JUNE SEMINAR

MINNESOTA SOCIETY OF CLINICAL PATHOLOGISTS

Case lo Submitted \y Dr . D. c. Dahlin

a 43 year old man had noted a mass in his neck for 31 yearso The maas was painless and there was no change in size or consistency. A circumscribed mass was removed surgically. It measured 3 x 2. 5 x 2 . 5 em.

Case 2. Submitted by Dr. P. c. Dietz

Female, age 691 became dyspneic and manifested auricular fibrillation during September~ 1952. She improved slightly under digitalis and restricted activity. A roentgenogram of the chest disclosed the right thorax to be fluid filled. Thoracentesis yielded 1500 ml . of bloody liquid. Dyspnea increased. Weight loss was minimal. Cough and expectoration developed during September, 1953, together with anasarca and orthopnea. At necropsy the right chest cavity was occupied completely by a firm mass .

Case 3• Submitted by Dr. w. A. Bennett

This male~ of 2 years of age , at the age of 22 months began to have an enlargament of abdomen. · Two months before thia 1 he developed macular eruption on his back. Six months before arriving, the skin lesions became sl ightly enlarged, spr ead over the entire body, associated with wasting of his muscles. The WBC was slightly elevated. The platelets were normal. The Kahn was positive . He developed purpuric xanthoma tosis with necrotic ulcers over the body and pan cytopenia. At post mortem the spleen weighed 350 grams and the lymph nodes were diffusely enlarged.

Case 4. Submitted by Dr. J . E. Edwards .

A 31 year old female . About six months before arriving at the clinic, developed shortness oi breathing and exertion, also radiating pain in both arms . A moa th before this time, the local doctor reported an enlarged heart . She was considered to have septal defect , a cardiotomy was done and a patent foramen ovale foundo The patient died in persistent heart failure.

Case 5• Submitted by Dr. E. M. Parkhill

White male 1 6 y~ars of age. Approximately two months ago , the patient ' s mother noticed the lids of the right eye becoming black and blue. Two weeks l ater she noticed the eye protruding slightly . Two weeks ago~ patient began to complain of occasional double vision and for the past week there has been occasional pain in the eye . Examination: There is a reduced moti l ity (-3} of all the muscles of the right eye. The globe is di splaced forward and temporalwerd. Upon trying to press the globe back into the orbit , firm re sistance is met with. There is sl i ght swelling of the right eyelids with slight ecchymosis. In the right eye 1 there is a papilledema of three diopters . The disk is hype r emic and the veins are engorged. There are circular wrinkles of retina exte nding out from the disk. A soft , irregular mass can be palpated; the mass seemed to fill the medial part of the orbit.

FUNDS FOR THIS SEMINAR CaNTRIBUTED BY MINNESOTA DIVISION, AMERICAN CANCER SOCIETY, INC .

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Case 6. Submitted by Dr .. c. J . Daw•

32 year old white femaleo Admitted with complaint of left upper quadrant pain one yea-r . GI roentgenograms normal . Chest film showed non- pulsating anterior mediastinal mau at level of aroh of aorta. No movement of mas s on swallowing. No cal.oifioation . Curare teat for myasthenia gr avi s negative . Sed . rate 28 mm. per hour . Hgb . 12. 8 gma . ~C 5 , 400 , STS negative . Tuberculin te at , negative , second a trength P 0 P . D. Anterior Mdiaatinal tumor involving lower portion of right lobe of thymu s gland removed a t eurgery .

Case 7. Submi tted by Dr . L.. B. Woolner

hmale • 51 years old . Black, firm , elevated nodule (8 mm. } dorsum right foot near h ae of 11 ttle toe .

Cue 8 0 Submitted by Dr. E . H. Soule

A 30 year old woman had been feeling below par for three months . Five weeks ago eudden onset of severe headache and nausea . One day later petechial hemorrhages on legs. found to be anemic . Positive Rumpel- L.eede test . platele t a 2s. ooo . prolonged bleeding t i me , bone marrow aaid to be normAl . Received five blood tranafuaiona . ~o weeks a go transient numbness right hand and dysarthria . When seen here slightly ioteric • nume r ous petechiae &nd eoohymoaes , liver and spleen not enlargedo Hemorrhages i n fundi. Hg. 67 . 6 , R.BC 2 . 58 , WBC 8 1 400 ; RBC fragil i ty normal , Coombs teat negative , Fecal urobilinogen 870 mgm. Condition of pat i ent continued to fail with transient cerebral symptoms. Spleneotomy done on the 36th day of illness .

