CALIFORNIA TUMOR TISSUE REGISTRY

California Tumor Tissue Registry c/o: Department of Pathology and Human Anatomy

Loma Unda University School of Medicine 11021 Campus Avenue, AH 335 Lorna Linda, California 92350

(909) 824-4788 FAX: (909) 478-4188

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Target audience; Practicing pathologists and pathology residenL<>.

Goal: To acquaint the participant with the histologic features of a variety of benign and malignant neoplasms and tumor-like conditions.

Ob!ective: The participant will be able to recognize morphologic features of a 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 with associated histories. Feedback on consensus diagnoses from participating pathologists. Listing of selected references from the medical literature.

Principal raculty: Weldon K Bullock, MD Donald R. Chase, MD

CMECredit: The CITR designates this activity for up to 2 hours of continuing medical education. Participants must return their diagnoses to the CITR as documentation of participation in this activity.

Accreditation: The California Tumor Tissue Registry is accredited by the California Medical Association as a provider of continuing medical education.

..

CONTRIBUTOR: Mark J. DeMeo, M.D. CASE NO. 1 • MARCH 1997 Santa Rosa, CA

TISSUE FROM: Right lung ACCESSION 27940

CLINICAL ABSTRACT:

This 75-year old Caucasian female smoker presented with a one year history of a chronic persistent cough. A chest x-ray revealed a large wedge-shaped alveolar opacity in the posterior basilar segment of the right lower lobe. In addition she was noted to have abnormally enlarged mediastinal lymph nodes at the level of the carina and below. Following biopsy, a right lower lobe resection was performed.

GROSS PATHOLOGY:

The 260 gram lobe of lung was 16.0 x 11.5 x 9.5 em. In the lateral posterior aspect was a 7.5 x 8.0 x 4.5 em firm area which appeared to be consolidated lung tissue. The involvement extended to the periphery of the lung, stretching but not grossly invading the pleura.

CONTRIBUTOR: Thomas Heinz, M.D. CASE NO. 2 • MARCH 1997 Orange, CA

TISSUE FROM: Right lung ACCESSION #28106

CLINICAL ABSTRACT:

This 2 1/2-year old girl presented wiih mild cough and wheeze. Following two albuterol treatments she developed a tension pneumothorax with total collapse of the right lung. After stabilization, workup revealed cystic change in the right lung and a right upper lobe lobectomy was performed for presumed lobar emphysema.

GROSS PATHOLOGY:

The 46 gram portion of lung was 12.5 x 7.5 x 2.0 em. Serial sections revealed multiple saclike structures up to 11.5 em in greatest diameter. There was no grossly normal lung parenchyma.

SPECIAL STAINS: Vimentin: HHF35:

positive' positive

Desmin: LCA:

positive negative

CONTRffiUTOR: F. Azizi, M.D. Fontana, CA

TISSUE FROM: Right lung

CLINICAL ABSTRACf:

CASE NO. 3 • MARCH 1997

ACCESSION #27883

This 39-year-old non-smolcing female was known to have had a positive PPD slcin test for many years. Her employment program included yearly chest x·rays. Her most recent x-ray showed a mass on the right side. A CT scan of the chest demonstrated a well-circumscnbed homogenous solid right upper lobe mass abutting the lateral aspect of the superior vena cava. A wedge excision was performed.

GROSS PATHOLOGY:

The 55 gram wedge of lung was 6.0 x 3.5 x 3.0 em. It included a 3.0 em diameter yellow-tan well-circumscribed nodule.

CONTRIBUTOR: Robert Reichmann, M.D. Covina, CA

TISSUE FROM: Left lung

CLINICAL ABSTRACf:

CASE NO. 4 • MARCH 1997

ACCESSION #28037

This 59-year old female started smoking at the age of eight and has continued to smoke for the last 51 years, up to 4 packs daily. She presented with a three year history of recurrent bouts of pneumonia. She denied hemoptysis or weight loss. Chest x-ray and CT scan revealed an obstructing endobronchial lesion of the left mainstem bronchus with post-obstructive bronchiectasis. A left sided pneumonectomy was performed.

GROSS PATHOLOGY:

The 340 gram left lung was 18.0 x 13.0 x 6.0 em. The mainstem bronchus was virtually occluded by a 2.0 em diameter, sessile, well-circumscribed, firm, round, pink-tan mass.

CONTRIBUTOR: Nelson J. Quigley, M.D. Anaheim, CA

TISSUE FROM: Left lung

CLlNICALABSTRACT:

CASE NO. 5 - MARCH 1997

ACCESSION #27825

This 55 year-old asymptomatic non-smoking female had a chest x-ray_as,part_of a routine __ physical exami.nation. This showed a chest mass originally interpreted as an aortic arch aneurysm. Excision of the left lung mass was performed.

GROSS PATHOLOGY:

The 17 gram lung wedge was 5.0 x 4.5 x 2.3 em. Within it was a 3.0 x 2.0 em gray-white tumor which produced a depression of the overlying pleura. Approximately 40 grams of focally hemorrhagic tumor-involved lymph nodes were submitted separately.

SPECIAL STAINS: Chromogranin: CAM5.2:

positive positive

CONTRIBUTOR: Marigold Ardron, M.D. Keesler AFB, MS

TISSUE FROM: Mediastinum

CLINICAL ABSTRACT:

Synaptoph.ysin: focal positive

CASE NO. 6 - MARCH 1997

ACCESSION #27873

This 26-year-old white female presented with dull chest pain radiating to the left shoulder and a two year history of intermittent decreased strength in the left hand with left arm paresthesias. A chest x-ray showed a: large(> 10 em) superior posterior mediastinill mass, which was resected.

GROSS PAT HOLOGY:

The specimen consisted of a 14.5 x 7.5 x 7.0 em oblong red-tan tumor with a smooth external surface. Serial sectioning revealed a solid, firm, pale yellow cut surface.

