PROtoCXlL

FOR

MONTilLY SLIDES

JULY, 1959

TUMOR TISSUE REGISTRY

LOS ANG~LES COUNTY HOSPitAL

IZ/4

CAS! NO. l July, 1959

ACCESSION NO. 9452 OUTSIIE NO. 5•1429·57

10011!: F ,S. AGE: 40 SEX: Pemale RACE: Cauc.

CONTRIBUTOR: Seymour B. Silvetman, M.D. 1130 East McDowell Road, Phoenix, Arizona.

nssUE PRLM: Eso~hagus

CLINICAL ABSTP~T:

HlS'IORY: Chief complaint was dysphagia of B wee!ts duration, associated with a 15 pound weight loe..s, there was no melena or hematemesis , Red cell count was 2,300,000 with 7.5 grams hemoglobin. X-ray revealed an elongated stenosis in the esophagus, with irregular luminal margins at the junction of the middle and lower thirds .

SURGERY: Esophageal biopsy was done on 3-22•57; followed by an esophagectomy on 3-25-57.

SURGICAL PA'nlOLOGY: The segment of esophogus measured length and 4.5 em, in circumference at the widest portion. obliterated by a tumor mass , which extended deeply into the UIUSCle.

13 em. in the lumen was underlying

FOLL0!~-UP: Patient seen at regular intervals - doing "real well". No evidence of recurrent nor metastatic Ca when last seen on May 20, 1959.

CASE HO. 2 July, 1959

ACCESSION NO, 10380 OUtsiDE NO, 32-64-66 C

N.Al'IE: W. T. AGE: 74 SEX: MALE RACE: Negro

CONTRillUtOR: Albert L. Olson, H. D. The College of Medical Evangelista Los Angeles, California

TISSUE FROH: EPIGLOTnS

CLWICAL ABSTRACT:

HISTORY: The patient was seen in the clinic on January 26, 1959 with a history of sore throat for two weetcs, associated with swallow­ing. He pointed to a spdt just above the thyroid cartilage as the point of pain. There was also alight cough. His smoking history re­vealed a consumption of 1\ packs a day until 7 years ago when be quit. He denied the use of alcohol.

On examination a mass was noted on the epiglottis, He was treated with antibiotics initially and subjective improvement was noted, as well as a recorded impression of decrease in the size of the mass.

SURGERY: A biopsy specimen was removed on the 9th of February, 1959. On the advice of the tumor board he was admitted for removal of the epiglottis. At surgery the epiglottis and hyoid bone were removed.

GROSS PATHOLOGY: The epiglottis measured 4.5 x 3,5 em. A sessile cauliflower-like tumor mass measuring 2 x 1.5 x 0.7 em. was noted on the posterior laryngeal surface. It showed a variegated ap­pearance ranging in color between glistening grey-white, tan and red. A region of granulation tissue was interpreted as the site of previ­ous biopsy. Grossly a minimum border of 4 mm. was noted around the tumor and the tumor did not erode the cartilage grossly.

FOLLOW-UP: The patient was discharged from the hospital on March 5, 1959. He was next seen in the out-patient department on June 2. In the meantime he had been a patient at Metropolitan State Hospital in Norwallt, having been sent there from Unit 3 of Los An­geles County General Hospital. He was seen again on June 9 and June 16. His tracheostomy tube was removed on June 9 and on June 16 he was said to be much better. The tracheostomy opening was healed and there was very little aspiration by swallowing . No re­currence of tumor was reported on any of these visits, this being specifically recorded on the June 2 visit.

CASE NO . 3

ACCESSIO\~ NO. 10424

NAUE: F .F. t,GE: 59 SEX: ~tale RACE: Cauc.

CONTRIBUTOR: Franlt R. Dutra, M.D. Eden Hospital, Castro Valley, Calif .

TISSUE FROH: Stomach

CLINICAL ABSTRACT:

July, 1959

OUTSIDE NO. S-14496-A

HISTORY: Tbe pat ient stated that he had been bothered with epigastric discomfort with bloating and anorexia for two months. Estimated ~~eight loss ~1as 5 - 10 pounds . On January 3, 1959 an Upper G.t . showed changes in the prepyloric area of the stomach.

Laboratory data: On 2-8-59, Hgb was 8.3 gm with Hct 33 vol.7.; 2-9- 59 - thymol turbidity was 3 units .

SURGERY: February 10, 1959 - gastrotomy followed by subtotal gastrectomy and proximal gastrot omy and cholecystectomy were per• formed. The antrum of the stomach was found to be involved in the diffusely fibrotic process which, upon opening the stomach to vi· sualize the mucosa, "as found to contain almost a pseudo-like mem· brane over the diffusely ulcerated mucosa, with a border of what appeared to be inflammatory·li!te polyps . There was drainage hyper­plasia which was typically benign along the lesser curvature of the stomach. Tbe greater curvature of the stomach was free of any hyperplasia. TI1e gallbladder ~~as acutely distended with the stone impacted in the cystic duct and found to contain clear white bile upon decompression. The liver, spleen, pancreas and remainder of the abdomen uere essentially negative.

