CALIFORNIA TUMOR TISSUE REGISTRY

California Tumor Tissue Registry c/o: Department ofPathol ogy and Human Anatomy Lorna Linda University School ofMedicine 11021 Campus Avenue, AH 335 Loma Linda, Cnllfomin 92350 (909) 824-4788 FAX: (909) 478-4188 Target audience: Practicing pathologists and pathology residen.ts.

Goal: To acquaint the participant with the histologic features of a variety of benign and malignant neoplasms and tumor-like conditions.

Oblectlve: 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 media: 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

CME Credit: 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 Tumor Tissue Registry is accredited by the California Medical Association as a provider of continuing medical education. CONTRIBUTOR: Shelley L. Tepper, M.D. CASE NO. 1 • JANUARY 1997 San Francisco, CA

TISSUE FROM: ACCESSION #25451

CLINICAL ABSTRACf:

This 34"year-old gay Caucasian male with generalized presented with a left . A few weeks later, a right neck mass developed. A total thyroidectomy was performed.

GROSS PATHOLOGY:

The right lobe of this 48 gram total thyroidectomy specimen vias markedly larger than the left and measured 7.0 x 3.0 x 4.0 em in greatest dimension. This lobe contained a 4.3 em diameter encapsulated nodule which bulged from the cut surface.

CONTRIBUTOR: RobertJ. Rosser, M.D. CASE NO. 2 • JANUARY 1997 Los Angeles, CA

TISSUE FROM: Thyroid ACCESSION #19217

CLINICAL ABSTRACf:

This 62-year-old Caucasian female was admitted with signs of congestive heart failure. An enlarged thyroid gland (4-5-times its normal size) was noted She had first noted the rieck mass about one year earlier and that it had been rapidly growing over the last six months.

GROSS PATHOLOGY:

This 210 gram thyroid gland had multiple nodules varying in diameter from 0.2 -3.5 em. The nodules were yellow,. white and pink, some were firm, others were soft and friable.

SPECIAL STAINS: High and low molecular weight keratin negative LCA diffusely strongly positive • CONTRIBUTOR: P.L. Morris, M.D. CASE NO.3 - JANUARY 1997 Santa Barbarn, CA

TISSUE FROM: Lert adrenal ACCESSION #26192

. CLINICALABSTRACT:

This 60-year-old male had an enlarged removed.

GROSS PATHOLOGY:

The included a 5.4 gram, 4.5 x 3.0 x 1.5 em portion of normal appearing adrenal gland and a 75 gram, 5.0 x 5.5 x 4.5 em multilobulated bright yeUow nodular mass.

CONTRIBUTOR: Howard E. Otto, M.D. CASE NO.4 -JANUARY 1997 Cheboygan, MI

TISSUE FROM: Parnthyroid ACCESSION #26916

CLINICAL ABSTRACT:

This 53 year old Caucasian female had a history of elevated calcium and parathyroid hormone levels. Her also had sinusitis, epistaxis, fatigue, anemia, polyuria, polydipsia, occasional urge incontinence and episodic elevations in blood pressure.

GROSS PATHOLOGY:

The·2.4 gram multin odula~. tan· brown mass was3.5 x 1.5 em x 1.2 em. The nodules varied from 1 to 1.5 cin and were orange and brown. CONTRIBUTOR: Roger McFadden; M.D. CASE NO. S - JANUARY 1997 Mission Hills, CA

TISSUE FROM: Thymus/Mediastinal ACCESSION #27638

CLINICAL ABSTRACT:

This 71 year-old male underwent a mitral valve repair. At that time, an incidental mediastinal tumor was found, described by the surgeons as very hard arid in the left side of the anterior . Two months later he underwent resection of the mediastinal mass.

GROSS PATHOLODY:

The 24.5 gram thymic mass was 4.5 x 4.0 x 3.8 em. Its cut surface was firm, rubbery, pale white and vaguely yellow.

SPECIAL STAINS: CEA strongly positive Chromogranin negative Keratin strongly positive

CONTRIBUTOR: Joseph Jarzynkn,M.D. CASE NO. 6 - JANUARY 1997 Bakersfield, CA

TISSUE FROM: Thyroid ACCESSION #20581

CLINICAL ABSTRACT:

This 43 year old Cauca?ial) 'male presented with a mass in the right side of his neck which caused no discomfort other than difficulty in swallowing and a feeling of fullness. Physical examination revealed·a thyroid nodule

GROSS PATHOLOGY:

The 65 gram thyroid was 83 x 5.3 x 3.5 em and weighed. The cut surfaces bulged slightly and were gray-white with areas of hemorrhage.