SPECIAL STAINS: Vimentin: S-100:

weakly positive positive

Cytokeratin: Neuron specific enolase:

negative negative

CONTRIBUTOR: Alexandra Reichman, M.D. CASE NO. 7 - MARCH 1997 Marysville, CA

TISSUE FROM: Mediastinum ACCESSION #27846

CLINICAL ABSTRACT:

This 62-year-old male-had progressive dysphagia over a ten-month period. Work-up showed Barrett's esophagus with a lower esophageal stricture. There was also displacement of the upper cervical esophagus and ~rachea towards the left. cr scan confirmed a 9 x 6 x 5 em mass in the upper anterior mediastinum and lower neck. A thyroid scan was normal. Past history included a right orchiectomy for testicular cancer (type unknown) 25 year earlier and.radical prostatectomy for adenocarcinoma 9 months earlier. The masS was excised.

GROSS PATHOLOGY:

The 78 gram bosselated tan mass was 8.5 x 6.0 x 3.2 em. Cross sectioning revealed variegated, vaguely nodular firm white or light tan tissue.

SPECIAL STAINS: S-100: Actin: CD-34: CAM5.2:

negative negative diffusely positive negative

CONTRIBUTOR: K. Greg Peterson, M.D. Sioux Falls, SD

TISSUE FROM: rvtediastinum

CLINICAL ABSTRACT:

Actin: CD-68: CD-34:

negative negative positive

CASE NO. 8 - MARCH 1997

ACCESSION #26935

This 58-year-old white male had a three year history of polyneuropathy and chronic diarrhea with marked weight loss, both of unknown etiology. About 2 weeks prior to admission a muscle biopsy showed polymyositis. In the 48 hours before admission he developed acute venous obstruction with

·edema of the left upper extremity. cr scan o f the· chest showed a 6 em diameter anterior mediastinal mass. At' surgery·the mass was attached to and involved the left phrenic nerve and the superior vena cava, completely obliterating the left innominate vein. About 90% of the tumor was removed.

GROSS PATHOLOGY:

A 70 gram, 6.0 em diameter specimen consisted of three fragments of firm, homogenous, tan­white tissue with focal necrosis but no hemorrhage.

CONTRIBUTOR: Raymond Lesonsky, M.D. CASE NO. 9 • MARCH 1997 Northridge, CA

TISSUE FROM: Med iastinum ACCESSION #26541

C LINICAL ABSTRACT:

-- This 69-year-old-female presented with-a 5 month history of interscapular pain and increased. shortness of breath on exercise. A thoracic.cr scan revealed an 8.0 x 8.0 x 6.0 em anterior mediastinal mass. A venogram showed complete obstruction of the left subclavian vein at the level of the axilla. At surgery, the mass involved the innominate vein, the pericardium, phrenic nerve and tip of the lung.

GROSS PATHOLOGY:

The 405 gram specimen was 18.0 x 12.0 x 6.5 em and contained a 10.0 x 6.5 x 9.5 em, well­c ircumscribed, nodular, homogeneously gray white, firm tumor.

CONT RIBUTOR: E. DuBose Dent, Jr., M.D. CASE NO. 10 • MARCH 1997 Glenda le, CA

TISSUE FROM: Right lung ACCESSION #26782

CLINICAL ABSTRACT:

This 69-year-old Caucasian female presented with a well-circumscribed mass just beneath the pleura. A wedge resection of the right upper lobe was performed

GROSS PATHOLOGY:

The 3.5 em diameter specimen was of pale red-brown with a soft consistency.

SPECIAL STAINS: Lambda: L-26:

positfve positive

Kappa: negative

CALIFORNIA TUMOR TISSUE REGISTRY

SUGGESTED READING (General Toplu from Recent U terature):

Pulmo111ry Carcinoid Tumors. CT Assessment. Davis SO, Zem JR, Govoni AF, et al. J. Comput Assist Tomogr 1989; 13(2): 244-247.

The Clinical Oulcolll¢ of Needle Aspiration of the Lung Wben Cancer is not Diagnosed. Calhoun P. Feldeman DS, Annstrong P, ct al. An11 Thorac Surg 1986; 41: 592-596.

Reproductibility of Major Diagnoses in a Binational Study of Lung Cancer in Uranium Miners and Atomic Bomb Survivors. Kuhn R, Auerbach 0, Nambu S, Carter D, ei al • .Am J Clin Patho/1994 (Sup!); 101: 478-482.

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) 824-4788 FAX: (909) 478-4188

CASE NO. 1, ACCESSION NO. 27940 MARCH1997

INlAND CR!YERSIPB'SAN BERNARDINO) • Small lymphocytic lymphoma (low grade lymphoma of BAL1) (1); Lymphoma (2); Well-differentiated lymphocytic lymphoma (1).

BAKERSPTEill (Cenrral Valley Study Group) • Diffuse large cell lymphoma. CAMARILLO {Alviso Groop) - Small cell lymphoma yP.NTIJRA IUnjlabl · Lymphocytic in~erstitia l pneumonia (2). PLEASANTON/FREMONT • Low grade (small lymphocytic) lymphoma. LONG BEACH - Malignant non-Hodgkin'slymphoma.low grade(?). OXNARD 1St. ·Johns Regional Or) - Lymphomatoid granulomatosis. SAN DIEGO (Naval Medical Or) - Low grade lymphoma, favor exlranodd marginal zone lymphoma (15); Mantle

cell lymphoma (1). SANJA BARBARA ICo!!•ge He<pjt•ll - Mahoma. SANTA CtARA ILoma·Prieta Group) - Malignant lymphoma (mantle cell lymphoma) (5). SANTA ROSA • Lymphoma, "diffuse", mixed l;rge and small oell. (2); Diffuse non·Hodgl<in's lymphoma, mixed (1).