CASE NO. 4

ACCESSION NO. 10430

NAHF.: AG£:

U,D. 59 SEX: ~tale

July , 1959

OUTSIDE NO. S-59•819

RACE: Cauc .

CONTRIBUTORS: E. L. Bllnjamin, ~t.D. and D. R. Dicksou, H.D.

nssUE FR~t:

Santa Bttrbal.'a Cottage Hospital, Santa Barbara, California.

Stomach

CLL~ICAL ABSTR/,~T :

~f-Y~ The patient w~s first aeen locally on February l o, 1959 with the chie~ c<.>mplaint of cons ta:1t gro~ring pai n unde r the ].ower left substernal are:1 nea r the :tiphoid, of four mon ths duration. Pain was nonradiating , LO~ re'ated to eating or posture, and l>as relieved by Aspirin or Em;>ir~n. ilo nause:~ , indigestion, melena or other digestive complaints we~·c c i i•:i ted.

RBC :l .5N; Hb 9.0 gm.; ~rnc 13 , 600 1~ith nonaal different i al count . ESR 64 m:n (1 b;·) . :;' o plus occutt bloocl in stc!>l. G!l:;trlc analysis not perfonned. H1>re:: G. I. sexiee sho1~ed a larea ulcer. r.r~':er 4 em. in diilmeter htgh i" Li•e po:ote.-ior wall of the body witl• suxrCA!nding mucosal dP.formity. Cmnr::.;:i g,,t: l'itit :t- rays of J anua ty 3, 19!;9 2.n retrospect showed s ti6ht di3to.-tion of mucosal folds i •l thiq a rea .

SUI'I}":R":: 0.1 Fe:n'Uary 19, 1959 la'>arocc,.;y disc:(•Sed a "fist-sized" mass in ·:i·e(•o.;tc;:i.:>: t•all of the store~·-h nC';J>: t;oP 1)1': 9~CI: curvature 1d.th ad!-••. ~ •• cc to tl:.' s ple.lic fle:wre <l~ t hC' ~clon ~ · ·I t-: <·;,.;: po;'lcreas . Frozen S'!Cti< u of r:~o.~:·rous C'n lar~cd \y,,:>l• nr.rlcs nlc•l! . r., ~ : ~.:t ll;·lll tric a -r tery anti t&il of pc.uc reas conta.illed a~ or.·,tastaser . '' t<;> ; "1 gaJtrec­tooy, pc ::tin 1 ?nnc1·c-a tee Lomy and sp lt:lne~ cn".y uere part ... r.·t:d .

F0',J 0l·J ·\IP: Convalescence ~1as corop H c.-ltc·1 by r i !)h t surd .l .. 'lphrag­ma t icf! ,;·d c ~llecti:ln and right pleu.al ~~.:ll.? C.ons , bu t w.:;.;; 6\i~.'lcquently unevenUul a~id~ hom ea~il !' cont'."ol ted C:ia; roc::a . M or .;,m~ 4, 1959 the app:;~i.te 1745 good , bo11e' move.-nents wc1:~ r.y·:nll a11d tbe t=-ati~nt had gained t:eight. There Here no complai nt3 and a') apparent recurrences. He is bei ng followe~ by his physician in Oalt~and a rea.

CASE NO. 5

ACCESSION NO. 10082

N~m: F .T. AGE : 52 SEX: Female RACE: Cauc.

CCUTRIBUTOR: P. L. Gauset:itz, H.D. 7901 Prost St., San Diego, Calif.

TISSUE FRQ!.i: Appendi x

CLINICAL ABSTRACT:

July, 1959

OUTSIDE NO. 2840-58

fiiSTORY: The patient was admitted to the hospital 7·29-58, with a history of illness for the preceding four days (abdominal pain) . This became gradually more severe. Past history and sys­temic revie>~ were not contributory . The patient refused to dis­cuss her family history .

On physical examination there was marked tenderness in her right lower quadrant, l~ith a rebound. A palpable mass was noted in this area. 111e diagnos i s was "acute appendicitis" , ~lith car­cinoma of the ceciJm to be ruled out. The temperature >~as 100°; pulse, 96; respirations, 20; blood pressure 130/30 . The wbc was 12,400, with 657. segmented neutrophils, 107. bands, 217. lymphs, and 47. monos. The hemoglobin and hematocrit "ere normal. n1e follo~l­ing morning the wbc was 12,250, with 767. segmen&ed cells, 127. bands; 1 eosinophil; 10 lymphocytes, and 1 monocyte. X-ray exami­nation of the abdomen shoHed no significant abnormalities on the plai.n film.

SURGERY: An appendectomy ~1as performed . At surgery, the appendix was noted to be swollen, and to have numerous adhesions. Some mucoid material 1~as noted free in the peritoneal cavity about the appendix.

GROSS PATHOLOGY: The appendix was distended, dilated, 5 em. long, and up to 1.3 em. Ln external diameter. There was an irre­gular, lobulated mass of firm tissue attached to the appendix. This measured 4.5 x 2 em. in its overall largest dimensions. The serosa was irregular, reddish-grey, and granular. There were also several irregular fragments of lobulated, yellowish-grey, moderate­ly firm tissue which sbo~1ed some mucinous areas. These formed an aggregate mass 3 by 2 by 2.5 em. across.

