CALIFORNIA TUMOR TISSUE REGISTRY "SOFT TISSUE PATHOLOGY" Study Cases, Subscription A ' APRIL1999 California T umor Tissue Registry c/o: Department of Pathology and li urn an Anatomy Loma Linda University Scbool of Medicine Jl021 Campus Avenue, AH 335 Loma Linda, California 9'2350 (909) 824-4 788 FAX: (909) 558-0188 E-mail: [email protected] Target audience: Practicing pathologists and p,athology residents. Goal: To acquaint the participant with the hiSiologic features of a variety of benign and malignant neoplasms and tumor-like conditions. Objectives: 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 peninent references in the medical literature. Educational mtthods and media: Review of represenlative glass slides with associated histories. feedback on consensus diagnoses from participating pathologists. Listing ofse lected references from the medical literature. Principal faculty: Weldon K. Bullock, MD Donald R. Chase, MD CMECredlt: Lorna Linda University School of Medicine designates this continuing medical education activity for up to 2 bours ofCa tegory I of the Physician's Recognition Award of the American Medical Association. CME credit is offered for the subscription year only. Accredi!Jition: Lorna Linda University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing medical education for physicians. CONTRIBUTOR: Richard L. Johnson, M .D. CASE NO.1 - APRIL 1999 Pasadena, CA TISSUE FROM: Right back ACCESSION #27925 CLINICAL ABSTRACT: This 40-year-old Caucasian male had a lump removed from his lower back. The lump returned and grew larger and ftrm to touch. MRI revealed a relatively well-circumscribed, solid mass, posterior to the spine. GROSS PATHOLOGY: The sped men consisted of a 72 gram, 8.5 x 5.0 x 3.0 em gray-pink soft tissue mass. The cut surface was fibrous and gray to light tan. .. CONTRffiUTOR: Donald Rankin, M.D. CASE NO.2 - APRIL 1999 Fontana, CA TlSSUE FROM: Obturator region ACCESSION #27919 CLINICAL ABSTRACT: During a workup for menometrorrhagia and dysmcnotrrhea, this 44-year-old female was fo und to have an obturator mass. GROSS PATHOLOGY: The specimen consisted ofa 9.0 x 5.5 x 3.5 em yellow-tan, partially ge lantinous piece of non­ encapsulated tissue. Sectioning revealed a nodular variable ye llow and white cut surface with no areas ofhemorrbage or grossly apparent necrosis. SPECIAL STUDIES: CD-34 positive CONTRIBUTOR: Philip G. Robinson, M.D. CASE NO.3 - APRIL 1999 Boynton, Beach, FL TISSUE FROM: Right shoulder ACCESSION #28414 CLJNICAL ABSTRACT: This 70-year-old male presented with a mass on the right shoulder and left chest. The mass was excised. GROSS PATHOLOGY: The 4.2 x 3.5 x 3.2 em specimen consisted of white rubbery tissue. Sectioning revealed a central mucoid area. SPECIAL STUDIES: S-1 00 negative Keratin negative Desmin negative CONTRIBUTOR: Guillermo Acero, M .D. CASE NO.4 - APRIL 1999 Santa Paula, CA TISSUE FROM: R ight cheek ACCESSION #28J 41 CLINICAL ABSTRACT: This 80-year-old Caucasian male gradually developed an ulcerated right cheek lesion, which was removed. GROSS PATHOLOGY: The 5.3 x 4.0 x 1.8 em ellipse of skin had a well-demarcated, 3.1 em diameter, ulcerated central area. SPECIAL STUDIES: PAS strongly positive for glycogen Desmin weakly. focally positive S-100 negative Keratin negative