MINNESOTA SOCIETY OF CLINICAL PATHOLOGISTS

ANNUAL TUMOR SEMINAR

November 10, 1979, 9:00 A.M.

·r1innesota Club

317 Washington, St. Paul

Dr. David C. Dahlin, Moderator Chairman of Surgical Pathology

Mayo Clinic, Rochester, MN.

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CLINICAL SUMMARIES

Case 1 - A 17-year-old man complained of pain of 3 weeks duration in the distal part of the thigh. Roentgenograms disclosed a zone of rarefaction, ''probably benign:• involving a zone with a maximum dimension of 5 em in the distal femoral metaphysis. (Contributed by Dr. D. C. Dahlin, Rochester, MN)

Case 2 - A 22-year-old man began having seizures 9 years previously. The first three, each a month apart, were grand-mal. Since then the seizures have been psychomotor type . Electroencephalogram disclosed a delta focus in the temporal lobe corresponding with the area of a probable tumor on CT scan. Angie­graphic studies, however, even with magnification and subtraction views were negative for tumor. Right anterior temporal lobectomy was performed on April 19, 1979, and a 2 em in diameter tumor was found on the surface of the brain. (Contributed by Dr. D. C. Dahlin, Rochester, MN)

Case 3 - A 27-year~old Korean woman, who had been living in this country for 2 years, complained of a right axillary mass of less than 6 months duration. The mass was excised. It measured 5.5 em in diameter and had a fleshy cut surface. (Contributed by Or. R. C. Munkittrick, Eitel Hospital, Minneapolis, MN).

Case 4 - 59-year-old male with symptoms of weakness and numbness of the upper extremity, and a palpabl~ axillary mass. The symptoms were exaggerated by applyin~ indirect pressure to the mass. No x-ray findings were noted. At surgery, the 1es1on appeared to ~e a fai·rly well-encapsulated 7 x 4 em mass intimately associated with the medial cord of the brachial plexus, from which it separated fairly easily. (Contributed by Dr. James Hansen, St. Cloud, MN)

Case 5 - A 69-year-old female complained of a suprapubic subcutaneous mass. It was present for 4 years and had been growing slowly. During the past 6 months the patient complained of morning spells of light-headedness, sweating and trembling. The abdominal wall mass was excised. It weighed 2100 gm. (Contributed by Dr. J. J. Baldwin, Fargo Clinic, Fargo, NO)

Case 6 - A 62-year-old woman presented with a three-month history of increasing nasal ''stuffiness'' and hyposmia. Examination revealed diffuse induration of the nasal and sinusoidal mucosae and periorbital edema. She was otherwise asymptomatic but laboratory studies revealed a high erythrocyte sedimentation rate and markedly abnormal liver function tests. Multiple biopsies of nasal mucosa were taken. (Contributed by Or. Peter Banks, Mayo Clinic, Rochester, MN)

Case 7 - A 58-year-old female had a vague history of upper abdominal discomfort . Gastric roentgenographic examination showed a 2 em polyp in the distal antrum. At gastroscopy, a pedunculated polyp was snared and removed without complication. (Contributed by Or. L. H. Weiland, Mayo Clinic, Rochester, MN) ,

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Case 8 - This otherwise asymptomatic 24-year-old man had a unilateral multinodular scrotal mass on the right. The duration of the lesion was not stated. There was no history of trauma or previous surgery. The right hemiscrotum was enlarged and multiple firm masses ranging from 1 to 3 em were palpated adjacent to the testis. {Contributed by Dr. D. C. Dahlin, Rochester, MN)

Case 9 - 68-year-old male with 2-year history of chronic lymphocytic leukemia, treated with chemotherapy. The patient has now developed a left lower lobe mass which has not responded to treatment when the lymphadenopathy decreased during treatment. A left lower lobe excision was performed. Grossly, a well circumscribed tumor, measuring 2 em in greatest dimension, was found within the pulmonary parenchyma. It was gray, solid and homogeneous. {Contributed by Dr. Stephen Ewing, V.A. Hospital, Minneapolis, MN)

Case 10 - 65-year-old female with a solitary cold thyroid nodule measuring 3 em in diameter. It was well circumscribed and solid. The remainder of the thyroid gland was unremarkable . Lobectomy with isthmusectomy was performed. Hormonal status is unremarkable. {Contributed by Dr. Robert Anderson, Minneapolis, MN)

Case 11 - 5-year-old male with abdominal mass. X-ray studies showed this to be loca l ized in the right kidney. A nephrectomy was performed. Grossly, the speci­men weighed 457 gm and measured 14 x 9 x 7 em. The upper pole of the kidney was replaces by a large tumor, which was grayish, somewhat myxoid, with yellowish areas of necrosis. The tumor invaded the capsule , perirenal soft tissues and hilar region. {Contributed by Dr. L. P. Dehner, Minneapolis, MN)