SPECIAL STAINS: Chromogranin positive AFP negative Calcitonin weakly positive CONTRIBUTOR: Victor J. Rosen, M.D. CASE NO. 7 • JANUARY 1997 Los Angeles, CA

TISSUE FROM: Thyroid ACCESSION #17379

CLINICAL ABSTRACf:

This 60-year-old Caucasian male presented with a right-sided palpable nodule on routine physical examination. It was non-tender and the patient denied any knowledge of this mass. Scanning revealed a cold nodule within the upper outer aspect of the right lobe. Excision of the right lobe and isthmus was performed.

GROSS PATHOLOGY:

The right thyroid lobe and isthmus weighed 12.5 grams and contained a 3.5 x 4.0 x 3.2 em lobulated, firm, gray to pink-tan, mass showing focal areas of hemorrhage.

SPECIAL STAINS: Calcitonin strongly positive Chromogranin strongly positive Keratin focally strongly positive Vimentin strongly positive CEA positive

CONTRIBUTOR: Lauren Monda, M.D. CASE NO. 8 • JANUARY 1997 Santa Barbara, CA

TISSUE FROM: Thymus ACCESSION #28144

CLINICAL ABSTRACf:

This 40-year-old Caucasian male presented with a six month history of left-sided ptosis, weakness of the small muscles of his hands, and nasal speech. A tensilon test was markedly positive. He was placed on Mestinon and predinisone, then later only on prednisone, which alleviated the sympt?ms. The patient elected for a thymectomy.

GROSS PATHOLOGY:

This 110 grams of yellow tan thymic tissue was received in two portions which together measure 15.5 x 8.5 x 1.8 em. Much of the tissue was fatty with scattered denser redder areas. CONTRIBUTOR: Gary C. Ponto, M.D. CASE NO.9 • JANUARY 1997 Santa Barbara, CA

TISSUE FROM: Thyroid ACCESSION #25327

CLINICAL ABSTRACT:

This 67-year-old female presented with a goiter which was treated with appropriate therapy. The majority of the gland shrank significantly in size, however, one large cold nodule failed to respond. A fine needle aspirntion was performed, followed by a partial thyroidectomy.

GROSS PATHOLOGY:

The 72 gram nodule was well-encapsulated, very soft, fleshy, lobular and brown-tan with no gross areas of necrosis or cystic degeneration.

CONTRIBUTOR: H. William Arndt, M.D. CASE NO. 10 - JANUARY 1997 Inglewood, CA

TISSUE FROM: Thyroid ACCESSION #17820

CLINICAL ABSTRACT:

This 25-year-old Caucasian female complained of a swelling in the right lobe of her thyroid for a six month duration. She was given irradiation to an enlarged thymus as a child and about eight years ago she had had her left thyroid lobe removed. A recent physical examination revealed an 4.0 em mass in the right lobe of the thyroid. An excisional biopsy of the right lobe of the thyroid was performed.

GROSS PATHOLOGY:

The 40 gram thyroid fragment was 6.0 x 4.5 x 3.8 em. Sectioning revealed a homogeneous, encapsulated mass occupying approximately 90% of the specimen.

SPECIAL STAINS: Thyroglobulin strongly positive CALIFORNIA TUMOR TISSUE REGISTRY

SUGGESTED READING (General Topics from Recent Literature): p53 in Life and Death. Shimamura A and Fisher DE. Clinical Researc!J 1996; 2: 435-440. Positron Emission Tomogxapby with 1-{18P) fluoro-2-Ctradiol in Breast Cancer. Correlation with Extrogen Receptor Status and Response to Systemic Therapy'· Clinical Cancer Research 1996; 2:933-939. Unifonn Requirements for Manuscripts Submitted to Biomedical Journals. International Committee of Medical Journal Editors•. A Mills oflnter Med 1997; 126{1 ): 36-47. The Descriptive Epidemiology of MalitpUnt Cystosarcoma Pbyllodea Tumors of the Breast. Bernstein I., Deapen D and Ross RK. Cancer 1993; 71: 3020-3040. Comparative Study of the National Cancer Institute and French Federation of Cancer Centers Sarcoma Group Grading Systems in a Population of 410 Adult Patients with Soft Tissue Sarcoma. Guillou I., Coindre J-M, Bonichon F, Bui NB, Terrier P, et al. J of Clin Oncol1991; 15(1 ): 350-362.

