PROTOCOL

FOR

Jo!Oll'rHLY SLIDES

Ma.y,l958

TtOOR TISSUE Rr.GISTRY

LOS ANGELES OO'ONTY HOSPITAL

IZS'f

CASE NO . 1

ACC1lSS ION NO , 8856

NAME: S, L, B. AGE: 72 SEX: Male RAOE: Oauc,

CONTRillUl'OR: Lavrence L, Frost, M,D, , Alta Vista Hospital, Paeadena, California.

TISSUE FROM; Right kidney.

CLINICAL ABSTRACT:

1157. 1958

OUl'SIDE NO, 51502-.56

HISTORY: Maeeive hematuria developed at ):00 A, l>i. on August 29t h,l956. Multiple bout a of hematuria lasting for short periods of time bad been present for the past one and one- half yeare , Laboratory findings disclosed a leuco-oytoeia ( )),)00), 4 plus allniminuria with many erythrocytes, NP1J of 54.9 md; and extremely poor concentration of dye by I. V , P,

SUl\GERY: A rigbt nephrectomy was performed on September 1,1956.

GOOSS PA!l'HOLOGY: The right lcidney weighed 807 grame and measured 1). 0 x 12, 5 x 11.5 om. The eurfaoe wae irregularly oovered by adipose tissue and maesee of eoft epongy yellow-gray tumor tissue . The kidney was bisected in the longi tudinal axis, both the upper and lower poles showed a normal appear­ance, but the middle third was replaced by a 12 x 11 x 9 em, tumor. The out surface of t he tumor was composed of irregular sponge-like tissue with oystic spaces. Some cyste were filled with clotted blood and others by gel a t inous :yellowish- tan and grayish-green mucoid mterial. 'lhe septae between the cysts measured from 0,1 to 0, 8 em. in thicknen and were composed of from gra.:yiab.­white to :yellow tumor tissue. The entire mass appeared to be encapsulated, with only a few small finger-like proJections i nto the adJacent normal paren­chyma, The pelvia was finely granular and appeared to be infiltrated by tumor , The renal artery and vein did not appear to be invaded by tumor.

CASE NO . 2

ACCESSION NO, 8992

NAME: G, V . AGE: 33 SEX: Female RACE: Negro ,

CONTRIBUl'OR: D. A. DeSanto, l-!,D, , Mercy Hospital, San Diego, Cal if orn·ia.

TISSUE FROM: Retroperitoneal tumor,

CLINICAL ABSTRACT:

~;y • 19.58

Otl'l'S!DE NO , .54J6-S6,

BIS'roRY: 'lhe patient bad noted a lump , the size of a grapefruit, in the left upper quadrant for one month, Her weigbt had recently gone from 193 to 1?0 pounda. She had three children, all living and well . '!here 1111os no past history of surgery or serious illness and no family history of ce.nosr or tuber­culosis .

Physical examination diaoloaed a blood pressure of 110/ 80 and 1111oa negative except for a moveable maaa located in the left upper quadrant that extended into the area below the umbilicus . 'lhe mass did not pulsate and it was not attached to the uterus. :Barium enema and cheat X..rays were nega,. tive. Laboratory findings were not remarkable.

SURGF.RYs On November 8, 19.56, a retroperitoneal tumor was removed.

GROSS PATHOWGY: The elongated necrotic mass of tissue weigbed 100 grams and measured 12 x .5 x 2 em, 'l'he surface showed considerable softening, At one edge there was a ~ em. thiok.-walled oyat. 'l'be inner lining of the oyat vall vas smooth, glistening and blue-tan in color. 'l'he second portion was re­moved from the posterior lllloll of the tumor mass and it measured 4 om, in diame·· ter. It vae alec composed of red-tan necrotic tissue ,

CASB 50, .3

.ACCESS ION NO , 9045

NAME: E . G, AGB: 72 SEX: Female RACE:

CONTRllltJrOR: W, W. Ball, M,D,, Mercy Hospital, Bakersfield, California,

TISSUE FBOM: Uterus,

CLINICAL ABSTRACT:

Ma.Y. 1958

oursrm: NO, M-4100..56,

HISTORY; This patient ·complained of recent ~nal bleeding. Pelvic eramination disclosed a sha&gy poln> protruding t.brough t he cel-vical oe,

SURGERY: A total hyetereotoJ~~Y waa performed at Meroy Boe:;:>ital in 1956. (date not further specified),

GROSS PATHOLOGY: A tumor wae located in the lower halt of the osl"fix on the right anterolateral aspect and appeared to be entirely of endocel"fical ex-tent , The endometrium throughout waa atrophic and cystic.

FOLLOit-UP: Patient wae last eeen on September .)Oth,l9.5? . No abnor~~~&lity, and Papa.nioaloau smears were negative at that time.

CASB NO. 4

ACCESSION NO. 929?

