barbara CCottage Hospital\ • Inflammatory fibroid polyp Monterey (Communi tv Hospital ofMonterey Peninsula) • Stromal tumor S;ln Diego CNaval Medical Center) • Inflammatory fibroid polyp Long Beach • Inflammatory fibroid polyp {Va.flek) {6) Mjchi~ • Inflammatory fibroid polyp ~ trcxas Tech Medical Health Cemcr) - Gl stromal rumor Nebmskn DIAGNOSIS: lnOnmmntory Fibroid Polyp, Small Intestine T-64000, M·7683() REFERENCES. Suster S, etal. lnflanunatory Fibrord Polyp of the SmaU Intestine. Ullra$1tuctural and Immunohistochemical Observations Ultrastn•ct Potho/1990: 14(2):109-119 M)1nt MA, t1 a1 Inflammatory Pseudolumor of the Ileum. A Report of a Multi focal. Tronsmurol Lesion \\ith Regrona1 L~mpb Node lnvoh·emcnt. Arch Patlro/ LabMtd 199<1: 118(11):1138-1142 Trillo, 1\A, t1 al The Histogenesis oflnOammntory Ftbroid Polyps of the Gastrointestinal Tract. Hmoparho/1991 ; 19(5) 431436. TadoS, ct al Endoscopic Removal of lnOammntory Fibroid Polyps of the Stomoch. Am .I Grurroenttrol 1991, 86(9): 1247-1250. Shih LN, ct nl ~>Onmmatory Fibrord Polyp of the Jejunum Causing Intussusception Am J Gasuoenrero/ I997 , 92( f): 162. I6 ~. Wille P, ct al. Fibroid Polyps ol' lniestinnf Tract nrc /nllnmmatory·Rcoctivc Prolilerotions of CD34-Positive Pcnvnseulor Cells. N/.woplllhol 1998; 32(6):498-502. Case No. 4, Accession No. 28153 Marclt2000 ~J:lili.!lli[ - Serous cystadenoma Riverside - Lymphangioma Mountain View CEI Camino Hospital) - Benign multicysric mesothelioma Orange (HCI Medical Cegter Re.~ - Lymphangioma Hayward - Cystic lymphangioma (3) .Ymtllra DIAGNOSIS: Benign Multicystic Mesotbclioma T -67000, M-90503 REFER EN~: Moore JH.Jr., ct al. Benign Cystic Mesothelioma. Cancer 1980; 45(9):2395-2399, McMemcycr R, et nl Multicystic Peritoneal Mesothelioma. A Repoi'L witJ1 Electron Microscopy ofa Case Mimicking Intra· Abdominal Cystic Hygroma (Lyrnphan,~;ioma). Ctmcer 1979: 44(2):692-698. Weiss SW ~ ct al. Muhicystic l\•1csothcliomn. An Analysis of Pathologic Findings and Biologic Behavior in 37 Cases, Am ../ Surg l'otho/ 1988; 12(10):737-746. Wu YJ, ct at. The Me~od~el ial Keratins. A New Family of Cytoskelelal Protei us ldentiGed in Cultured Mesothelial Cell, .and Non Keratinizing Epithelia. Ci>ll 1982; 31(3 Pt 2):693-703. ZotaJis G, et al. Lciom~·omalosis-Pcritoncalis Disscminata, Endometriosis, and MuJticysl,ic Mesotllelioma. An Unusual Association. lnt.!Gynecol f>mho/ 1998: 17(2):178-1 82. Cas ~ No. S, Accession ~o. 28680 Ma r~h 2000 Bakersfield • Mucinous cystadenoma Riverside • Mucocele Mounlain View lEI Gamino Hospital) • Mucinous cystadenoma with mucocele Qmn!llLCUC! Medical Center Residems\ • Acute appendicitis with perforation and granulomatous infla mmation ~~.n! . Mucocele, mucosal hypet·p!asia type (non-neoplastic) (3) Venturn ll!oj!ab) - Mucocele (2) S•nta Rosa • Mucinous cystadenoma by history (3) Santa Barbara (Cottage Hospital) • Mucinous hyperplasia Montercv CComrnunily Hospital of Monterey Peninsula) · Mucinous cystadenoma San Diego CNaval Medical Cemer) • Mucinous cyst.adenoma (8); Mucinous hyperplasia (S) Long Deacll . Circumferential villous adenoma (6) Michigan DIAGNOSIS: Mucinous Tumor of Unceo1nin Mlll ignant .Poleotial, Appendix T- 66000, M-800 I I REFERENCES: Htgo E. C1 ol. Mucosal Hype Bakersfieli! - Bile duct hamartoma Riverside - Angioma Mountain View lEI Camino_Hospit!!!