CALIFORNIA TUMOR TISSUE REGISTRY
"SOFT TISSUE PATHOLOGY"
Study Cases, Subscription A ' APRIL1999
California T umor Tissue Registry c/o: Department of Pathology and li urn an Anatomy Loma Linda University Scbool of Medicine Jl021 Campus Avenue, AH 335 Loma Linda, California 9'2350 (909) 824-4 788 FAX: (909) 558-0188 E-mail: [email protected] Target audience: Practicing pathologists and p,athology residents.
Goal: To acquaint the participant with the hiSiologic features of a variety of benign and malignant neoplasms and tumor-like conditions.
Objectives: The participant will be able to recognize morphologic features ofa variety of benign and malignant neoplasms and tumor-like conditions and relate those processes to peninent references in the medical literature.
Educational mtthods and media: Review ofrepresenlative glass slides with associated histories. feedback on consensus diagnoses from participating pathologists. Listing ofse lected references from the medical literature.
Principal faculty: Weldon K. Bullock, MD Donald R. Chase, MD
CMECredlt: Lorna Linda University School of Medicine designates this continuing medical education activity for up to 2 bours ofCa tegory I of the Physician's Recognition Award of the American Medical Association. CME credit is offered for the subscription year only.
Accredi!Jition: Lorna Linda University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing medical education for physicians. CONTRIBUTOR: Richard L. Johnson, M .D. CASE NO.1 - APRIL 1999 Pasadena, CA
TISSUE FROM: Right back ACCESSION #27925
CLINICAL ABSTRACT: This 40-year-old Caucasian male had a lump removed from his lower back. The lump returned and grew larger and ftrm to touch. MRI revealed a relatively well-circumscribed, solid mass, posterior to the spine.
GROSS PATHOLOGY: The sped men consisted of a 72 gram, 8.5 x 5.0 x 3.0 em gray-pink soft tissue mass. The cut surface was fibrous and gray to light tan. ..
CONTRffiUTOR: Donald Rankin, M.D. CASE NO.2 - APRIL 1999 Fontana, CA
TlSSUE FROM: Obturator region ACCESSION #27919
CLINICAL ABSTRACT: During a workup for menometrorrhagia and dysmcnotrrhea, this 44-year-old female was fo und to have an obturator mass.
GROSS PATHOLOGY: The specimen consisted ofa 9.0 x 5.5 x 3.5 em yellow-tan, partially ge lantinous piece of non encapsulated tissue. Sectioning revealed a nodular variable ye llow and white cut surface with no areas ofhemorrbage or grossly apparent necrosis.
SPECIAL STUDIES: CD-34 positive CONTRIBUTOR: Philip G. Robinson, M.D. CASE NO.3 - APRIL 1999 Boynton, Beach, FL
TISSUE FROM: Right shoulder ACCESSION #28414
CLJNICAL ABSTRACT: This 70-year-old male presented with a mass on the right shoulder and left chest. The mass was excised.
GROSS PATHOLOGY: The 4.2 x 3.5 x 3.2 em specimen consisted of white rubbery tissue. Sectioning revealed a central mucoid area.
SPECIAL STUDIES: S-1 00 negative Keratin negative Desmin negative
CONTRIBUTOR: Guillermo Acero, M .D. CASE NO.4 - APRIL 1999 Santa Paula, CA
TISSUE FROM: R ight cheek ACCESSION #28J 41
CLINICAL ABSTRACT: This 80-year-old Caucasian male gradually developed an ulcerated right cheek lesion, which was removed.
GROSS PATHOLOGY: The 5.3 x 4.0 x 1.8 em ellipse of skin had a well-demarcated, 3.1 em diameter, ulcerated central area.
SPECIAL STUDIES: PAS strongly positive for glycogen Desmin weakly. focally positive S-100 negative Keratin negative CONTRffiUTOR: Arno Roscher, M.D. CASE NO.5 - APRJL 1999 Granada Hills, CA
T ISSUE FROM: Smull bowel ACCESSION #28297
CLINICAL ABSTRACT: This 51-year-old male had a several year history of steroid and NSAID use with episodes Gl bleeding and development ofan iron deficiency anemia. He collapsed after developing abdominal pain with vomiting and bright red blood per rectum. At the time of surgery, a 12 em firm mass was · found, attached. to the small bowel.