NAME: D. A. AGE: 51 SEX: Female RACE: Oauo.

CONTRil!tJrOR: Se;ymour :s. Silverman, M,D., Memorial HOspital, Phoenix, A.ri~ona.

TISSUE FROM: Uterine &or!)dliuga •

CLmiCAL ABSTRACT:

M!\y, 1958

0Ul'SI1I8 NO. S...69?- 5?

HISTORY: oter1ue bl eediuc had been present for two mouth• and weak­usn had been noticed for tvo veeka . laboratory fiudiD«S on admhaiou to the hoapit&l re•ealed 900, 000 Rbc with 1.? grama of hemoglobin.

SURGERY: A D and C vas performed on January 16th,l95? and a total abdominal h)'eterectotey" and bilateral e&lpi.uco-oopborectomy waa done on January 2let,l95?.

GROSS PATHOLOGY: The first apeoimeu consisted of a large amount of uterine ourett1uga and blood clots. The aecoud waa the uterus with attached cervix, tUbes and ovaries. Tbe endometrial cavity was lined by a thick, soft, friable, tan tissue which did not groaely involve the uuderlyiug myometrium. The exterual surface of the uterus, a1 well aa the tUbes and ovaries were greatly normal. .

J'OLLOW- UP1 The patient returned to Nev York City shortly attar surgery and poet- operathe follow- up iB not a•ailable.

CASE NO , 5

ACCESSION NO, 9260

NAME: B. B. AGE: J4 SEX: Female RACE: Ce.uc.

CONTRIBUTOR: E. L. :Benjamin, M,D,, D, R, Dickson, ~! .D,, Sante. :Barbara Cottage Hospital, Santa :Barbara, California.

TISSUE FROM: Right lung,

CLINICAL ABSTRACT:

~Ia¥. 1958.

OUl'SIDE NO . 5-57-539.

HIS'IORY: A routine chest X-r!IJ' demonstrated a peripheral ltcoi~lesion" in the poeterior eegiD8nt of the right upper lobe , There were no oo~QPlainta and the laboratory findinga were normal.

SURGERY: A thoracotomy waa performed on February 20th,l957.

GROSS PATHOLOGY: The wedge-ahe.ped portion of lung weighed 4. 5 grama, Six millimetere beneath the smooth transparent pleura was a well-defined, but unencapsulated 16 x 16 x 12 millimeter nodule. The out surfaces of the nodule were bulging, homogeneous, and pale gra;y- ;yellow in color,

FOL:WW-UP: In Febr~ry, 1958, the eurgeon examined the patient and re­ported that she wae feeling well and had no complaints.

OASE NO. 6

ACCESSION NO • .5813

NAI<!Et R. D. C. AGE: 18 SEXt Male RACE : OaliC.

OON'l!Ril!U'i'OR: Albert F. Brown, I~.D., 1.509 East Wilson Avenue, Gl endale, California.

TISSUE FBOMI C7, Tl and 'l!2 vertebrae.

CLINICAL ABSTRACT:

May, 19.58

Ot1rSI1lE NO. GSH .58-863.

NOTE: The original material vas presented as Case No. J in the March 2.5,1954 monthly Conference.

HISTORY: This boy enter ed the hospital on December 12, 19.53, because of progress1ve pe.i n and atrophy of the left shoulder and a.l'll1 for three months. There was associated numbness of the last three fingers of Ute left hand and left sided sweating of the face . Six month& prior to entry he had fallen from hie bicycle and vas unconscious for one day. During the year he had a weight lose of thirty pounds.

Phyaical e:a:ami nation at that tiiDII shoved that the head and left shoulders were hel d in an immobilized position. Pupils were normal. Blood count vas normal except for a Wbc ll, 200. Uri ne contained 2~-% albumin by volume. J<;.ray demonst rated enlargement and vacuolization in the left trano­verae precess of the first dorsal vertebr ae with decrease in intervertebral foramina both above and below the pr ocess.

At surgery on December 13th,l9.5J, th e transverse process of the first dorsal vertebr ae was found to be eroded by a 11vaacular t:;pe tll!DOr" , Which was removed by c1ll'8ttace. 'lhis was followed in March and Febl'1lary ,19.54, by irradi ation (1000 r) t o the spine.

X-ray in April,l9.5.5, showed partial regression of the lesion. Other than alight deformity of t he neck, the patient was ae:;mptomatic then.

In ~faroh. 19.58, he returned to the hospital because of in­creasing pe..in in the neck, left shoulder and down the left arm for two years. This was asaociated wi th progreesiv~ weaknesa of fingers of the left hand. Because of i ncr eaeing fati gue, he had to quit active aport& several weeks pr ior to hospital entr y.

