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CAUFORNIA TIJMOR TISSUE REGISTRY

LOMA LINDA UNIVERSITY

PROTOCOL

FOR

MONTIU.Y STUDY SUDES

JANUARY 1995 GENERAL

····~············································································· CONTRIBUTOR: Donald Rankin, M.D, CASE NO. 1-January 1995 Fontana,CA

TISSUE FROM: Nodule, lower back ACCESSION #27618

CLINICAL ABSTRACT:

Historv: This 29-year-old male presented with a 2.0 em. nodule on his lower back, which had been present for several years. A biopsy four years previously was diagnQSed as dennatofibrorna. Since that time the lesion has retmned and continued to expand.

SURGERY: 10/05/94

Excisional biopsy of tbe lower back

GROSS PATHOWGY:

The segment of skin contained a 1. 7 x I. 7 em mushroom-like mass which was partially elevated above tbe surrounding skin. The bulk of tbe lesion was dermal. On cut sections it was fleshy white. CONTRIBUTOR: Karl ADders, M.D. CASE NO. 2 • January 1995 Woodland mus, CA

TISSUE FROM: Left chest wall ACCESSION 1127587

CLINICAL ABSTRACI':

History: This 65· year~ld roan presented '~ith a mass on left chest. The mass had increased in size over several \\~.

SURGERY: 08103/94

Excision of left chest "''3.11 mass.

GROSS PATHOLOGY:

Tbe 5.0 x 3.5 x 3.0 em specimen consisted of fatty breast tissue conlaining a fairly well demarcated 3.2 em gray to yellow nodule. CONTRIBUTOR: M. L. Bassis, M.D. CASE NO. 3 -January 1995 Sao Francisco, CA

TISSUE FROM: uft arm ACCESSION #11000

CLINICAL ABSTRACT:

Historv: This 65-year old, Black, female presented with a two month histozy ofa painful lump in the posterior aspeet of the lett upper arm. The lump was tender but remained unchanged in size. Past histozy included a lymphoma (diagnosed 3 years earlier following lett upper jugular lymph node biopsy) and nodular goiter with partialth}TOidectomy 1 year earlier.

SURGERY: 12/19/67

Excision of mass. posterior aspeet ofthe left ann.

GROSS PATHOLOGY:

A 6.5 x 3.5 x 3.5 em pieoe ofskeletal muscle had a 2.5 x 1.5 em oenlral tough gray interstitial fibrous-like reaction. The muscle suands were still visible throughout most of that region, however. CONTRIBUTOR! Philip G. Robinson, M.D. CASE NO. 4 - January 1995 Boynton Beach, FL

TISSUE FROM: Right neck mass ACCESSION 1#27579

CLINICAL ABSTRACT:

Historv: This 84-year-old Caucasian female presented with a mass in the upper portion of the sternocleidomastoid border on the right side of the neck. The lesion had grown significantly in size for about I 1/2 years. It was hard and appeared to be fixed to surrounding structures. A nasopharygeal and cervical examination did not localize any primary tumors in the oropharyn.x. She had no past history of any neoplastic disease.

SURGERY: 00127/94

Excision of right neck mass.

GROSS PATHOLOGY:

This 3.4 x 2.2 x 1.8 em nodule of reddish tissue had a golden yellow, somewhat lobulated cut surface. The tissue was soft and somewhat friable. CONTRIBUTOR: M. Rose Akin, l\LD. CASE NO. s- January 1995 Lorna Linda, California

TISSUE FROM: Right mulllary-nasal wall ACCESSION NO.: #27460

CLINICAL ABSTRACT:

History: This 58-year-old female presented with a long-standing history ofsinus problems. Her main complainlS ...-ere of sinus headaches and difficulty lmathing through the right side of her nose. She had a history of nasal polyps being removed four years earlier. She now complained of almOst total right nasal obstruction. A huge rigbt nasal polyp was seen on physical examination with almost I 00% obstruction of the right side of the nose. The left side of the nose demonstrated large turbinates but no immediately apparent polyps. CT scan of the paranasal sinuses showed total obliteration of the right ethmoid sinus and a soft tissue density along the right nasal passage with soft tissue extending into the medial aspect of the right maxillary sinus. ·

SURGERY: (January 17. 1994)

Right medial maxillectomy.