CONTRffiUTOR: Arno Roscher, M.D. CASE NO.5 - APRJL 1999 Granada Hills, CA T ISSUE FROM: Smull bowel ACCESSION #28297 CLINICAL ABSTRACT: This 51-year-old male had a several year history of steroid and NSAID use with episodes Gl bleeding and development ofan iron deficiency anemia. He collapsed after developing abdominal pain with vomiting and bright red blood per rectum. At the time of surgery, a 12 em firm mass was · found, attached. to the small bowel. GROSS PATHOLOGY: Attached to the small intestine was a 9.0 x 12.0 em thinly encapsulated yellow-tan mass. The mass involved the small bowel wall, with a focus of hemorrhage appeared on the mucosal side and extension to the serosa. The cut surfaces showed multiple yellow-tan nodules up to 3.5 em in diameter with foci of necrosis. SPECiAL STUDIES: Virnentin diffuse, strongly positive Muscle specific actin positive S-100 negative CD-34 negative Keratin negative CONTRffiUTOR: Wafa Michael, M.D. CASE NO.6 - APRlL 1999 Fontana, CA TISSUE FROM: Left inguinal region ACCESSION #27886 CLimCAL ABSTRACT: This 84-year-old male noted a left inguinal bulge for more than a year. It was not reducible and caused him occasional discomfort but he had had no changes. in bowel habits, abdominal pain or melena. He was taken to surgery for an inguinal hernia repa i:r. GROSS PATHOLOGY: The 380 gram. 16.0 x 12.0 x 7.0 em specimen consisted ofan irregular tan-pink-yellow mass of fibromembranous and adipose tissue. CONTRffiUTOR: B. P. Carman, M.D. CASE NO. 7 - APRIL 1999 Upland, CA TISSUE FROM: Mediastinal tumor ACCESSION #27968 CLINICAL ABSTRACT: This 36-year-old male Caucasian, with a longstanding diagnosis ofneurofibromatosis, was found to have a mediastinal mass. Three years earlier, he had had an 8.0 em thigh mass resected, followed by post operative radiation. At the mediastinal exploration, tumor was found seeding the pericardia I fat, left pleura, diaphragm, anterior pulmonary ligament and pericardium. GROSS PATHOLOGY: The 8.0 x 4.0 x 2.0 em specimen consisted of firm homogeneous gray-white to tan tissue without areas ofgross necrosis and hemorrhage. CONTRIBUTOR: Lorna Linda Pathology Group {drc) CASE NO.8 - APRIL 1999 Lorna Linda, CA TISSUE FROM: Maxilla and bard palate ACCESSION #27888 CLINICAL ABSTRACT: This 78-year-old Caucasian male had had a lip lesion resected about I year earlier. He now complained of a tight lip with difficulty in pronouncing some words. He was found to have a rapidly enlarging recurrent cystic mass involving the columella, nose and passing into the nasal cavity. The patient underwent a total rhinectomy, bilateral medial maxillectomy. GROSS PATHOLOGY: This 97 gram specimen included nose, nasal septum and hard palate. A 2.0 x 1.0 x 0.6 em lobulated red mass extended from the nasal septum. CONTRIBUTOR: Daniel J Luth ringer, M.D. CASE NO.9 - APRIL 1999 Los Angeles, CA TISSUE FROM: Right chest wall ACCESSION #28338 CLINICAL ABSTRACT: This 26·year-o ld male presented with a 22.0 em right chest wall mass. The mass was biopsied and subsequently resected. GROSS PATHOLOGY: The 30.2 x 12.6 x 12.6 em chest wall resection included of portions of four ribs with attached skeletal muscle and soft tissue. The medial a~pect of the specimen had a 15.0 x 5.2 x 4.1 em firm white lobulated mass which involved the