GROSS PATHOLOGY: Attached to the small intestine was a 9.0 x 12.0 em thinly encapsulated yellow-tan mass. The mass involved the small bowel wall, with a focus of hemorrhage appeared on the mucosal side and extension to the serosa. The cut surfaces showed multiple yellow-tan nodules up to 3.5 em in diameter with foci of necrosis.
SPECiAL STUDIES: Virnentin diffuse, strongly positive Muscle specific actin positive S-100 negative CD-34 negative Keratin negative
CONTRffiUTOR: Wafa Michael, M.D. CASE NO.6 - APRlL 1999 Fontana, CA
TISSUE FROM: Left inguinal region ACCESSION #27886
CLimCAL ABSTRACT: This 84-year-old male noted a left inguinal bulge for more than a year. It was not reducible and caused him occasional discomfort but he had had no changes. in bowel habits, abdominal pain or melena. He was taken to surgery for an inguinal hernia repa i:r.
GROSS PATHOLOGY: The 380 gram. 16.0 x 12.0 x 7.0 em specimen consisted ofan irregular tan-pink-yellow mass of fibromembranous and adipose tissue. CONTRffiUTOR: B. P. Carman, M.D. CASE NO. 7 - APRIL 1999 Upland, CA
TISSUE FROM: Mediastinal tumor ACCESSION #27968
CLINICAL ABSTRACT: This 36-year-old male Caucasian, with a longstanding diagnosis ofneurofibromatosis, was found to have a mediastinal mass. Three years earlier, he had had an 8.0 em thigh mass resected, followed by post operative radiation. At the mediastinal exploration, tumor was found seeding the pericardia I fat, left pleura, diaphragm, anterior pulmonary ligament and pericardium.
GROSS PATHOLOGY: The 8.0 x 4.0 x 2.0 em specimen consisted of firm homogeneous gray-white to tan tissue without areas ofgross necrosis and hemorrhage.
CONTRIBUTOR: Lorna Linda Pathology Group {drc) CASE NO.8 - APRIL 1999 Lorna Linda, CA
TISSUE FROM: Maxilla and bard palate ACCESSION #27888
CLINICAL ABSTRACT: This 78-year-old Caucasian male had had a lip lesion resected about I year earlier. He now complained of a tight lip with difficulty in pronouncing some words. He was found to have a rapidly enlarging recurrent cystic mass involving the columella, nose and passing into the nasal cavity. The patient underwent a total rhinectomy, bilateral medial maxillectomy.
GROSS PATHOLOGY: This 97 gram specimen included nose, nasal septum and hard palate. A 2.0 x 1.0 x 0.6 em lobulated red mass extended from the nasal septum. CONTRIBUTOR: Daniel J Luth ringer, M.D. CASE NO.9 - APRIL 1999 Los Angeles, CA
TISSUE FROM: Right chest wall ACCESSION #28338
CLINICAL ABSTRACT: This 26·year-o ld male presented with a 22.0 em right chest wall mass. The mass was biopsied and subsequently resected.
GROSS PATHOLOGY: The 30.2 x 12.6 x 12.6 em chest wall resection included of portions of four ribs with attached skeletal muscle and soft tissue. The medial a~pect of the specimen had a 15.0 x 5.2 x 4.1 em firm white lobulated mass which involved the parietal pleura. The cut surfuce of the tumor was firm, white yellow, lobulated and friable.
SPECIAL STUDIES: (as evaluated by contributor) LCA Minimal reactivity Chromogranin I Synaptophysin Minimal reactivity S-1 00 Protein/ Minimal reactivity Keratin Minimal reactivity AEl/3 Mjnimal reactivity KP-1 Minimal reactivity Smooth Musc le Actin I Desmin I Myoglobin Minimal reactivity Ewing's epitope 013 (CD99) Strong immunoreactivity CAM 5.2 Perinuclear dot-like distribution NSE Weakly positive in some groups of cells Minimal glycogen is identified
CONTRIBUTOR: Lorna Linda Pathology Group (mtm) CASE NO . 10 - APRIL 1999 Lorna Linda, CA
TISSUE FROM: Right buttock ACCESSION 1#28367
CLINICAL ABSTRACT: This 64-year-old black male bad a one year history ofa mass in the right buttock. There was no evidence of skeletal involvement on CT scan.