GROSS PATHOLOGY:

This 25 gram specimen consisted ofan 8.0 x 7.0 x 2.8 em aggregate of yellow-tan tissue and nasal turbinates with intact mucosa and underlying bone. CONTRIBUTOR: Howard E. Otto, M.D. CASE NO. 6-January 1995 Cheboygan, MI

TISSUE FROM: Left breast mass ACCESSION 1#27602

CLINICAL ABSTRACT:

Histqrv: This 26-year-old female was presented with a palpable lump in the 12 o'clock position of the left breast, which she felt to be more prominent during menses. Ultrasound of the breast showed a solid, non-<:ystic lesion. Patient had used birth control pills for five months, earlier in the year, but had discontinued them prior to noticing the mass. She has no history of breast trauma or infection. She has never been pregnant. Her menarche was at age thirteen. There is no family history ofbreast carcinoma.

Phvsical Examination: There was a 1.5 x 2.0 ern moveable, nontender mass in the left upper outer quadrant.

SURGERY: 07/22/94

Excision ofleft breast mass

GROSS PATHOLOGY:

This 4.5 x 3.5 x 2.3 em multinodular portion of gray tissue had a smooth membranous-like covering over a pale gray, son, papillary cut surface. ~ CONTRIBUTOR: Farooq Ali, M.D. CASE NO. 7- January 1995 Ventura, CA

TISSUE FROM: Left breast ACCESSION #27573

CLINICAL ABSTRACT:

History; This 49-year-old G9, P8·, SAB 1 Hispanic female was evaluated for multiple masses on tlte left breast, the largest of which was diseovered on mammogram one year previously. On ultrasound, tlte largest and some of tlte smaller masses appeared.to be solid. Others of the smaller masses appeared to be cystic. She stated that she had not felt the masses until approximately 4 montlts ago. She reponed that the largest mass and possibly some of the smaller masses appear to be increasing slowly in size and did not fluctuate Vlith her menstrual cycles which she was still having. She has had no nipple discharge and noted no skin changes. She denies ever smoking;or using alcohol or drugs. There is no history of breast cancer in the family.

Phvsical examination: The right breast had a 5 x 5 em mobile, nonctender mass in the 1 o'clock position. Several smaller .masses 2.0, 1.5, and 1.0 em were also palpable. There was no nipple discharge and no puckering or change in skin over the nodules. There was no axillary adenopathy. The right breast was normal without palpable nodes or tenderness.

SURGERY: 07/ 14/94

Excision of left breast mass

GROSS PATHOLOGY:

The specimen consisted of a circumscribed lobular pale yellow and white mass which weighed 13.5 gm and measured 3.8 x 3.0 x 2.8 em. There was gray-pink and white fibroconneciive tissue on the external surface, forming a capsule which was intact over 90% of the mass e.xcept for a 1.0 x 0.5 em area at the base of the mass. CONTRIBUTOR; Mindy Cooper-Smith, M.D. CASE NO. 8 · January 1995 Ojai, CA

TISSUE FROM: Right ovarian mass ACCESSION 1127603

CLINICAL ABSTRACT:

!::IW2!Y: This 17-year-old female presented with an abdominal pelvic mass. Family history is significant for ber 10-year old brother currently undergoing treaunent for lymphoma.

SURGERY: 09/06/94

Right salpingo-oophorcctomy anti appendectomy. Approximately 1400 ml of fluid was removed from the ovarian mass prior to $\ltgical removal.

GROSS PATHOLOGY:

The partially deflated, 18.0 x 15.0 x 12.0 em cyst included a 10.0 x 9.0 x 5.0 em solid area consisting of soft pink tan tissue with central areas of yellow necrosis. The cyst not involved by the solid area was multilocular but one locule predominated. No normal ovary was identified. The e>:temal sudace of the cystic mass was smooth and glistening and did not appear to be invaded by tumor. It bad an attached 12.0 em long, 0.6 em diameter fallopian tube, the fimbriated end of which was suetcbed over the mass. CONTRIBUTOR: Ernest Holbert; M.D. CASE NO. 9 -January 1995 Murrieta, CA

TISSUE FROM: Left calf ACCESSION #27596

CLINICAL ABSTRACT:

History: This 8-year-{)ld female presented with a 6 x 4 em mass in the left calf which had been increasing in size.

SURGERY; .08/01/94

Excision of left calf mass

GROSS PATHOLOGY:

The 8.0 x 5.5 x 2.5 em specimen oonsisted of muscular tissue with an underlying 7.5 x 5.0 x 2.0 em finn, white, partially lobulated mass. CONTRIBUTOR: Richard F. Martin, M.D. CASE NO. 10 - Jaouary 1995 Bamiltoo, OB

TISSUE FROM: Wt brea.!t ACCESSION #27600

CLINICAL ABSTRACT:

HmruY: This 69-year-old woman presented with an enlarging lump on her left breast which she had observed for approximately two months.