FOLUY.i-UP: As of June 26, 1959 there was no indication of any recurrence, and the patient was apparently been in good health.

CASE NO. 6

ACCESSION NO . 9842

NAME: E.E. AGE: 63 SEX: Female RACE:

CONTRI.BU'roR: Thos. F. McKellar, t1.D. 1243 Garden Street, San Luis Obispo, Calif.

July, 1959

OUtsiDE 110, 58·875

TISSUE FROM: Lnrge bowel at splenic flexure.

CLINICAL ABSTRACT:

HISTORY: The patient complained of severe abdominl!.l crampi ng pain and foul smelling etopls for about six months. X-ray examina­tion disclosed discrete fillins defect in the region of the splenic flexure.

SURGERY; Laparatomy was performed on !·larch 3, 1958 with segmen- . tal resection of large bowel and thiclt wedge of mesentery.

CROSS PAmOLOGY: A 31 em. segment of lnrge bowel and fatty me­sentery included some lymph nodes. In the central part of the bowel , arising from the mucosal surface , was an egg shaped polyp 7.5 x 4.5 em. with a necrotic surface and having the odor of decomposing tis­sue. Gross sections disclosed a rubbery tumor of nearly whi te color containing a few streaks of hemorrhage but no areas of softening. It appeared to have arisen from the bowel wall below the mucosa. Twenty- two lymph nodes were recovered from the mesentery, and none showed metastatic tumor.

FOLLOW- UP: Sarium enema was negative in January, 1959. Follow­up examinations have all been nonual, •ras last seen professionally three months ago . She has no symptoms and has bemt employed fu ll time since her discharge from the hospital.

CASE NO, 7

ACCESSION ~~. 10418

lW!E: B. P . AGE: 64 SBX: Female RACE: C4uc,

OON'IlUBUTOR: S, T, Nerenberg, M.D. Children's Hospital, San Francisco, Cslif,

TISSUE FR<»t: Colon

CLINICAL ABSTRACT:

.July, 1959

OUTSIDE NO. 059·978

HISTORY: The patient had been well up until recently when she experienced a spontaneous massive hemorrhage from the rectum. On proctoscopic examination the surgeon thought a carcinoma of the bowel was present, A biopsy failed to show the presence of neoplasm. The patient was prepared for surgery,

SURGERY: On 4 ·7·59 a segmental resection of the lower sigmoid colon was carried out,

GROSS PATHOLOGY: The specimen consisted of a segment of aig• moid colon 1~hich measured 26 em. in length and 6 em, in max. diem. The mesentery was mar!cedly infiltrated with fat. Several longitudi· nally oriented ulcerations were seen in the mucosa; they measured respectively 0,5, 1.5 snd 5.5 em, in greatest diameter and spread over a segment of colon measuring approximately 10 em, In addition, several small raised yellowish nodules averaging 0, 7 em, in maximum diametor projected into the lumen from the mucosa between the ul• cerations . On gross section of the specimen numerous capillaries were seen to be present in the mesentery extending directly into the bowel wall up t o ~~e base of the ulcerations and also in the bowel wall where the mucosa was intact,

FOLLOW-UP: As of 6·22•59 the patient is doing well with no evidence of recurrence,

CASE NO, 8

ACCESSION NO. 9813

July, 1959 • .;t ' '

NAME: tt .A . AGE : 69 SEX: Female RACE: Cauc.

""' OOTSIIE NO. 8·57-4069

CONTRIBUTORS: E. L. Benjamin, M.D: and D. R, Dlcboa, H.D. Santa Ba~ba~a Cottage Hospital, Santa Barba~a, Callfo~~ia.

nSSUE PRQII: Colon

CLINICAL ABSTRt.CT:

•

HISTORY: In late June, 1957 persi stent tenderness in the ~igbt lo~rer margin of the rib cage oecur~ed fo llmri.ng the t~auma of a vig• orous embrace . I n late August bo~borygini with mild gaseous distention and a tender area in the right lower quadrant we~e noted. ln mid­October, 1957 a painless lump was present in the right lowa~ quad~ant . Nausea, vomiting, melena, change in bowel habits and abdomina! pain were absent,

Examina tion was negative aside f~om pallor and a non- t ender; bard , slightly moveable !llllSS measuring 8 by 10 em. in the right lovrer quad· rant. Barium enema showed a filling defect of the ascending colon. RBC 2, 7 M, Hb. 6.2 gm. , ~!BC 7,750 ~lith normal differential. Urinalysis negative. Urine negative for Bence•Jones protein.

Serum Electrophoresis : 12·6·57 4·23· 59

Total protein Albumin Alpha 1. Alpha 2 Bet a G!UIIIIa

6.0 BQI.1. 2.7 gm.1. l.O gm.1. 1.1 gm.'r. 1.0 gm.1. O.B gm.~

7.6 gm.7. 0.6 8111 · '7. 0.2 8IJI . 'J. .2.:1..sm. '7. 0.4 gm.7. 1.0 p.l

SURGERY: On Novembe·~ 29, 1957 a right colectomy was performed.

GROSS PATHOLCGY: Slteleta l survey negative for bone lesions .