Examination showed atrophy of t he fir st dorsal intercostal IDU.Icle of the left hand. Arm 11111as1U'8ments were identical and there was no eeD­eory loaa . J(;.raye demonstrated destruction of 07, 'l!l and '1!2 ,

SURGJi:RY: On M!l.rch 19, 19.58, portiomof the above vertebrae were re-moved.

<moSS l'A'I'HOLO(}l; 'lhe epeo imen consisted of numerous bone fragl!l8nte , the larger piecee were portione of rib that meaaured together .5. 7 em. in length~ Two of these 1Deluded posterior articular extremities . The portion from the pathological area of the vertebra consisted of numerous irregular, partially bony, dark tan-red fragments, making a 1 • .5 em. mass.

CASE NO. 7 ~. 1958

ACCESS lOll NO, 9233 OtJrSI!E liO , A- 6.3

NAJ.IIh D, M, :S , .AGE: 59 SEX: Female RACE: Cauo,

CONTRI:BU'l'OR: E . !4, Hall, ~t.D., S~n Antonio Hospital, uplaDd, California

TISSUE FBOM1 Right l'Uilg,

CLINICAL ABSTRACTs

HISTOBY: 'lhe patient 'lm8 essentially well until the veek prior to adJD.iesion when ther e were episodes of vertigo and nausea.. On J'ebruary 17, 1957, there wa.s sudden onset of sharp, severe chest pain located substernally which radiated into both artD.B, A ~icia.n wa.s called who administered lllOr­

Jbine eul}ilate , gr,l /4. She wa.e hoepital1zed a.nd oxygen given, ':!here was no prior history of cardiac or respiratory difficulty,

On admission , the patient was pale, cyanotic and perspiring protueely. :Blood pressure was 110/90 . 'lhe extremities were cold and olalmly, but not edematous, The remainder of the physical examination was ne@l!l.tive,

'lh·e patient developed shock ao I ,V, Levophed and fluid were administered. This wa.s associated with recurring severe chest pain and con­tinued ahock, She expired on February 20th,l957. Death was due to recent DG'Ooardial infarction lt1th oardia.o tamponade due to rupture of left vsnh·icle.

AtJl'OPSY FpmiNGs: An incidental finding included a well enoapeulated tumor involving the right upper lobe a.nd medial half of the middle l obe , The el ongated tumor had a slightly nodular surface and measured 5 ::r: 4.5 ::r: 0.5 om. Cut section& were hard, oartil~oua and had the appearance of ca rtilage in the central portion with granular yellowish areas i nterspersed,

OASlll NO. 8 May, 1958

ACCESSION NO, 8801 OUTSIDE NO, 5-1373-56.

NAME: M, L, AGE: 23 SEX: Female RACE: Cauc,

CONTRilltJl'OR: lawrence L, Frost, ~.D . ,

Alta Vista Hospital, Pasadena, California.,

TISSUE FRO!~ : Pleural lesion,

CLINICAL ABSTRACT:

HISTORY: For two to three months prior to admission on August 5th, 1956, there was oough, fever, dyspnea. and night awea.ts . A feeling of tight­nee& was present in the r ight chest and there wae difficulty lying on the right aide, Physioal examination was negative except for distant breath sounds on the right , P, P,D. and sput um were negative. Clinio&l laboratory findings were nonoontributOJ"F• llronohoecopy failed to reveal the evidence of adenoma or other bronchial neoplaam,

SURGERY: On August 6th, 1956, a thoracotomy was performed •hiob di s­ol oaed ll8rked thiokeni.ng of the pleura by a granulating grayiab.-tan tiaeue . There were numerous adhesions between the visceral and parietal pleura., and the neoplasm waa noted to involve the entire pleura. Biopsy was taken,

CASE NO . 9

ACCESSION NO. 8874

NAMEt M.S. Amlt 7 hours SEX: Feme.ls RA.cr&: Cauc.

CONTRIBUTOR: Dorothy Tatter, l<I.D , , Loa Angeles County Hospital, Loa Angeles , C&lifornia.

TISSUE l!'ROM 1 Liver tumor.

OLngiCAL ABSTRACT:

MaT. 1958

AOOPSY ~. 55797.

HISTORY: This Caucasion teuale infant was born by normal epontaneoua deliv&rf at Santa Marta Hospital on September llth,l9S6. at 2:29 P.M. Birth weight was 9 lbe. 2 oe, 2be child required o:xygen resuaoitation and was in a poor condition with a markedly dietended abdomen, This was the eeooDd prs~ nano;r for the mother who vas mildly h;rperteneift. 'lhe birth vaa complicated by poll'bYdraamioe and a long cord with three lmote . The first pregnanc;r yielded a norual full term infant. ihe mother was RH positive and had a negative eerolo·

lihysio·a.l e%amination of the child revealed a slow, regular pulse and elow r espirations of moderate depth. 'lhe face vae purpl e and eoohymo­tio. '!here was edema. of the eyelids, Ecchymosis and pateohia.e were present on the cheat, arms, back and soles of feet. Heart and lunp were normal and spleen waa not pal:pable, The abdomen was very protuberant and a maae filled the en­tire right upper quadrant of the abdomen to the right iliac oreat , extending to the midline and ooou~ most of the left upper quadrant. Bowel eouade were heard and the anue was patent.