} • Infantile hemangioendothelioma Orange !UCI Medical Center Residents) - lnfaniile hemangioendothc.lioma Hayward - Infantile hemangioendothelioma (3) Ventttrn (!}.D.iJJ\l!l - lnlimtile hemangioendothelioma (2) Santa Rosa - Infantile hemangioendothelioma (3) Santa Barbara (Cottage Hospitall - Infantile hemangioendothelioma Monterey (Community Hospital of Monterey Peninsula) - Biliary atresia San Diego Q!!aval Medical Center) - (nfantile hemangioendothelioma Long Beach - Infantile hemangioendothelioma (6) W!i&~IJ !Dearborn) - Cirrhosis with massive ductal proliferation (cystic fibrosis ?, infantile obstructive cholangiography ?) Texas Cfexas Tech Medical Health Center) - Hamartoma Nebraska (Creighton University) - Infantile hemangioendothelioma FIQrida CMmu.~gi on jjl Medical Center) - Extrahepatic biliary atresia Maryland !University of Mary laud) - Infantile hemangioendothelioma Maaland (Woodbine) - lnf.1ntile hemangioendothelioma (2) M....ar,y.l.!!!liHNa!jooa) J::!ava! Megical Cen.tW - Infantile hemangioendothelioma New Jersey (Overlook Hospital) - Infantile hemangioendothelioma (3) Pennsylvania (Lehigh Valley Hospl!!J.U - Extrahepatic biliary mesia Pennsylvania (CQnemaugh Memorial Hosnitall - Bile duct hamartoma New York (Montefi ore Medical Center) - Multiple hemangioendothelioma ofth e liver ~ew York (j.gng [slaod Jewish Medical Center) - Infantile hemangioendothelioma ~lis.Y.L( lln jyersity of Conne~ticut He~lth Cen(erl - lnfantile hemangioendothelioma Canada (Foothills Hospital) - Infantile hemangioendothelioma Japan (Shimada City) - lnfan!ile hemangioendothelioma Australia !Sydney\ - lnfuntile hemangioendothelioma DIAGNOSIS: lllfantile Hemangioendothelioma, Liver T-56000, M-91310 REFERENCES: Dochmnn AH, ct al.. Infantile Hemangioendothelioma of the Lil'er. A Radiographic-l'olhologic.·Cfinical Correlation. AJR 1983: 140(6): 1091·1096. Denn PJ. clal MaJignaot Rcmangiocndothclioma of the Liver in a Young Woman~ ReJa~i ouship to Ora) C'.onlrnccptivc-Us-c. Am J Surg Patho/ 1985:9( I0):695· 704. Amonknr P, et nl Infantile Hema11gioendod1elioma of the Liver Med l'edlmrOncol 1999; 32(5):392-394. Wollcring MC, ct nl. Hepatic Hemangioendothelioma of Infancy. Treatment with Interferon Alpha. ./ Pedlmr Ga.srroenteTOI Nmr I997 24(3):348·351. Selby OM, et al. Infantile Hemangioendothelioma of the Lil'er. Hepato/ 1994; 20(1 PL 1):39·45. Case No. 7, Accession No. 26302 Marth 2000 Bakersfield • Hemangioma Riverside • Hemangioma Mountain View CEI Camino HospitaD - Cavernous hemangioma Orange CUCI Medical Center RC§idents) • Cavernous hemangioma Hayward • Intravenous leiomyomatosis, metastatic (2); Hemangioma ( I) Ventura CUnilab) • Hemangioma (2) Santa Rosa • Hemangioma ( 1); Hemangioma, rule out "low grade" angiosarcoma ( 1); Low grade hemangiosarcoma, rule out hemangioma (I) Santa Barbara CCottuge Hospil.l!!} • Cavernous hemangioma Monterey (Community Hospital ofMontereY Peninsula\ • Hemangioma San Diego INayaJ Medjcal Cemer) - Cavemous hemangioma Long Beach • Cavemous hemangioma (6) Michigan CDearbom) · Hemangioma Jexa• !TexM Tocb Medjcal Health Center) Papillary mesothelioma Nebraska {Creighton University) • Cavernous hemangioma flllljda {Monroe Reuional Medical Center) • Cavernous hemangioma Marvland (Universily of Marvland) ·Cavernous hemangioma Matyland (WoQdhjne) • Cavernous hemangioma (2) Marvland ® tiona! Nayal Medical Center) · Hemangioma New Jersey {Qyer!ook