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View PDF (Sem1288.Pdf) .. * * * * * * * * * * * * * * * * * * * * * * * * * * CALIFORNIA TUMOR TISSUE REGISTRY LOS ANGELES COUNTY - UNIVERSITY OF SOUTHERN CALIFORNIA MEDICAL CENTER PROTOCOL For MONTHLY STUDY SLIDES JUNE 1976 MYOENDOMETRIAL TUMORS PART I * * * * * * * * * * * * * * * * * * * * * * * * * * CONTRIBUTOR: Roy L. Brynes, M.D. JUNE 1976 - CASE NO. 1 South Coast Community Hospital South Laguna, California ACCESSION NO. 21178 TISSUE FROM: Uterus CLINICAL ABSTRACT: This 83 year old Caucasian female was seen for a complaint of vaginal bleeding. of one week's duration. Six months previously she had a similar problem, but a pelvi c exam disclosed a large benign polyp, which was removed. The PAP smear at that time was negative. A pelvic exam on this admission showed r edundant vaginal mucosa, making visualization of the cervix imposs i ble. A D&C on frozen read as 11 "sarcoma • SURGERY: (December 1974) A hysterectomy and bilateral salpingo-oophorectomy were performed. GROSS PATHOLOGY: The uterus wei ghed 200 gr ams and measured 10 x 42 x 3.5 em . The serosa was smooth, but a massive pedunculated irr egular tumor protruded into the endcmetrial cavum. The endometrial cavum measured 6.5 x 4.5 x 4.0 em., was soft gray-whit e with encephaloid features. It was also ulcerated and hemorrhagic in one area, and was attached by a broad stalk to the anterior fundus, rather high near the apex. The tumor had a pushing border with little gross invasion of the subjacent myometrium. FOLLOW-UP: This pat ient underwent a cholecystectomy February 1976, and at that time no recurrence was present. The patient was last seen April 1976, with no evidence of recurrence. CONTRIBUTOR: J. R. Craig, M.D. JUNE 1976 - CASE NO. 2 Saint Luke Hospital Pasadena, California ACCESSION NO. 21333 TISSUE FROM: Uterus CLINICAL ABSTRACT: Thir, 67 J"t':a.r old female complained of spotting and occasional heavy flow of l to 2 months f duration. She also had occasional left lower ab­ dominal pain and dysuria. There were no other complaints besides easy fatigP.l:ility. A PAP smear 3 months preYious was negative. On physical examination a huge irregular pelvic mass, which reached the umbilicus, was palpated. It was most pronounced on the right. The IVP showed dilatation of the upper ureter and renal pelvis. The barium enema was negative. The tentative diagnosis was a large uterine fibroid. SURGERY: (March 1975) A hysterectomy with a right salpingo-oophorectomy was performed. GROSS PATHOLOGY: The total specimen weighed in excess of 1000 grams. It measured 18 x 14 x 10 em., and externally was multilobulated and wrinkled with necrotic tumor subjacent. The myometrium contained multiple smooth muscle tumors measuring 2 to 6 em. in diamter as well as the large necrotic, creamy­ white hemorrhagic tumor, which extended from the myometrium to within a few millimeters of the serosa. The bulk of the tumor was located anteriorly near the endocervical area. FOLLOW-UP: The patient is thriving on Depo Provera. The pelvic exam was negative in March 1976. CONTRIBUTOR: Robert E. Wybel, M.D. JUNE 1976 - CASE NO. 3 Greater Bakersfield Memorial Hospital Bakersfield~ California ACCESSION NO . 20676 TISSUE FROM: Uterus CLINICAL ABSTRACT: This 67 year old female developed postmenopausal bleeding while on estrogen therapy,vhich ·she had been taking f or some time. On physical examination the uterus vas atrophic. However, peculiar whit ish mucoid material was curetted from the uter ine cavity~ not from the cervix. SURGERY: (March 1974) A hysterectomy, right salpingo-oophorectomy, left oophorectomy and partial omentectomy were performed. GROSS PATHOLOGY: The uterus weighed 53 gms., 7.5 em. long and vas sounded to 6.5 em. At the fundus it was measured at 4~ 1 x 2.5 em. The entire endometrial cavity was fill ed with a degenerated appearing , tan, polypoid, irregular mass which measured 4.5 x 3.0 x 1.2 em. On section, it was mottled yellowish gray white with a generally extremely soft consistency, but did have firm areas. There was only superficial infiltration of the underlying myometrium. At the junction of the upper end of t he cervix and the lower uterine segment, t here was a 1.0 em. diameter out pouching into the l eft lateral aspect of the uterine wall and a portion of t he tumor projected i nto the defect. FOLLOW-UP: The patient was seen on December 2 , 1975 and was free of any significant di sease. CONTRIBUTOR: E. G. Edwards, M. D. JUNE 1976 - CASE NO . 