GROSS PATHOLOGY: The 46 gram, 5.7 x 1.2 x 0.5 em. brown-tan ellipse of skin had an attached 5.8 x 5.0 x 4.0 em ye llow-red, encapsulated, gelatinous cystic mass filled with necrotic and hemorrhagic material. CALIFORNIA TUMOR TISSUE REGISTRY
SOFTTISSUEPATHOLOGY
Minutes - Subscription A
Aprill999
SUGGESTED READING (General Topics from Recent Literature):
C-Reactive Protein and Cardi.ovascular Risk in Women. Ridker PM, et :al. Circulation 1998;98(73): 1-3. Tumor Markers of Ovarian Center. The Search Goes On. Xu Y, et al. JAMA 1998; 280:719-723. Endooervical Gi¥1dular Atypia. Does a Prenooplastic Lesion of Adenocarcinoma In-Situ Exi.st? Goldstein, NS, Ahmad E, Hussain M, Hankin, RC, etaL AmJC/in Patho/1998; 110(2):200-209. The Cellular Basis of Metastasis. Ruiz, P and Gunthcrt U. World J Urology 1996; 14{3):141-150. Chan, JKC. Mesenchymal TumO
California Tumor Tissue Registry c/o: Department of Pathology and Human Anatomy Lorna Linda University School of Medicine 11021 Campus Avenue, AH 335 .. Lorna Linda, California 92350 (909) 558-4788 FAX: (909) 558-0188 E-mail: [email protected] CASE NO. l , ACCESSION NO. 17925 APRIL 1999
!NI.ANP DIAGNOSIS: FIBROMATOSIS (EXTRA-ABDOMINAL DESMOID TUMOR), BACK TYIIOO, M76100 R!lfERJlNCES: Allen PW. 1'he Fibromatoses. A Clinicopathologic Classification Based on 140 Cases. AmJSurg Patho/1971; 1(3):255-270. Goellner JR tu1d Soule E!;l. Dcsmoid tumors, An Uhrnstructuml Study of Eight Cases. Hum f(Jiho/1980; II :43-SO. Ll M, Cordun-Cardo C, Gorald WC and Ro""i J. Desmoid Fibromatosis i• u Clonal Process. Hum Pat/w/1996; 27(9):939-943. CASE NO. 2, ACCESSION NO. 27919 APRIL 1999 INLAND CRimi de/San !lqnardinol • Synovial sarcoma (2) ORANGE • Solitlll)' fibrou.~ tumor V AI..ENC!A · Hcmangioperic-ytomaiangiusarooma SANTA ROSA • Soliwy fibrous rumor vs. hcmAAgiopericytoma (l); Mesenchymal neoplasm consiStent with bemangiopcriC)1oma (l ): HemangioperiC)1oma (solitary fibrous tumor)(!) SAN D!E('JO CNuynl Medical Center) • !lemangiop<.'l'iC)1omu (6); Solitlll)' tibrou.• tumor (3) VENTI!RA - Hemangiopcricytoma (2) LONG BEACH - Solitary fibrous tumor (4) BAY MEA - Angiofibroma (angiomyofibroblll!toma) (3) MONTEREY !Community tlospical ofMonta:ey Peninsula) - Neurofibroma (4) BAKERSFIElD (San looqujn Communjty Hospi!!!ll · Hemangiopericytoma BAKERSFIELD (Central Valley Studv Grounl • Leiomyosarcoma HAYWARD CSt. Rose Hoopit!!ll - Solitlll)' fibrous tumor (I); Vascularlumor (vs. sc:hwannoma) (I); Newofibroma(l); SclenJBin& hemangioma (I) NEVADA {Reno) - Solitary fibrous rumor (2) IDNjO CIDX Pathologvl • Pelvic fibromatosis COI.()RADO (North Colorado Medical Ct;ntq) - Solillll)' fibrou.