He1110globin when the child vas four hours old wae lJ. S creme . Blood W&l type 0, RH positive, Coombe negative, A rlat plate of the abdomen revealed a large abdominal mass . At 8:00P.M., the child waa grunting aDd appeared worse, 'lhe patient expired at 9::30 P. M. Poatmortem blood was drawn for culture, he1110gram and ohemiatriee, Culture reftaled hemolytic ataphyloooo;; oua aureue; coagulase positive.

AUTOPSY FINDINGS : There was a large quantity of blood, both clotted and fluid, in the eubaraohnoid apace and in the ventricles . '.\bare waa patchy ata-­leotaaia. Heart and great vessels were normal . '.\be abdominal oavit;r contained a large quantit;y Of hemorrhagic fiuid, 'lhe Visceral and parietal peritoneum wae involved b)' a hemorrhagic, fibrinous exudate , 'lhe liver weighed 4JO grams and allllOet filled the entire abdomen. Pinlt white tUIOOr oooupied IDOet of the oau.data lobe, It measured S om. in diameter and contained numerous aree.a of neorosia and hemorrba&e. '.\be bili&rT duct wa• patent aDd th.e panoreae va• normal, '!here vas a reduplication of the left ureter. The remainder of the autopa;r wa.a not remarkable.

Anatomical diagnotes vera: Massive intracerebral heiDDrrhace, "oaroinom • o.f liver, pari toni tie, septicemia, redupl.1oat1on of lett ureter and massive extramedulla.r;r hematopoiesis, liver.

CASE NO. 10 !•lay, 1958

AOOESSIOU NO , 9357 OUTSIDE NO , 57i'-589

.NAJ.IE: Unknown, AGE: 29 SEX: J'emale RAOE : Ca'IIC ,

OONTRmUO:OOR: George A. l'la.tson, !o!,D., French Hsopita.l , San Francisco, California,

TISSUl.'l li'.ROM: Left lung,

CLINICAL ABSTRACT:

HI5TORY: Thi s patient v~s fi r st seen in 1950 at which time a chest X..~ revaaled a 2. 5 om. mass close to the hilum, By 1951, thi s had enlarged to J om, and was radiated wi thout expl oration, 'lhe dose to the tumor was 2, 000 r. In subsequent months there was a decrease 1n s be wen t he diameter was l ese than 2 em, A regrowth ensued until the dimension had reached J ,5 om. At the time of surgery, tha radiologist noticed an adJacent 1 om, metaetaai e.

SURGERY: In Febrae.ry, 1957, a thoracotomy was performed and the left lung was removed,

GROSS PATHOLOOY:. The lung ~tei(!hed 270 grams and measured 17 x 8, 5 x 4.5 om, The t ·umor measured J om. in diameter and obstructed the bronchllll extending to the linP,1ll.a, The tumor was soft, gra;y-red in color, homogeneous and gross­ly tree of hemorrhage or necrosis , At J ,5 om, distally, was a 1,5 om. m~tasta­tio nodule, .No additional metastaeaa or lymph node involvement were found ,

CASB NO . 11

ACCESSION NO . 9368

!lAME: 0 , J. AGE: 48 SEX: Female BACE: Ca.uo .

OOlll'l'RDIUl'OR: W. I~. Ball, M.D., Mercy Hospi te.l, ! a.kerafield, Oaliforni a.0

TISSUE FROM: Right lung,

CLINICAL ABSTRACT:

May, 1958

OUTS IDE llO • W.l:J48-57 •

HISTORY: 'lhia patient had been well until the l atter part of 1940, when a COJIU)lete hyetereoto1111 v&s perfo1'1118d bece.uu of pelvic dif ficulty. No malignancy ve.a found. In 19,52, surgery was perfor med for intesti.n&l obstruo­tion eeoondary to adhesions.

In late 1956, cough e.aaoc1ated with right pleural pain and development of pleural fluid occurred, The patient was thoro1J8bly studied at Doctor's Hospital in Los Angeles, by b~nchoaoopy, several pleural tapa, spu­tum examinations for tumor cella and a complete liver and ga.stro-intestin&l etudy, 'l'beaa were all negative for tumor, 'lhe pleural fluid was grossly ~lood and oont~ined 6 gr~s% protein and the tuberculin akin teat was positive.

The patient then returned to her home and later entered the Mercy Hospital in Bakersfield, 'l'horacenteeia Yielded no fluid , The right chest was so obeoured on X-ray examination that evidence of pleural or pul­monary patholou was limited.