FOLLOVI-UP: Postoperat ive course had been uneventful. The RBC bad risen to 4. ~1 , rib tenderness had di sappeared and she .was free of complaints . I n June, 1958 a parti al l y obs tructing ~ecurrence 7 em. 1~ diameter at the site of the ileo·· t ransverse colostolll)' was resected. She gradually deterio'rated and died on May 3; 1959. At autopsy t here , were massive nodular ~ecu~ences in the ~esentery with intes~inal ob· strucdon and eJ:tensive contiguous spread to ~etroperitorteum and pelvis . No gross or microscopic bone lesions were found at a~tOpsy,

,,

' '

CASE iiO. 9

ACCESSION NO . 10344

NAHE: G.U. AGE: 79 SEX: ~tale RACE:

CONTRIBUTOR: D. A. DeSanto, H.D. Mercy Hospital, San Diego, Calif.

CLINICAL ABSTRACT:

July, 1959

OUTSIDE NO . 976- 59

HISTORY: The patient firs t complained of GI symptoms four years ago. He complained of constipation and barium enema and rectal study produced no positive findings. Tao years later he again had barium enema studies for the same complaints, the only findings at that time being diverticula in the louer colon. In November 1950 he consul ted a proctologist who discovered a growth just above the dentate line in the rectum. This growth was bi­opsied . That same month he \las treated ~rith r.-ray (10 treatments -total of 1600 a. r . ) . Six >~eelts later it appeared that the gro\~th had not been affected appr eciably.

The patient was examined and found to be in good health. Blood pressure >~as 100/60; heart rate was 78 and regular, and the breathing rate Has 18/min., unlabored. Pooitive physical findings included a liver palpable J em. along the RCM, not tender atld not nodular. The descending colon was palpable through the abdominal wall and a proctoscopic examination revealed the presence of an indurated l esiotl ~1hich encompassed the rectum in an annular fashion about 8 em. >~ithin the anal canal. An elimination work up dis­closed the following: The bariUIII enema sho~1ed "findings in the rectum consistent ~nth a severe procti tis and apparently residual neoplasm and diverticulosis of the left colon ." The IVP was nor­mal, and the ureters sho\·Ted no displacement. No osseous metastases were visualized in the lumbar or pelvic films. The chest x-ray was negative for metastases. Urinalysis was within normal limits 11s ~<a a the serum all~aline phosphatase . n1e BSP sho~<ed 8. 25'7. reten­tion of dye 45 min. after the injection of 6 cc . of dye. (The patient weight was 132 pounds). The hemogram shO\·Jed 11.5 gms. of hemoglobin and a normal differential and l·ffiC. On February 20, a repeat biopsy of the lesion uas done.

SURGERY lias performed on March 2, 1959.

GROSS PATHOLOGY: The specimen consisted of 3 segments of large bowel, each of llhich had been previously opened; the largest measured 17 em. in Length and included perianal skin. There >~as abundant pericolonic and perirectal adipose tissue attached. The mucosa at the mucocutaneous junction of the rectum was pale white and thickened for a distance ranging from 1 to 2.5 em . At the proximal border of this white area there was an ulcerated area ex­tending 8 mm. proximally. n11s ulcerated area included the ci>­cumference of the bowel mucosa. The margin distally was somewhat polypoid. The margin proximally was indeterminate . No definite lymph nodes were identified in the adjacent tissue, however, sev­eral suspicious areas were embedded. The second portion consi sted of a segment of colon, measuring 16 em. in length, the mucosa of which appeared intact. Sections revealed several small diverticula. The third portion consisted of a section of a large bowel measuring 9 em. in .t .. ns~th. 'lbe mucosa appeared intact.

ADDENDUM

CASE 9

ACCESSI ON NO. 10344

At laparotomy on Narch 2, 1959, examination revealed o large tumor in the rec tut: si.gonoid area, but ri~ht on the pelvic floor and too lo>~ to be t·es;)=t~d f rom a>l anteri?r approach. There were no palpable or vis~ble lymph-nodes. The pelvic colon was per fectly free and movable. !he li•:er was negative for metastases and there was no sisn of generalized disease, so an abdominal perineal resec­tion was carried out.

CASE NO, 10

ACCESSION NO. 9496

J .F' 57 SEJ': : Female RACE: Cauc,

CONTR'J:atlTOR: Ce~·-~~n .J. F•lllll:ler, ti.D. St . ~T :,i .. -, • ; ·~.:s,ital

Sa·.1::c !;r..uca, Calif .

TISSUE FRO!l: Si~c:hl :md rectum

CL'!.N i.C'i~i. ABSTR.\CT:

July, 1959

OUTSIDE NO, S-2149- 57

!i!:31'0!J.Y: The patient ~~as admitted to this hospital for the first time on 5-5-57. During the previous tha:ee months, &'•') had felt "sOI!Iething heavy" in the perineum associated with di£~ ;. :·ol::y in passing stool. There was pain on evacuation and after pc~sage of stool, she also passed bright red blood,

Upon physical examination, there was a hard mass in the recto­vaginal septum which encroached on the rectum, anus and vagina . The mass measured approximately 6-7 em. x 3- 4 em. It t~as very hard and felt cylindrical. There was no mucosal ulceration in the vagi­na or rectum. The cervix was small and regular, The uterus »as noc enlarged, There were no masses in the rectum. Bone survey was negative for metastasis as ~rere chest x-rays. Sigmoidoscopic exami­nation was also ne~ative.

