CALIFORNIA TUMOR TISSUE REGISTRY "LUNG AND MEDIASTINAL PATHOLOGY" Study Cases, Subscription A October 2000 California Tumor Tissue Registry do: Department of l'atbology and Human Anatomy !Alma Linda Universily School of Medicine 11021 Campus Avenue, AH 335 Lorna Linda. California 92350 ' (909) 558-4 788 FAX: (909) 558-0188 E-mail: £[email protected] Target audience: Practicing pathologists and pathology resideniS. Goal: To acquaint the participant with the nisrologic f""tures ofa variety of benign and malignant neoplasms and rumor-like conditions. Ob!eetlves: 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 pertinent references in the medical literature. Educational methods and media: Review of representative glass slides 'vith associated biSiories. Feedback on consensus diagnoses from participating pathologiSIS. l.isting of selected references from dJeJDedicalliterature. Principal faculty: Weldon K. Bullock, MD Donald R. Olase, MD CME Credit: Lorna Linda University School of Medicine designates this continuing medical education activity for up to 2 hours ofCategory r ofthe Physician's Recognition Award ofthe American Medical Association. CME credit is o.frered for lhe subscription year only. Accreditation: Loma Linda University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing medical education for physicians. Contributor: Charles I. Goldsmith, M.D. Case No. 1 - October 2000 Santa Monica, CA Tissue from: Left pleura Accession #28892 Clinical Abstract: While being evaluated for pneumonia, this 56-year-old man was noted to have a pleural-based mass on the left side. One year earlier a chest x-ray had been normal. A 6.5 em mass was resected along with attached parietal pleura. During routine follow-up eight years later, a CT scan revealed a Tecurrent disease in the form of multiple pleural nodules. These were resected. Gross Pathology: An en bloc resection of ribs and soft tissue included three tumor nodules up to 2.5 em in greatest diameter. SPECIAL STUDIES: CD34 moderate to strongly positive Vimentin strongly positive CD31 weakly positive Keratin negative SIOO negative Actin negative Contributor: Paul Meyer, M.D. Case No. 2 - October 2000 Los Angeles, CA Tissue from: Pleura Accession #26863 Clinical Abstract: After working for 40 years as a Longshoreman, with numerous exposures to asbestos, this 68- year-old man presented with a two week history ofdifficulty breathing. Following biopsy, be was sent home with oxygen. After a second attack of shortness of breath, he was re-admitted and expired one week later. An autopsy was performed. Gross Pathology: Autopsy findings included a tumor involving mediastinum, pericardium and left pleura along with multiple pleural plaques on the left side. Contributor: K. Greg Peterson, M.D. Case No. 3 - October 2000 Sioux Falls, SD Tissue from: Mediasti.num Accession #28905 Clinical Abstract: Following a one-year history of left shoulder pain, this 11-year-old girl was found to have no breath sounds on her left side. ACT sean showed a left sided mass with calcifications. At surgery, a left sided mediastinal mass was found compressing the left lung. The tumor had ruptured and caused a local reaction making the resection difficult due to adhesions. Gross Pathology: A 730 gram shaggy but encapsulated~ was 14.5 x I 0 x 9.5 em. The cut surface showed variegated, multicystic fibroadipose tissue with focal calcification and larger cysts containing grumous yellow-tan material. Contributor: Pamela Boswell, M.D. Case No. 4 - October 2000 Sa.n Diego, CA Tissue from: Mediastinum Accession #28751 Clinical Abstract: This 33-year-old female was found to have a large anterior mediastinal mass. Gross Pathology: The I 0.0 x 2.0 x 1.0 em fatty specimen included a 5.0 x 5.0 x 5.0 em mass. Contributor: LLUMC Pathology Group (np) Case No. 5 - October 2000 Loma Linda, CA Tissue from: Right lung Accession #28725 Clinical Abstract: A lobectomy was performed on this 70-year-old male with a right upper lobe mass. Gross Pathology: The 224 gram lobe contained a 5.1 x 4.1 x 4.0 em firm, yellow mass within the largest bronchus. The mass extended peripherally to the pleura. SPECIAL STUDIES: Chromogranin 1-2+ NSE 4+ CAM5.2 4+ Contributor: LLUMC Pathology Group (rc) Case No. 6 - October 2000 Loma Linda, CA Tissue from: Right lung Accession #28874 Clinical Abstract: After a reported 10 pound weight loss, this 75-year-old Caucasian male was found to have a ~. 