BAY AREA - Lymphoma, probably non·Hodgl<in's with? pulmonary alveolar proreinosis (3). SACRAMENTO IUC Qavis) - Small lymphocytic lymphoma of BALT,low grod" ARIZONA IVA Med Or) • Small cell lymphoma (Maltoma). NE8RASJ<A (Cmjgbton University\ - Malignant lymphoma of smalllympboey)es, probable MALT type. MISSISSIPPI (Baprist Hospital\ • Low grade lymphoma. FLORIDA CTallaha.soe) - Lymphoma (3). MARYlAND IBethe.da Naval Med Ctr) • Malignant lymphoma, low grade (small lymphocytic with plasmacytoid .

differentiation vs Maltoma) (13) ·

CONNECTICUT (!Jniv Conn Health Or) - Malignaot lymphoma, diffuse, .intel'!llediate cell type. CONNECIJC(IT !Yale Unjv) - B-ee II lymphoma ofMALTtype. MAsSACHUSB'M'S lllerkshire Med Or) • Malignant lymphoma, small oelltype. NEW HAMPSHIRE (Manchester) • Malignant lymphoma, small cleave cell type (1); Lymphoma (1}. NEW JERSEY I Overlook Hospital Summit) • Lymphocytic lymphoma- well-<lilferentiated (Baltoma} (4). NEW YORK (Merro£101it•n Hospital\ - B..:elllymphoma. NEW YORK (lmnath) - Malignant lymphoma, small B-oell, marginal woe, probable BALT (4) . • WYOMING • Small oe.lllymphocytic lymphoma/CI.L MAINE (Bangor) - AU., Grade 1.

lAPAN ISbjmada-Kyoto) - SmalllY.mphocytie lymphoma.

DTAGNOSIS; MAUGNANT LYMPHOMA, SMALL LYMPHOCYI'IC CELL TYPE, RIGHT WNG

1'28000/M%203

CONSUl,TATION; Thomas V, Colby, M.D., Mayo Clinic Scollsdalc, Ariwna: "Features of small lymphocytic lymphoma.•

REFERENCES: Zuketberg Ut, Mederios UL, Ferry lA, and Harris NL Diffuse I,Dw-Grade ll-Cell Lymphoms. Four Clinically

Distinct Subtypes Defined by a Combination of Morphologic and lmmunophcnotic Features. Am J Clin Patlwl 1993;100: 373-385.

Grogan TM (Commentary). The Low Grade B-Cell Lymphoma Polyglot. Is It a Step Forward or Backward? AdvAnal Pal/w/1995; 2(1): 39-42.

Koss MN, Hocbolz.er L, Nichols·PW, et al. Primary Non-Hodgkin's Lymphoma and Pseudolymphoma of Lung. A Study of 161 patients. Hum Patho/1983; 14: 1024-1038.

Segal GH. (Commentary) Marginal Zone B-Cell Lymphoma. Ao Agreeable Union of Several Rcioenlly Described Entities. Adv in Anal Patho/·1991; 4(1): 44-50.

Leith CP, BChir Mil, Mongalik A ani! Foucar K. A B-Cell•Chameleon". Striking Clinical, Morphological, and lmmunophenOfypic Diversity of a Single Low-Gra,de B Cell Clone. Hum Patho/1991; 28(1): 104-110.

CASE NO. 2, ACCESSION NO. 28106 MARCH1997

INLAND CRIVERS!DEJSAN BERNARDINO) - Cystic pulmonary blastoma of childhood (1); Embryonal rbabdomyosorcoma (1); Congenital Iabar emphysema (1); Pulmonary b1.3stoma (1).

BAKERSFIElD (Central Valley Study Grouul - Congenital cystic adenomatoid malformation. CAMARIU.O (Alviso Groopl • Cystic hamartoma with leiomytomosis. VENTIJRA CUnilab) - Cystic pulmonary blastoma of childhood (1), Cystic pulmonary blastoma of childhood (1). Pl.EASANTQN/FREMONI - Cystic pulmonary blastoma of childhood. --lPNG BP..ACH - <llildhood pleuro-pulmonary cystic blastoma with rhabdomyosarcomatous elements (7). OXNABP CSt.Jobm Regional Or) - Pulmonary blastoma, cystic.- -S'AN DIEGO CNaval Medical Comer) - Cystic blastoma of childhood with rbabdomyosarcomatous differentiation (16). SANTA BARBARA (Cottage Hospital) - Embryonal mabdomyosarcoiDll. SANTA Cl.ARA CLDma Prieta Group) - Cystic pulmonary blastoma of childhood (S). SANTA ROSA - Embryonal rhabdomyosarcoma (2); Rhabdomyosarcoma (1). BAY AREA - Rhabdomyooarcoma (3). SACRAMENTO (UC Davis) • Embryonal rhabdomyosarcoma. ARIZONA CVA Med Or) • Congenital alfenomatoid malformation. NEBRASKA (Creighton UnjveJ1!j!v) - Pleuropulmonary blastoma/embryooal rhabdomyooarcoma. MISSISSIPPI <Bantist Hospital) - Cystic blastoma (rhabdomyooarcoma) o[childhood (see fig 21-17 in blue fasctcle). FLORIDA CTa!!oha=e) - Pulmonary blastoma (3). MARYI..AND CBetnesda Naval Med Qrl - Cystic pulmonary blastoma (q). CONffECDC!JT CUnjv Conn Health Or) - Embryonal rbabdomyosorcoma rising in type I adenomatous cystic

malformation. CONNECDcuj IYA!e Univ) - Cystic mesenchymal hamartoma/cmbryona.l rbabdomyooarcoma. MA5SACHUSEIJS CBerk,<hire Med Or) - Embryonal rhabdomyosorcoma. NEW HAMPSHIRECMonchc;;terl - ~habdomyoiarcoma (1); Pulmonary blastoma vs rbabdomyooarcoma (1) NEW JERSEY (Overlook Hospital Summj!l - Rhabdomyosorcoma rising in adenomatoid malformation (2); Pulmonary

cystic blastoma with rhabdomyooarcoma (1); Rhabdomyosarcoma (1). NEW YORK CMetrooolitan Hospital\ - Pulmonary blastoma. NEW yoRK (Jmpath) - Cystic pleuropulmonary blastoma. WYOMING • Pulmonary blastoma. MAINE !Bangor) - Mesenchymal cystic hamartoma. JAPAN (Shimada-Kyoto) - Pulmonary blastoma of childhood.