SURGERY: On 5-G-57, an abdominal-perineal resection of the tumor mass was performed . The greater portion of the posterior wall of ti-e vagina ~ras excised uith the tumor mass. l1le mass ~:as densely adherent to the ~rall of both the rectum and vagina, but there t:as no mucosal ulceration.

FOLLOW-UP: The patient exrerienced one local recurrence with resection of all visible neoplasia. The exact date of this opera­tion is not available, ho~•ever, on September 8, 1958 the patient was re- ope!:ated at the Cedar s of Lebanon Hospital t~here a pel vic-eventra­tion operation was made . The uterus, urinary bladder, vagina, por• tiona of the buttocks and palvic floor and pelvic wall were removed en mass. Tumor was noted to involve ur~nary bladder, uterus and vagina. (Rectum had been removed previously). On September 19th a surcical attempt was made to suppoa:t the pelvic floor by using tan­talum 1-1ire prostesis. l1le patient died on September 20, 1953, the day following this latter pelvic floor repair attempt. Postmorteo examination was made at the Cedars of Lebanon Hospital. Final diagnoses were: pneumonia, lung; status following radical resections of rectum, anus, perineum, bladdec, vagina, and uterus for tumor; artificial bladder, ileum; adhesions, obstruction, intestine; resec• tion, colon; colostomy, colon, levophed therapy; anastomosis, ileum; hemorrhages, spleen; prosthesis, pelvis.

CASE NO. 11

ACCESSION NO, 9542

NAKB: M.D,R. AGE: 53 SEX: Female RACB: Cauc.

CONTRIBU'l'OR: Dorothy Tatter, M.D • .

July, 1959

tlo .57850

Los Angeles County Hospital

ttSSUE FROM: 57-6005 - Ovary (surgery) 57-850 - Peritoneum (autopsy)

CLINICAL ABSTRACT:

HIS'l'ORY: On April 15, 1957, entry "'as made to the hospital becallae of increasing abdominal fullness noted for the previous five weeks. There was some shortness of breath and d~nution in the diameter of the stools.

Past history disclosed the onset of pigmented areas on the back, at age 13. This gradually progressed to other parts of the body. Nodu­les ~1ere first noticed in the areas of pigmentation at age 22. Some of the nodules were firm and others were soft, Several tumors were removed at various times and diagnosis of neurofibromatosis vas lllllde. The father, a paternal uncle, brother and two cousins also had neurofib~­tosis.

Physical examination revealed a well developed, well nourished fe­male. Numerous 0.5 em. to 1 em. subcutaneous nodules were present over the body. The skin of the flanka and abdomen bad brown pigJDented areas. 1'b! abdomen was distended by a firm, smooth, non-tender, non-pulsating 11111. on pelvic examillaUon, I!!Ultiple, hard, adnexal nodules were palpated. Ankles showed 3 plus pitting edema.

Chest x-ray on May 10, 1957, showed reticular infiltration throu&h­out both lung fields, consistent with bronchopneumonia. 83rium e.aema, upper G.I. series and I.V.P. showed deformities consistent with extren­eic mass. Liver function teste were normal. Hemoglobin was 12 graa 1 . Serum albumin was 2.8 gr~ 1 and ee~ globulin was 2.2 grams 1.

SURGERY: IP.'J>loratory l aparotomy was pedomed on May 10, 1957. The peritoneal cavity was filled by a large vascular papillary tumor. Exact origin of the tumor could not be ascertained, but the portion visuali~ed was thought to represent metastatic tumor replacing omentua. Peritoneal nodules were present. '1\lmOr 11111&S waa biopsied ,'

FOLLO!f-UP: 'lbe post-operative condition wu fair. Eighteen radlology treabaenta were given from June 5 to June 26, 1957. On J une 26, tbe patient beceaa confused. She expired on July 7, 1957. Autop­sy revealed matsive peritoneal involvement by papillary, fina, yellow tumor nodules that varied from 0, 5 to 3.0 CCI. In the central portion of the meeeatery the matted maaa of tumor measured lS Clll. 1n diameter.

The 4 x 2 em. right ovary waa adherent to the tumor aan aud was infiltrated by numerous nodules. The left ovary waa alailar, only 8maller. A few ..all tumor nodules were found 1n the diaphrag.atic pleura.

Lunge allowed broncbopne..-ie end congeetioa. Skin of the abd­had bl'OWD pipellted areas. Thera were n~ue filii, O.S to 2.0 ca., subcutaneous nodules.

CASE NO, 12

ACCESSION NO . 9745

NAME: AGE:

ll.J.L. 33 SEX: Female RACE: Negro

COlfl'RIBU'IOR: Elizabeth Conforth, M.D.

July, 1959

OUTSIDE NO. 4526-12-57

Sumerlin Mem~rial Hospital, San Diego, C~lifornia.

TISSUE FRCM: Greater omentum.