HospJW) • Hemangioma (3) Pennsylvania ll.chigb Ylllley Ho~pi t al) • Hemangioma Pennsylvania IConQrnaugh Memorial Hospital\ - Hemangiomatosis J:!ew York !MoOJefiore Medjcal Center) • Cavcmous hemangioma with (no! legible)? New York (Lon• Island Jewish Medical Center) · Cavemous hemang.ioma Conneclicyt (UniyersiJy of Connecticut Health Center) • Sinusoidal papillary hemangioma Canada (l'oothjl!s Hos!lW!.U • Hemangioma Japan (Shimada Cjty) • Lymphangioma Australia (Sydney> • Cavernous hemangioma DIAGNOSIS: Cave.rnou.s Hemangioma, Liver T-56000, M-91210 REFERENCES: flobbs KE. ec nl, Hepntie H cman~>iomas. Worl Bakersfield - Fibrolamellar variant hepata<:ellular carcinoma Rjverside - liepatoeeUular carcinoma, sclerosing type Mountain View CEI Camino Host>ilall - Hepatocellular carcinoma Orange CUC! Medjcal Center Residents) - Hepatocellular carcinoma (6); Acinar cell carcinoma (2) Hayward - Fibrolamellar carcinoma (3) Ventura CUnilab) - Acinar cell carcinoma (2) Santa Rosa - Acinar cell carcinoma (3) Santa Barbara (Couage Hospital} - Malignant neoplasm, lavor carcinoma, site undetermined Momecey !Community Hospital ofMonterey Peninsula) - Pheochromocytoma San Dic1,10 (Nayal Megical Center) - Hepatocellular carcinoma (8); Adenocarcinoma (7) Long l3epch - Fibrolamcllar hepatocellular carcinoma (6) ~!m CDcub.ru:.o) - Acinar cell carcinoma. pancreas. Tc.xas (Tc~as Tech Medical Health Cent~rl - Neuroendocrine tumor 'ebraska CCrejghton Universitvl - Pheochromocytoma/acinar cell carcinoma Florida (Monroe Regional Medical Center) - Hepatoid adenocarcinoma Maryland CUpjyersitl'-(lfMarylaod) -Hepatocellular carcinoma (5), Acinar cell carcinoma (5) Marvtand !Wooc!bine) - Sclerosing hepatocellular carcinoma (2) M.!!!yland (N~tional "'aval Medical Cemer} - llcp;1tocellular carcinoma. lihrolamellar variant New Jersey (Qy_erlook HQSJli1il!l - Hepatocellular carcinoma (2); Unclassified earcinnmn (I) ~QnsYI¥anja CJ,migh Valley Hospital\ - Endocrine carcinoma Penn,y!ynnia (Cpncmaugh Memorial Hospital) - Acinar cell carcinoma, pancreas/Malignam melanoma, mctastat ic New York ili! DJACNOSIS: Fibrolamellar Cardooma, Liver T-56000.~1-80 1 03 REFERENCES· Crais J, c1 nl. f' ibrolnrncllnr Carcinoma of the Lil'cr. A Tumor of AdotesCCI)IS ~ nd Yow>s Adults will1 Distinctive Climcot>otholosic Features. ('mwer I~ RO ; 46(2):372-379. Bcrm~1n M, ct nl. Fibrolnmclln.r Carcinoma of Lh e Liver J\n Immunohistochemical Study ofNineLccn Cases nnd n Rovicwoi' Lh e Literature. 1/um l'mhn/ 19K8; 19(7):784-794. Torii A. et nl. Tumor Localization as o Prognostic Factor in Hcpotocellulnr Carcinoma. Heparogostroenterology 1994; 4t( I): 16· 19. Epstein BE, c;.t nl. Mctostntic Nonrcscclablc Fibrolruucllar Hepatoma Pro,rnostic Features 3nd Natural H1story. Am J Clln Um·oJ 1999: 22(1 ):22-28. Davison FD. et nl. HBV-DNA Sequences in Tumor and NonrumorT•ssuo in o Patient "ilh the Fibrolamcllar Voriont of HepatoccUul3r Carcinoma. Heparo/ 1990; 12(4 Pt I) 676-679. Oa\'onp Bakersfield - Clear cell carcinoma Riverside - Hepatoma Mountain View CEI Camino Hos!lilAI.l - Hepatocellular carcinoma, clear cell type Orange CUC! Medical Center Residents) - Hepatocellular carcinoma ~s! - focal nodular hyperplasia, liver ( I): Me tasta~ic renal cell carcinoma (2) Yentyra (Unilab) - Hepatocellular adenoma (2) Santa RoM - Adenoma vs. focal nodular hyperplasia (3) Santa Barbara (Cottage Hospilal) - Hepatocellular carcinoma. clear cell pattem Momerey /Community Hosojtal ofMonu:rey Peninsula) - Hepatoma -clear cell San Dje11o CNaval Medical Center) - Metastatic renal cell carcinoma Long Deneb - Hepatoma, grade I (6) Mjg]]!Uin.IDearboml - Hepatocellular carcinoma, well-diflerentiated Texas DIAGNOSIS: Clear CeU Variant of Hepntocellular Carcinoma, Liver T-56{H}O, M-81700 REFERENCES: Cnl\1 fOfd J. Ct ol. Pathologic .