' 1131- CALIFORNIA TUMOR TISSUE REGISTRY "GYN PATHOLOGY" Study Cases, Subscription A May 1999 California Tumor Tissue Registry c/o: Department of Pathology and Human Anatomy Lorna Lioda Universily Sebool of Medicine 11021 Campll!l Avenue, AB 335 Lorna Linda, California 92350 (909) 824-4788 FAX: (909) 558-0188 E-mail: [email protected] Target audience: Practicing pathologists and pmhology residents. Goal: To acquaint the participant with the histologic features ofa variety of benign and malignant neoplasms and tumor-like conditions. Obj..,tives: The panicipant will be able to recognize morphologic features ofa variety of benign and malignWJt 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 with associated histories. Feedback on consensus diagno= from participating pathologists. Listing ofselected references from the medical titerarure. Principal faeultv: Weldon K. Bullock, MD Donald R. Chase, MD CMECredit: Loma Linda University School of Medicine designates this continuing medical education activity for up to 2 hours of Category 1 of the Physician's Recognition Award ofth~ American Medical Association. CME credit is offered for the subscription year only. Aecreditalfon: Lorna Linda University School of Medicine is acaedited by the Accredilalion Council for Continuing Medical Educatioo (ACCME) to sponsor continuing medical education for physicians. CONTRfBUTOR: Robert E. Rieebmann, Jr., M.D. CASE NO. 1 - MAY 1999 Covina, CA TISSUE FROM: Right ovary ACCESSION #28045 CLINICAL ABSTRACT: A 28-year-old female developed abdominal pain and vomiting. Examination showed a large firm mass filling the abdomen up to the umbilicus. Ultrasound showed cystic components. A pelvic examination one year previously had been normal GROSS PATHOLOGY: The 840 gram, 15.0 x 12.0 x I 0.0 em lobulated mass was fleshy tan with cystic areas filled with gelatinous hemorrhagic material up to 2.0 em in greatest diameter. CONTRIBUTOR: Norman Sharoff, M.D. CASE NO. 2 - MAY 1999 National City, CA TISSUE FROM: Right ovary ACCESSION #28357 CLINICAL ABSTRACT: Irregular menses and dysmenorrhea had become increasingly severe for this 30-year-old unmarried mentally retarded female. Examination revealed a pelvic mass, which was confirmed by MR1 and interpreted as a I 0 x 7 em leiomyoma. At surgery, the mass was identified as right ovary rather than a uterine fibroid. GROSS PATHOLOGY: The 537 gram, 14.0 x 11.0 x 6.5 em well circumscribed mass was smooth, nodular pink and white. The cut surfuce showed residual ovarian parenchyma adjacent to solid lobulated pink-tan tumor. CONTRIBUTOR: Gordon Honda, M.D. CASE NO.3 - MAY 1999 Fresno, CA TISSUE FROM: Left ovary ACCESSION #28374 CLINlCAL ABSTRACT: This 71-year-old female presented with a history offibroids. Ultrasound studies confirmed a large fibroid uterus, as well as a left ovarian mass. GROSS PATHOLOGY: The 506 gram, 14.0 x 10.0 x 10.0 em left ovary had a smooth tan capsule without excreseoces. Cut sectioning showed numerous area~ of soft tan cystic degeneration. CONTRIBUTOR: Kenneth Frankel, M.D. CASE NO.4 - MAY 1999 Covina, CA TISSUE FROM: Left ovary ACCESSION #28420 CLINICAL ABSTRA CT: During work-up for abnormally frequent menses, this 41-year-old female was found to have