• tumor MICHIGAN CF001c Hospi!!!ll - Solitary fibrous rumor Ml CHIGAN fSt. Marv's HospjtaD • Solitary fibrous tumor (4) NEBBASKA (Creighton) • llemangioperiC)1oma WlSCQNSIN (Menter Health Sc'n'jeesl - Degenc111tcd peripheral nerve sheath tumor INDIANA fGoshcnl • Epithelial hemangioma ILLINOIS - Granular cell reaction NORTI! CAROLINA fWN C Pathology! - .Epithelioid hemangioendothelioma (3) LOUISIANA (f.oyjsiana Stg Univcrsjty Medical C!:nter) • Hemangiopcrkytoma n. neurofibroma Fl,()RIDA ITa!!!lhassce) - Myxoid neurofibroma MMYLANQ CW9odbjncl - Solitary fibrous tume< (2) MARYLAND CNaliO!U!I Nuy!l! Medical Center) - Solitary fibrous tumor (7); HemangiopcriC)1omu (5) PENNSYLVANIA DIAGNOSIS: SOLITARY FIBROUS TUMOR, OBTURATOR REGION TY2300, M9051 0 REfERENCES: Good lad JR und Fletcher CQ. Solitary Fibrous Tumor Arising at Unusual Sites. An!l!rsis ofa Series. Histopolhology 1991: 19(6):5 15-522. Khalifa MA. ct a!. Solitary Fibrous Tumors. A Series of Lesions. Some in Unusual Sites. Soulh Med J 1997; 90(8):793-799. Va!lat·Dealuvelavc AU, Dry SM and Flclcher CD. Atypical and Malignant Solitary Fibrous Tumors in E> !!!LAND IRiyqside!San Bqnardino) • Myxoid neurofibroma(!); Ncuro6broma wi1h myxoid chani\CS (1) ORANGE· MyxoidMHI VALENCIA - Myoma vs. myxoid lipa5aroomu SANTA ROSA • Myxoid Mf'H (3) SAN DIEGO !Naval Mec!lcal Canerl • l.ow grade myxofibromsarooma ( II) VENTURA • Low g11lde myxoid liposarcoma (2) LONG BEACH • Atypical myxoma (4) BAY AREA • Low grade Upc5arcoma (3) MONTERllY (Community llospilal ofM!MJterev l'enirn~u!al - Myxold liposaroomo (4) BAKERSFIElD (San J000ujn Gnmmunjty Ho:milal\ • Myxoid liposarcoma BtiKER,Sf!ELD CCcnua! Valley Srudy Gtpup) • Myxoma UAYWARQ CS1 Rn DIAGNOSl S: LOW GRADE MYXOFIBROSARCOMA, SHOULDER TYI220. M88403 CONSli!:CAIION: Madeline S. Milcbcll, M.D., Anmed Forces lnSlitUlcofPalhology. "Low grade myxofibrosarcoma." REFERENCES: Men12el T. Edwnrdo C. Waddc:n C. Carnp!ejohn RS, e1 Ill. Myxofibrosarcoma Oinicopalhologic Analysis of75 Cases with limphyxis on the Low·Gradc Varian~ Am J Surg l'ollro/1996; 20(4):391-405, E1•1U1S Iii.. Low Grnde l'ibromyxoid Sarcoma. A n:port of 12 cases. Am J Surg l'orhol 1993; 17:595·600. Kindblom LQ, ct al. lbe Ultrastructure: of Myxofibrosarcoma. A study of II """""- Virclrow Arch A PolhQI Anat Hislo 1997; 381:121-39 C ASE NO. 4, ACCESSION NO. 28141 APRlL1999 IM.ANP CRj..,ajdc;ISan !lqnaa!jno) • Dmnatofi~a prolubcnws (I); Malignant fibroul histiOC)1cma(l) OKJ\NGE - Leiomyosarcoma VAL6NCIA - Flbrosaroomn vs. myolibrosarcoma SANTA ROSA - Leiomyosarcoma (I); MCS01chymal {tumor of skin. nialigrnsnt, oon.•istcnt with leiomyosarooma rio AFX (I); G.I.S.T. ofunlcnO\m malignant pot..,tial (I) SAN DIEGO fNoval Medical Center) - Leiomyuoarcoma ( 10); At)llical fibroxanthoma(l) VENTURA - At)llical fibroxunlhoma (2) LONG BEACH - Leiomyosarcoma (3); DFSP (I) BAY AREA - Leiomyosar DIAGNOSIS: CUTA!VEOUS LEIOMYOSARCOMA, CHEEK TY0300, M88903 REfliRENCI'.S: Dahl I and Angervoll L. Cutaneous rutd Subcutaneous Leiomyosarcoma. A Clinicopathologic Study of 47 PatientS- Pntlrol 6ut 1974; 9(4):307-315. •• Sustcr S. Epithelioid