SURGERY: 08129/94

Left modified xadical mastectomy

GROSS PATHOLOGY:

The specimen consisted ofthe entire left breast, with axillary dissection. Present in the upper outer quadrant was a 4.5 em diameter white mass. MINUTES

FOR

JANUARY 1995 MONTHLY STUDY SET

"GENERAL PATHOLOGY"

Suggested Reading:

Santa Cruz, DJ (Ed). Tumors Showing Skeletal Muscle Differentiation. Seminars in Diagnostic Pathology. February 1994; Volll(l ). Pathology Patterns. Issues in Carcinoma of the Breastand Prostate. Am J Clin Pathol1994; 102(4) (Supplement 1 thru 57) CASE NO. 1, ACCESSION NO. 17611 JANUARY 1995

SAN BERNARDINO ONLANP> - Giani cell fibroblasiOma ( 4); Keloid wilb recunenllibrous hisliocy!Oma (1}.

LA MESA • Cuuneous fibmus bistiocy!Oma (6}.

LONG BEACH - Hyoliniud dennotofibroma (7).

SAN DIEGO • Fibrobistiocytic lesion favor giant celllibroblastoma (3); Fibrobisliocytic lumor (8).

SANTA BARBARA - Elastolibroma (3)

SAN!A ROSA - Benign fibrocollagenous tumor (keloid like), r/o collage noma (1); Collagenous (connective tissue nevus}, r/o elasloma (1).

OAKLAND - Ancient schwonnomo (2); Sclerosing nevus (2).

PLEASANTON • Keloid (6}; Fibromo (2).

MARYlAND- Pleomorphic fibroma (7); Benign fibroblastic proliferalion wilh mullinucleated giant cells (2}.

NEW JERSEY- Cutaneous fibrous bistioeyiOma, benign (3).

~ -Sclerosing hemangioma (1 ).

OKINAWA. Benign fibrohistiocytic tumor (2); Extra· abdominal desmoid (1).

SACRAMENTO - Keloid (10).

NEBRASKA (OMAHA) ·Hypertrophic scar.

TENNESSEE- Pleomorphic fibroma.

DIAGNOSIS:

GIANT CELL FWROBLASTOMA, LOWER BACK TY11ZO/M69%10

REFERENCES:

Z.mecnik M and Michal M. Giant·Cell Fibrobllstoma witb Pigmented Dermatofibrosarcoma Protuberans Component. Am J Surg Palhol1994; 18(7): 736-740. Connelly JH, Evans HL. Dennatofibrosarcomo Protuberans. A Clinicopathologic Review witb Emphasis on Fibrourcomatous Areas . Am J Surg Potbol, 1992; 16(10): 921-92.5. Dymock RB, Allen PW, StirlingJW, Gilber1 EF, elol Giant Cell Fibroblastomo. A Distinctive, Recurrent Tumor of Childhood. Am J Surg Patbol, 1987; 11{4): 263-271. Abdui-Korim FW, El-Naggar AK, Joyce MJ, el al. Diffuse and Localized Tenosynovial Giant Cell Tumor and Pigmented Villonodular Synovitis. A Clinco-Patbologic and Flow Cytomctric DNA Analysis. Hum Patbol 23; 729-735. Cue 11, Juuaey 1995

JWFERENCFS:

Michal M and Zlmecnik M. Giant Cell Fibroblastoma witb a Denmtofibrosarcoma Protubcrans Component Am 1 Dennatopotbotlm; 14: 549-552. Sbmookler BM, Enzinger FM and Weiss SW. Giant Cell Fibroblastoma. A Juvenile Fonn of Dennatofibrosarcoma Protubcrans. Cancer 1989; 15: 2154·2161. ~ CASE NO. 2, ACCESSION NO. 27587 JANUARY 1995

SAN BERNARDINO QNlANp) • Well-diffexentiated liposarcoma (5).

LA MESA. Pleoi!IOrpbic lipoma (6).

LONG BEACH • High grade liposarcoma (7).

SAN DIEGO· Pleomorphic lipoma (6); Pleomorphic liposarcoma (5).

SANTA BARBARA· Myxoid liposarcoma (3).

SANIA ROSA· Atypical lipoma vs liposarcoma (1); Atypical lipoma, r/o low grade liposatcoma (1).

OAKLAND ·Liposarcoma, weU-diffexentiated ( 4).

PLEASANTON· Lipoma-like liposarcoma (6); Pleomo.rphic lipoma (2).

MARYLAND· Well-diffexentiated (lipoma-like) liposarcoma (8); Pleomorphic lipoma (1).