parietal pleura. The cut surfuce of the tumor was firm, white­ yellow, lobulated and friable. SPECIAL STUDIES: (as evaluated by contributor) LCA Minimal reactivity Chromogranin I Synaptophysin Minimal reactivity S-1 00 Protein/ Minimal reactivity Keratin Minimal reactivity AEl/3 Mjnimal reactivity KP-1 Minimal reactivity Smooth Musc le Actin I Desmin I Myoglobin Minimal reactivity Ewing's epitope 013 (CD99) Strong immunoreactivity CAM 5.2 Perinuclear dot-like distribution NSE Weakly positive in some groups of cells Minimal glycogen is identified CONTRIBUTOR: Lorna Linda Pathology Group (mtm) CASE NO . 10 - APRIL 1999 Lorna Linda, CA TISSUE FROM: Right buttock ACCESSION 1#28367 CLINICAL ABSTRACT: This 64-year-old black male bad a one year history ofa mass in the right buttock. There was no evidence of skeletal involvement on CT scan. GROSS PATHOLOGY: The 46 gram, 5.7 x 1.2 x 0.5 em. brown-tan ellipse of skin had an attached 5.8 x 5.0 x 4.0 em ye llow-red, encapsulated, gelatinous cystic mass filled with necrotic and hemorrhagic material. CALIFORNIA TUMOR TISSUE REGISTRY SOFTTISSUEPATHOLOGY Minutes - Subscription A Aprill999 SUGGESTED READING (General Topics from Recent Literature): C-Reactive Protein and Cardi.ovascular Risk in Women. Ridker PM, et :al. Circulation 1998;98(73): 1-3. Tumor Markers of Ovarian Center. The Search Goes On. Xu Y, et al. JAMA 1998; 280:719-723. Endooervical Gi¥1dular Atypia. Does a Prenooplastic Lesion of Adenocarcinoma In-Situ Exi.st? Goldstein, NS, Ahmad E, Hussain M, Hankin, RC, etaL AmJC/in Patho/1998; 110(2):200-209. The Cellular Basis of Metastasis. Ruiz, P and Gunthcrt U. World J Urology 1996; 14{3):141-150. Chan, JKC. Mesenchymal TumO<s o(the Gastrointestinal Tract. A Paradise for Acronyms (STUMP, GIST, Gant, and Now GIPACT), Implication ofc-kit in Genesis and Yet Another of the Many Emerging Roles of the Interstitial Cell ofCajal in the Pathogenesis ofGastrointestinal Disease. Adv in Anatomic Pat hoi 1999; 6( I): 19-40. Gastrointestinal Pacemaker Cell Tumor (OIPACT): Gastrointestinal Str.omal Tumors Show Phenotypic Characteristics ofthe Interstitial Cells ofCajal. Kindblom LG, Remotti H, Aldenborg f', and Meis-Kindblom J. Am J Parho/1998: 152(5):1259-1269. California 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: [email protected] CASE NO. l , ACCESSION NO. 17925 APRIL 1999 !NI.ANP <Rhmjde/San Bernardino! • Extra-abdominal fibromatosis (desmoid tumor) (2) ORANGE • Extra-abdominal dcsmoid vALENCIA • Fasciitis, rule out angiosarcoma SA!fiA ROSA . Solital)' fibrws tumor (2): Benign mesenchymal tumor consistent with desmoid fibromatosis ( I) SAN Q!EGO <Naval Medical Center> • llxtra-abdominal dcsmoid (fibromatosis) (9} YllNTIIBA • Fibromatosis (2) !.ONQ BEACH - fibromatosis (4) BAY AREA • Fibromatosis (3) MONTEREY <Community !iO!!nj!AI ofMontqey Penjnsu!a) • Fibroma (3); E:lastofibroma (I} BA!{ERSf!EID (San Joagujn Cornmyojtx HosPital! • Fibromatosis BAKllRSf!E!.O (Central Valley Study Group) • Myxoid leiomyoma HAYWARD CS~ RoseHospjta!l - FibromatOSis(4) NEV APA CRcnol - Extra-abdominal fibrom810Sis (desmoid tumor ) (2) IDAHO f!DX Pathologvl • Extra-albdornirull fibromatosis (dcsmoid tumor) CO!.ORAOO CNorth CoiO!Jld9 Medjrol CcnJcrl ·- Fibromarosis M!Ct!!QAN (foote Hospital! • Fibromntosis MICHIQAN 1St.