Case 12 = 28-year-old man who presented with a mass in his right testis. He had a history of maldescent of the right testis, treated surgically 19 years ago . He subsequently married and has had children. At the time of his orchiectomy, a metastatic workup was negative. Preoperatively, human chorionic gonadotropin levels were less than 1.3 micro international units per milliliter {normal is less than 5), and his alpha fetroprotein was 22 nanounits per milliliter {normal is 5-30). Grossly, the testis measured 8.5 x 6 x 6 em and weighed 148 gm. On cut section, the organ was completely replaced by multiple tumor nodules, varying in size from 0.3 to 2. d em. They were ye 11 owi sh, white, soft, with areas of necrosis. {Contributed by Dr. Kathleen Holahan, Minneapolis, MN)

Case 13 - 60-year-old female with recent development of postmenopausal bleeding. Physical examination revealed evidence of an enlarged uterus {uterine cavity probed to depth of five inches). Dilatation and curettage yielded approximately 100 cc of curettings. Some of these curettings were grayish-pink and friable, while others were yellowish-tan and rubbery. Subsequently the patient underwent a total hyster­ectomy with bilateral salpingo-oophorectomy. On gross examination, there was adenocarcinoma in the fundus limited to the endometrium', with no areas of invasion. The uterus also contained three typical, benign appearing leiomyomata. A fourth tumor seen in the corpus was bright yel l ow, rubbery in consistency, and intramural, with projection inte the endometrial cavity. This tumor, from which the Seminar sections were taken, was in the posterior wall and measured 5.5 em in diameter. {Contributed by Dr. Elias N. Manoles, Minneapolis, MN)

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Case 14 - The patient, a 65-year-old male, presented with a four day history of constipation with abdominal pressure. The day prior to admission, he began vomiting fecal smelling material. X-rays revealed the presence of a classic small bowel obstruction with air fluid levels . At exploratory laparotomy, large, firm white, rubbery tumor nodules were present in the liver, measuring from 4 to 6 em in diameter. There was a small bowel obstruction due to a constricting le$ion of small bowel, 4.5 x 3 x 2 em., located 4.5 em. proximal to the ileocecal valve. A smal l bowel resection with primary anastomosis was accomposed. The cross-sectional cut surface, in the area of constriction revealed a firm, white, rubbery tumor mass, focally interspersed with orange-yellow material. (Contributed by Dr. Peter M. Banks, Rochester, MN)

Case 15 - 16-year-old female with secondary amenorrhea and abdominal mass. At laparotomy a 520 gm tumor was found involving the left ovary. Surgical operation consisted of left salpingo-oophorectomy plus appendectomy. The ovarian tumor was described grossly as partially cystic, encapsulated, nonpapillary, with a fleshy, multi-chambered and partially necrotic surface on cross section. (Contributed by Dr. Richard Reece, Minneapolis, MN)

Case 16 - A mother noticed a "mole" on top of her baby's head. At age 3-4 years the infant developed brown spots on her trunk. At 13 years of age she complains that traumatizing the "mole", e.g., by combing hair, causes facial flushing, light-headedness and headache. Examination showed a 1.3 x 1 em raised reddish­yellow lesion on scalp and multiple macular-brown spots on trunk. The scalp lesion was excised. (Contributed by Dr. J. R. Goellner , Mayo Clinic, Rochester, MN)

Case 17 - 79-year-old male with a nodule on the left cheek, initially noted two and a half years ago. The nodule has progressively increased in size, and now there is extensive involvement of the entire left half of the patient's face. The tumor has been biopsied several times, and diagnosed as poorly different iated lymphoma. The tumor is unresponsive to various courses of chemotherapy, and is now growing quite rapidly. There is no evidence of disseminated disease. (Contributed by Dr. R. Sibley, Minneapolis, MN)

Case 18 - 24-year-old female with history of tumor nodule over the tibia of the left leg, initially removed at the age of 21 years, which recurred locally six times. Eventually, inguinal lymphadenopathy developed on the side of the tumor. A left inguinal node dissection was performed , followed a month later by para-aortic and iliac lymph node dissection. The patient died one year later with clinical signs of acute abdomen. No autopsy permit was obtained. (Contributed by Dr. John P. Knoedler, Duluth , MN)

Case 19 - A 51-year-old woman had tissue removed from a zone of rarefaction approximately 4 em in diameter in the central part of the femoral shaft distally . She had had local discomfort. On February 28, 1974, she had had a "meningioma" removed from the occipital region at another institution. (Contributed by Dr. D. C. Dahlin, Rochester, MN)