NEW JERSEY· Liposarcoma (2); Dediffexentiated liposarcoma (I).

JAPAN· Pleomorphic liposarcoma (1).

OKJNAWA - Pleomorphic liposarcoma (3).

SACRAMENTO · Well-differentiated liposarcoma (atypica.llipoma).

NEBRASKA (OMAHA)· Liposarcoma, well-differentiated.

TENNESSEE · Well-differentiated liposarcoma

DIAGNOSIS:

LIPOSARCOMA BREAST, WELL-DIFFERENTIATED T04000/M88513

REFERENCES:

Austin RM and Dupree WB. Liposarcoma of the Breast: A Clinicopathologic Study of20 Cases. Hum Palhol 1986; 17: 906-913. Kristensen PB an~ Kryger H. Liposarcoma of the Breast. Acta Cbir Scand 1978; 144: 193-196. Enzinger FM and Weiss SW. Liposarcoma. In: Soft Tissue Tumors, Edited by StaiiJatbis, G. St. Louis: C.V. Mosby Co., 1988; p. 346-382. CASE NO. 3, ACCESSION NO. %1000 JANUARY 1995

SAN BERNARDINO ·Proliferative myositis (5).

LA MESA . Proliferative myositis (6).

LONG BEACH • Proliferative myositis (7).

SAN DIEGO· Proliferative myositis {11).

SANIA BARBARA · Rhabdomyosarooma (3).

SANTA RQSA • Proliferative myositis (2).

OAKLAND· Proliferative myositis (4).

PLEASANTON • Myositis proliferans (8).

MARyt.AND • Proliferative myositis (9).

NEW 1£RSEY. Fibromatosis (I); Proliferative myositis {1).

JAPAN . Proliferative myositis {1).

Ol

SACRAMENTO • Proliferative myositis.

NEBRASKA (OMAHA) • Proliferative myositis.

TENNESSEE· Proliferative myositis.

FOU,()W.UP:

Patient expired 08/un2.

DIAGNOSIS:

PROLIFERATIVE MYOSITIS, LEFT ARM TY8000/M46780

REfERENCES:

ei·J abbour JN, Wilson GO, Bcnnetl MH, BurJie MM, et al, Flow Cytometric Sllldy of Nodular Fasciitis, Proliferative Fasciitis and Proliferative Myositis. Hum Patbol 1991; 22(11); 1146-1149. Meis JM, &zinger FM. Proliferative Fasciilis and Myositis of Child hood. Am J Surg Patbol 1992; 16(4): 364-372. REfERENCFS:

Lundgten L, Kindblom LO, Wilkms J, Falkmer U, clal. Proliferative Myositis and Fasciilis. A Light and Electron Microscopic, Cytologic, DNA-Cytometric and lmmunobislocbcmlcal Study. APMIS 1992; 100(5): 437-448. CASE NO. 4, ACCESSION NO. 17579 JANUARY 1995

SAN BERNARDINO CIN1AND) • Acinic cell carcinoma. clear cell type (S).

LA MESA· Warthin's tumor with sebaceous melaplasia (6).

LONG B£ACH • Acinic cell carcinoma (5); Oncocytic tumor (2}.

SAN D!EGQ. Low grade papillary adenocarcinoma of salivary gland (8}; Low grade mucocpidemtoid carcinoma (2); Acinic cell carcinoma ( 1).

SANIA BARBARA • Acinic oell odenocarcinoma (3).

SANJ'A ROSA· Papillary carcinoma, variant acinic eel! carcinoma (1); Acinic cell carcinoma, cySlic and papillary type {I).

OAKLAND· A<;iniccell adcnocarcinoma (4)

PLEASANTON· Acinic cell carcinoma (6). Warthin's (2).

MARYlAND- Oncocytoma arising in a Warthin's lumor (7); Oncocytic with papillary features (2). .

NEW JeRSEY- Epithelial-myoepithelial carcinoma (2}; Acinic cell tumor (1).

~ · Monomorphic adenoma(!).

OKINAWA • Acinic cell carcinoma, clear cell variant (3).

SACRAMENTO • Acinic oell carcinoma - low grade.

NEBRASKA COMAHAl - Monomorphic adenoma.

TENNESSEE· Sebaceous lymphadenoma.

OliTSIDECONSULTATION:

John G. Balsakis, M.D.- Tbe tumor is primary in the parotid and generically a clear cell ocoplasm. Its encephaloid protrusion and lobular gro"'1h pattern suggest an epimyoepitbelial carcinoma. Warthin's tumor is also present.