Case 9 . Submit ted by Dr. J . s. MoCartney

A man of 76 noted pain and swelling of the testis whioh he thought to be related to repeated bruising incurred while riding a tractor durin g the preceding few months . !he testis was enlarged and hard . Orchiectomy was performed. The testis was replaced hy a hemorrhagic soft nodular tumor 6 x 5 x 3 em.

Case 10. Submi tteci by Dr . Paul Lober

A ~aa was found in the upper a bdomen of a 6 mo nths old girl. A massiv e tumor was r~oved from the right l obe of the livero It weighed 480 gma., was lobular, sharply ciroumscri bed , covered with a layer of normal l i ver , and on aeotion 1 was !i rm , gray t o brown and showed some oa l oifio fool .

Cue 11 . Submitted by Dr . Robert Hebbel

h unmarried woman, age 60 1 n oted a mass in the right breast one week bef ore and a •loody discharge from the right nipple one day before examina tion. A hard moveable aaaa about 5 om. in diameter was present beneath the nipple. The tumor was about 5 om. in diameter , sharply circumscribed , p a rtly cys t ic , soft , granular and partly hemorr ha gio .

Cue 12. Submitted by Dr. c . w. Freeman

Awoman age 4 3 had several episodes of lower abdominal pain , the most recent of which had been present for several days and was more severe . Examina t ion revealed a pelvic tumor Ylloh was re~oved piecemeal . It was adherent to but did not otherwise involve the uterus .

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Case 13 . Submitted by Dro J . I . Coe

A woman age 62 had pain and swelling of the right knee of 6 weeks duration. During lhe preTious 10 years , she had infrequent seizures which were well- controlled with dilantin . There was left sided spasticity. Cerebral angiogram a and pneumo encephalogram s showed a space- occupying lesion in the right hemisphere . The right knee was swoll en firm and tender , x - r::t.ys showed a large destructive lesion in the lower femur involving both condyles and the metaphysis . In one area the cortex was broken through. On exploration the cortex of the medial condyle was soft and easily broken. A copious

amount of soft grayish tissue was scooped out .

Case 14. Submitted by Dr . M. . B. Llewellyn

A woman age 38 , para V , grav VI was admitted in active labor on 2- 3- 53 and delivered a 1tillborn infant two hours later. Five hours later uterus well contracted and no unusual abdominal findings . On 2- 4 - 53 the abdomen was tense and there was rebound tenderness. The WBC was 18 , 200. Laparo tomy was performed and thick creamy material containing fat was found in the peritoneal cavity. There was a ruptured right ovarian cyst 8 . 5 x 7 x 4 . 5 om. with walls from 3 to 20 mm. in thickness , which con­tained hmr and greasy material. The cyst showed no unusual gross features.

Case 15 . Submitted by Dr . c . W. Freeman

A 2 year old boy had episodes of blood- tinged urine beginning in Nov. 195~ At that time the uri~e showed albumin, pus and red cells . Exoretory urograms were said to be negative . Bleeding episodes with difficulty in voiding continued and he was hos­pitali~ed on 1 - 15- 53. Intravenous urogram s showed normal kidneys and nume rous defects in the bladder which were interpreted to have been produced by a tumor . Cystoscopy showed numerous small hydatiform tumors projecting from the mucosal surfaces. A cyst­ectomy was performed. About half of the bladder presented closely packed warty soft excrescences to bulky soft masses , the largest of which was about 5 om. in diameter and multilobular.

Case 16. Submitted by Dr . Paul Heise

A woman di~d at age 52 after an illness of several years during which time there were 20- odd hospi~al admissions . At a ge 18 she had weakness and swelling of the feet. Diagnoses of •anemia, ~idney trouble and leakage of the heart• were made . Iron was adTiaed and taken intermittently . She apparent ly had no furthe~ trouble until 1948 when dyspnea , pa~pitation and edema appeared. In August 1949 her blood showed a hgb. ot 3.4 gm. with 2.02 million rbo . The WBC , Diff ., icterus index and van den Bergh were normal . U~der liver the hgb. rose to 6 . 1 gm. in six months . She was hospitalized in June , 1950. The BP was 125/60 , pulse 145o Dullnes s and rales were found in both bases . The heart and liver were enlarged , spleen palpable , edema ankles. Cheat films showed oongeatioD and pneumonia. Laboratory : hgb. ~9, rbc . 1 . 64, serum iron 31 gamma %, wbo. and diff'o normal o With transfusions hgb . rose to 13 . 9 gms . A month later hgb. 11 .5 gtn& o Weekly IV iron advised. Ten injections failed to maintain h«b • Survey showed similar findings plus fine granular densities in lung fields . For balance of life there t was