SURGERY and GROSS PATBDIDGY; In May, 195?, a right thoracoto1111 vas performed, 'lbe entire right lower pleural cavity was fUl ed with pink- white t1llllor maae which waa i ncompletely removed in "small hands-full, 11 The tumor waa ap:parently crowing on the surface of the visceral, as 11811 aa the parietal pleura, and a large amount of tumor wae lett in the chest cavity.

li'OLLOW-UP: Patient expired on July 2, 195?. Autopsy was not performed.

CASE HO, 12

ACCESS ION NO, 9454

NAME: L, M, A, AGEt 46 SEXt Female RACE : Oauc.

OONTRIB'O'I'OR: Se11110ur B, Silverman, M.D,. Memorial Hospital , Phoenix, Arizona.

TISSUE FllOMt Posterior bladder wall tumor,

CLINICAL ABSTRACT:

J.!a7, 1958

oursiDE NO. MS la:l-57

HISTORY: '!here had been recurring, chronic pain in the right lover quadrant, aometimes quite severe. Ph1&ioal namtnation revealed tenderness in the right lower quadrant, but no maaaea, A right ealpingo-oo~oreot01117 had been performed in the }lBat.

StlRGERYt On Januaey 29th,l957. a laparotomy waa performed. Adheeione were l711ed and a bladder tumor was reaeoted, The 8 x 4 x ) om. tumor involved the poater ior wall of the urinaey bladder from the trigone up to the dome.

GROSS PATHOLOGY: The lobulated gray~red tumor mass measured 7 x ),2 x 29 0 0111.,. and moat of the external surface wa.a smooth, Sections revealed a tougb, gray, fibrous tissue containing 111a117 mucus filled spaces that meaaured up to 0. 7 om. in diameter.

~LLO'ri-UP: Poet-operative reeulte were good. A r eoent I . V. P711logram &bowed good renal function with a da!ormitT of the bladder dome. It vu esti­mated that there was a lKf/, reduotion in bladder oapacit7• 'l'here vu no ertdeooa of raourrellCe,

REFO.R!l' ON THE

STUDY (JII.OUP CASES

FOR

MAY, 1958

v

CASE NO, 1 , ACO:E:SSION No. 8856, Lawrence L, Frost, M,D., Contributor.

LOS AN(}ELES: The vote was unanimous for C18tio hy];lerne}:ilroma, 1he assigned disouseoJ·' 'r

diagnosis was hemangi~

CENTRAL VALLEY: It was felt that this oaee had to be described aa a papillary c;yetio

tumor of the kidney cortex. No one had any particular notions as to its hiBto .• genesis. Five called it benign and three lllaligaant,

SAN DIEGO: Carcinoma of kidney with 01Bt1C change J votes, Benign polyo111t1c

lesion of unepea.1t1ed type , 2 votes •

S}J! FRAJ!OISOO: Variant of clear cell carcinoma, kidney,l4 votes •.

PAU.&NJ);

Papillary o;yate.denocarcinoma of renal cortex,

WEST LOS ANGELES i The vote wa.e una.nimous for cYstic adenocarcinoma of the kidney, Members

of the gsooup felt t~t portions of the tumor wae hiatologicall:V benign, FILE DIAGNOSIS 1 Adenooarc1noma of the kidney with cystic cbaJ189,

OA§l: NO, 2, ACCESSION NO, 8992. D. •\.: DeSanto, M,D., Contributor.

IDS ANGELES; Disoussor1e diagnosis: Pheochromocytoma.

It was turther stated that not all have dominant symptom~ be shook (post oris1a). probably extra-e.dreDal.

dKNTRA I, V e !Jo"A' 1

paro:zysmal hypertension, Pre­Th.e TOte was pheochromocytoma ,

It was felt that more precise information on the anatomical relationships of this retroperitoneal mass woUld have been helpful, and that a definitive diagnosis was not poeeible ·at the present, ~rea favored .adrenal cortical car­cinoma and three were for paraganglioma ( including }:ileoohromocytoma,) 1here was one vote for choriocarcinoma and one' for rhabdo~sarcoma. Several stated that they had eons1dered liposarcoma but preferred other diagnoses.

SA}l DlJOO: Para.pnglioma , J votes 1 adrenal cortie~ carcinoma 2 votes. NOTE:

Follow-up was recently obtained on this patient who is currently ~iva and well

- 2-

Case No. 2, Aooesaion No, 8992- continued,

with no evidence of r ecurrence, It vas mentioned that slides from this case had been submitted to the Armed FOrces Institute of Pathology where a diagnosis ot malignant P&o!'aCI!IoDglioma, probabl7 arising f rom the org~~D of Zookerlr:aDdl 's was made . It vas atated however , tha t an adrenal origin could not be oom­pletel,- excluded on the basis of the slide,

SAN !RAN CISCO ; Pheoohromoc,-toma, 16; adrenal cortical carcinoma, 2.