DIAGNOSlS: CYSTIC PLEUROPULMONARY BLASTOMA, LUNG

1'28000/M .

CONSULTATIONS: Jon M. Rowlan~. M.D., Ph.D., <llildrcns Hospital, Los Angeles, "Consistent with pleuropulmonary blastoma with

predomi'nantly myogenic phenotype." Stephen J. Qual man, M.D., Intergroup Rhabdomyosarcoma Study, "Cystic Pulmonary blastoma."

FOLLOW-UP: The patient is currently receiving chemotherapy with no recurrence (follow period of9 months.)

REFERENCES: Minniti CP, Tsokos M, Newton WA Jr, and Helman U. Specific E.<p~sio.o of lnsulin-uke Growth Factor II in

Rhabdomyooarcoma Tumor Cells. AmJ Clin Patho/!994; 101: 198-203. Henry K and Keal EB. Pulmonary Blastoma with Striated Muscle Compon-ent. Br J Dis Clu:stl966; 60: 87-92. Sousa RC, Elm us DP, Takaro T: Pulmonary Blastoma. A Distinctive Group of Carcinosarcoma Lung. Am Thorax

Surg 1965; 1: 259·268. Asmar L, Gehan EA, Newton W A, Webber Bl, et al. Agreement Among and Within Groups offalhologisrin the

Oassification of Rhabdomyosarcoma and Related Childhood Sarcomas. ·Report of an International Study of Four Pathology Classifications. Cancer l994; 74(9): 2579-2588.

CASE NO. 3, ACCESSION NO. Z7883 MARCH1997

INlAND (RIVERSIDE/SAN BERNARDINO) • Pulmonary histiocytosis X(l); Poorly differentiated bronchoalveolar careinoma.wilh marked histiocytic response (1); Sclerosing hemangioma (2).

BAKERSFIELD (Central Valley Study Group). • Metastatic clear ecU carcinoma. CAMARILLO (Alviso Group) • Papillary adenosquamous carcinoma. VENTURA (Unilab) • Bronchoalveolar carcinoma (2)

PLEASANTON/FREMONT • Adenocarcinoma, NOCvs bronchoalveolar. LONG BEACH • Adenocarcinoma with broncboalveolar spread (7) •

. OXNARD (St. Johns Regional Ctr) • Bronchoalveolar carcinoma. SAN DIEGO <Naval Medical-Center) • Sclerosing hemangioma (13); Papillary adenoma (3).

SANTA BARBARA (Cottage Hospital) • Adenocan:inoma with clear cell features. SANTA CLARA CLoma Prieta Group) ~· Bronchoalveolar tumor (5). SANTA ROSA • Adenocarcinoma, papillary with clara cell component (2); Papillary adenocarcinoma (1). BAY AREA • Bronchoalveolar carcinoma (3). SACRAMENTO (UC Davis) - Papillary bronchoalveolar adenoma vs adenocarcinoma, well-differentiated,

papillary bronchioalveolar type. · ARIZONA (VA Med ctr) - Bronchoalveolar carcinoma. NEBRASKA (Creighton University) • Adenocarcinoma, bronchoalvcolar type (rule our meiasiasis). MlSSJSSIPPI <Baptist Hospital) • Sclerosing hemangioma. FLORIDA ITallahassee) • Sclerosing hemangioma (3). MARYLAND <Bethesda Naval Med ctr) • Sclerosing hemangioma {13). CONNECTICUT <Univ Conn Health ctr) • Sclerosing bem,angioma (4); Bronchoalveolar tumor (4). CONNECTICUT (Yale Univ) - Sclerosing hemangioma (papillary pneumocytoma) dd: papillary

mesothelioma. MASSACHUSEJTS CBerksbire Med ctr) • Bronchoalveolar carcinoma, non-mucinous type. NEW HAMPSHIRE CM•nchester) • Papillary adenocarcinoma with clear cell features (2). NEW JERSEY (Overlook Hospital Sununit) • Sclerosing hemangioma (4).

NEW YORK CMetrooolitan Hospital) • Papillary adenocarcinoma, lung. NEW YORK Ompath) • Sclerosing hemangioma (4). WYOMlNG • Metastatic renal cell carcinoma MAINE ffiongor) • Sclerosing hemangioma of lung. JAPAN (Shimada-Kyoto) • Adenosquamous carcinoma.

DIAGNOSIS: SCLEROSING HEMANGIOMA, LUNG

T28000/M88320 .

REfERENCES: Katzenstein_AA. Gmelich JT and Carrington CD. Sclerosing Hemangioma of !he Lung. Am Surg Pathol 1980; 4: 343-

356. Chan KY/, Gibbs AR, LoWS, et al. l.lenign Sclerosing Pneumoeytoma of !he Lung (Sclerosing Hemangioma). Thorax

1982; 37: 404-412. Semeraro D and Gibbs AR. Pulmonary Adenoma. A Variant of Sclerosing Hemangioma? J Clin Patho/1989; 42:

1222-1223. Yousem M. Hoehholzer L Alveolar Adenoma. HumPatlwl 1989: 1066-1071.

CASE NO. 4, ACCESSION NO. Z8037 MARCH1997

JNlANP CRJVERSIDE!SAN BERNARDINO) • Adenoid cystic can:inoma of bronchus (4). BAKERSfiELD (Central Valley Srudy Group) • Adenoid cystic carcinoma CAMARlUQ (Alviso Group) • Cylindroma. VENIURA CUnil•b> - Adenoid cystic carcinoma (2).