SPECIAL STAINS:

Keratin • no immunoreactivity except in ducts S-100 ·Clear cell are positive Mucin -negative .. c-~.c, Jaalllll')' 199.5

DIAGNOSIS:

EPITHELIAL-MYOEPITHELIAL CARCINOMA, PAROTID T.5.5110/M89820

REfER.ENCES:

CorioJU., Seiubba JJ, Brannon BB, et ol. Epithclioi-Myoepithelial Carcinoma. An lmmu.nocytochemical Srudy. Oral Surg Oral Med Oral Pothol1985; 59: 511-515. Nobjma T, Watanabe S, Sato Y, Kameya, et al. An lmmunoperoxidase Study of S-100 Protein Distribution in Normol and Neoplastic Tissues._Am J Surg Palhol 1982; 6: 715-727. Carlo RL, Sciubba JJ, Brannon RB and Batsakis JG. Epitheliai-Myoepitbeliol Carcinoma of Intercalated Duct Origin. Oral Surg, Oral Med, Oral Potbol 1982; 53: 280-287. Pogral MA and Hansen LS. Second Primary Tumor Associated with Salivary Oland Cancer. Oral Surg, Oral Med, Oral Pathol 1984; 58: 71-75. Luna MA, Ordonez NO, Mackay B, Batsakis JG, eta!. Salivary Epithelial-Myoepithelial Carcinomas of Intercalated Ducts. A Clinical, Electron Microscopic and Immunocytochemical Study. Oral Surg. Oral Med, Oro! Potb 1985; 59: 482-490. CASE NO. !!, ACCESSION NO. 11460 JANUARY 1995

SAN BERNARDINO lJNLAND) • Schneiderian (inverted) pa.pilloma (4); Schneiderian papilloma with c1n:inoma in-situ (1).

LA MESA- Scbneiderian papilloma (6).

LONG BEACH • Scbneiderian papillom• (?).Cylindrical cell papilloma (12).

SAN DIEGO- Cylindrical cell papillom1 (12).

SANTA BARBARA- Scbneideri•n p1pilloma (3).

SANTA ROSA- Inverting papilloma, r/o odd form fungiform papilloma (I); Schneiderian papilloma, fungiform type (1). ·

OAKLAND - Scbneiderian papilloma (4)

PLEASANTON • Scbneiderian polyp or papilloma (8).

NEW JERSEY - Schneiderian papilloma (3).

MARY1AND- Cylindrical cell papilloma (7); Inverted (Scbneideri1n) papilloma (2). lAf6H- Inverted papilloma (I).

OKINAWA - Sebneiderian papilloma (3).

SACRAMENTO- Cylindrical cell papilloma.

NEBRASKA

TENNESSEE- Inverted papillom1.

FOJ,LOW-UP:

The patient is doing well and bas bad no complaints.

DIAGNOSIS:

SCHNEIDERIAN PAPrLLOMA, RIGHT MAXIlLARY NASAL WALL TlXllO/M81210

REfERENCES:

Ridolfi R, Lieberman PH, Erlandson RA, and Moore OS. Scbneiderian Papillomas- A Clinicopathologic Study of30 C.ses. AmerJ Surg Patbol1977; 1{1): 43-53. Welch TB, Barker BF 1nd Williams C. Peroxidase-Anliperoxidase Evaluation of Huma.n Oral Squamous Cell P•pillomas. Oral Surg 1986; 603-6()6. .. ca.e ~. Jaawory 1995

REFERENCES:

Norris HJ. Papillary Lesions oftbe Nasal Cavity and Para-Nasal Sinuses. Part I. Exophytic (Squamous) Papillomas. A Study of28 Cases. Laryngoscope 1962; 72: 1784. Norris HJ. PapillaJ}' I..uioru oftbe Nasal Cavity and Para-Nasal Sinuses. Pan D. Inverting Papillomas. A Study of29 Cases. Laryngo!COpe 1963; 73: 1. Mukai K. Scbollmeyer JV and Rosai J. Immunohistocbemic.•l Localization of Actin. Applications in . Am J Surg Patbol1981; 5(1): 91-97. CASE NO. 6, ACCESSION NO. 27602 JANUARY 1995

SAN BERNARDINO ONl..AND) • Pbyllodes tumor, benign (S).

LA MESA • low ·grade pbyllodes tumor (6).

LONG BEACH· Phyllodes tumor of low grade malignant potentitl (7).

SAN DIEGQ • Pbyllodes tumor (3); Berugn pbyllodes tumor (3); Borderline phyllodes tumor (4); Malignant pbyllodes tumor (2).

SAN]'A BARBARA· Berugn pbyllodes tumor (3).

SAN]'A ROSA • Pbyllodes tumor (2).