California Tumor Tissue Registry c/o: Depanment of Pathology and Human Anatomy Lorna linda University School of Medicine ll021 Campus Avenue, AH 335 Lorna Linda, California 92350 (909) 824-4788 FAX: (909) 478·4188 CASE NO. 1, ACCESSION NO. 25451 JANUARY 1.997

INlAND CRJVERSIDEISAN BBRNA@INO) • Angio invasive follicular carcinoma, thyroid {1) BA!(ERSF!ELD (Centrnl Valley Study Group) • Mixed medullary-follicular carcinoma YENIURA CUnilab) • Insular carcinoma {1); Poorly differentiated carcinoma {1) LONG BEACH • Follicular carcinoma ( 4); Poo.rly differentiated carcinoma (2) SAN DIEGO

DIAGNOSIS: POORLY DIFFERENTIATED FOLUCULAR CARCINOMA, THYROID T96000/M83303

CONSULTATION: Harry Evans, M.D., Un.iversity of Texas, Anderson Hospital. "Poorly Differentiated Invasive Follicular carcinoma oftbe thyroid extending into extra-thyroid tissue."

REfERENcroS: Segal K. Shpitzer T, Feinmes.""r M, Stern Y and Feinmesser R. Angioll"nesis in Follicular Tumoa oft he Thyroid. J of Surg Onco/1996; 63: 95-98. Basolo F, Pollinal, Pacini F, Fontanini G, Menard S, et al. Expression of the M,67,000 Laminio Reccp1or is an Adverse Prognostic Indicator in Hum on . An Immunohistochemical Study Clln Canar Rewudr 1996; 2; 1777-1780. CASE NO. 2, ACCESSION NO. 19217 JANUARY 1997

INLAND ffi!VERSTDE/SAN BERNARDINO) • Malignantlympboma, large cell type BAKERSFIELD (Central Valley Study Group) • Diffuse large cell VENTURA CUnilab) • Malignantlymphol11ll,large cell type (2) LONG BF.ACH • Noo·Hodgkin'slympboma,large cell type (6) SAN DIEGO a, large cell diffuse ARIZONA (VA Med Ctr) • Large cell lymphoma, immunoblastic WASHINGTON (Seattle VA Mec! Ctr) • Malignant lymphoma; large cell type with high grade cytology NEBRASKA CCreigbton University) • Large cell lymphoma MlSS!SSIPP! @aptist Med go · Lymphoma imrnunoblastic TEXAS (proyjdcnce Memoriol HospitaD • Large cell lymphoma FLORIDA CTallahassee) . Large cell lymphoma (3) NEW YORK Ompathl - Large cell lymphoma associated with chronic thyroiditis (4) NEW YORK

DfAGNOSfS: lARGE CELL LYMPEIOMA, THYROID T96000/M.9S903

FOLLOW-UP: Four months later the patient died of bear! failure. No tumor was found at autopsy.

REft'.R!jl'!CfS: Cheuy R, O'Leary JJ, Biddolph SC and O.ttet KC. Immunohistochemical Detection ofpS3 and ll<:l·Z r toteius in Hashimoto's Thyroiditis and Primary Thyroid . J Coml"'tllssi.st Tomogr 1995; 19(2): 282·288. Doria R, Jekel IF and Cooper OJ.. Thyroid Lymphoma. The O.se for Combined Modality Therapy. Cancer 1994; 73(1): 200-206. DevereU M and Salisbury J. Nucl/1992; 18{2): 89·92. Manra;a JM, ContrerA$ E, Caballo! Rand Sirvent JJ. Thyroid Lymphoma. A Medical Emergency (l.lr). Med Clin Bare 1992; 99(1): 38-39. CASE NO. 3, ACCESSION NO. Z619Z JANUARY 1997

INLAND

DIAGNOSIS: ADRENAL CORTICAL ADENOMA T93000/M83700

REfERENCES: Weiss LM. Comparalive Histologic Study o( 43 Metastasizng and Non·Met3Siasizing Adrenocortical TUmors. AmJ Surg PaJ/w/1984; 8: 163-169. Chan JKC and Tsang WYW. Endocrine Malignancies that May Mimic Benign Lesions. &m.in Diag Patho/1995; 12(1): 45-63. ()s(:IJe G, Terzola M, Oarriclla G, et all. 1 Clin £ndticri110/ M~tab 1994; 79: 1532-1539. Jarucb S, Kornely E, Kley HK and Scbloghccke R. Adrenal JncidentaiOGia and Patients witb Homozygoos or Heterozygous Congenital Hypetplasia. J Clin Eruioaincl M

INl.AND CRJ\IERSIDE,ISAN BERNARDINO) - Pantbyroid adenoma BAKERSFIELD (Cenln!l Valley Study Group) - Pan thyroid adenoma VENTURA Nnilab) • Chief cell hype~plasia (1); (1) LONG BEACH - Parathyroid adenoma (6) SAN DIEGO