PL'f.ASANTQN/FRE¥0NT • Adenoid cystic carcinoma. LONG BEACH • Adenoid cystic carcinoma (7).

0.1CNARD (St. Johns Regional Or) • Adenoid cystic carcinoma. SAN DIEGO <Naval Medical Center) • Adenoid cystic carcinoma (16). SANTA BARBARA (Cottage Hospital) • Adenoid cystic carcinoma. SANTA CLARA <Lorna Prieta Group) • Adenoid cystic carcinoma (5). SANTA ROSA • lntralumenal polypoid adenoid cystic carcinoma {1); Adenoid cystic carci11onta (1);

Adenocystic carcinoma of tbe polypoid type (1). ·

BAY ARFA • Adenoid cystic carcinoma (3). SACRAMENTO CUC Davi<) • Adenoid cystic carcinoma. ARIZONA (VA Med Or) • Adenoid cystic carcinoma. NEBRASKA (Creighton University) • Adenoid cystic carcinoma. MJSS!SSJPP! CB•pti<t Ho"l'itaD - Adenoid cystic carcinoma. FLORIDA Cfallahossee) • Adenoid cystic carcinonta (3). MARYLAND CBctbesda Navel Med Or) • Adenoid cystic carcinoma (13). CONNECTJCUICUniv Conn He~ltb Or) • Adenocystic c.orcinoma. CONNECDCliT (Vole Univ) - Adenoid cystic carcinoma. MASSACHUSJ.ITTS (Bcrk<birc Med Or) • Adenoid cystic carcinoma. NEW HAMPSHIRE (Manchester) • Adenoid cystic c.orcinoma.(2}. NEW JEBSEY (Overlook Hosoital Summit) • Adenoid cystic carcinoma (4). NEW YORK (Metropolitan Ho.pital) • Adenoid cystic corcinoma. NEW YORK Omp•th) • Adenoid cystic carcinoma. WYOMTNQ • Adenoid cystic carcinoma. MAINE CB!ngor) • Adenoid cystic carcinoma, endobronchial. JAPAN (Sbimada·Kvoto) • Adenoid cystic carcinoma.

DIAGNOSIS: ADENOID CYSTIC CARCINOMA, LUNG

TZ8000/M82003

RBfEI\BNCf.S: Moran CA, Susrer S and Koss MN. Primary Cystic Carcinoma o£ the Lung. A Cliniooparhologic and

Immunohistochemical Study of 16 Cases. Cancer 1994; 73: 1390-1397. Miertinen M and Rapola J. lmmunobisrochemk:al Spcc~rum Rhabdomyosarooma and Rbabdomyosarooma-Uice Tumor.

Expression of cytokeratin and the 681cD Neuromamcnr Protein. Amf Surg PtJt/10/1989; 13(2): 120-132. uwrenceJB, Mazur MT. Adeooid Cystic Carcinoma. A Comparative Pathologic Study of Tumors in Salivary Oland,

Breas~ Lung aod Calyx. Human Patbol1982; 13: 916-92.4. Roggli VL Editorial. Histologic a-ificat.ion of Luns Canoen. Faaon Affecting its Variability. Am J CIU. PDI/ool

1994; 100(3): 411-412. . Mor.an CA, Susrer S, K.oos MN. Primary Adenoid Cystic Carcinoma of the Lung. A Cioioopathologic and

Immunohistochemical study of 16 Cases. Can= 1994; 73: 1390-1397.

CASE NO. 5, ACCESSION NO. 17825 ~MARCHtm

JNI.AND lRJVERSIDEJSAN BEBNARPJNO) - Large cell neuroendocrine carcinoma (1); Carcinoid tumor (mitotic activity not bigh enough for atypical carcinoid) (1); Neuroendocrine carcinoma (1); Atypical carcinoid (1).

BAKERSFIELD (Central Valley StudY Group) - Neuroendocrine carcinoma. CAMARILLO (Alviso Group) - Adenocarcinoma. VENTURA lUnilabl - Alypical carcinoid (1); Spindle cell carcinoid (1). PLEASANTON/FREMONT - Atypical carcinoid. LONG BEACH - Neuroendocrine carcinoma (7). OXNARD (St. Johns Regionol Center) - Pulmonary pmganglioma (chemodectoma). SAN DIEGO CNaval Medical Center) - Atypical carcinoid (6); Welloo(Jifferentiated neuroendocrine

carcinoma (10). SANTA BARBARA - Neuroendocrine carcinoma. SANTA CLARA <Lorna Priet• Group) - Large cell neuroendocrine rumor (atypical carcinoid) (S). SANTA ROSA - Carcinoid tumor (2); Neuroendocrine carcinoma (1). BAY AREA - Neuroendocrine carcinoma (3). SACRAMENTO lUC Davis\ - Spindle cell (atypical carcinoid). ABIZONA <YA Med Or\ - Peripbical, spindle carcinoid tumor .

. NEBRASKA (Creighton University) - Malignant paraganglioma. M!SSJSSJPPJ @aptist HospitaD - Alypic.d carcinoid. FLORIDA Cfallabassce) - Neuroendocrine carcinoma, atypical carcinoid (3). MARYLAND @etbcsda Naval Med Qrl - Alypical carcinoid (13). CONNEcnCUT CUniv Conn Heal!h Ctr) - Neuroendocrine carcinoma (S); Atypical carcinoid (1). CONNECTICUT ITale Univl - Malig,lantcarcinoid/atypical carcinC>id. MASSACHUSE'ITS CBcrkshire Med Qrl - Atypical carcinoid. NEW HAMPSHIRE CManche.<tcr) - Malignant carcinoid (2).

NEW rnRSEY - Alypical carcinoid (4). NEW YORK (Metropolitan Hospi!aD - Atypical carcinoid. NEW YORK Ompalll) - Alypical carcinoid tumor (4). WYOMING - Poorly differentiated squamous cell carcinoma. MAINE (Bangor) - Large cell carcinoma with neuroendocrine features (atypical carcinoid, grade Ill). JAPAN (Shimada-Kyoto) - Atypical carcinoid.