Case 20 - This 16-year-old man complained that the 7th tooth was not erupting properly. Roentgenogram showed a lucent , discretel y-outlined area of the right maxilla containing an impacted right lateral incisor. The lesion was enucleated. (Contributed by Dr. D. C. Dahlin, Rochester , MN)

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HSCP 1979 ANNUAL TUMOR SE~HNAR DIAGNOSES

HAIL TO: Dr. Juan Rosai Department of Laboratory Medicine and Pathology Mayo 13ox 609 420 Delaware Street S.E. University of Minnesota Minneapolis, MN 55455

MINNESOTA SOCIETY CLINICAL PATHOLOGY SEMINAR CASES

1. Distal femur

Contributor ' s diagnosis: Discussant's _diagnosi s:

November 10, 1979

David C. Dahlin, M. D.

t elangiectatic osteosarcoma. telangiectatic (hemorrhagic) osteosarcoma.

Reference : Matsuno , T., Unni , K. K. , McLeod, R, A., and Dahlin, D. c.: Telangi ectatic osteogenic sarcoma. Cancer 38:2538 (December) 1976

2. Brain

Contrlbutor's diagnosis: Discussant's diagnosis:

xanthoas t r ocytoma . xanthoastrocytoma .

Reference : Kepes, J . J . , Rubinstein, L. J., and Eng , L. F.: Pleomorphic xanthoastrocytoma. A disti ncti ve meningocerebral glioma of young s ubj ects with relatively favorable prognos is . In press, Cancer . To be published in November 1979 issue .

3. Axillary node

Contributor' s diagnosis: Discussant's diagnosis:

signet ring malignant lymphoma . signet ring cell malignant lymphoma .

Refer ence: Kim, H., Dorfman, R. F. , and Rappaport, H. : Signet ring cell l ymphoma ; a rare morphol ogic and functional expression of nodular (follicu l ar) lymphoma . Am . J . Surg. Pa t h . 2 :119 (June) 1978

4. Axilla

Contributor ' s diagnosis : peripheral neuroepithelioma. Discussant's diagnosis: malignant neuroepithelioma (ependymoma) .

Reference : D'Agostino, A. N., Soule, E. H. , and Miller , R. H.: Primary malignant neoplasms of nerves (malignant neurilemmomas) i n paU ents without manifes t a t ions of multiple neurofibromatosis (von Reckling­bausen's disease) . Cancer 16 :1003 (August) 196 3

5. Abdominal wall

Contributor's diagnosis: Discussant ' s diagnosis :

hemangiopericytoma. grade 2 (3 grades) malignant hemangiopericytoma with hypoglycemia.

continued ->

~1SCP SEHINAR CASES, page 2

Nov. 9-10 , '79. David C. Dahlin , M. D.

References: Enzinger , F . M., and Smith, B. H. : Hemangiopericytoma . An analysis of 10'6 cases. Human Pathology 7:61 (January) 1976

Anderson, J., and Lokich, J . J . : Mesenchymal tumors associated with hypoglycemia . Case report and review of the literature . Cancer 44:785, 1979

6. Nasal cavity

Contributor's diagnosis: Discussant's diagnosis:

angioendotheliomatosis proliferans . intravascular grade 4 angiosarcoma

References : Scott, P . W. B. , Silvers, D. N., and Helwig, E. B. : Prolif­erating angioendo'theliomatosis. Arch. Pat. 99 : 323 (June) 1975

Kurrein , F.: Systemic angioendotheliomatosis with metastases . J . Clin . Path. 29:347, 1976

7. Stomach

Contributor's diagnosis : Di s cussant's diagnosis:

inflammatory fibroid polyp . inflammatory fibroid polyp .

References : Hehvig , E. G., and Ranier, A. : Inflammatory fibroid polyps of the stomach. Surg . , Gynec., and Obstet . 96:355 (Harch) 1953

Samter, T. G., Alstoll, D. F., and Kurlander, G. J .: Inflammatory fibroid polyps of the gastrointestinal tract . Am . J . Clin. Path . 45 :420 (April) 1966

8 . Tunica vaginalis

Contributor's diagnosis: Discussant ' s diagnosis :

inflammatory f ibroid polyps . inflammatory pseudotumors.

Reference: Mostofi , F . K., and Price, E. B. Jr .: Tumors of the male genital system. Atlas of Tumor Pathology . A.F.I.P., page 151, 1973

9. Lung

Contributor's diagnosi s : atypical carcinoid. Discussant ' s diagnosis: grade 3 adenocarcinoma, carcinoid type .