5 em cavitary lesion in his right middle lobe. He had a long history of chronic obstructive pulmonary disease associated with a 60 pack-year smoking history. Gross Pathology: The I I 0 gram right upper lobe contained a 5.0 x 5.0 x 3.4 em white-tan nodule which was located 5 em from the bronchial margin and extended to the superior and inferior pleural surface. Contributor: Philip Robinson, M.D. Case No. 7 - October 2000 Boynton Beach, FL Tissue from: Right lung Accession #28701 Clinical Abstract: An 80-year-old male presented with a nodule in the middle lobe of his right lung. Gross Pathology: The II 0 gram lobe oflung was 12.2 x 9.2 x 2.6 em and had a 2.0 x 1.8 x 2.6 em gray nodule which infiltrated through the visceral pleura. Contributor: Joseph Carberry, M.D. Case No. 8 - October 2000 Los Angeles, CA Tissue from: Right lung Accession #26198 Clinical Abstract: During workup for dyspnea, this 59-year-old male was found to have a pleural effusion on the right with an underlying tumor mass on the diaphragm. Gross Pathology: The resected right lobe oflung with attached portion ofdiaphragm was 2200 grams and 20.0 x 16.0 x 12.0 em. Tt contained a 15 x 12 x 12 em gritty white tumor with areas of hemorrhage and softening. SPECiAL STUDIES (outside facility): Keratin negative SlOO negative CEA negative EMA negative NSE negative Desmin negative Virnentin strongly positive Actin focally positive Contributor: Octavio.Armas, M.D. Case No. 9 - October 2000 LaMesa,CA Tissue from: Left lung Accession #28921 Clinical Abstract: For two to three weeks this 72-year-old Caucasian female experienced cough and chest pain. A chest x-ray revealed a large left lung mass. Gross Pathology: Within the parenchyma of the 20 x 18 x 12 em left lower lobe was a 12.0 x 11.0 em globoid, necrotic tumor mass. · SPECIAL STUDIES: Cytokeratin cocktail positive Vimentin positive Chromograoin negative Desmin negative Contributor. Pamela Boswell, M.D. Case No. 10 - October 2000 San Diego, CA Tissue from: Left lung Accession #28877 Clinical Abstract: After experiencing fatigue for six months, this 64-year-old female was found to have a left lower lobe mass. Gross Pathology: The 17.0 x 13.0 x 3.5 em lobe oflung contained a 3.4 x. 2.5 x 1.8 em spongy, hemorrhagic, mottled gray-tan tumor. CALIFORNIA TUMOR TISSUE REGISTRY LUNG AND MEDIASTINAL PATHOLOGY Minutes- Subscription A October 2000 SUGGESTED READING (General Topics from Recent Lllnaturr): Association Between Medications TI1at Relax the Lower Esophagral Sphincter and Risk for Esophageal Adenocarcinoma. Lagergren J, Bergstrom R. Hans-Oiov A, and Nyren 0. Annals of /merna/ Medicine 2000; 133(3): 165- 175. Mandatory Second Opinion Surgical Pathology at a Large Referral Hospital. Kranz JD. Westrn WH. and Epstein Jl. Cancer 1 999~ 86(11):2198-2220. Embryonal ~Botryoid" Rhadomyosarcoma of the Lruynx. A Clinicopathologic and lmmWlohistocbemical S!Udy of Two Cases. L.ibera DO, Falconicri G and Zanella M. Annals ofDiagnostic Pathology 1999; 3(6):341-349. "Vinual Microscopy" and the lnlcntet as Telepathology Consultation Tools. Diagnostic Accumcy in Evaluating Melanocytic Skin Lesions. The Am J ofDermatopathol 1999; 21(6):525-531. Cal ifornia 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: cnr't1 hnklinc com Case o f' the M<llllh: www.llu.edu/llu/cnr/cotm Web Page: www.ctir.org Case No. I, Accession No. 28892 Oetober 2000 L!.UMC Pntholoay Rcsisknts • Solitaty fibrous tumor (3 mali@IWll. 2 benign) Mounlflin View l EI camjno Parhologv Ornunl .. Solitary {ibrous lurnor Kh-ersisk · Mesocheliomu Oaklnnd CKai,.,rl • Solitary fi brous tumor (4) Sebast0001I PIII holo•v S.:rvioesl • Solitary librous turnor of pleura Montro;y CCommunjtr l·lospjt.al o(Momcrev PenjmuJal - Mesothelioma Bakersfield - Hcmnngiopcricytoma Long Bead! - Malignam bcmangiop..-icytoma (7) Santa CI!U11 !Lorna Prie!Ul - Malign1Ult fibrous tumor of pleura (6) :is;nlll!l! CUgjlabl - Fibrous tumor of pleura (2) S8J)ta Ro<a - Solitary fibrous tumor (2) Sucrameoto Q JC Duvjs Health Svstem<l • Solitary fibrous tumor of pleura HI!\'Wllrdlfmnom - Epilhelioid ongio<arooma (4): Benign fibrous rumor ofpiCilra ( I) Nevada (Reno) • Soliw ry fibrous tumor Wisoonsjn <Meritcr) - Mnlignant solitary fibrous tumor of the pleura witl1 recurrence Looisiana O.ouisjana State Unhqsiw Medical Center> - HemangiopcriC)1oma Illinois <Puoagc PruhoiQ&v Asso<;iutcsl • Locnli;o;d fibrous tumor of the pleU11l (cellular, likely malignMt) Mjcru!!jlp IDakwoocj Hospj!all • Malignant solitwy fi brous tumor lndjana lfon Wuvne) • Solitary fibrous tumor. pleum Keprucl.:y (\Jnivejcyity of LoWsvme Resjskmts) - Mali~ uln t solhary fib rous tumor florida IMO!!!OC Rcgiooal Medic:ol Cmql - Solitary fibrous rumor J'lorjda (Wjnter Haven) - MaliJ.111 11nt mesothelimnn (I): Mnlignnnt fibruus mesothelioma ( 1);