OAKLAND: Pheochromocytoma, ( 1 vote for adrenal cortical tumor).

II'EST LOS .ANGELES: Alveolar soft part sarcoma ( nonobromat!in paraganglioma) -8 votes,

Of this group 7 considered the tumor malignant and 1 considered it probably benign, Non!unotioning Iileooliromoo,-toma (probabl7 extra--adrenal ) -3 votes, HhabdomTOaarcoma vas considered in the differential discussion, but ex.oluded. Dr, Melnick called attention to the Gomori Aniline Orange G stain for pa~­lionio tissue, Onl7 other cella that etain eimilarl7 are one of the cella of the pi tui tar,- and i elande ot Langerbans ( ot .Lilla pg,l71 ),

FilE DIAGNOSIS: iheoehromoo,-toma ( probably extra--adrenal). Cross-index: Paraganglioma,

OASE NO , ), ACCESSION NO, 9045, W, \1, Hall, M,D, Contributor,

!.OS ANGELES: Diaeueaor 1a diB8JlOs1B: Adenocarcinoma of cervix, The in situ appear­

ance in some areas eontil'IIIS that the primar,- origin was in the cervix. The vote was unanimoua tor adenocarcinoma of cervix,

CEll'l!RAL V AIJ,U: The interesting glandular lesion of the cerviX was called cel-t·ical adenoma

by one, adenoma malign\1111 or carcinoma in situ by two and adenocarcinoma b,y five members,

SAN DIEGO: '!be vote was unanimous for adenocarcinoma, a riaing in endocervical polyp,

SAN :FRANCISCO; Adenocarcinoma of endocervix , 17 ; ot meaone!ilric origin, 1,

OA!L.UJD; Low grade mucinous adenocarcinoma of cervix, 12 votes , Dieouaeion of

endocerviooeie or endometriosis , l and adenoma 1.

WRST LOS ANgELES; Adenocarcinoma of the cervix, ll votes, Invasive 10 votes. ·lB eitu,one

vote , Coneenaua of opinion was that this vaa probabl7 of Mullerian duct or igin,

FILE DIAGNOSIS: Adenocarcinoma, cervix,

_,_

OA§E NO, 4, ACCESSION NO, 9297 ,Saymour ~. Silverman, M,D, , Contributor,

LOS ANGELES: As·aignad diacuaaor 'a diagnosis: A4anoaoantholll8. of endometrium. The vote

vas unanimous for adenoaoanthoma ( adenocarcinoma, Gr.III ), of endometrium. Reference: Novak, E, R., Nalley, 1'/,ll,, Uterine Adenoaoanthoma, Obst, & Gyn, Vol,9, pg, 396, 195?. This is a Review Article of 16 Oases from Johns Hopkins Hospital and e~rts the general ~rassion that these ars,in the majority of patients, lesions from which the patient does not succumb,

Dra,Edvard G. Jones and Theodore Drake are studying adenoaoanthoma.a of the endometrium in the Loa Angeles area and have over 110 oases, They are study-­ing them f.rom the standpoint of survival rates. This paper should be out with­in the next year and will be the largest aerie& aver followed.

CENTRAL VALI.EY; There was general agreame.nt that this was an endometrial oaroinoiJla, Dis ...

ouseion centered about the clumps of cells raaembl1118 squamous cella, 'lhasa ware conapicuous in some slides and sparse in others. Some thought they repre­sented squamous metaplasia of endometrial glandular tumor, wbile others felt that they indicated pseudo-decidual change in the stroma.

SAN DIEGO! Adenooarcinoma., with squamous mete.plas 1a, unanimous.

Si\N :&'RANCISCO: Adenocarcinoma of endometrium, 16; adanoaoanthollla, 4,

OABJ.A?!ll : Adenocarcinoma of endomatri um ( adenoaoantbollla).

~ST LOS ANGELES: Adenoaoanthollla of the endometrium, 8 votes ;caroinoaaroo~~~a, 3 votes,

FILE DIAGNOSIS: erose-index:

Adenocarcinoma, endometrium, Adenoaoanthollla, endometrium.

CASE NO, 5, ACCESSION NO, 9260, E .L~enjamin, M,D,, D,R,Dickson, M,D,, · Contributors.

lOS ANGELES r Assigned diacussor'a diagnosis: Bronchjdar earcinoma ( llle.ligne.noy low) .

Alternate diagnosis: Epithelial neoplasm, low grade malignancy, possibly from bronchial appendage. The vote: Bronchial adenoma ( ne,ppende.ge"} 5 votes, Bronchiolar ca.rcino~~~a 1, secondary carcinoma 1,

CENTRAL VAALEY: This waa considered e. metaata.tic lesion by two members and a. pulmonary

"adenoma." by aU members.