DIAGNOSIS: PARATHYROID ADENOMA T97000/M81400

REfERENCES: Delellis RA. Tumors or lbe Panlhyroid Gland. Atlas or lbe Parolhyroid Gland. Atlas or Tumor Palhology, 3rd Seri.. , Fascicle 6. Washington D.C.: ,4.rmedFor~h ofSur&ery 1996; 224(3): 308-322. CASENO. 5, ACCESSIONNO. 276:38 JANUARY 1997

INLAND (RIVERSIDE/SAN BERNARDINO) • Thymic carcinoma, possibly metastatic BAKERSFIELD (Central Valley Study Group) - Metastatic adenocarcinoma VENTURA (Unilab) - Carcinoid (2) LONG BEACH - Malignant thymoma·(6) SAN E>IE60

DIAGNOSIS: MALIGNANT EPITHELIAL NEOPlASM OF MEDIASTINUM, FAVOR THYMIC CARCINOMA 11{2300~80003~85803

CONSULTATION: Juan Rosai, M.D. from Memorial Sloan-Kettering Cancer Center. "I agree that this ·mediastinal lesion represents an epi,thelia! neoplasm, and therefore a type of carcinoma. The pattern of growth is distinctly trabecular,.and there ~s extensive amount of hyalinized stroma. ImmunohistocbcmicaUy, the tumor cells are positive for keratin and negative fof chromogranin. Because of tlie location, the· possibility shoulo be eonsidcred of this being a tliymic carcinoma, although the pattern of growth is not particularly characteristic for that tumor type. An alternative possibility ofthis representing a direct extension or metastasis from a carcinoma of another site (such as lung) cannot be excluded."

REFERENCES: Suster S, Rosai J. Thymic Carcinoma. A Clinicopathologic-St•dy of 60 Cases. Canar 199167: 1025-1032. Walker AN, Mills SE; Fechner RE. Thymomas ani! Thymic Carcinomas. &min Diagn Paihc/1990; 7: 250-265. Wick MR, Schcithauer BW, Weiland U l, et al. Primary Thymic Carcinomas. Am J Surg Pathc/1982; 6: 613-630. TruonglD, Mody Dr, Cagle PT. ct al. Thymic Carcinoma, a Oiriico Pathologic Study of 13 Cases. Cancer1991; 67: 1025-1032. CASE NO. 6, ACCESSION NO. 10581 JANUARY 1997

INlAND CRIVERS!DB!SAN BEBNARPINOl - Medullary carcinoma, thyroid BAJ - Medullary carcinoma SACRAMENTQ CUC Davis Med Ctrl - Medullary carcinoma vs para~nglioma ARIZONA NA Mcd C!rl - Medullary carcinomro£ thyroid WASHINGTON (Seat1le VA Mcd C!rl - Neuroendocrine neoplasm, calcitonin secreting, malignant potential uncertain. NEBRASKA (Creighton University) - Medullary carcinoma MISSISSIPPI CBapti~! Med Or) - Medullary carcinoma TEXAS (providence Memorial Hospital) - Medullary carcinoma FLORIOA ITallahasseel - Medullary carcinoma (3) NEW YORK Gmpoth) - Medullary carcinoma of thyroid gland ( 4) NEW YORK

DIAGNOSIS: Jl.fEDULLARY CARCINOMA, THYROID T96000/M85103

REfERENCES: Saad MF, Ordonez NO, Rashid RK, Guido JJ, Hill CS, et al. Medullary Carcinoma or the Thyroid. A Study of !he Clinical Features and Prognostic Factors in 161 Patients. Medicine 1984; 63(6): 319-342. Bergholm U, Adami HO, Bergstrom R, Johansson li, Lundell 0, Telenius-Berg M, Akerstrom G. Clinical Characteristics io Sporadic and Familial Medullary Thyroid Carcinoma. A Nationwide Study of249 Patienl$ iD Sweden From 1959Througb 1981. CtvtUT 1989; 63(6}: 1196-1204. DeLellis RA and Balogh K. Histochemical Chal'l!Cieristi<:a of Parafollicul ar Cells and Medullary Thyroid Carcinoma. AmJ Surg Pat/w/!913; 72: 119. Albores-Saavedra J, UVolsi VA and Williams liD. Medullary Carcioomo. Seminars in Diagnostic Patlwlo({Y 1985; 2: 137-146, Ekman ET, Bergholm U, Backdahl M, Adami H-0, Bergstrom R, Orimeli us L, Auer 0 and the Swedish Modutlary Thyroid Canoe.- Study Group. Nuclear DNA COntent and Survival in Modullary Thyroid Carcinoma. Canur 1990; 65: 511-517. CASE NO. 1, ACCESSION NO. 17379 JANUARY 1997