Leiomyosorcoma of the Skin and Subcutaneous lisstJe. Oinieopathologlc. Immunohistochemical. and Uhra' INLAND (Riverside/San Oemardinol • Gastrointestinal stromal tumor of uncertain malignant potential (2) QRANGE • Leiomyosarooma · VALENCIA • GJ.S.T., lci<>myosarooma SANTA ROSA · G.l.S.T. ofund"!ennined malignant potential (3) SAN DIE\J{) DIAGNOSIS: LOW GRADE LEIOMYOSARCOMA, SMALL BOWEL (Director's Note: See I ~ reference below) T64000, M88903 REFERENCES: Miettinen M, Virolainen Mt and Sarlomo-Rikala M. G11SlrOinte..OnaJ Stromal Tumors. Value ofCD34 Antigen in Their Identification and Separation From True Leiomyomos and Schwannomas. dm .I Surg Patho/1995; 19(2):207-216. Min KW. Small Intestinal Stromal Tuniors with Skeinoid Fibers. Clinioopatho!ogical,lmmU(IOhistochemical and )Jitrastrucwrdl Jnvestigntions. Am .I Surg Patho/1992; 16(2}:145-155. Ng EH, Pollock RE, Munsell MF. et al. Prognostic·factors Influencing Survival in Gastrointestinal Lelomyosaroomas. Implications foe Surgical Management and Staging, Ann Surg 1992; 215(1):68-77. Ricci A, Jr., Cicearclli 0 . Canun RW and Newcomb P. A CJinioopathologic and Immunohistochemical Study of 16 PatiollS with Sm•lllntestinal Leiomyosarooma. Limited Utility ofln1munophcnoLyping. Ccmcer 1987; 60(8):1790·1799. CASE NO. 6, ACCESSION NO. 27886 APRIL 1999 INLAND (Rh·ersidc/San Bantvdinol - Well-difl'erentiatcd liposiU1XJma (atypical lipoma) (1); Atypical lipoma ( 1) OBANGE - Wcll-difl'cn:ntia!cd liposarcoma VALENCIA • Liposarcoma SANTA ROSA - Wcll-differcntiDicd liposarooma (3) S4N DIEGO DIAGNOSIS: WELL-DIFFERENTIATED SCLEROSING LlPOSA,RCOMA, INGUINAL REGION TY7000, M88503 REEERENq;s: LUCII$ DR, Nascimento AG, SW.joy BK and Rock MG. Weii-Oiffcrcn!iau:d Uposorooma. The Mayo Clinic Experirooe with 58 Cases. Am J Clin Pot/ro/1994; I02 (5):6n-683. Dalla Palma P and Bnrbal:ia'R. Well-Differentiated Liposarcoma of the P:u-atesticulur an:o. Rcpon of a Cuse with Fine-Needle Aspil'lllion Preopcntive DillgllaSis and Review c>fthe Literature. Dlag C,topatho/1990; 6(6):421-426. Farshid 0 and Weiss SW. Massive Localized Lymphedema in Morl>idly Obese. A Histologically Distinct Reaaivc J.,esion SimulatingLip<>Sarcoma. 1/m J Surg Potho/1998; 22(10):12n-1283. CASE NO. 7, ACCESSION NO. 27968 APRJL 1999 INLAND CRjvmide/San Bernardino> • Malignant peripheral ne.ve sheath twnor (I); NeurofibrosataJcrul ( I) ORANG£ - MPNST, low grade VAlllNC!A - Now-ofibrooarooma with OSSIOOU$ metaplasia SANTA ROSA • Malignant peripherol n1.-rvc sho:uth tumor(!); Malignant mcse:nchymal neoplasm consiste-nt with neural origins, reoommcnd II'OX (I); Cellular neurofibnlmo, rio peripheral nerve sheoth snroomn (I) SAN P IE(){) CNaval Medical Center\ • Malignant peripherol nerve sheath tumor (II) VENTURA - Neurofib DIAGNOS IS: MALIG NANT PERIPHERAL NERVE SHEATH TUMOR, MEDIASTINUM TY2300. M80001 CONS\JJ; I'ATION: Sharon Weis.