II+/ CALIFORNIA TUMOR TISSUE REGISTRY "PEDIATRIC PATHOLOGY" Study Cases, Subscription A May, 2004 California Tumor Tissue Registry c/o: Department ofPathology and Human Anatomy Lorna Linda: UniVersity School of Medicine 11021 Campus Avenue, AH 335 Loma Linda, California 92350 (909) 558-4788 FAX: (909) 558-0188 E-mail: cttr@ linklinc.com Web page: www.cttr.org Web site & Case oftbe Montb: www.cttr.org Target audience; Practicing pathologists and pathology residents. Goal: To acquaint the participant with the histologic features ofa variety of benign and malignant neoplasms and tumor-like conditions. Obje<:tiyg; · 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. Edoeatlonal methods and media: Review of representative glass slides with associated histories. Feedback on consensus diagnoses from participating pathologists. Listing ofselected references from the medical literature. J>rlneipal facultv: Weldon K. Bullock, MD Donald R. Chose, MD CMECredit: Loma Lindo University School ofMedicine designates this continuing medical education activity for up to 2 hours of Category I of the Physician's Recognition Award ofthe Atnerican Medical Association. CME credit is offered for the subscription year only. Accredi.tatioo: Lorna Lindo Univernity School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor corotinuiog medical education for physicians. Contributor: LLUMC Pathology Group (de) Case No. 1 • May 2004 Loma Linda, CA Tissue from: Spleen Accession #29758 Clinical Abstract: This 16-year-old male was admitted for acalculous cholecystitis and splenomegaly with thrombocytopenia. Gross Pathology: This 1350 gram, 21.5 x 14.0 x 10.5 em red-tan spleen contained multiple small white-tan nodules ranging from 0.1 to 0.3 em which were scattered throughout the entire cut section ofthe spleen. · Contributor: LLUMC Pathology Group (cz) Case No. 2 - May 2004 Lorna Linda, CA Tissue from: Omentum Accession #28437 Clinical Abstract: A seven month old male infant developed a large multinodular intra-ab-dominal mass, which at surgery was associated with numerous abdominal implants. Gross Pathology: The 1,250 gram, 25.0 x 18.0 x 7.0 em specimen was composed of innumerable well­ circumsc.ril>ed , rubl>ery to firm pink-tan nodules ranging from 4 mm to 11 em in diameter. Contributor: Jozef Kollin, M.D. Case No. 3 - May 2004 Lakewood, CA Tissue from: Right scapula Aceessi<ln #29575 Clinical Abstract: This eight year-old male was found to have a prominent mass that interfered with shoulder function. MRI showed a 5 x 4 x 3 em mass in the medial superior border of the-right scapula. Gross Pathology: The 17 gram specimen was 3.6 em in greatest diameter and was composed of nodular bony and cartilaginous-appearing tissue. Contributor: LLUMC Pathology Group (bhl) Case No. 4 - May 2004 Lorna Linda, CA Tissue from: Sacral mass Accession #29668 Clinical Abstract: This term female infant was delivered by C-section to a 19 year old woman with. two healthy children, also delivered by C-section. The baby girl was noted to have a large finn mass surrounding the sacral area involving the b_uttocks and vulva, completely covered by skin. Gross.Pathology: The 404 gram mass was 12.1 x 11.0 x 6.5 em. The cut surface was variegated multicystic and gelatinous. Contributor: LLUMC ·pathology Group (cz) Case No. 5 - May 2004 Loma Linda, CA Tissue from: Left adrenal gland Accession #29669 Clinical Abstract: At seven months of age, this female infant was noted to have dark pubic hair, and then some axillary growth. An abdominal ultrasound showed a 7 em left adrenal mass. Gross Pathology: The 152 gram adrenal gland measured9.0 x 7.0 x 4.5 em. The cut surface was homogeneous red-brown, soft and friable. Contributor: Donald Rankin, M,D. Case No. 6 - May 2004 Fontana, CA Tissue from: Parapbaryngeal mass Accession #29442 Clinical Abstract: This 17-year-old male noted amass in the right side of his neck. Gross Pathology: The 120 gram mass measured 8.7 x 6:5 x 4.5 and included a composite resection of the mandible. The cut surface was gray-white and whorled. Contributor: LLUMC P!!thology Group (cz) Case No. 7 - May 2004 Lorna Linda, CA Tissue from: Left kidney Accession #29551 Clinical Abstract: A mass was discovered in the left kidney of this four-year-old female. Gross Pathology: The 483 gram kidney contained a 9.0 x 8.0 x 8.0 em tan-white tumor. Contributor: LLUMC Pathology Group (cz) Case No. 8 - May 2004 Lorna Linda, CA Tissue from: Left kidney Accession #29481 Clinical Abstract: While ata well baby clinic for vaccinations, this four-month boy was noted to have a left sided abdominal mass. Gross Pathology: The 708 gram kidney was almost completely replaced by a 14.0 