OAKLAND • Pbyllodes tumor ( 4).

PLEASANTON. Phyllodes tumor, high grade (4); Phyllodes tumor, low grade (4).

MABYlANJ) • PbyUodes tumor, low grade (9).

NEW /ERS.EY · Phyllodes tumor, mtligntnt (3).

JAPAN · Benign pbyllodes tumor (1).

OKINAWA • Pbyllodes tumor (3).

SACRAMEJI!TQ • Benign pbyllodes tumor.

NEBRASKA COMAHAl · Pbyllodes tumor, benign.

TENNESSEE· Phyllodes tu.mor of borderline malignAncy.

OUTSIDE CONSULTATION:

Charles N. Jknayan, M.D. · Phyllodes tumor oftbe breest.

DIAGNOSIS;

PHYLLODES TUMOR, BREAST T0400/M90201

REfERENCES:

Hiraoka N, Mukai M, Hosoda Y,and Hata J. Phyllodes Tumor of the Bre.ast Containing the lntucytopltsmic Inclusion Bod ies Identical with Infantile Digi ..l Fibromatosis. Am J Surg Pathol1994; 18(5): S06-Sl1. Wud RM, Evans HL. CyslosaiCOma Pbyllodes: A Clinicopathologic Study of 26 CaS<:S. Cancer 1986; S8: 2282-2289. REfERENCES:

Pietruszka M. Barnes L. CystosaJCOtrul Phyllodes: A Clinlcopalbologic Analysis of 42 Ca6Cs. Cancer 1978; 41: 1974-1983. Kessinger A, Foley JF, Lemon HM, and Miller OM. Cytosarcoma Pbyllodes. A Case Report and ReviewoftbeUterature. JSurgOnc 1972; 4: 131-147. Pollard SG, Marks PV, Temple LN, and Thompson HH. Breast . A Oinicopatbologic Review of 25 Cases. Cancer 1990; 66: 941-944. CASE NO. 7, ACCESSION NO. 17573 JANUARY m.s

SAN BESNARPINO CJ.NlAND) - Fibroadenoma (5).

LA MESA · Cellular ('Juvenile' ) fibroade.noma (6).

LONG BEACH • Pbyllodes tumor, benign (5); Giani fibroadenoma (2).

SAN DIEGO · Cellular fibroadenoma (7); Benign pbyl!odes tumor (6).

SANTA BARBARA· Fibroadenoma, intraeanicular (3).

SANTA ROSA· Giant fibroadenoma (t); Fibroadenoma (1).

OAKLAND- Fibroadenoma ( 4).

PLEASANTON -Fibroadenoma (7); Phyllodes tumor (1).

MARYI.ANP - Cellular fibroadenoma (9).

NEW JERSEY · Pbyllodes tumor, benign (2); Fibroadenoma (I).

~ ·Fibroadenoma (1).

OKINAWA • Fibroadenoma (3).

SACRAMENTO · Fibroadenoma (9); Benign pbyllodcs rumor (I).

NEBRASKA (OMAHA) • Fibroadenoma.

TENNESSEE· Fibroadenom•.

FOLI,QW-UP:

The patient's wound is doing well.

DIAGNOSIS:

JUVENILE FIBROADENOMA, BREASf T04000/M90300

REfERENCES:

Brean K, Tron VA, Cburg A, Clement PB. Mammary Fibroadenoma with Mullinuclealed Slromal Giant Cells. Am J Surg Palbol 1986; 10: 823-827. Pike AM and Obennan HA. Juvenile (Cellular) Adenofibromas. A Clillicopatbologic Study. AmJ Surg Pathol 1985; 9(10): 73().743. Miel C and Rosen P. Juvenile Fibroadenoma with Atypical f9itbelial Hyperplasia. Am J Surg Polhol 1987; 11(3): 184-190. CASE NO. 8, ACCESSION NO. .Z7603 JANUARY 199S

SAN BERNARDINO (INLAND)- Papillary adenocarcinoma, NOS (4); Oxyphilic clear cell careinoma (1).

LA MEsA- Cysudenoc~reinoma (6).

LONG BEACH- Adenocareinoma with endometrioid features (7).

SAN DIEGO- Papillary adenocarcinoma (4); Endometrioid adenocarcinoma (1); Serous papillary carcinoma (7).

SANJA BARBARA - Papillary adenocarcinoma (3).

SANTA ROSA- Papillary hurtle cdl neoplasm (ex struma ovarii?) (1); Papillary carcinoma, probable endometrial carcinoma, r/o hepatoid carcinoma and malignant struma ovarii (1).

