'"o CALIFORNIA TUMOR TISSUE REGISTRY "GENERAL PATHOLOGY" Study Cases, Subscription A March 2002 California Tumor Tissue R egistry d o: Department ofP athology and H uman Anatomy Lorna Linda University School of Medicine 11021 Campus Avenue, AH 335 Loma Linda, Cnli fo roia 92350 (909) 558-4788 FAX: (909) SSS-.0188 E-mail: cur~tlinkhnc.com Web page: "~'w .<.nr.ore Web site & Case oft'bc Month: www.crtr.org Target aodien<e: Practicing pathologists and patholqgy residents. Goal: To acquaint the participant with the histologic features ofa variety of benign and malignant neoplasms and tum?<·like conditions. Objectives: The participant will be able to recognize m'Orphologic features of a variety of benign and malignant neoplasms and ttunor-like conditions and relate those processes ·to pertinent references in the medical literature. Educational methods and media: Review ofrepresentative glass slides with associated histories. Feedback on conseo.sus diagnoses from participating pathologists. Listing ofselected references from the medical literature. Principal faculty: Weldon K. Bullock, MD Donald R Chase, MD CMECredit: Lorna Linda University School ofMedicioe designates this continuing medical education activity for .up to 2 hours ofCategory 1 of the Pbysici'ao 's Recognition Award oflhe American Medical Association. CME credit is offered for the subscription year only. Accreditation: Lorna Linda University School ofMedicine is accredited by the Accreditation Council for Contiiluing Medical Education (ACCME) to sponsor continuing medical_cducation for physicians. Contributor: K. M. Hollis-Perry, M.D. Case No. 1 - March 2002 San Diego, CA Tissue from: Spleen Accession #29406 Clinical Ab~tract: Two years earlier, this 26-year-old male had had a melanoma of his scalp and had undergone radiation therapy and a parotidectomy with neck dissection. A follow-up CT showed a mass in the spleen. Gross Pathology: Within the 470 gram spleen was a 7.0 x 5.0 x 5.0 em soft gray-tao mass. SPECIAL STUDI ES (Outside facility): S-100 positive HMB45 positive Cytokcratin negative Contributor: Xuedong Wang, M.D. Case No. 2 - March 2002 Pasadena, CA Tissue from: Left testicle Accession #28978 Clinical Abstract: This 30--year-o ld male presented with a testicular mass. A radical orchiectomy was performed. Gros.~ Pathology: The 112-gram testicle with spermatic cord included a 6.5 x 4.5 x 4.0 em tan, firm mass replacing 95% ofth e testis. Contributor: Phillip C. Gordon, M.D. Case No. 3 - March 2002 Winter Haven, FL Tissue from: Right testicle Accession #29355 Clinical Abstract: This 56-year-old roale complained ofa large scrotal mass. A right radical orchiectomy was performed. Gross Pathology: The testicle measured 5.0 x 3.0 x 5.5 em and was replaced by dull gray-tan firm tissue with areas of necrosis. Contributor: Xuedong Wang, M.D. Case No. 4 - March 2002 Pasadena, CA Tissue from: Left breast Accession #29326 Clinical Abstract: For eight years, this 35-year-old female bad had a left breast mass, originally described as "tluid filled .." A recent mammogram exam showed the roass to be solid. An lumpectomy was performed. Gross Pathology: The 11 x 8.5 x 5.0 em ovoid portion of breast tissue contained a well-circumscribed fleshy soft pink-tan tumor measuring 7.0 x 6.5 x 4.5 em. Contributor: Mark Janssen, M.D. Case No. 5 - March 2002 Anaheim , CA Tissue from: Abdominal waU Accession #29291 Clinical Abstract: After two years ofgradually worsening intermittent abdominal pain, this 75-year-old male noted a non-tender mass on the right side of his abdomen. Physical exam showed a non-movable irregular mass over the rectus abdominis muscle. There were no hernias or lymphadenopathy. A CT showed the mass involved the lower abdominal wall and right rectus muscle. Gross Pathology: The 98 gram, 9.5 x 6.0 x 4.5 em specimen consisted of abundant skeletal muscle with a central, ill-defined fibrous mass admixed with muscle and adipose tissue. Contributor: John McGill, M.D. Case No. 6 - March 2002 Pasadena, CA Tissue from: Left groin Accession #29113 Clinical Abstract: Eight yelii"S after a hysterectomy for cervical carcinoma-in-situ, this 55-year-old female developed a left groin mass. Gross Pathology: The 64 gram. 7.5 x 5.0 x 4.0 em firm, ovoid, mass had a solid, pale pink whorled cut surfilcc. SPECIAL STUDIES (Outside faci lity): S-100 negative Vimentin positive Smooth muscle actin positive Desmin positive Contributor: Kenneth A. Franke~ M.D. Case No. 7 - March 2002 Glendale, CA Tiss ue from: Right parotid Accession #29154 Clinical Abstract: This 70-year-old female developed a mass in her right parotid gland. Gross Pathology: The 7.5 x 6.0 x 3.2 em right parotid specimen contained a 3.0 em in greatest dimension, firm indurated mass. Cont ributor: Phillip C. Gordon, M.D. Case No.8 - March 2002 Winter Haven, FL Tissue from: Right leg Accession #29354 Clinica I Abstract: A gradually