CLINICAL ABSTRACT:

HI~~ Recurrent RLQ pain bad been present one year or more. Hospitalization t·las necessary on two occasions in the past year for acute lower abdominal pain, fever, and leukocytosis. A tender, ill defined left adnexal mass '~as palpable. There was an old his tory of duodenal ulcer and treatment since 1954, and P. I . D. 10 years ago.

SURGERY: On December 14, 1957 the tumor and appendix were ex­cised.

FOLLOI-1-UP: On August 26, 1958,60% of the stomach '~as resected for a gastric ulcer. At that time the surgeon explored the abdomen, and there was no evidence of any recurrence. The patient was last seen on October 11, 1958 and had no complaints .

REPORT ON TBE

STUDY GROUP CASES

FOR

JULY, 19.59

CASE NO. l , ACCESSION NO. 9452, Seymour Sil verman, M.D., Contributor

LOS ANGELES : Squamous celt c&rcinoma of the esophagus • unanimous.

SAN FRANCISCO: Squamous carci~oma of the esophagus -unanimous.

OAKLAND: 1·1e U differentiated squamous cell carcinoma - unani.'IDOus.

CENTRAL VALLEY: No. 1 was agreed to be a squamous cell carcinoma of the eso­

phagus. The apparent therapeutic result to date is of interest. Also of interest ~1ere the rather lurid spind1.e cells between the clumps of squamous cells. These t~ere thought to be spindle cells of epithelial origin

SAN DIEGO: Squamous carcinoma of the esophagus -unanimous .

WST LOS ANGELES: Polypoid squamous cell carcinoma of the esophagus (circumscribed) •

u ~tanimous.

FILE DIAGNOSIS: Epidermoid carcinoma of esophagus. 637•81~

CASE NO. 2, ACCESSION NO. 10380, Albert L. Olson, M D. , Contributor

LOS ANGELES : Assigned discussor's diacnosis was seromucinous gland tumor,

).ow malignancy. (Solid carcinoma of seromucinous glands). General discussion and alternate diagnosis: Melanoma was originally con­sidered as a diagnosis, and still so regarded by some. Resemblance of some sweat g land tumors to me'.anoma mentioned. Mucin stain re­quested. VOTES: Seromucbous carcinoma, 4; Melanoma, 3.

SAN FRANCISCO: Adnelcal or bronchial adenoma, 3; amelanotic melanoma, 3;

salivary type carcinoma of epiglottis, 1.

OAJ.QJJID: Catcinoid, malignant, 7; melanoma, 4; undiffe rentiated carci•

noma, 3; salivary gland tumor, malignant, 1.

- 2 -

Case No. 2, Accession No. 10380 - continued.

CENTRAL VALLEY: 1'he discussion on No . 2 centered on the relation of the "tran­

sitional cell carcinoma in situ" in one area of mucosa to the under­lying tumor, which in most areas uas covered by noxmal lookL'lg epi­thelium. The glandular structure · (? thyroid or salivary gland) in the cartilage was noted, but was considered unrelated to the tumor. VOTES: Carcinoid, 4; T~ansitional Cell Carcinoma, 1.

SAN Dr.EGO: -· -~~;;:;l·at discussion of carcinoid&, p<~raganglioo.as, bronchial ad~nott~s. a~liv~ry Bland c~1cers, V~1Z$: ~a~aganglicma, 2; adeno­ca-.:ciuoma, :.!; adenoma malignum, t:

W£ST LC'S ANG?.U:S : --,:;;:~.;-c;c J'1.-';;inoma of the epi Blottis, carcinoid type, 7; Adenoma of the epJ.glor.tis, carcinoi-d type, 2,

FILE OTN:;;¥:SIS: Malignant carcinoid, ep:.Slottis. 331-8191P

Cross-inde:>: Adenocarcinoma, epiglottis (salivary type). 331-8091F

Amelauotic melanoma. 331-8175F

CASE NO. 3, ACCESSION NO. 10424, Prank R. Dutra, M. D. Contributor

LOS .ANG_gtES : c~r~inoma in situ oZ stomach. Superficially spreading carci­

noma of ~to~ach - possibly ori ginating i h at rophic gastritis -unanimous.

SAN FRt.NCISCO : -·;~pe::fkial spreading ( ill situ) carcinoma of the stomach -unani."!!Ot:S .

OAKLAND: Superficial spreading adenocarcinoma - unanimous.

CENTRAL VAI.J,BY: - No . 3 .,.~-;· felt to be a nice example of superficial apreading carcin•1ma of the stomach (Ca::cboma in situ) .- unanimous.

SAN DI1GO: -S~•perficial spreading carcinoma of stom:1cb - unanimous .

WEST J.~s .ANGELES : -----Suverticiit (surface) spreading adenocarcinoma of the stomach -unanimous.

FILE DIAGNOSIS: Superficial spreadi ng adenocarci noma, stomach (Carcinoma in situ) 640- 8091E

- 3 -CASE NO . 4, ACCESSION NO. 10430, E. L. Benjamin, M. D. and

D. R. l>icltson, M. D. Contributors

LOS ANGELES: Hodgkin's sarcoma; medullary carcinoma offe.red as alternative

diagnos i s. Reticulum stain tends to enclose groups rather than single cells. VOTES: Hodgkin's sarcoma, 7; undifferentiated car• cinoma, 2.