4 Santa Ana Community Hospital Santa Ana, California ACCESSION NO. 19101 TISSUE FROM: Uterus CLINICAL ABSTRACT: This 78 year old female noted vaginal bleeding over a period of several months, increasing in severity. An endometrial curetting was performed, yielding about 60 gms. of hemorrhagic gray tissue fragments, which were rather large, measuring up to 5 em. SURGERY: (March 1971) A hysterectomy and bilateral salpingo-oophorectomy were performed. GROSS PATHOLOGY: The specimen consisted of a large uterus with ce~vix, weighing 225 gms. and measuring 10.5 x 8~5 x 8.0 em. The serosa was smooth and on sectioning the myometrium and anterior wall were markedly thinned, measuring at most 0.8 em. In the endometrial cavity was a large necrotic tumor, yellow-red on secti on, which measured 7 x 4 x 4 em. FOLLOW-UP: This patient was seen in 1974 and physical examination, including a PAP smear, was negative. CONTRIBUTOR: Francis Buck, M.D. JUNE 1976 - CASE NO . 5 Los Angeles County Hospital Los Angeles, California ACCESSION NO. 11713 TISSUE FROM: Uterus CLINICAL ABSTRACT: This G III, P I, 20 year old female delivered a normal full term male infant on September 17, 1959. The placenta was unremarkable. One month later, vagianl bleedfng necessitated a curettage. Products of conception were seen. Two weeks later, persistent vaginal bleeding again necessitated hospitalization. A positive pregnancy test was obtained a week lat er. On November 24, 1959 she was admitt ed to LACH in shock with profuse vaginal bleeding. She was st abilized and transfused. Physical examination revealed abdominal pain. Uterine curettage and culdoscopy were perf ormed. On the next day profound shock again developed and an emergency laparotomy was performed. A large ruptured cyst of the right ovary and an intra-abdominal hemorrhage were found. The left ovary also appeared cystic and the uterus was enlarged to the size of a two months' gestati on. A right salpingo-oophorectomy and a left ovarian cystectomy were performed. Laboratory and X-ray reports: · Urinary HCG titer, using animal assay, ) was found greater than 10,000 but less than 40,000 I.U. per liter. A post­ laparotomy chest x-ray revealed bilateral metastatic nodules. SURGERY: (December 12, 1959) A hysterectomy and a left salpingo-oophorectomy were performed. GROSS PATHOLOGY: Hemorrhagic, friable necrotic tumor was found in the uterus and fallopian tube. FOLLOW-UP: Postoperative (2 1/2 weeks) gonadotrophin levels were reported as being between 40,000 and 200,000 I. U. Methotrexate therapy was begun and levels were less than 10,000 on January 4, 1960. Within 5 weeks after institution of therapy, the assays were negative until September of 1961. At that time the assays were reported as over 1,000 but under 10,000 I. U. per liter. Chest radiographs in 1961 and 1966 were negative as was t he serum HCG. In 1974 a 2 em. left breast mass, read as intraductal papillomatosis, was removed. CONTRIBUTOR: Avram Jacobson, M.D. JUNE 1976 - CASE NO. 6 Beverly Glen Hospital Los Angeles, California ACCESSION NO. l8515 TISSUE FROM: Uterus CLINICAL ABSTRACT: This 34 year old female was admitted with a history of vaginal bleeding and not feeling well. She was a gravida III, para II with a delivery expected in about 4 months. The two previous deliveries were normal. No fetal heart tones were heard and examination of the abdomen revealed an enlarged uterus. The pelvic radiograph revealed no fetal parts. However, chest radiograph revealed 2 rounded nodules in the ·lung fields. The first HCG titer was greater than lOl,OOO I.U. SURGERY: (February 1970) • An abdominal hysterecto~ was performed. GROSS PATHOLOGY: The specimen consisted of a 15 x lO x 7 em. uterus. The endo­ metrial cavity was filled with grape-like struct ures, measuring ) around 1 em. Areas of the tissue were yellowish and somewhat lobulated. FOLLOW-UP: Following surgery she received Methotrexate for 5 days but was soon r eadmitted with a history of chest pain. Another chest radiograph re­ vealed additional pulmonary metastases. The HCG was greater than 23,000 but less than 34,650 I.U. She received 2 more courses of Methotrexate with resultant decrease in HCG to less than 1,000. The final chest radiograph showed some resolution of the pulmonary metastases. CONTRIBUTOR: Donald Alcott, M.D. JUNE•I 1976 - CASE NO. 7 Santa Clara Co . Hospital San Jose, California ACCESSION NO. 14603 TISSUE FROM: Endometrium CLINICAL ABSTRACT: History: This 72 year old gravida II, para II Caucasian female was approximately 20 years postmenopausal. In June 1964, a diagnostic D&C was performed because of intermittent vaginal spotting. The microscopic report included chronic endocervicitis, chronic endometritis and senile atrophy of the endometrium. The clinical diagnosis was that of cervical stricture and uterine procidentia. The patient was followed for 15 months during which time her symptoms recurred. Green purulent material re­ accumulated within the uterine cavity, which on culture grew anaerobic streptococci. SURGERY: (September 1965) An elective hysterectomy was performed. GROSS PATHOLOGY: The uterus measured 8.5 x 5 x 3 em. and showed a normal external surfacf The cervix measured 3.2 em. in length. The os was patulous and the canal was now patent. The myometrium measured up to 2.5 em.
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