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' -.. CALIFORNIA TUMOR TISSUE REGISTRY "GASTROINTESTINAL PATHOLOGY" Study Cases, Subscription A November 2007 California Tumor Tissue Registry c/o: Department of Pathology and Hum110 Anatomy Lorna Linda University School of Medicine 11021 Campus A'•eoue, AR 335 Lorna Linda, California 92350 (909) 558-4788 FAX: (909) 558-0188 E-mail: [email protected] Web page: www.c!tr.org Web site & Case of the Month: www.cttr.org Target audience: Practicing pathologists and pathology residents. Goal: . To acquaint the panicipant with the histologic features ofa variety of benign and malignant neoplasms and tumor-like conditions. Objectives: The. panicipant will be uble to recognize morphologic features of a variety of benign and malignant neoplasms and rumor-like conditions and relate those processes to pertinent references in the medical literature. Educational methods and media: Review ofrepresentative 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: Lorna Linda University School of Medicine designates this continuing medical education activity for a maximum of2 hours of Category I ofthe Physician's Recognition Award ofthe American Medical Association. CME credit is offered for the subscription year only. Accreditation: Lorna Linda University School of Medicine is accredited by the Accreditation Counci l for Continuing Medical Education (ACCME) to sponsor continuing medical education for physicians. 2 Study Cases, November 2007, Subscription A Contributor: LLUMC Pathology Group (mp) Case No. 1 - November 2007 A Lorna Linda, CA Tissue from: Small bowel Accession #30652 Clinical Abstract: A 74 year old woman had a past history of endometrioid adenocarcinoma of the vagina. At a follow-up visi t, a I 0.0 em proximal jejunal mass was discovered. Gross Pathology: A 277 gram, 11 x I I x 6 em mass was attached to a 3 em length of small bowel. The well circumscribed white whorled mass appeared to arise from the bowel wall and did not involve the mucosa. The cut surface showed no necrosis or cystic degeneration. , Special Studies: Negative: CD 34, CD11 7, SIOO Positive: Desmin (strong), Smooth muscle actin (focal) Contributor: Robert Zuch, M.D. Case No. 2 - November 2007 A Baldwin Park, CA Tissue from: Stomach Accession #30593 Clinical Abstract: A 49 year old man presented with nondescript abdominal pain. A gastric biopsy was performed with subsequent gastric resection. Gross Pathology: The gastrectomy specimen had an intact mucosa Detached from the gastrectomy specimen, but submitted with it, was a 1,835 gram, 22 " I 9 x I I em mass. The cut surface was a variegated white-tan. Special Studies: Strongly positive: CD34, CD117 Negative: Desmin Sl\tdy Case.s. November 2007, Subscription A 3 Contributor: LLUMC Pathology G roup (mp) Case No.3 - November 2007 A Lorna Linda, CA Tissue from: Stomach Accession #30708 C linical Abstract: A 79 year old woman presented with upper GI bleeding and was found to have an abdominal mass. Radiographic studies showed a lobulated mass involving the fundus ofthe stomach with central cys ti c change. Gross Pathology: This 6 x 3 x 3 em portion of stomach was attached to an I I x 7 x 3 em spleen. A 6 x 5 x 4 em mural-based nodule extended from the stomach and had a central pale gelatinous area. Special Studies: Positive: CD 117 Contributor: LLUMC Pathology Group (ec) Case No. 4 - November 2007 A Lorna Linda, CA Tissue from: Liver Accession #30576 Cliniclll Abstract: A 35 year old man was found to have a li ver mass. lie had no history of cirrhosis. Gross Pathology: This 16 x 13 x 8 em partial liver resection contained an I 1.7 x 10.0 x 6.5 em solitary, well­ circumscribed yellow-white mass with a lobulated cut surface. The cut surface showed foci of hemorrhage and necrosis. 4 Study Cases, November 2007, Subscription A Contributor: Lester Thompson, M.D. Case No. 5 - November 2007 A Woodland Hills, CA Tissue from: Right ovary Accession #30595 Clinical Abstract: A 65 year old woman presented with right lower quadrant abdominal pain. Ultrasound showed a heterogeneous mass in the right ovary. Gross Pathology: The 8.5 gram ovary was fi1111 with a gray-tan lobulated but smooth surface. The cut surface was edematous and focally hemorrhagic. ' Contributor: Gu.Wermo Acero, M.D. Case No.6 - November 2007 A Ojai, CA 93023 Tissue from: Gallbladde•· Accession #30491 Clinical Abstract: A 72 year old woman was in good health until the evening ofThank sgiving dinner, when she developed right upper quadrant pain. She denied weight loss or systemic symptoms. Radiographs showed gall stones and a possible mass at the tail of the pancreas. At surgery, the pancreas was normal. Gross Pathology: The 8 x 3.5 em gallbladder had numerous calculi and a 2 em indurated gray area at the