SAN FRANCISCO: Reticulum cell sarcoma, 6; Stem cell lymphosarcoma, 1.

OAKLAND: Halignant lymphoma, reticulum cell type - unanimous.

CENTRAL VALLRY: Hodgkin's sarcoma, 4; Anaplastic carcinoma, 1,

SAN DIEGO: In this case a muci-carmine and a reticulum stain might have

helped. VOTES: Reticulum cell sarcoma, 1; Hodgkin's type malignant lymphoma, 2; Malignant l~~phoma, 2; Hodgkin's tout court, 1.

WEST LOS ANGELES: Undifferentiated carcinoma of the stomach, 5; Reticulum cell

sarcoma, 4.

FILE DIAGNOSIS: Malignant lymphoma, stomach. 640-839F

Cross-index: Hodgkin 's sarcbma, stomach. 640·832F Reticulum cell sarcoma, stomach. 640-831F Anaplastic carcinoma, stomach. 640-8191F

CASE NO. 5, ACCESSION NO. 10082, P. L. Gausewitz, M. D. Contributor

LOS A!i>ELES: Adenocarcinoma of appendix, low grade, with mucous .granuloma •

unanimous.

SAN FRAi'lCISCO: Ruptured mucocele of appendix with pseudomyxoma peritonei, 6;

Low-grade mucinous carcinoma of the appendix, 2.

OAKLAND: Hucocele, 8; ~!ucin-forming adenocarcinoma,, 7.

CENTRAL VALLEY: No. 5 could be called nothing more than mucocele of the appendix

in some of the slides. However, with the slide in his set, Dr. Miller was able to convince the group of the diagnosis of mucinous carcinoma of the appendix.

SAN DIEGO: Chronic inflammatory process Bequent on ruptured mucocele, 5;

mucinous adenocarcinoma, 1.

-4 -

Case No. 5, Accession No. 10082 - continued.

WEST LOS ANGELES: Mucocele of the appendix - unanimous .

FIL& DIAGNOSIS: Mucinous adenocarcinoma, appendix, 661-809lF

Cross-index : Mucocele, appendix. 661·610 .8A

CASE NO. 6, ACCESSION NO . 9842, Thos. F. McKellar, M. D. Contributor

LOS ANGELES : Leiomyosarcoma - unan~us ,

SAN FRANCISCO: Leiomyosarcoma - unanimous.

OAKLAND: Leiomyosarcoma ·unanimous .

CENTRAL VALLEY: No. 6 was agTeed to be a leiomyosarcoma of the ·large .bowel.

SAN DIEGO: Leiomyosarcoma - unanimous.

~JEST LOS ANGELES: Polypoid leiomyosarcoma of the colon • unanimous,

FILE DIAGNOSIS: Leiomyosarcoma, colon. 660-866F

CASE NO. 7, ACCESSION NO, 10418, S. T. Nerenberg, M. D. Contributor

LOS ANGELES : Telangiecta.t:ic repar<~tive process, cause not .evident - unanimous .•

SAN FRANCISCO: Ulcerative colitis, 3; &tgioma or low-gTade.angiosarcoma, 3;

Infarct, 1; No vote, 1.

OAKLAND: Hemangioma, 12; focal telangiectasia, 3.

CENTRAL VALLEY: Hemangioma - unanimous.

SAN DIEGO: Multiple ulcerating hemangiomas of G.I • . tract - unanimous.·

''Weber..Oaler-Rendu--Parlu!s" syndrome, if you go for eponyms.

- 5·-

Case No. 7• Accession No, 10418 - contin~ed,

WEST WS ANGELES: Infiltrative capillary hemangioma, 8; Kaposi sarc~, 1,

PILE DIAGNOSIS : Hemangioma, colon . 660-850A

Cross-index: Telangiectasia, colon. 660-851A

CASE NO . 8 , ACCESSION NO, 9813, E. L. Benjamin, M. D. and D. R. Dickson, M. D., Contr1butors

LOS ANGELES : Plasmocytoma of colon - unanimous. Ref: J. R. Nasaim and

T. Crawford, Solitary myeloma with generalized metabolic dis~r­bsnces . British Journal·of Surgery 37:287, 1950.

SAN FRANCISCO: Myeloma - unanimous.

OAKLAND: Soft tissue myeloma - unanimous.

CENTRAL VALLEY: Hodgkin's sarcoma - unanimo~s.

SAN DIEGO: Myeloma, 3; Extramedullary malignant lymphoma, Hodgkin's type, 3.

WEST LOS ANGELES: Malignant lymphoma, reticulum cell type, 3; Extramedullary

plasmocytoma, 6.

FILE DIAGNOSIS: Extramedullary plasmocytoma, colon. 660-833F

Cross- index: Malignant lymphoma, colon. 660-839F

CASE NO . 9, ACCESSION NO, 10344, D. A. DeSanto, M. D. Contributor

LOS ANGELES : Hocl.gkin' s Disease of rectum - unanimous . Ref: Geclwan, et al,

Hodgkin ' s Disease of Rectum, Arch, Int. Med. 97 : 403 (1956).

SAN FRANCISCO: Hodgkin's Disease - unanimous.