DIAGNOSIS: A TYPICAL CARCiNOID TUMOR, LUNG

n8000/M81401

RI)!'ER!WCBS: MC>dlin IM and Sandor A. An Anolysis of 8305 Cases of Carcinoid Tumors. CllllCer 1997; 79: 813-829. Wise ts, Bonder P, Aikawa M ond Hsieh CL. Carcinoid 1\Jmor of Lung with Varied Histology. Am J Surg Pathol

1982; 6: 261·2.67. El-Naggar AI<. Ball once W, Abdui-Karin FW, et at. Typical and Atypical Bronchopulmonary CarcinoidJ. A

Oinicopothotogicand Flow Cytometric Study. Ami Clin PaJho/1991; 82.8-834. Volli M, Fabris GA. Dewar A, et :al. Atypical Carcinoid Tumor of the Lung. A Study of33 Cases wilb Prog~~ootic

Features. Histopotl.o/2.4: 363-369. Ranchod M and Levine G. Spindle-Cell CarcinoidTIIlDO<S of the Lung, A OinicopotbologicStudyof3S Cases. Ami

Surg Poth<>/4: 315-322.

CASE NO. 6, ACCESSION NO. 27873 MARCH1997

INUNQ CRrVERSIDFJSAN BERNARDINO) • Granullr oell tumor (1); Degenerated neurilemom~ (ancient scbwanoo~m) (1}; Malignant scbwannoma (2).

BAKERS FJELD (Central Valley Study Group) - Spindle oellsarcoma. GAMARILLO (Alviso Group) - Neurofibroma

VENTURA CUnilab) - Neurilemoma. (2}. PLEASANf/PREMONT - Schwannoma.

LONG BEACH - Scbwanooma (1). OXNARD (St. Johns Regional Cr) • Neurilemoma SAN DIEGO (Naval Medical Center) • Ancient scbwannoma (16).

SANTA BARBARA • Scbwannoma. SANIA CLARA CLoma Prieta Group) - Upidizcd sc.bwannoma (5). SANTA ROSA • Neurofibroma, r/o neurofibrosarcorna (1}; Cellular neurofibroma! neurilemn1oma with

xanthomatous change (1); Neurofibroma, r/o neurofibrosa=ma (1).

BAY AREA - Scbwannoma (3).

SACRAMENTO CUC Davis) • Scbwaonoma (neurilemoma). No histologic evidence of malignancy. ARIZONA (VA Med Ctrl • Scbwanooma.

NEBRASKA (Cneigbton University) • Scbwannoma. MISSISSIPPI <Baptist Hospital) - Scbwannoma.

FLORIDA CTallahasseel - Scbwannoma, low grade malignant schwannoma (3}. MARYLAND (Bethesda Naval Mcd Cr) • Pigmented scbwannoma (13). CONNECUCUI <Univ Conn Health Cr) - Scbwannoma. CONNECTICUT (Ya le Univ) • Neurofibroma.

MASSACffi]SE'ITS <Berkshire Mcd Ctr) • Cellular scbwannoma.

NEW HAMPSffiRE (Manchester) - Cellular schwannoma (1); Malignant schwannoma (1). NEW lERSEY (Overlook Hospital Summit) - Schwannoma (4). NEW YORK (Metrooolitan Hospital) - Ancient 5Chwannoma.

NEW YORK Ompatb) • Schwannoma (4).

WYOMING - Scbwannoma. MAINE <Bangor) • Scbwannoma (with foam oells).

JAPAN (Shimada-Kyoto) - Scbwannoma.

DIAGNOSIS: SCHWANNOMA WITH DEGENERATIVE CHANGES ("ANCIENT SCHWANNOMA"),

1\fEDIASTINUM TY2300/M95600 .

REFERENC&'l: Obennan HA and Abell Mit NeurogenollS Tumors of I he Medlaslinum. Cancer 1960; 13: 882·898. Ad<erman LV and Taytor PH. Neurogenous Tumors wilhin tbe Tllorax. A OinicopalbologicEvaluatioo ofForty-Eigbl

Cases. Conctr 1951; 4: 669-691. Swansoo P£. Son Tossue Neoplasms of lbe Mediastinum. Semin Diat;n Pmho/1991; 8; 14-34. S""ter Sand ROIUi J. Thymus. O..p1<r 12. Histol ftN Po tho/ (Ed) StephenS. Sternberg. IUven Press 1992.

CASE NO. 71 ACCESSION NO. 27846 MARCH1997

INLAND ffilVERSIDEISAN BERNARDINO> - Solitary fibrous tumor o( the mediastinum (2); Sclerosing mediastinitis (1); Solitary fibrous rumor (1).

BAKERSFTELD (Central Valley Study Group) - Spindle cell thymoma. CAMARILLO (Alviso Group) • Neurofibroma. VENTURA'CUnilab) -=- Localized· fibrous rumor of childhood (1); Localized fibrous tufll(lr of pleura (1).­PLEASANTON(FREMONT - Solitary fibrous tumor of pleura; Treated (remote germ cell tumor (1).

LONG BEACH • Solitary fibrous tumor (J). OXNARD (St. Johns Regional Or) - Solitary fibrous tumor. SAN DIEGO (Naval Medical Center) • Solitary fibrous rumor (16). SANTA BARBARA - Solitary fibrous tumor. SANTA CLARA <Loma Prieta Group) - ·Soli.tary fibrous tumor (5). SANIA ROSA • Solitary fibrous tumor, r/o hyalinized bemangiopericytoma (1); Hemangiopericytoma vs

solitary fibrous rumor (2). BAY AREA • Fibrous histiocytoma (2); Solitary fibrous tumor(? angiofibroma) (1). SACRAMENTO CUC Davis) - Solitary fibrous tumor (localized mesothelioma). ARIZONA (VA Med Ctr) • Solitary fibrous tumor. NEBRASKA (Creighton University) • Solitary fibrous tumor. MISSISSIPPI <Baptist Hospital) • ·solitary fibrous tumor. FLORIDA Cfallahassee) - Solitary fibrous tumor (3). MARYLAND (Bethesda Naval Med Ctr) - Solitary fibrous tumor (1:3).