x 11.0 x 8.5 em smooth, ovoid mass with a homogeneous pink tan fleshy cut surface. Contributor: LLUMC Pathology Group (cz) Case No.9 - May 2004 Lorna Linda, CA Tissue from: Liver Accession #29480 Clinical Abstract: This 13-year-old male had a three-month history of intennittent fever and upper respiratory tract infections. He was brought to medical attention when his parents noted decreased appetite and weight loss. Physical exam showed an abdominal mass and CT scan showed a large hepatic tumor. Gross Pathology: Within the resected 3113 gram right lobe of liver was a 13.0 x 6.0 x 4.0 em, hemorrhagic, multicystic, largely necrotic mass. SPECIAL STUDIES: PAS positive Des min positive CAM5.2 punctate or globular perinuclear positivity Synaptopbysin negative Contributor: LLUMC Pathology Group (bhl) Case No. 10 - May 2004 Lorna Linda, CA Tissue from: Sigmoid colon/bladder/omentum Accession #29219 Clinical Abstract: Approximately nine months after removal ofa mass from the urinary bladder of this 9-year-old male, aCT scan revealed a recurrent mass involving the bladder, bowel, omentum, and abdomi.oal wall. Gross Patbologx: The 335 gram resection of colon and bladder included a 11.5 x 7.8 x 7.0 em cylindrical portion of yellow to red-tan, fum tissue attached to the serosal surfaces. Cut surface of tumor was white to yellow with areas of hemorrhage. Separate omental and abdominal wall masses were 24 grams and I 0 grams, respectively. CALIFORNIA TUMOR TISSUE REGISTRY PEDIATRIC PATHOLOGY . Minutes - Subscription A May, 2004 SUGGESTED READING (General Topics from Recent Literature): Sala A, Penchan P 11nd Barr RD. Children, Cancer and Nutrition. A Dynamic Triangle in Review. Cancer 2004; 100(4):677-687. Yin H, Leong AS-Y, et nl. Histologic Grading of Noninvasive Papillary Urotbelial Twnors. Validation oflhe 1998 WRO/ISUP System by lmmunophenotypiog and Follow-Up. Am J Clin Pathol 2004; 121 :679.{)87. Zebrack BJ, Eshlman OA, Hudson MM. Mertens AC. et al. Henltb Care for Childhood Cancer Survivors. Insights and Perspectives from Delphi Panel ofYoung Adult Survivors ofChildboocl Cancer. Cancu2004; 100(4):843-850. Eicbhom JH, Young RH, et al. Transitional Cell Carcinoma of the Ovary. A Motpbologic Study of 100 Cases With Emphasis on Differential Diagnosis. Am J Surg Pathol 2004; 28:453-463. Tomoczlcy T, Kalman E, Kajlar PG, N~11ri T, et aJ. large Cell Neuroblastoma A Distinct Phenotype ofNeuroblastoma with Agg1eSSive Clinical Behavior. Cancer 2004; I 00(2):390-397. California Tumor Tissue Registry c/o: Department of Pathology and Human Anatomy Lorna Linda University School ofMedicine 11021 CampusAveoue,AH335 Lorna Linda, California 92350 (909) 558-4788 FAX: (909) 558..()188 E-mail: cttr@linkli*com Web site & Case ofthe Month: www.cttr.org FILE DIAGNOSES (Ifposs ible, submit answers on website at www.cttr.ors. Click "subscriptions", !ben "submit answers".) CTfR Subscription A May,2004 Cuel: Splenic coccidioidomycosis (granulomatous splenitis with Coccidicides immitis) T -07000, 0-0560 Case 2: Inflammatory myofibroblastic tumor ("pseudotumor"), omentum (see note) T-63850, M-0390 Cue 3: Osteochondroma, scapula T-11280, M-92100 Case 4: Mature sacrococcygeal teratoma T-Yl410, M-90801 Case 5: Adrenal cortical neoplasm, likely low grade carcinoma T-93020, M-83703 Case6: FibromatO§is, parapharyngeal region T-6Xl20, M-76100 Case 7: Wilms' tumor (nephroblastoma), favorable histology, kidney T-71000, M-89603 Case 8: Wilms' tumor (nephroblastoma), favorable histology, kidney T-7 JOOO, M-89603 Case 9: Undifferentiated embryonal sarcoma (malignant mesenchymoma), liver T-56000, M-89913 Case 10: Rhabdomyosarcoma, intra-abdominal metastases T-67000,M-89003 Case No. I, Accession No. 29758 May2004 ~. • Cocci with zranulomata Baldwin Pads !Kajsq Pqmancntel • Coccidioidom}'llOSis (2) Fon!IM !Kaiser PCUJW!<!!Ie\ - Coccidioides immili8 Glenc!ale - Coccidioidom}'llOSis HaYWlllll/fremoot • Coccidioidomycosis Lon• Beach CLakeW09d Regional Medical Center) - Cooc:idioidom}'llOSis (8) Monterey ICoromunjty Hospj!f! ofMonterey Peninsula) • Coceidloidomyeosis Oakland CKajsq Pel1!l4J1en!el · Coceidioidomyccois (4) Orange IQrange CountY Pathology Me<iica! Group) - Coceidioidomyeosis ~cnto IUC Qayjs Medjcal Center) - Coccidioidomycosis, spleen San Diego CNayol Medical Center) · Coccidioidomycosis San F!Dllci!!!lO <San francisco General Hospi!all • Coccidioidomycosis ~ • Coceldloidomycosis Arizona. Pbos;njx • Granulomatous splenitis due to coccidioidomycosis Colorado Eyetl!I'S!!n • Di.seminated coccidioidomycosis .;.i!h zranuiOIIUIIOUS inflammation Colorado CLu!henln Medical Cen!erl - Coceidioidomy=is Florida IBapti.n H.. pha)l • Toxoplasmosis (4); CoceidioidomyCO$is