•, M.D., Emory University. "Malignant •chwannoma." She felt th31 the material Wtl$ metastatic rather than rcl!e"1ing a seOOild primwy and also that the tumor wa.• high pde. Rlifl'lR!lNCES: Moon WK. lm JG, Ham MC. Mali87'ant Schwonnoma of the: Thorax. Cr Findin31- J Comput Assist Tomogr 1993: 17(2):274-276. Pelton J, J!ldckola S. Lebwohl M, Renva!l S, d al. Cellular Differentiation and Expression ofMOirix Genes in Type I Neurofibromatosis. lAb lnvnt 1988; S9(6):760-nl. Un BT. Weiss !.M, Medeiros U. Neurofibroma and cellular neurofibroma with atypia: A n::pon of 14 tumo CASE NO. 8, ACCESSION NO. 27888 APRIL 1999 INLAND (Rjvcrnidt/San Bem!!!dinol - Anaiooarooma (2) ORANGE - Anglosnrcoma VALEJ:IC!A - Anaiosarooma r/o mdaStaSis from papilhuy carcinoma of th)Toid SANTA ROSA - High grade angiosan:oma ( I); Angio DIAGNOSIS: ANGTOSA.RCOMA (Grade II of ill), MAXILLA AND HARD PALATE '1'10170. M91203 RF.fERENCE.<;: Fu Y- S ond Perlin KH. Nonepithelial Tumo~ of the Nasal Cavity, Pttnll1aSa! Sinu.'!CS and N~m. A Clini""fl'llhologjc Study XI. General l'eatures and va.,cular Tumors. Cancer 1974; 33(5): 1275-1288. Heffner OK. Problems in Pediatric Parbolol:Y II. Vaswlnr Tumors and Lesions of the Sinona.al Tract and Nusophllr)11X. lnt J Pt diotr Otorhlnoloryngic 1983:5(2) 12S· I38. Kimura Y, T3!1!lkA S andl'brulcawa M Angiosarcoma of the; N:lsal Cavity. J Loryngol Oto/1992; 106(4):368-369. Kuricn M, Nair Sand ThomiL• S. Angiowooma of the Nll:lal Cavity ond Ma:dllary Antrum. J l.oryngo/oto/1998; 103(9):874-876. CAS£ NO. 9, ACCESSION NO. 28338 APRIL 1999 11\'LANP (Rive!J!jdc/San Bsroardinol • Ewins's sarroma (I); Primitive neuroendocrine tumor (Ewing's) ORANQE • PNET VAL!lNCIA · !!wing's sarcoma vs. PNET tumor SANTA ROSA • PNET (2); Small round-Cell neoplasm consistent wilh periphoral neurooetodermul tumor (I) SAN DIEGO {Naya! Medjc:aJ Ccn!et) • PNET (10); Extraskdctal Ewing's/PNET(I) \'EN1URA · Ewing's SotWma (2) WNG BF..ACii • Ewing's(4) BAY AREA • Ewing!PNET sarcoma (3) MONTEREY CCommWlity Hospj!al of Monterey Peuinsulal - PNET (4} BAKijRSFIELD CSan Jo!l!!ujn Community Hoopjtall • Extra.•kelctal £wing'• sorooma BAKERSFIELD (Central Valley Study Grounl - Ewing's sarcoma HAYWARD CSL Rose H00pitall • Ewing's t~ (also c:aJied malianant small cell tumor of the thoracopulm DIAGNOSIS: PRIMITIVE NEUROENDOCRINE TUMOR (PNET/EWING'SIASKIN), CHEST WALL TY2100, M.92603 REFERENCES: Zucman I, Melot T, Dema7.C C. e1 al. Combinational Gencrution of Variable Fus ion Proteins in the Ewing Family of Tumors. EMBOJ 1993; 12(12):4481-4487. Ladanyi M. The Em INLAND IRivcaid!:/San Banardinol - Chondroma ofsoft potU (2) ORANGe - Myxoid lunl DIAGNOSIS: IJOW GRADE CARTILAGENOUS NEOPLASM, CONSISTENT WITH EXTRA·SKELET AL MYXOID CHONDROSARCOMA, RIGHT BUTTOCK TY 1600, M92203 REFERENCfiS: Payne C, Oordiet I and Mackay B. ExUaSkeletal Myxoid Chondrosarcoma with lotr.u;istemal MiC