Ref erence : Arrigoni, M. G. , Woolner, L. B .. , and Bernatz , P . E. : Atypical carcinoid t umors of the l ung . J , Thoracic and Cardiovasc. Surg . 64:413 (September) 1972

10. Thyroid

Contributor's diagnosis: Discussant ' s diagnosis:

atypical adenoma . atypical adenoma

Reference: Meissner , W. A. , and Warren, 5. : Tumors of the t hyroid gl,and . Atlas of Tumor Pathology . A.F . I.P . , page 46, 1969

J

11. Kidney

Contri butor ' s diagnosis : Discussant ' s diagnosis:

MSCP SENI NAR CASES, page 3

Nov . 9-10, '79 David C. Dahlin , M.D.

bone- metastasizing clear cell tumor . bone- metastasizing renal sarcoma of choldhood .

References : Marsden, H. 1L , Lawl er , W., and Kumar , P . M. : Bone metastasizing renal t umor of chi ldhood , Mor phological and clinical features and differences Erom tHlms ' tumor . Cancer 42 : 1922 (October) 1978

12. Testes

Contributor ' s diagnosis : Discussant ' s diagnosis :

anaplastic seminoma . anaplastic seminoma.

References: Pugh, R. C. B. : Pathology of the testes . Blackwell Scientific Publ ications, 1976

13. Uterus

Kademan , M. , Bosch , A., Caldt~ell , H. L., and Jaeschke, \~ . : Ana­plastic seminoma . Cancer 40 : 3082 , 1977

·Percarpio , B. , Cl ement s , J . C. , McLeod , D. G. , Sorgen, S. D. , and Cardinale, F . S. : Anapl astic semi noma . An analysis of 77 patients . Cancer 43 : 2510 (June) 1979

Contribu tor ' s diagnosis : combined muscle-stromal tumor . l eiomyosarcoma, grade 1. Discussant ' s diagnosis :

Ref erence : Tang , c . -K., Taker , c ., and Ances, I . G.: Stromomyoma of the uterus . Cancer 43 : 308 (January) 1979

14 . Ileum

Contributor ' s diagnosis : glandular carcinoid. Discussant ' s diagnosis : grade 3 adenocarcinoma, ?carcinoid related .

Reference : Harkel, R. L. , Cooper , P. H. , and Helwig, E. B. : Adenocarcinoid, a mucin- producing carcinoid tumor of the appendix . Cancer 42 : 2781 (December ) 1978

15 . Ovar y

Contri butor' s diagnosis : teratoid androblas t oma . Di scussant ' s diagnosis : androblastoma with heterol ogous elements .

Reference : Scully, R. E. : Ovarian tumors . Am. J . Path . 87 : 686 (J une) 1977

16. Ski n, head

Contributor ' s di agnosis : mastocy tosis . Discussant ' s diagnosis : mastocyt osis (mast cel l nevus) .

References : Klaus, S . N. , and IHnkelrnann , R. K. : The clinical spectrum of ur t icaria pigmen t osa . Mayo Clin . Proc . 40 : 923 (December) 1965

·NSCP SEMINAR CASES, page 4

Nov . 9-10, ' 79 David C. Dahlin , H. D.

Fishman, R. S., Fleming , C. R. , and Li , C.-Y.: mastocytosis with a r ·evi ew of gastrointestinal Mayo Clin . Proc . 54 :31 (January) 1979

Systemic manifestations .

17 . Skin, cheek

Contributor's diagnos i s : Discussant ' s diagnosis :

neuroendocrine (?Herkel cell) tumor . grade 4 malignan c neoplasm, . type?

Re f erences : Taker , C. : Trabecular carcinoma of the skin . Arch . Dermatol. ~05 : 107 (January ) 1972

18. Skin, leg

Contributor ' s diagnosis : sweat gland carcinoma . Discussant ' s diagnosis: grade 3 adenocarcinoma of sweat gl ands .

Ref erence : Niller , W. L. : S\veat-gland carcinoma . A clinicopa thologi c problem. Am. J . Clin . Path. 47 : 767 (June) 1967

19 . Femur

Contributor ' s diagnosis : bemangiopericytoma, gr ade 3. hemangiopericytoma, grade 3. Discussant' s diagnosis:

Reference : Goellner , J . R., Laws , E. R. Jr ., Soule , E. H., and Okazaki, H. :

20. Maxilla

Hemangiopericytoma of the meninges. Am. J. Clin . Path . 70:375 (September) 1978

Contri but or ' s diagnosi s : adenomatoid odontogenic t umor. adenomatoi d odontogeni c tumor. Discussant's diagnosis :

References: Bedrick , A. E. , Solomon , M. P . , and Ferber, I. : The adenomatoid odontogenic tumor: An unusual clinical presentat i on . Oral Surg . , Oral Ned , , and Oral Path . 48 : 143 (August) 1979

Cina, M. T., Dahlin , D. C., and Gores, R. J .: Ameloblastic adenomatoid tumors. Am . J . Clin . Path . 39:59 (January) 1963