,, ., 1312.. CALIFORNIA TUMOR TISSUE REGISTRY "GENERAL PATHOLOGY" Study Cases, Subscription B October 1998 California Tumor Tissue Registry c/o: Department of l'nthology and Ruman Anatomy Loma Lindn Universily School'oflV.lcdicine 11021 Campus Avenue, AH 335 Lomn Linda, California 92350 (909) 824-4788 FAX: (909) 478-4188 E-mail: cU [email protected] CONTRIBUTOR: Philip G. R obinson, M.D. CASE NO. 1 - OcrOBER 1998 Boynton Beach, FL TISSUE FROM: Stomach ACCESSION #28434 CLINICAL ABSTRACT: This 67-year-old female was thought to have a pancreatic mass, but at surgery was found to have a nodule within the gastric wall. GROSS PATHOLOGY: The specimen consisted of a 5.0 x 5.5 x 4.5 em fragment of gray tissue. The cut surface was pale tan, coarsely lobular with cystic degeneration. SPECIAL STUDIES: Keratin negative Desmin negative Actin negative S-100 negative CD-34 trace to 1+ positive in stromal cells (background vasculature positive throughout) CONTRIBUTOR: Mar k J anssen, M.D. CASE NO. 2 - ocrOBER 1998 Anaheim, CA TISSUE FROM: Bladder ACCESSION #28350 CLINICAL ABSTRACT: This 54-year-old male was found to have a large rumor in his bladder. GROSS PATHOLOGY: The specimen consisted of a TUR of urinary bladder tissue, forming a 7.5 x 7. 5 x 1.5 em aggregate. SPECIAL STUDfES: C)1okeratin focally positive Vimentin highly positive MSA,Desmin faint positivity CONTRIBUTOR: Howard Otto, M.D. CASE NO.3 - OCTOBER 1998 Cheboygan, Ml TISSUE FROM: Appendix ACCESSION #28447 CLINICAL ABSTRACT: This 73-year-old female presented with acute appendicitis and at surgery was felt to have a periappendiceal abscess. GROSS PATHOLOGY: The 7.0 x 1.5 x 2.0 em hemorrhagic appendix showed a 3.0 x 2.0 em area of hemorrhagic discoloration and possible perforation. Multiple cross sections showed a mucinous growth extending from the lumen onto the serosal surface. CONTRIBUTOR: Chisa Aoyama, M.D. CASE NO.4 - OCTOBER 1998 Sylmar, CA TISSUE FROM: Appendix ACCESSION #28231 CLINlCAL ABSTRACT: This 10- year-old morbidly obese male was fow1d to have an abdominal tumor during surgery for suspected acute appendicitis. GROSS PATHOLOGY: The resected appendix was replaced by a 14.0 x 8.5 x 7.0 em ovoid mass. The cut surface was homogeneously white-tan with focal nodularity and a 1.0 em area of white chalky necrosis. SPECIAL STUDIES: CD3 Negative in neoplastic ceUs CD20 Positive in neoplastic cells CONTRIBUTOR: Douglas Kahn, M.D. CASE NO.5 - OCTOBER 1998 Sylmar, CA TISSUE FROM: Right testicle ACCESSION #28029 CLINICAL ABSTRACT: This 26-year-olcl Hispanic male presented with an enlarged right testicle. An orchiectomy was performed. GROSS PATHOLOGY: The gray- tan testicular tumor weighed 133 grams and measured 12.0 x 6.0 x 5.0 em. CONTRIBUTOR: Robert Riccbmann, M.D. CASE NO.6 - OCTOBER 1998 Covina, CA TISSUE FROM: Left submandibular gland ACCESSION #28229 CLINICAL ABSTRACT: This 80-year-old femole presented with a gradually enlarging neck mass involving the left submandibular gland. GROSS PATHOLOGY: The 6.0 x 2.0 em submandibular gland had a 3.5 em dian1eter well-circumscribed flflll tan­ white nodule at one pole. CONTRIBUTOR: Lorna Linda Pathology Group (kt) CASE NO.7 - OCTOBER 1998 Lorna Linda, CA