CONNECTICUT (Univ Conn Health Ctr) • Solitary fibrous tumor. CONNECTICUT IT ale Univ) - Solitary fibrQus tumor of the pleura. MASSACHUSETTS (Berkshire Med Ctrl - Solitary fibrous rumor. NEW HAMPSHIRE (Manchester) • Benign lesion, favor fibromyosarcoma vs desmoid tufiiOr (1);

Myxofibroma (1). · NEW JERSEY (Overlook Hospital Summit) • Solitary fibrous tumor (3); Benign·stromal tumor (1). NEW YORK (Metropolitan Hospital) - Solitary fibrous tumor. NEW YORK ampathl - Solitary fibrous tumor. WYOMING - Solitary fibrous tumor. MAINE (Bangor) - Solitary fibrous tumor JAPAN (Shimada-Kyoto) - .I:.ocalized fibrous rumor of pleura.

DIAGNOSIS: SOLITARY FIBROUS TUMOR, ANTERIOR MEDIASTINUM

TY2JOO/M90510.

REfERENCE$: Goodlad AR and Fletcher CD. Solitary Fibrous Tumor Arising at Unusual Sites. Analysis of a Series. Histopa1hol

19~h; 515-522. WitiCi!IS OB and Rosai l. Solitary Fibrous Tumor of the Mediastinum. A Report of 14 Cases. Am J Surg Patho/1989;

13: 547-557. (See Case 6--Swan.son)

CASE NO. S, ACCESSION NO. 26935 MARCH1997

INlAND CJU\IERSIDPJSAN BERNARDINO) • Thymoma, malignant (1); Thymoma (3). BAKERSFIELD (Central Valley Study Group) • Malignant lymphoma, large cell type. CAMARILLO (Alviso Group) - Lymphocytic thymoma. VENTURA CUnilab) - Thymoma (2). PLEASANTON/fREMONT - Thymoma, mixed (probably malignant based on history). LONG BEACH - Malignant thymoma (7). OXNARD (St. Johns Regional Or) - Thymoma. SAN DIEGO <Naval Medical Center) • Malignant thymoma (9); Thymic carcinoma (7). SANTA BARBARA - Thymic cueinoma. SANTA CLARA <Lorna Prieta Group) - Thymic carcinoma (5). SANTA ROSA - Malignant thymoma (1); Thymic carcinoma (malignant thymoma, type I) (1); Thymic

carcinoma vs.lymphoma (li. · BAY AREA • Invasive thymoma (3); (? seminomatous type cells) SACRAMENTO CUC Davis) - Thymoma, malignant clinically. ARIZONA (VA Med Or) - Malignant thymoma. NEBRASKA (Creighton Univernity) • Thymic carcinoma MISSISSIPPI <Baptist Hospital) - Thymoma. FLORIDA O'allhassee) - Thymoma (3). MARYLAND <Bethesda Naval Medical Center) - Invasive thymoma (13).

CONNECfiCUT CUniv Conn Health Or) - Thymoma. CONNECfiCUT (Yale Univ) • Malignant thymoma, type I. MASSACHUSETI'S <Berkshire M«< Ctr) - M~Jignant !l!ymoma, type I vs seminoma. NEW f!AMPSIDRE<Manchester) - Malignant thymoma (2). NEW JERSEY (Overlook Hospital Summit) • Invasive thymoma (3); Seminoma (1). NEW YORK <Metrooolitan Hospital) - Thymic carcinoma probably non-keratinizing. squamous cell. NEW YORK aropath) - Invasive (malignant) thymoma (4). WYOMING - Thymic carcinoma MAINE (Bangor) • Thymoma. JAPAN (Shimada-Kyoto) - Malignant thymoma

DIAGNOSIS: INVASIVE THYMOM.A, .MEDIASTINUM

TY280o/M8$800

FOLLOW-UP: . There bas been no tumor rccu rrcncc (8 year follow period).

REfERENCES: Kuo TI and Lo SK DNA Flow Cytometric Study of Thymic "Epithelial Tumors with Evaluation of its Usefulness in the

Pathologic Clilssifocation. /{um Patho/1993; 24: 746-749. Lewis JE, Wick MR and Sheihaur BW, et at. Thymoma. A Clinicopathologic Review. Cancu 1987; 60: 2727-2743, Picb A, Oliarle Rand Cbiura L a_nd Palestro G. Argyrophilic Nuclear Organizer Region COunts Predict Survival in

Thymoma. Cancer 1994; Suster Sand RosaiJ. Thymic Carcinoma. A OinieopathologicStudy of 60 Cases. Cancer 1991; 67: 1025-1032. Pescarmona E, Rendina BA, et at. The Prognostic Implication of Thymoma tlistologic Subtyping. A Study of 80

Consecutive Ca.o:es. Ami C/in Patho/1990; 93: 193·195.

CASE NO. 9, ACCESSION NO. 26541 MARCHI997

INlAND CRJ\IERSTDF/SAN BERNARDINO • Thymoma (I); Thymoma with prominent fibroblastic component (1); Malignant thymic epithelial neoplasm (1); Seminoma (1).

BAKERSFIELD (Centra 1 Valley Study Group) • Metastatic P/D carcinoma. CAMARILLO (Alviso Group) - Large cell immunoblastic sarcoma. VENTURA CUnilab) • Thymoma (2).

PLE6SANJPN/FRFMONT • Thymiccarcinoma. LONG BEACH • Malignant tbymom1 (4); Cucinom1 showing tbymus-lilce elements (CASTI.E) (3).