neck. Study Cases, November 2007, Subscription A 5 Contributor : Lester Thompson, M.D. Case No.7 - November 2007 A Woodland Hills, CA Tissue from: Gallbladder Accession #30602 Clinicnl Abstract: An 87 year old man presented with an acute abdomen. ACT showed a liver lesion which yielded pus on aspiration. Gallstones were noted, along with a thickened gallbladder wall. Gross Pathology: The resected gallbladder was received in multiple fragments, accompanied by a single 4 em diameter calculus. Contributor: Rose Akin, M.D. Case No.8 - November 2007 A Fresno, CA Tissue from: P ancr eas Accession #30767 Clinical Abstract: A 29 year old woman was found to have an abdominal mass. Gross Pathology: The 75 gram, 8 x 7 x 4.2 em specimen included the tail of the pancreas and a portion of stomach. Within the pancreas was a 6.5 x 5.0 x 4 em lobulated mass with a variegated cut surface showing focal hemorrhage and necrosis. · 6 Study Cases, November 2007, Subscription A Contributor: Edgar Fischer, M.D. Case No.9 - November 2007 A Albuquerque, NM Tissue from: Stomach Accession #30411 Clinical Abstract: A 53 year old man presented with non-specific ttpper Gl tract symptoms and was found to have a 10 em mass in the proximal stomach. Gross l'athology: A 10 x I 0 x 4.5 em exophytic mass v.>as present in the proximal stomach, near the gastro­ esophageal junction. Contributor: Ujvala Sawkar, M.D. Case No. LO - November 2007 A National City, CA Tissue from: Cecum Accession #30570 Clinical Abstract: A 73 year old man complained of sudden onset of acute abdominal pain, without accompanying nausea or vomiting. The right lower quadrant was tender to palpation. Gross Patboloey: A 32 em long portion of colon, terminal ileum and appendix included an 8 x 7 x 3 em ulcerated mass in the cecum. Special Studies; Positive: Keratin, CEA Weakly positive: CK7, CK20, Chromogranin Negative: Synaplophysin Study Cases, November 2007, Subscription A ·1 ',;:;:; CALIFORNIA November, 2007 'IVMOR Tissut: RWISTRY \!,!;, Study Cases, Subscription A roup answers due: December 7th) Finalized minutes will be mailed and POSted on the website by the Ist week of December NAME: S\JIV\'1 ~ w \ EO l 'tA DATE:_ ___.:O:L_fc_C...~.o,_~0~3.::.,..1-,.,Jr.,..,.l.IO....J .) C...:3-;I:., - STUDY GROUP {IF Al'I'Y): _______ _____________ EVALUATION: Please circle the best response. ~ I. Technical slide quality: Very Good Average Below Average 2. Did the slides adequately depict the case? All did Most did few did 3. Were the case histories adequate? Usually Sometimes Never General comments:___ _______ _ __________________ DIAGNOSES: . Case Ill (Accession #30652) __...:;L;_ t(,:_'_l :::.O_Il)__:_\ _,_0=---"'- fiL-_____________ _ Case 112 (Accessio11 #30593) _____G=-- \...:S."'--'\'--- ----------------- Cfl,ve #4 (Accessioll #30576) ___\;\.:...:..l<( ;;...~..;.t(fl...-.,;f \J:w...(->.9_,L..;.t ..::(J..:.l_,.~\-L-~{-fl:..J,.,;.I\..,:(;..:., .:.:~'>.:::17.,;..rr>_,fl.~.-___ _ Case 115 (Accessio11 ii30595) ___~,:: (__1.:..,;_.JC.;..'L.=-:.£_r.J_:f>:_:}:_:(I~~:.__:C:..!.Jf]'----------- Case #6 (Accession #30491) Case H7 (Accession #30602)_--!Jlfd~O..lSc!.r-l:.:li~C~'Y\..!..l..!.\..:~-"':..:.;V:....:.;tv'..J((fLLl..______ _______ Case 118 (Aues~" #30767)_....::,0::.;N:.:..~.{ ~.!.I '(.!..--..:.' .:_• _:L:...._:(;:,__JI)"---~_:)~,~-.__:_?_\.!.~:..::.L ~·I)'-!./~~c:.A..u.~~~..!.I.Jf\L!:l'\:1__L_ Case 119 (Acces,vlo" #304 I J) __.,_P\:.::; O...;~c.:N'-'U"---5"-"0._.v...,llr"'"-o.:..:;w.Dl.....,~.:,__,(....Lef\U2Q"-(-"\ "i>i.l1>.ll,!CmC!.I.:f>r~-. ___ Case ff I 0 (Acc<.$sio11 #30570) ___T'f _~_v _n .i.(__:__N O..:.lX..=...:.I\ _11_:_\\.,___C...:A...:__________ _ California Tumor Tissue Registry Objectives: Participants will be able to: c/o Lorna Linda University I) Recognize morphologic features oro variety of benign and School of Medidnc/Dcpa11ment of Pathology malignant neoplasms and tumor-like conditions 11021 Crunpus Avenue, AH 335 2) Relate those processes to pertinent references in the medical l-<>ma Linda, CA 923 50 literature FAX: (909) 558·0188 FACSIMILE TRANSMITTAL SH EET TO: CTTR FROM: STUART SWIEDLER FAX: 415-382-7889 COMPANY: DATE: 12/03/07 FAX NUMBER: 909-558-0 188 TOTAL NO. OF PAGES INCLUDING COVER: 2 NOTES/COMMENTS: November Study Cases attached. Smart J. Swiedler, M.D., Ph.D. Sr. Vice President, Clinical Affairs BioMarin Phannaceuticallnc. 415-506-6706 (Phone) 415-382-7889 (Fax) sswiedler(ti)brnrn.com ********************* *** 'fX REPORT *** ******************'** TRANSMISSION OK TXIRX NO 1900 RllCIPlENT ADDRESS 190955&0188 DESTINATION Ill ST . 'riME 12/03 15:34 TIME USll 00 ' 24 PAGES SENT 2 RESULT OK FACSIMILE TRANSMITTAL SHEET TO: CTTR FROM: STUART SWIEDLER FAJ{:415-382-7889 COMPANY: DATE: 12/03/07 FAX NUMBER: 909-558-0188 TOTAL NO.
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