SAN DIEGO; llronchia.l adenoma, unanimous,

continued.-

- 4..

Case No , 5, Accession No, 9260 - continued,

SAN li'RANCISOO: llronabial. ad.enom&, 18; adenocarcinoma of lUDg, 1.

OAKI,AND: "Bronchial adenoma•, carcinoid type .

WEST IDS ANGELES: The vote was unanimous for peripheral bronchiolar adenoma,

FILE DIAGNOSIS: Bronchial adenoma,

CASE NO , 6, ACCESSION NO , 5813, Albert F. Brown, M,D. , Contributor.

IDS ANGELES; Osteoblastoma ~votes; osteosarcoma 3 votes; benign lesion 1 vote and

malignant giant cell tumor , 1 vote ,

ClEN'l'RAL VALLEY: In thie caee , the problem was that of mali gnant lesion versus somewhat

atypical "roaction . • Since it was fel t that this distinction could not be made with aceurance on histologic pattern, the group voted to defer conclusion on this case, TWo member & favored a recurrent aneurysmal bone cyst, two were for :Bullock-Sharp reparative granuloma , while four coneider ed it probably malignant, i.e , , osteosarcoma arising in an irradiated area.

SAN DIEGO: Reparative changes in bone, probablT seoondar7 to X-ray, unanimous.

SAN FF.ANCISOO: Reaotion to injury, 3; osteogenic sarcoma, 10; beni gn osteoma, l; benign

gi~At cel l tumor, 1 ; beni gn process i n bone, 2; no vote, J ,

OAKLAND: Controversial : Ei&ht members favored osteogenic. Aneurysmal bone cyst,

two votee, reparative granuloma, 1 vote.

WF..ST LOS ANGELESJ Benign oeteoblastoma, 5 votes, no opinion ( net malignant) 6 vot es,

Corrment: Previous L-ra;r treatment believed inadequate , Should have 2000 to 3000 r.

FILE DIAGNOSIS : Osteoblastoma, benign. Cross-index: Osteogenic sarcoma,

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CASE NO. ? , ACCESSION NO, 92JJ, E. M. Hall, M.D., Contributor.

LOS ANGELES t !!he vote was unanimoWI tor bronchial hauartoma. •

CENTRAL VALLEY: Hamartoma , 8 votes •

SAN DIEGO: 'lhe vote was 1l!lanimoWI for hamartoma,

SAN FRANCISCO: Ha.ma.rtom of l1l!lg, 20 votes.

OAKLAND: Ha.ma.rtom of bronchWI.

WEST LOS ANGELES: Hamartoma of lung, ll votes.

FILE DIAGNOSIS: Hamartoma, l1lng.

CASE NO. 8, ACCESSION liTO, 8801, Iaw~nce L. host, M.D., Contributor,

LOS ANGELES: Disouaeor 1a diagaosis: Mixed type mesothelioma. Alternate diagaosie:

Metastatic carcinoma. 'lhe vote: 1-!esothelioma 4 and secondary carcinoma, s. f.ENTRAL VALLEY:

This was considered a pleural mesothelioma by si x members and an undiffer­entiated (oat-oell) carcinoma by two members,

SAl! D !EGO : The vote was unanimous .for anaplastic malignant tumor of undetermined

origin,

SAN FRANCISCOt Metastatic oaroinoma to pleura, 10; mesothelioma, 9.

OAKLANX>; Adenocarcinoma, metastatic, 12 votes; mesothelioma, 2 votes, 'lhere was

a question of Ewing's tumor.

WEST LOS 4NGELES: Malignant tumor , ll votes; type undetermined 7 votes. ( Either mesothe­

lioma or metastatic. carcinoma). Probable malignant mesothelioma, J votes,

FILE DIAGNOSIS: Oroes-index;

Hetastatio carcinoma to pleura. Mesothelioma, pleura.

04SE NO, 9, ACCESSION NO. 8874, Ibrotb.y ~tter, ~i,D . , Contributor,

IDS ANGEJiS; Dieoueeor•e diaposiJI : Liver oell oaroinome. of newborn. (Hepatic mued

t111110r ), General dieoueeion.t 'lhe etruoture is eWlar to pre-plate eta&e of hepatogoeneaia, The tumore are u.aually looalhed. Recurrences are slow, but ~ be DIOre malignant . Hemtopoieeie 1a oomon in liver tumors in the firat rear of life,

CENTRAL V eTJ.EY; There were four votes for bile duot oaroinome., two for embryonal hepa­

toma and two for mesobl astic tumor,

SAll DIEOOt Moat of the membere noted the f ibrosis duot h;yperplaeia, 1nfarot1on and

extl'& medullary hematopoieei a, but were unable to give this a speoifio d1B&no­e1a, There vaa one vote tor hamartoma and one for liver cell oaroinoma,

SA!! F1W!fJ ISOO 1 Hamartoma, B; helllll1giom of liTer, S ; hemangio-endothelioma, 1; malig­

nant hepato-blaatoma, 2; no vote , 1,

om,A111lt Hamarto11111: ot liver ,

WEST LOS ANGELES: Hama~tome.toue malformation, 7 vote; benign neoplasm, type undetermined,

4 votee,

IJ'ILE DIAGNOSIS: Hamartoma, liver, Oroea-i ndex: Liver cell carcinoma of newborn.