OXNARD (St. Johns Regional Qr> • Thymoma r/o undiCferentiated carcinoma, r/o genn cell tumor. SAN DIEGO <Naval Medical Center) • Thymic carcinoma (16).

SANfA BARBARA • Thymic carcinoma. SANIA CLARA <Lorna Prieta Group) • Thymic carcinon1a (5). SANTA ROSA • Malignant germ cell tumor(2); Dysgerminoma (1).

BAX AREA • Thymic carcinoma (2); Adenocarcinoma (?seminoma/germ cell tumor) (1). SACRAMENTO CUe Davi•) • Thymic carcinoma (2); Malignant thymoma (2). ARIZONA (VA Med Ctrl • Malignant thymoma. N'EBRASKA (Creighton University) • Thymic carcinoma. MISSISSIPPI ffiaptist HospitaD • Thymic Cllcinoma.

FLORIDA Cfallahassee) • Thymoma (3).

MARYLAND <Bethesda Naval Medigl Center) • Thymic carcinoma (13).

CONNECTICUT CUniv Conn Health Qrl • Metastatic carcinoma (5); Thymoma (1). CONNECIJCUT <Yale Univ) • Malignant thymoma, type 1/Well-differentiated thymic carcinoma. MASSACHUSEITS @erkshire Mcd Qrl • Malignant thymoma, type II. NEW HAMPSHIRE <Manche•terl • Malignant thymoma (2). NEW IERSEY (Overlook Hospital Summit) • Thymic carcinoma (NOS-large ceU type) (4).

NEW YORK <Metropolitan Hospjt•!) • Poorly differentiated thymic carcinoma with clear cells. NEW YORK llmpatb) • Thymic carcinoma (4).

WYOMING • Carcinoma ?neuroendocrine. MAINE CBangor) • (?thymic) Clrcinoma, r/o dysgerminoma/met. JAPAN (Shimada-Kyoto) • Genninoma.

DIAGNOSIS: THYMIC CARCINOMA, MEDIASTINUM

nsoooJM8sso3

REfERENCES: See Rere..,nc:es for Case #8.

CASE NO. 10, ACCESSION NO. 26782 MARCH1997

INLAND (RIVERSIDE/SAN BERNARDINO) - Low grade B-cclllympboma (1); Pulmonary lymphoma (1); Lymphoma, small cleaved cell (1); Well-differentiated lymphocytic lymphoma (1).

BAKERSFIELD (Central Valley Study Group) - Ps<:udolympboma. CAMARILLO (Alviso Group) - Lymphoma (leukemia?). VEN'IURA <Unilab) - Malignant lymphoma, smalllymph·ocytic (2).

PLEASANTON/FREMONT • UP (small oelllymphoma). LONG BEACH - Malignant non-Hodgkin's lymphoma (plasmacytoid) (7).

OXNARD (St. Johns Regional Cir) - Malignant lymphoma, small cleaved cell type. SAN DIEGO <Naval Medical Center) - Extranodal marginal zone (MALl') lymphoma (16).

SANTA BARBARA - Small lymphocytic lymphoma with plasmacytoma features. SANTA CLARA <Lorna Prieta Group) - Malignant lymphoma (5).

SANTA ROSA - Malignant lymphoma, r/o rna llama (1); Maltoma (1); Small lymphocytic lymphoma of theMALTtype.

BAY AREA - Lymphoplasmacyticlymphoma (2); extra medullary plasmacytoma (1).

SACRAMENTO <UC Davis) - Small lymphocytic lymphoma, low grade. ARIZONA <VA Med Cir) - Small B-ci:ll lymphoma of MALT. NEBRASKA (Creighton University) - Malignant lymplloma of small lymphocytes, probable MALT type. MTSSISSIPP! (Baptist Hospital) - Low grade lymphoma. FLORIDA Cfallhassce) • Lymphoma (3). MARYLAND (Bethesda Naval Medical Center) - Maligr~ant lymphoma, low grade (13).

CONNECTICUT <Univ Conn Health Ctr) - B·cclllympboma, low grade. CONNECTICUTCYale UnivY- B-eelllymphoma ofMALTtype. MASSACHUSETTS (Berkshire Med Cir) - Maligr~ant lymphoma, small cell type. NEW HAMPSHIRE <Manchester) - Malignant lymphoma (1); Lymphoma· with plasmacytic features (1). NEW JERSEY (Overlook Hospital Summit) - Low grade lymph·oma (4).

NEW YORK<Metrooolitan Hospital) • B-cclllymphoma. NEW YORK CTmpath) - Maligr~ant lymphoma, small B-cell, marginal zone, probable BALT. WYOMING - Low grade MALT lymphoma. MAiNE (Bangor) - Lymphoma of BALT. JAPAN (Shimada-Kyoto) - ):..ow-grade lymphocytic lymphoma ofBALT.

DIAGNOSIS: CONSISTENT WITH LYMPHOPLASMACYTIC LYMPHOMA, LUNG

T28000/M96113

CONSULTATION: l3har'at N. Nathwani, M.D., USC Medical Center, Los Angeles, "Strongly Suggestive of Lymphoplasmacytic

Lympboma.H

REFERENCES: BieJtenstock J and flet'us AD. Gut and Bronch ... --As~oclated Lymphoid Tissue. Am J Anat 170: 437-445. Sai2Stein SL. Pulmonary Malignant Lymphomas.and Pseudolympbomas. Classification, Therapy and Prognosis.

COliCer 16: 928-955. Turner R, Colby T and Dogget R. Well-Differentiated Lymphocytic Lymphoma. A Study. of 47 cases with Primary

Manifestationin the I..JJng. C(Uicer 1984; 54: 2088-2096. Kobuk L. Benign Pulmonary lesions That May Be Misdiagnosed as Malignant. Semin D.iagn Patlw/1990; 7: 129·

138.