enlarging soft tissue mass was removed from the right leg of this 38-year-old female. Gross l'athology: The multilobulated pink-tan, fatty tissue mass measured I 0.5 x 10.0 x 4.5 em and appeared well-encapsulated. Cut sections displayed a soft pink-brown parenchyma without hemorrhage or necrosis. Contributor: Kenneth A. Frankel, M.D. Case No. 9 - March 2002 Covina, CA Tissue from: Gallbladder Accession #29370 Clinical Abstract: Because ofchronic cholecystitis and cholelithiasis, this 70-year-old female w1derwent a laparoscopic cholecystectomy. Gross Pathology: The previously opened gallbladder was 9 x 3.8 em, with a wall that generally varied from 0.2 to 0.5 em in thickness. Visible on the mucosal surface were two dome-shaped slightly elevated nodules, one of which measured up to 1.2 em in diameter and the other measuring up to 1.3 em in diameter. Contributor: Robert H. Zucb, M.D. Case No. 10 - March 2002 Baldwin Park, CA Tissue from: Right distal femur Accessioa #29293 p inical Abstract: During a workup for a 6~mooth history of a painful, swollen knee, this 56-year-old female was found to have a mass occupying the majority of the distal femur with extension into the knee joint. Gross P athology: Within the resected distal femur was a 6.5 em gritty, lobulated, expansile mass with a glistening mucoid, translucent gray-white cut surface. The tumor extended onto the articular surface of the distal femur and into surrounding soft tissues. CALIFORNIA TUMOR TISSUE REGISTRY GENERAL PATHOLOGY Minutes - Subscription A March 2002 SUGGESTED .READING (('..,neral To·pics from 'Recent Literature): A Review of Tumor Suppressor Genes in Cutaneous Neoplasms with Emphasis on Cell Cycle Regulators. Smith KJ, Barrett 11.., Smith WF, et al. Am J of Derma/opatho/ 1998; 20(3):302-3 13. Tolerance and Autoimmunity. Mackay IR and Rosen FS. Adv in lmmunology200 I; 344(9):655-664. Cytologic Diagnosis ofDysplasia in the Alimentary Tract. Tambouret R, Pitman MB, and Wang l:lH. Sem in Diagn Patho/2002; 19(1):38-47. The Molecular Basis ofDysp lasia. Zukerberg L Sem in Diagtt Patho/2002.; 19(1):48-53. DisrnantUng the Germinal Center. Comparing the Processes of Transformation, Regression, and 'fragmentation ofth e Lymphoid.Follicle. Jones D. Adv in AtUII Pathr>/ 2002; 9(2): 129-13 8. 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-tnail : [email protected] Web site, Case of the Month and Monthly Case Diagnoses: www.cttr.org FILE DIAGNOSES CTIR Subscription A March 2002 Case 1: Metastatic melanoma, spleen T-07000, M-87203 Case2: Classic seminoma, testis T-78000, M-90613 CaseJ: Embryonal carcinoma. testis T-78000. M-90703 Cau 4: Pbyllodes tumor, breast T-04000, M-90213 Case 5: Abdominal fibromatosis (desmoid tumor) T-Y4100, M-76!00 Case 6: Myxoid vascular leiomyoma ("'angiomyoma"), groin T-Y7000, M-88900 Case 7: Metastatic poorly differentiated adenocarcinoma, possibly of acinic cell origin. lymph nodes of neck T-55100, M-85503 Case 8: Hibemoma, leg T-Y9400, M-88800 Case 9: Invasive adenocarcinoma, gallbladder T-57000, M-81403 Case 10: Chondrosarcoma, femur T-11710. M-92203 CIU~ No. I, Ac~ession No. 29406 March 2002 Bakqsfickl • Metastatic mclaooma Bay ArCl! • Mctastatic mclanoDUl (3) Havward!Fn:mont • Mewtatic melanoma !.on• 8each !La}sewoo<l Regionn! Mcxli~ol Center\ · Metastatic maligJ11nt melanoma (5) Monterey !Community Hospital of Monterey Peninsula\ - Metastatic mclnnoma Momcrey Plllk !Garfield Medical Center\ - Metastatic malignaot mclonomn Oakland !Kaiser Pcnnancntcl • Metastatic malignant melanoDUl (5) Orange NCI Medicn! Ceote:r Resic!enyl • Malignanl mclllllOIDJ! Rumi!k (Kaiser Pc.nn.aoemel • Metasutic malignaot melanoma RjymjdoJMon:no Vallev • Mewwie melanoma ( I); Mel.tSI.tticmalilllant mclaooma (I) Sacramento CUC Davis Medicn! Ccn!er\ • Mel.tSI.ttic melanoma, spi<en San Dicoo CNaval Medical Ccotetl • Metastatic mclano!Dll (I); Metastatic malignant melanoma (I) Santa Bad!a.ra !Cottage Hospital) • Metastatic melanO!Dll Santa Rosn !Santa Rosa Memorinl Hosojtall • Metastatic malignllDt melanoma (2) IlJ.IIiu • Metastatic malignant melanoma Yl:!l1uin • Metastatic maligoont melanoma (3) &abomn IBMC Princeton> - Metastatic melanoma AtkO!Jw aJAMSl - Metastatic malignant melanoma, spleen Oelow.am (Christiana Howitall - Metastatic melanoma Florida !Ba!l!i!! Medjca! Ceo!tt l • MOIAStatie melanotic melanoma ( I); Mcwtatic mclliiiOID3 (3); True histioc)'li<: lymphoma ( I) Flori@ !Mwvpc 1\cgional Mec!jcal Cen!er\ - MelaSIAtic melanoma Florida (pathology AssociaiCSI • Metastatic melanoma Florida !WiAter Hayen Hospjull - Metastatic melanoma (2) !llinqjs Cbjcogo - Melanoma Jllinois lijyanston Hospital) - Metastatic melanoma ll!joojs INorlhwcstem Memorial Hospjtall • Metastatic melanoma lndil!ll• !Fort Waypel • Metastatic mnlignMt melanoma, spleen Indiana <Howard Community Hospital) • Metastatic melanoma I gujsjona £Louisiana State Uniymi'Y HOJpital) · Metastatic mclonoma.