CASE liQ, 10, ACCESSION NO. 9:357 , George A, tlatson, M, D., Contributor,

IOS ANG'EI!§ 1 Assigned diaouaeor 1e diagnoa1B: Bronchial adenoma, (carcinoid type) ,

There waa unaniDIOue agreement with thie diaa:noaie • (mali8J1ant ),

CENTRAL VALLEY I 'lhia wae considered a malignant pulmonary adenoma ~ aix member&, a

metastatic tumor by one and an ang1osaroOlll8. by one.

SA.!! DimO; B1'onoh1al adenoma ( adenooaro 1no11111: - low gl'&de) unanimous •

SA! FJWiO ISI:X>: Malignant bronchial adenoma, 8; oaroinome. of 1UD8, 8; malignant tumor

of lung, 1; metaetat1c islet cell carcinoma, 1 ,

OAKLAND; ''llronoh1al adenoma, • care inoid t;yp~ ( me.l1gnan t) .

continued..

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caae No. 10, Aocession No , 9357 - continued.

WEST LOS ANGELES : Bronchial adenom, 9 votes, angiosarcoma , 1 vot e and UDdeci ded, 1 vot e .

FILE DlAGBOSIS: Bronchial adenoma, Cross-index: Bronchial adenoma ( care 1noid t;y:pe) w1 th malignant

change.

OA§E NO, 11, ACCESSION NO , 9368, W, W, Ball , M~ •• Contr ibutor,

LOS AffG ELES : Assi gned discussor 1s diagnos i a: Malignant spindle cell ~oma, aite

UDdetermined, Other d i agnoses : Sarcomatous 1118Sothel1ol!ll, 4 votea, leio~qo­sarcoma, 4 votes and fibrous mesothelioma, 1 vote,

CEII'l'R AI, VA LT.F:y;

Six votes for mesotheli oma, one vote f o r neurofibrosarooma and one fo r anaplastic ca rcinoma.

SAN DIEGO: All agreed with the diagnosill of sarcoma and three felt it should be

further olareified as a leiomyosarcoma,

SAN FRANOISOO ; ~lalignant fibrous mesothelioma, 6; l eiomyosarcoma, 6; spindle cell sar­

coma, 3; malignant tumor , 1; fibrosarcoma, 3.

OAKI.AND; Leiomyosarcoma, UDan1mous vote .

~ST LOS ANGELES: Lei omyosarcoma, 9 votes; unclassified sarcoma, 2 votes, This could be

elt.her metastatic from an unrecognized leiomyoearcom of the uterue, or primary of the pleura,

FILE DIAGNOSIS: Leiomyosarcoma. Prose-index: Sarcomatous mesot heli oma.

CASE NO , 12, ACCESSION NO. 9454, Seymour B. Silvel'I!BD, M. D. , Cont ributor,

LOS AllGELES ; Diaouseor's diagnosis! Urachal c;vst . Comment: 'lhese ooour dominatel ;v

or solely i n women, possibly suggesting t he lesion to be endometriosis , 'lhe vote: Urachal cyst 4 , Mullerian (endomet rial) origin, 3.

oont1nue4,..

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Oaae No. 12, Aooeaeion No, 94-54 - eont1!1U8d,

CENTRAL VALLEY 1

There was agreement on the deaer1pt1ve term of 11111Cinoue o;ystadenoma. of the bladder , with aome epeoulation ~~obout olo!lO!Il or uraoh!ll origin.

SAJ! DUOO; Benign e;yetadenoma, probably arising from urachal remnant.

SAN P'!WrCISCO! Benign oyat1a tumor of vestigial origin, 12 votes; maligll!lllt o;yatie

tumor of vestigial ori gin, 2 votes; no vote, 5; ovarian paeudo11111C1nous a;yat­adenoaaroinoma implant, 2 votes.

QA!T.All]):

~e vote YaB unanimous for muoinoue cystadenoma.

WEST IDS ANGELES; 'l'here were ll votes f or developmental anomaly of bladder w!lll .

Considerable diaoues1on developed regarding the origin of the lesion. varied between aloao!ll reate , uraob!ll rests , or MUllerian duot reate . 1111t7 or conclusion reached.

:fiLE DIAGNOSIS: Cross-i ndus

OT&tadsnoma ( urachal origin). Cystadenoma ( urinary bladder).

Comment I Op1.nion No 'llll8Jl1-