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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 <UC! Medical Center Residents) - Extranodal sinus histiocytosis with massive lymphadenopathy (5), Inflammatory pscudotumor (3) tlayward - Organizing periappcndiceal abscess (1) Vwtura CUnilabl - Crohn's disease (2) Santa Rosa - Rosai-Dorfinan disease (I); Probable Rosai-Dorfman disease, rule out specific inflammatory reaaion (2) Santa Barbara (Co ttag~ Hospila!l - Sinus histiocytosis with massive lymphadenopathy.
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