JN!.AND ffiiVERSIDPISAN BERNARDINO) • Medullary

DIAGNOSIS: MEDULLARY CARCINOMA, THYROID (SPINDLE CELL VARIAN11 T%000/M8S103

RBFBRENCES: Oaudin PB and Rasai J. florid Vascular Proliferation Associated with Neural and Neuroendocrine Neoplasms. A Diagnostic Clue and Potential Pitfall. AmJ Surg Patho/1995; 19(6): 642-652. Uribe M, Fenoglio-Pieiser CM. Medullary Carcinoma of the Thyroid Gland, Clinical, Pathological and Immunohistochemical Features with Review of the Liter.ature. l.mJ Sur& PaJhc/1985; 9: 571-594. 8U$$0lati G,Mooga G. Medullary Carcinoma or the Thyroid wilb Atypical Ponems. Cancer 1979; 44: 1769-tm. Kimura N, Nakazatoy, Nagura H. et al. Expression of Intermediate Filaments in Neuroendocrine Tum0!5. Arch PaJ/w/ LobMed 1990; 114: SOS-510. CASE NO. 8, ACCESSION NO. 2ll144 JANUARY1997

INlAND CRJVERS!DE/SAN BERNARDINO) • Atrophy thymus BA! · Atrophic thymus \'ENfURA £Unilab) • Thymolipoma (2) LONG BE'ACH • Thymolipoma (6) SAN DIEQO (Naval Medical Center) • Thymo!ipoma (16) SANIA BARBARA (Cottage Hospital) • Thymo!ipoma SANTA ROSA • Thymus gland (1); Thymus with no specific cba_nges (1); Involuting thymus with dystrophic calcification and prominent cortical epithelial ceUs (1) BAY AREA • Thymoma (2); Thymolipoma (1); With myasthenia gravis (3) SANTA CLARA C!.oma Prieta Group) • Nonna! thymus SACRAMENTO CUC Davis Med Ctrl • Thymus ARIZONA (VA Med Ctr) • Thymus with mild rympboid hyperplasia WASHINQTON CScRtlle VA Med Ctrl • Thymus removed irt treatntent for myastbcni.a gravis(? when do such lesions become nthymolipoma") NE8RAS!(A (Creighton Univel'lliM · Thymolipoma MJSSISSIPPI CBaptjst Med gu · Thymolipoma TEXAS TECH (Providence Memorial Hospital) • Thymolipoma fLORIDA ITa!labos.

DIAGNOSIS: THYMOUPOMA T98000/M88SOO

Rf.FERENrn:i: Swanson PE. Soft Ttssuo Neoplasms ofthe Mediastinum. S.min Diagn PaJJ.o/1991; 8: 14·34. Moran CA. Rooack>de-O>ristenson M. and Suster S. Thymolipoma. Oinic:opothologic Review o[ 33 Cues. Mod Patlw/1995: 8(7): 741·744. van-Hoeven KH, Brennan MF. Upothymoadenoma of the Paratllyroid. Arch Pnthol Lab Med 1993; 117(3): 312·314. Hull MT, Warfel KA, Kotylo P, Goheen MP and Orown JW. Proliferating Thymolipoma. Ultrastructural, lmmW10hislochemical, and Flow Cytometrie Study. UltrastrucJ P

INLAND (RfVERSIDF/SAN BERNARDINO\ - Hurtble cell neoplasm BAJ{ERSFIELD (Central Vall ~y Stydy Orouol - Follicular carcinoma VENJVRA CUnilab\ - Follicular cerci noma (2) LONG BEACH - Hurthle cell tumor (6) SAN D!EGQ

DIAGNOSIS: MINIJI.iALLY INVASIVE, EN CAPSUlATED, HURTHLE CELL CARCINOMA, THYROID T96000/M82903

REfERf!NQ!S: Oranl CS, BanD, Goellner JR and Hay ID . Beoigo HurthleCeiiThmO

DIAGNOSIS: FOLLICULAR ADENOMA (CLEAR CELL TYPE), THYROID T96000/M83300

FOU.OW-UP: One year .followi ng surgcty, she was welt and in good healtb with no evidence of local recurrence.

REFERENCflS: Rosai J, Catcangiu ML end Delellis RA. TUmors wirh Oear Cell Fealura. Allao ofT\1100< PaJhology, 3rd Series, Fascic:le 5. Washingron D.C : Armed Forou IIISfitut< ofPOilaology 1990.