severe hypoohronic anemia requiring frequent transfusions . There were repeated in­creasingly severe episodes of dyspnea , o ough , cheat pain, fever and sometimes cyanosis . Crepitant rales and sometimes dullness present at these times . Granular densities with or without pneumonia persisted in chest films . BP ranged from 110-120/70-80. No murmurs , ECGnormal. Hgb . 40%- SO% after transfusions . WBC , diff . always normal , urine negative . Cold agglutinins , aoid hemolysin , fragility , indirect and direct Coomb• oon­aistently normal . In aoute episodes icterus inde:x to 14 , indirect bilirubin . 5- 1 . 5. Cortisone / was given in Augu s t 1953 but caused elevation BP to 170/100 and was discontinued . The final acute episode was in Nov . l953 and there was no response to the usual supportive measures .

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Case 17. Submitted by Dr. R. w. Koucky

Ea amination of the thyroid of an 8 year old g.irl1 several weeks after her mother had noted a "lump" in the neck, showed a smooth, soft 1 em. mass in the left lobe. Two months later it had reached a size of 'about 2 x 2 x 1 em. The nodule was removed about six months after it was first noted and was now about 2Q5 em. in diameter, sharply circumscribed and encapsulated, opaque and fleshy .

Case 18. Submitted by Dr . Kano Ikeda

A res t l ess, disoriented man, age 55, was admitted to the hospital . Neurological and routine laboratory examinations gave normal results . The left eye was absent. Ventriculography gave evidence of a mass in the left frontal region and there was bone destruction in the wing of the sphenoid and ma&illary sinus . Craniotomy re­vealed a large, soft friable tumor involving the frontal lobe.

Case 19. Submitted by Dr. J. w. James

lhtte male , age 28, admitted November 28, 1948, because of proptosis of left eye , first noted three and one-half years ago and had gradually become more marked. A gr ay tumor 4 om. in diameter with punctate hemorrhagic areas was r emoved from the left orbit. One week later an exenteration of the orbit was performed. There was no evidence of recurrence or metastasis when last seen December , 1953•

Case 20. Submitted by Dr. J . L. Jaeck

Male, age 55, had a tumor removed from the upper port ion of the arm which measured 8 x 5 x 4 em. and was not attached to the bone or the shoulder joint. Five months lat er 1 there was a recurrence at the same site which was again excised and the tumor weighed 170 grams.

Case 21. Submitted by Dr. A. c. Aufderheide

Routine chest films of a woman age 38 admitted to the hospital in actiTe labor showed a widened superior mediastinum. There was a palpable mass on the ri ght side of the necko . A photofluorogram one year previously was said to have been negative . Exploration three weeks postpartum showed a tumor mass attached along the bodies of the upper thoracic and lower ceryical wertebral bodies which displaced the thyroid and common carotid forward . The tumor weighed 70 gms . , was 7 x 7 x 5 em. , encapsulated, tan , homogeneous , and rubbery .

Case 22o Submitted by Dr. M. B. Dockerty

Female , 53 years. For one month post-menopausal spot~ing . For one week , rather profuse vaginal bleeding. Pathology: 12 em. tumor right ovary - adherent . Uterine !ibroids. Proliferative endometrium.

Case 23• Submit ted by Dr. Judd

A woman, 331 grav V1 para IV entered hospital on 11-5-53 because of heavy vaginal bleeding. Her last period was , - 16- 53• The uterus was soft and size of 3t month pregnancy. On 11-8-53 curettage yielded a mole. The uterine cavity felt smooth. A quantitative Friedman was positive 1:50 and negative 1:100 on 11- 9-53• On 12-1,-53 the uterus was the size of a 2 months pregnancy. There was no vaginal bleeding. A quantitative A-Z test showed 68000 rat units . On 12 - 22- 53 curettage yielded about 5 cc. of necrotic tissue which again showed a mole . On 12-28-53 the uterus was removed. High on the posterior wall there was a roughened area about 3 em. in diameter beneath which , to a depth of 2 em. , there were rounded discrete and con­fluent hemorrhagic areas from some of which small cystic masses could be expressed.

Case 24. Submitted by Dro J . Fo Noble

Three years ago a woman age 4o had a tumor , said to be a cyst, removed from the medial aspect of the sole of the footo It recurred two years ago and gradually enlarged. The excised tissue showed a circumscribed, lobular, soft tumor about lo5 Cmo in diameter.

Case 25o Submitted by Dr . L. B. Woolner

remale1 '0 years old. Goiter of two years 9 duration. BMR -8. Difficulty in swallowing and episodes of difficulty in breathing. Surgery 4-4- 50• No reply to follow-up letter of 11-10-53•

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