a large ovarian cyst palpable on physical examination, and conf11111ed by MRI and ultrasound. A salpingo-oophorectomy was performed. GROSS PATHOLOGY: The 70 gram, 8.0 x 6.0 x 4.5 em ovary had a collapsed 2.5 em, thin-walled cyst filled with dark purple and sebaceous material with a few hair structures. Adjacent to the cyst was a 3.0 x 2.0 x 2.0 em soft, circumscribed , pink-tan nodule. CONTRIBUTOR: Brian Datnow, M.D. CASE NO. 5 - MAY 1999 San Diego, CA TISSUE FROM: Left ovary ACCESSION #27834 CUNICAL ABSTRACT: During a routine laparoscopic tubal ligation, this 31-year-old African-American woman was found to have a large left ovarian mass. A left oophorectomy was performed. GROSS PATHOLOGY: The 52 gram, 6.5 x 5.0 x 3.5 em specimen was partially cystic and partially solid. The cystic portion was 2.5 em and contained yellow, soft, amorphous material and hair. The solid portion was 3.5 em in diameter and almost spherical, had dark red to red-maroon areas and a rubbery consistency. CONTRIBUTOR: W. Michael Green, M.D. CASE NO. 6 - MAY 1999 Oxnard, CA TISSUE FROM: Left ovary ACCESSION #28299 CLINICAL ABSTRACT: After two weeks of pelvic pain, especially on the left side. this 55-year-old Hispanic woman presented for examinatioa Ultrasound showed a 7.2 x 5.9 X 5.5 em left ovarian mass. GROSS PATHOLOGY: The 7.0 em oval mass of gray tissue was approximately 60% cystic and 40% solid. A dominant cyst measured 6.0 em in diameter and there were scattered other small cysts measuring 1-2 em in diameter. Cyst walls had smooth linings. Intervening solid tissue was gray and slightly mottled. SPECIAL STUDIES: Thyroglobulin positive Chromogranin positive CONTRIBUTOR: Douglas Eglen, M.D. CASE NO.7- MAY 1999 Kokomo, IN TISS UE FROM: Uterus ACCESSION #28343 CUNICAL ABSTRACT: A 49-year-old black female had a two year history of persistent abnonnal uterine bleeding. D&C, done soon after onset, was consistent with endometrial hyperplasia but the patient refused hysterectomy ahbough bleeding continuing. A second D&C was performed 18 months after the original onset and ultrasound revealed a large uterine fibroid. A total abdominal hysterectomy with bilateral salpingo-oophorec10my was performed. GROSS PATHOLOGY: The 180 gram, 10.0 x 6.0 x 7.0 em uterus bad a mass which protruded anteriorly about 4.0 em above the surface ofthe uterus. When cut, the bulging anterior mass revealed a hemorrhagic center. The myometrium bad other fibroid tumors with a swirling, tan cut surface. SPECIAL STUDIES: CAM5.2 positive AE-1 positive Calretinin positive SMA negative Desmin negative CONTRIBUTOR: Loma Linda Pathology Group (gws) CASE NO. 8 - MAY 1999 Loma Linda, CA TISSUE FROM: Cervical cone ACCESSION #27996 CLINICAL ABSTRACT: This 65-year-old female was foWld to have a cervical mass. A cone biopsy, dilatation and eurenage was performed. GROSS PATHOLOGY: The 5.8 gram, 3.0 x 2.5 x 1.7 em pink-tan cer\lical cone bad two polypoid masses which were 0.5 and 0.8 em in greatest diameter. CONTRIBUTOR: Anthony Miglcr, M.D. CASE NO. 9 - MAY 1999 Oxnard, CA TISSUE FROM: Right ovary ACCESSION #28004 CLJNICAL ABSTRACT: After two days of right sided pelvic pain, this 22-year-old female was admitted through the emergency room. She had been on oral