OAKLAND - Adenocarcinoma, NOS (3); Serous papillary adenocareinoma (1).

PLEASANTON - Endometrioid carcinoma (5); Adenocarcinoma, NOS (2); Papillary serous carcinoma, high grade, oncocytic change (1).

MARYU\ND- Mixed serous and mucinous carcinoma (6); Mucinous carcinoma (2); Metastatic colonic adenocareinoma (1).

JAPAN- Endometrioid carcinoma (1).

OKINAWA - High grade serous papillary careinoma (3).

SACRAMENTO- Serous carcinoma at LMP with foci at invasion.

NEBRASKA (OMAHA) - Mucinous cystadenocarcinoma.

TENNESSEE- Endometrioid adenocarcinoma.

SPECIAL STAINS:

Mucicarmine- positive.

DIAGNOSIS:

MUCINOUS CYSTADENOCARCINOMA, OVARY T87000/M84703 Cue II, Jaauary 19t5

REfERENCES:

Nictolis M, Montironi R, Tommasoni S, Valli M, etal. Benign Borderline, and Well­ Differentiated Malignant Intestinal Mucinous Tumors of the Overy: A Clinicopathologic , Histochemical. lmmunobistochemical, and Nuclear Quantitative Study of 57 Ca~s . lnt J Gynecol Patbol 1994 13(1): 10-21. Fenoglio C.M., Ferenczy A, Richart R.M. Mucinous Tumors ofthe Ovary. Ultrastructural Studies of Mucinous CySIIdenomas wilb Histogenetic Considerations. Cancer 1976; 36: 1709-1722. Hut WR. Norm HJ. Borderline and Malignant Mucinous Tumors oftbe Ovary. Cancer 1973; Cancer 31: 1031-1045. NIH Consensus Conference. Ovarian Cancer. Screening, Treatment, and Follow-up. JAMA 1995; 273(6): 491-497. Rutgers JL and Baergen RN. Mucin Histochemistry of Ovarian Borderline Tumors of Mucinous and Mixed-Epithelial Types. Modem Pathol 1994; 7(8): 82$-82-ll, CASE NO. 9, ACCESSION NO. 17!% JANUARY 1995

SAN BERNARDINO (INLAND) - Embryonal rbabdomyomcoma (3); Primitive neuroectodermal tumor (2). '

LA MFSA- Small round cell tumor, favor primitive neuroepithelial tumor (6).

LONG BE'ACH- Alveolar (7).

SAN DIEGO - Malignant blue cell tumor of childhood (12).

SANTA BARBARA- Embryonal rhabdomyosarcoma (3).

SANTA ROSA- Rbabdomyosarcoma·(?)(l); Small round cell malignancy c/w rhabdomyosarcoma, r/o lymphoma, soft tissue Ewings, etc. ·

OAKLAND - Embryonal rhabdomyosarcoma ( 4).

PLEASANTON - PNET or Ewings tumor (3); Small blue ceU tumor. Needs stains ( 4). Alveolar rbabdosarcoma (1).

MARYlAND - Rhabdomyosarcoma (alveolar type) (8); PNET (1).

NEW JERSEY - Probable embryonal rhabdomyosarcoma (3).

JAPAN- Embryonal rhabdomyosarcoma (1).

OKINAWA - Extraskeletal Ewings sarcoma (2); PNET (1 ).

SACRAMENTO -Alveolar rhabdomyosarcoma.

NEBRASKA (OMAHA) - Primitive neuroectodermal tumor (PNET):

TENNESSEE- PNET.

FOLLOW-UP:

Patient doing fine and continuing radiation treatment.

OliTSIDE CONSULTATION:

Sharon Weiss, M.D., The Hospital : Alveolar rhabdomyosarcoma.

SPECIAL STAINS:

Desmin and actin - positive. MIC-2 (gene product)- positive..

' DIAGNOSIS:

ALVEOLAR RHABDOMYOSARCOMA, LEG TY9400/M89l03

REFERENCES:

Parbom D, Shapiro DN, Downing JR, Webber BL, etal. Solid Alveolar with the t(2;13). Report of Two Cases with Diognostic Implications. AmJ Surg Pathol 1994; 18(5): 474-478. Asmar L, Oehan EA, Newton W A. WebOer BL, etaI. Agreement Among and Within Groups of Palbolo~IS in the Classification of Rhabdomyosan:oma and Relattd Childhood . Report of an lntemolional SIUdy of Four Palbology Classif.cations. Cancer 1994; 74(9): 2579-2588. Kilpatric k SE, TeolLA, Geisinger KR, Martin Pl., eta). Relationship of DNA Ploidy 10 Histology and Prognosis in Rbobdomyosan:oma. Comparison of Flow Cytometry and Imoge Analysis. Cancer 1994; 75(12): 3227-3233. Parham DM and Jenkins, 11111. Short Course: Pathology of Selected Pediatric Embryonal . Modem Pathology 1994; 7(4): 501-519. (Nott: Desmin and MSA have been found to be the most useful. Cytogenetic studies indicate that a cbromosonaltranslocation, t (2; 13) (q 35; q 14) is specific for rbabdomyosarcotnl and is reslricttd to lbc alveolar subtype.) CASE NO. 10, ACCESSION NO. %7600 JANUARY 1995