OAKLAND: Hodgkin's sarcoma, B; Undifferentiated malignancy, 7.

CENTRAL VALLEY: Anaplastic carcinoma, 4; Rcxlgkin' s l.

6 -

Case No . 9, Accession No. 10344 - continued.

SAN DIEGO: Type Hodgkin 1 s sarcoma wit h radiation effect, 3; Malignant

lymphoma, 3.

\fflS T LOS ANGELES : Hodgkin 1 s sarcoma of rectum, 8; Undetermined, 1.

FILE DIAGNOSIS: Hodgltin 1 s Disease of the rectum. 668-832P

CASE NO. 10, ACCESSION NO, 9498, George J. Hummer, M. D. Contributor

LOS ANGELES : Anal crypt carcinoma. (Proctodea! plate carcinoma) (Cloacogenic

carcinoma of anus). Remarked that this type of tumor is radiosensitive • ...

SAN FRANCISCO: Squamous carcinOIJI(l of the anus, 4; Anal duct carcinoma, 4.

OAKLAND: Squamous cell carcinoma - unanimous. Suggest probable origin

from anal ducts .

CENTRAL VALLEY: No. 10 was considered a squamous cell carcinoma arising from

vaginal mucosa.

SAN DIEGO : Transitional cell carcinoma, cloacal cell origin - unanimous .

tmST LOS ANGELES : "Cloacal" transitional carcinoma of the rectum, 7; Adenosquamous

carcinoma, 2.

PILE DIAGNOSIS: Transitional cell carcinoma, rectum (anal crypt). 663-8llP

Cross-index: Adena- epidermoid carcinoma, rectum. 668-Bl4P 668-8091F

CASE NO. 11, ACCESSION NO. 9542, Dorothy Tatter, M. D. Contributor

LOS ANGELES : Mesothelioma; diagnosis arr:I:\Mld at "by exclusion," also suggested

by gross appearance. Secondary carcinoma suggested. VOTES: Meso­thelioma, 3; Secondary carcinoma, 4; Unclassified tumor, 2.

SAN FRft.!!"CISCJ : No ·voee; 4; Malignant tumor, 1; Chordoma, 1; Neuroblastoma, 1;

Sympathicogonioma, 1.

- 7 -

Case No. 11, Accession No. 9542 • continued.

O~.KLAND:

All of the members agreed that they didn't knov what this waa. Six members thought this was a primary ovarian malign.ancy and con­sidered granulosa cell tumor and arrhenoblastoma. Pive Qembers be· lieved this to be a metastatic tumor. Pour members had no opinion.

CENTRAL VALLEY: The group was exceedingly puzzled over No. 11. VO'IES: Mali.g·

nant mesothelioma, 2; Ovarian carcinoma, 1; GriiJ'>lOBa cell carcinoma, 1; undetermined, 1. Tbe problem of the rel~ton, if any, of this tumor to the neurofibromatosis waa discussed but not clarified. No one felt able to rule out neuroepithelioma, yet no one wished to make this diagnosis.

SAN DIEGO: Discussion on glomus cell, mast cells , carcinoid. VOTES: Neuro•

epithelioma, 2; Poorly dffferentiated clear cell carcinoma of ovary, 2; Undifferentiated malignant tumor, 1; Sympathico-blastoma, 1; metastatic carci :toea, l.

WEST LOS ANGELES: Metastatic carcinoma from the breast, 2; Unclassified calignant

tumor, 7. Suggested possibilities: Granulosa cell tumor; gynandro­blastoma; Mesothelioma. He would like to know if anyone has made an association bet"een tbe peritoneal tumor and the pigmented skin lesions.

FILE DIAGNOSIS: Unclassified malignant tumor, peritoneum. 060-8191P

Cross- index: Metastatic carcinoma (primary ovary vs. breast) 060-81911

Mesothelioma. 060· 8772A

CASE NO. i2, ACCESSION NO. S745, Elizabeth Conforth, M. D. Con tributor

LOS ASGl!LES: Schwannoma; Fibrous mesothelioca suggested. VOTES: Mesothelioma,

3; Parasitic myoma, 2; Sch\:a:tnOllla, 2.

SAN FRANCISCO: Post-inflammatory keloid type of tumor, 5; Malignant Schwannoma, 1;

Angiosarcoma, 1; Fibrous oesothelioma, 1.

OAKLAND: Neurofibrosarcoca, 7; cyxo!ibrosarcoma, 7; benign reactive

fibrosis, 1. A more descriptive report of tbe operative findings and gross appearance of the tumor was unantmously requested.

CENTRAL VALLEY: It was felt that the absence of gross or surgical description

oaa s-.-'>at t:antali:tina. voms: Neurilernrnoma, 3; Fibroaarc0111a, 2.

• 8 •

Case No . 12, Accession No. 9745 • continued.

SAN DIEGO: Mixed mesodermal tumor, 2; Liposarcoma, 4.

WEST LOS ANGELES: Pseudosarcomatous nodular fasc i itis, 5; Mesenchymoma, 3;

No opinion, 1.

FILE DIAGNOSIS : Mesothelioma, omentum. 0671·8772A

Cross • index: Sarcoma, unclassif~ed. 0671•879