contraceptives for one year, without reported side effects. Examination and ultrasound revealed a large pelvic mass. At surgery, a right adnexal mass was 9.4 x 7.6x8.1 em. GROSS PATHOLOGY: The previously opened cystic mass was 7 em in diameter. CONTRIBUTOR: Nora OstrLcga, M.D. CASE NO.IO- MAY 1999 Sylmar, CA TISSUE FROM: Ovary ACCESSION 28402 CLINICAL ABSTRACT: This 37-year-old female reported abdominal cramping, light vaginal bleeding, and burning on urination. cr scan revealed a mass in the right adnexa. At the time ofsurgery, the uterus was small Liver, spleen and stomach appeared normal. There was no lymphadenopathy. GROSS PATHOLOGY: The 14.0 x 7.0 x 7.0 em right ovary had a smooth external surtace and a 5.0 em diameter cyst on cut section, surrounded by a 6.0 em rim of fleshy, homogenous, light tan tissue. SPECiAL STUDIES: Mucin strongly positive CALIFORNIA TUMOR TISSUE REGISTRY '· GYNECOLOGIC PATHOLOGY Minutes - Subscription A May 1999 SUGGESTED READING (General Topics from R~unt Literaturt}: Diagnostic Value of Cervical Lymph·Nodc Biopsy. A PatllOiogical Study of 596 Cases. Amr SS, Kamal Mf', and Tarawneb MS. J ofSurg Onco/1 989; 42(2):239-243. Adenoid Cystic and Adenoid Basal Carcinoma of the UterincCtn~ix. Comparative Morphologic, Mucin, and Immunohistochemical Profil e ofTwo Rare Neoplasms of Putative "Reserve Cell" Origin. Grayson W. Am J Surg Pwlrol 1999; 23(4 ):448·458. Prognostic Knowledge. Interest and Metltods. O.astang C. Auguier A and Grcrny F. Bull Cancer 1980; 67(4):430· 436. California Tumor Tissue Registry c/o: Department of Pathology and Human Anatomy Lorna Linda University School of Medicine II 021 Campus Avenue, AH 335 Loma Linda. California 92350 (909) 558-4 788 FAX: (909) 558·0188 E·mai I: cttr@ linkli ne.com CASE NO. I, ACCESSION NO. 28045 MAY 1999 INLAND fRiverSidc/San BemW'dinol - Juvenile granulosa ocll tumor VENTURA (!lnilabl • Juvenile gronulosacell tumor (2) !IAKERSJ'IRLO (San Jooqujn Community Bospitall • Endodermal sinus tumor BAKERSFIELD (Central Valley Study Group) · GmouJosa cell tumor LAKEWOOD - Malignant large cell lymphoma SAN DIEGO (Naval Medical Cc.nerl • Small cell carcinoma, bypercalocmic type (I I) BAY AREA • Granulosa cell tumor (l} SANTA PAUJ:A • Qranulosaocll tumor !.ONO IJEAC~I • Grunulosa-rell tumor (4); Fli&fl·gradc l)mphoma (l) SANTA ROSA • Large cell lymphoma ( l ); Malignant; rule out large cell lymphoma. rule out stromal tumor of ovary (need to perform immuno) (I); f:)illuse largecell l)11lphoma (I) NEVADA (Reno) . Small cell carcinoma. hypercalcemic type (1) TEXAS (Texas Tech Medical Hltll Ctrl • Juvenile.granu losa cell tumor l'IJiBRASKA (Omahal. • Small <Jell carcinoma, hypercalcemic type LOUISIANA /Shrevcoortl • Small cell carcinomu INDIANA CGoshenl • Endometrial strOmal sarooma ILLINOIS <Merite.r Hlth Scr,·icts> - Malignant sex cord-stromal tumor. f3vor m"lignant granulosa cell tumor ILLINOIS /Hillsdllle) . Juvenile granulosa cell tumor MICHIGAN /Foote Bospitall · Juvenile granulosa cell tumor MICHIGAN (St. Joseph Mcrcv Hospital) • Small. cell carcinoma (5) MKBIGAN /Oakwood Hospital\ • Juvenile granulosa cell tumor FLORIDA <Tallaha"ec) • Smull cell carcinoma NORTH CAROLINA IV£NC J'athology Group) • Granulosa cell tumor \'S.