SAN BERNARDINO UNLAND)· Metaplastic ~rcinoma (4); Cbondrosarooma (1).

LA MESA. Primary cbondrosaocoma vs cystosarcoma with chondroid and focal osteoid differentiation vs carcinoma with sarcomatoid features (6).

LONG BEACH • Metaplutic ~rcinoma (7).

SAN DIEGO· High grade saocoma (2); Metaplastic ~rcinoma (9).

SANTA BARBARA • Metaplastic carcinoma (3).

SANIA ROSA· Metaplastic carcinoma type ll (I); .Metaplastic carcinoma (1).

OAK!..AND · Metapl astic carcinoma (4)

PLEASANTON • Metaplastic carcinoma, high grade (7); Sarcoma (1 ).

MARXLAND · Metaplastic ~rcinoma (9).

NEW JERSEY· Carcinosarcoma (2); Osteogenic saocoma (1).

~.Metaplastic ~rcinoma (1).

OKINAWA • Metaplastic ~rei noma (3).

SACRAMENTO - Chondrosarcoma.

NEBRASKA

TENNESSEE· Chondrosarcoma.

SPECIAL STAINS:

Keratin· spottily present in spindle cells and cartilage. S-100 ·spottily present in spindle cells, not in cartilage .

DIAGNOSIS:

METAPLASTIC ADENOCARCINOMA, BREAST T04000/M81406

REfERFNCES:

Pal•~·Wessel s C, Gown AM, Wang E, and Coltrera MD. lmmunocytocbeotical Detection of Stalin, a Nuclear Protein of 0 0 Phase, in Human Breast Cancer Tissues. Correlation with Expression of Proliferating Cell Nuclear Antigen and Markers of Clinical Outcome. Appl lmmunobistocbem 1994; 2(4): 248-253. • Case 110, J IUIWII')' 1995

REFERENCES:

Cody HS and Urbt11 JA. Internal Mammary .Node Stilus. A Major Prognosticator in Axillary Node-Negative Breast Cancer. Ann Surg Oncol1995; 2(1): 32-37. Foochini MP, Dina RE. Eusebi V. San:omatoid Neoplasms of the Breast: Proposed Deficitions for Biphasic md Monophasic Sarcomatoid Mammary Carcinomas. Semin Diag Patbol 1993; 10(2): 128- 136. Picardo M, Schor SL Grey AM, Howell A, et aJ. Migration Stimulating Activity in Serum of Breast Cancer Patients. Lancet 1991; 337: 130-133. Fineberg S, Rosen PP. CUtaneous Angiosan:oma and Atypical Vascular Lesions of the Skin and Breast after Radiation Therapy for Breast Carcinoma. Am J Clin Pathol of 1994; 102(6): 757-763. Sneige N, Fornage BD, Saleh G. 1Jltrasound ·Guided Fine Needle Aspiration of Non-Palpable Brust Lesions: Cy1ology and Histologic Findings. Am J Clin Patholl994; 102: 98-101. Fisher B, Anderwn S, Fisber ER, Redmond C, etaI . Significance of Ipsilateral Breast Tumor Rec:unence After Lllmpectomy. Lancet1991; 338: 327-331. Hartman LC, Marschke Jr, RF, Ingle JN. Systemic Adjuvant Therapy in Wome.n with Resected Node-Negative Breast Cancer. Mayo Clin Proc 1991; 66: 805-813. Casey TT, Rogers WH, Baxler JW et al. Stratified Diag~~ostic Approach to Fine Needle Aspiration of the Breast. Am J Surg Patbol 1992; 163: 305-311. Feuer FJ, Wan LM, Bouing CC, Flanders WD, etal. lbe Lifetime Risk of Developing Breast Cancer. JNCI 1993; 85(11): 892-897. Faverly 0, Holland R, Burgers L. An Original SteromicroscopicAnalysis oftbe Mamma.ry Glandular Tree. Vircb Arch Patbol Anat1992; 421: 115-129.