TISSUE FROM: Left paravaginal r egion ACCESSION #28252 CLINICAL ABSTRACT: This 40-year-old female presented with a left paravaginaVparaeervieal mass discovered on pelvic exam. This was excised at the time of a hysterectomy and bilateral salpingo-oophorectomy. GROSS PATHOLOGY: The specimen was 3.2 x 2.5 x 2.5 em firm, well-circumscribed mass of white soft tissue. SPECIAL STUDIES: Desmin positive S-100 negative CONTRIBUTOR: Laura Williams, M.D. CASE NO.8 - OCTOBER 1998 Stanford, CA TISSUE FROM: Ovary ACCESSION #28199 CLINICAL ABSTRACT: This 85-year-old female presented with lower abdominal pain. On pelvic ultrasound there was a large, complex and panially cystic mass in the pelvis. The CA125 level was elevated at 845. GROSS PATHOLOGY: The specimen consisted of a multilocula!ed intact cystic mass weighing 230 grams and measuring 14.5 x 12.0 x 6.0 em. The outer surface was intact. Cross sections of the cyst wall showed somewhat mucoid, gelatinous, gray-white surfaces. CONTRm UTOR: Sheldon Miller, M.D. CASE NO. 9 - OCTOBER 1998 Ventura, CA TISSUE FROM: Thigh ACCESSION #28320 CLINICAL ABSTRACT : This 48-year-old male presented with a lesion deep in the upper thigh/buttock area, just above the muscle at the gluteal fold. An exeisional biopsy was performed. GROSS PATHOLOGY: The specimen consisted of a finn, nodular, fatty tissue mass measuring 4.0 x 2.7 x 2.0 em. Sectioning revealed a 1.5 em nodular area. CONTRmUTOR: Arthur L. Koehler, M.D. CASE NO. 10 - OCTOBER 1998 Pasadena, CA TISSUE FROM: Right labia ACCESSION #282 26 CLINICAL ABSTRACl': This 75-year-old female presented with a 4.0 em mass in the right labiwn. An excisional biopsy was performed. GROSS PATHOLOGY: This 8 gram 2.9 x 1.9 x 2 .1 em portion of light tan-brown soft tissue was hemorrhagic and nodular. On sectioning there was a hemorrhagic cystic zone and zones of white-yellow nodularity. CALIFORNIA TUMOR T ISSUE REGISTRY GENERAL TUMOR PATHOLOGY Minutes - Subscription B October 1998 SUGGESTED READiNG (General Topics from Recent Literature): The Cellular Basis of Metastasis. Urology 1996. 141-150. Ruiz, P and Gunthert U. Expression ofMyogenic Regulatory Proteins (Myogenin and MyoDI) in SmaU Blue Round Cell Tumors of Childhood. AmJ Pathoii99S; 147: 1799-810. The CDKN2A Tumor-Suppressor Locus-A Tale of Two Proteins. New England.!ounUJ! ofMedicine 1998; 338: 910-912. Clwman, Band Groudinc M. Malignant Small Bowel Neoplasms. Histopathologic Determinants of Recurrence and Survival. Annals of Surgery 1997; 223(3): 300-305. California Tumor Tissue Registry c/o: Department ofPathol ogy and Human Anatomy Loma "Linda University School of Medicine 1102 1 Campus Avenue, AH 335 Lorna Linda, California 92350 (909) 824-4788 FAX: (909) 478-4188 E-mail: [email protected] ., CASE NO. 1 ACCESSION NO. 28434 OCTOBER 1998 CALIFORNIA <G lendale) - Epithelioid GIST CALIE'ORNIA (Oakland) - Gastric stromal tumor ofunce.rtain malignant potential (STUMP} (2) OHlO (Columbus) - Gastrointestinal stromal tumor MICHIGAN (Foote Hospital. Jackson) - Benign stromal tumor TEXAS (Houston) - Gastrointestinal stromal tumor (GIST) of undetermined malignant potential TEXAS (Waco) - Malignant gastrointestinal stromal tumor FLORIDA (Winter Haven Hospital) - Gl stromal tumor, borderline malignant MARYLAND (Baltimore) - Gastric stromal tu mor (leiomyoblastoma) MARYLAND (National Naval Med Ctr. Bethesda) - GIST (uncertain malignant potential) (10); Epithelioid GIST (2). PENNSYLVANIA (Philadelphia) - GI ST, malignant MASSACHUSETfS (Longmeadow) - Gastrointestinal stromal tumor (GIST) undetermined type, potentially malignant MASSACHUSETIS (Medfield) - Malignant hemaogiopericytoma of stomach. MAINE CBangor) - Leiomyoblastoma (GIST) JAPAN (Shimada Citv Hospital) - Leiomyoblastoma, stomach DIAGNOSIS: GASTROINTES TINAL STROMAL TUMOR (GIST) OF UNCERTAIN MALIGNANT POTENTIAL, STOMAC H Director's Note: Before immunostains and the concept of GIST's this tumor was know n as a "Ieiomyoblastoma." T63000, M80 I 03 REFERENCES: Appelman HO. Smooth Muscle ofthe Gastrointestincxal Tract. What We Now Know That Stout Didn "t Know. AmJSurgParhol, Suppll, 1986; 10: 83-89. Van De Rijn, M, Hendrickson MR and Rouse RV. CD-34 Expression in Oasrrointestinul Tract Stromal 1\unors. Hum Pat/101 1994; 25: 766-771. Newman l'L., Walden C. and Fletcher CD. Gastrointestinal Sltomal Tumors. Correlation of lromunophenotype with Clinicopathologic Features. J Patho/1991; 107-117 Lauv.'CfS OY. Erlandson RA. Casper ES, et al. Gastrointestinal Autonomic Nerve Tumors. A Clinicopathological Immunohistochemical and Ultrastructural Study of 12 Cases. Am J Surg Pathol 1993; 17: 887-897. Suster S, Saracen and Moran CA. Oas~rointestinal Stromal Tumors with Prominent Myxoid Matrix. Cl.inicopathologic, Immunohistochemical, and Ultrastructural Study of Nine Cases of a Distinctive Morphologic Variant ofM yogenic Stromal Tumor. Am J Surg Pathol 1995; 19(12): 59-70. Owen CH, Madden JF, and Clavien P-A. Spindle Cell Stromal Tumor of the Pnnaeas. Treatment by Pancreatoduodenectomy. Surgery 1997 122: 105-lll. CASE NO. 2 ACCESSION NO. 28350 OCTOBER 1998 CALIFORNIA (Glendale) -Inflammatory fi bromyxoid tumor CALIFORNIA (Oakland) - Pseudosarcomatous fibromyxoid tumor (2) OHIO (Columbus) - Reactive stroma nodule MICRlGAN (Foote Hospital, Jackson) - Inflammatory myofibroblastic tumor TEXAS (Houston) - Inflammatory myotibroblastic tumor TEXAX (Waco) - Inflammatory pseudotumor FLORIDA (Winter Haven Hospital) - Leiomyosarcoma MARYLAND <Baltimore) - Leiomyoma of urinary bladder vs post-operative spindle cell nodule MARYLAND (National Naval Med ·ctr. Bethesda) - Inflammatory pseudotumor (I I); Sarcomatoid carcinoma ( I) · PENNSYLVANIA (Philadelphia) - Inflammatory pseudotumor MASSACHUSETTS (Longmeadow) - Low grade leiomyosarcoma, bladder MASSACHUSETTS (Medfield) - Inflammatory pseudotumor of bladder MAINE (Bangor) - Pseudotumor JAPAN (Shimada City Hospital) - Pseudosarcomatous fibromyxoid tumor, bladder DIAGNOSIS: PSEUDOSARCOMATOUS FIBROMYXOID TUMOR, BLADDER T74000,M80043 REFERENCES: Nochomobitz LE and Orenstein JH. Inflammatory Pseudotumor of the Urinary Bladder. Possible Relationship to Nodular Fasciitis. Two Case Reports Cytologic Observations and Ultrasrructural Observations. Am .I Surg Patho/1985; 9: 366-373. Proppe KH, Scully RE and Rosai J. Postoperative Spindle Cell Nodules of Gen itourinary Ttact Resembling Sarcomas. AReportof8Cases.