<\ssessment ofLorcr Cell Dysplasia and Bcnisn u,cr Tumo Bakersfield - Mucinous cystadenoma Riw~ - Mucinous cystadenoma Mow>tain View CEI Camino Hospital) - Mucinous cystadenoma Orange fUCI Medical Center Residents) - Mucinous cystic neoplasm with no stromal invasion lfll~ - Low grade mucinous carcinoma (3) Ventura CUoilab) · Mucinous cystic tumor, adenoma (2) Santa Rosa - Mucinous cystadenoma (1); Cystadenoma (2) Santa Barbqm {Cpttage H'osoitall - Mucinous cystic neoplasm, borderline Monterey (Community Hospital ofMonterey Peninsula) - Mucinous cyst.adenoma San Diego (Naval Medical Center) • Mucinous cystic neoplasm (mucinous cystadenoma) (9); Borderline mucinous cystic rumor (4) J,ong Beach • Mucinous cystadenoma (6) Michigan (Dearbom\ · Mucinous cystic neoplasm Texas ITexas Tech Medical Health Center) • Mucinous cystic neoplasm ~ska (Creighton Universit)'l · Mucinous neoplasm of pancreas Florida (Monroe Regional Medical CenJ&r} • Mucinous cystadenoma Marvland CUnjversity ofMa..IJ1arull ·Mucinous cystic tumor M.iln:J,md (Woodbine) • i'vfucinous cystic tumor, borderline (2) Maryland (National Naval Medical Center) - Mucinous cystic neoplasm New Jersey (Overlook Hospital) • Mucinous cystadenoma (3) fe!'n~~~~un il\.{!..ehigh Vallev Hospital) · Mucinous cystadenoma, borderline Pennsylvania (Conemaugh Memorial Ho ~P.ilJ!D. · Mucinous cystadenoma, microcystic L}'Pe New York IMontefiore Medical Center) • Mucinous cystadenoma New York (Long Island Jewish Medical Center) · Mucinous cystadenoma Connecticut (University of Connecticut Health Ce!UW • Mucinous cystic neoplasm, low malignant potential with ovarian srroma ~bills HQ~pj tal) • Mucinous cystic tumor, benign Japan DIAGNOSIS: ' Mucinous Cystadenoma, Pancreas T-59000, M-84700 ~~: . Bergmann LS, eta!. CystadCllomas of !he ~nncre.'lS. The American Surget!ll 1992;58:57-71. Albores·Saavcdra J; ct al. 'Rc.commendnli01\S for the Rei)Orting of Pancreatic Specimens <;ontaini1tg MolignMl ·1\amors, The AssQCiation of Directors of Anatomic and Surgical Pathology. Am.! Clin !'athol I 9?9; I J 1(3):304-307. Albores-Saavcdra J~ ct al. Mucinous Cystodcuncnrcinomo of the Pancreas. Morphologic and Immunocytochemical Obscrvntions. Am.J Surg Patho/ 1987; I I(1 ): ll-20. Obara T, et -al. MucinwProducing Tumor of the Pancreas. Natural History and Serial PancrenlOgram Chongcs. Am J Gas1roenrerol t993: 88(4):564-569. Cyst Fluid Cytologic Analysis in the Oit'ferentiat Diagnosis of Pancreatic Cysuc Lestons, Am .J Clin !'athol t994: I 0 1(4):483-487. Shyr VM, ct al. Mucin-Producing Ncoplasmsoflhe Pancreas. Intraductal Papillary and Mucinous Cystic Neoplasms. Ann Surg t996: 223(2): 14)-146. \V'oulc.rs K._ CL al. A Pnncreadc Mucinous Cystadenoma in a Man with Mesenchymal Strom~ . E~pressins Oesltogcn and Progesterone Receptors. Vi chows Arch I998 ; 432(2): I87 · I 89. Fukumoto T, et al. Clinicopathological Study on Cystadenocarcinoma of the Pancreas. Gastroemeroi .Jpn t987; 22( t):63-73.