\ .. .

FOR

TIJ'.;OR TISSUE RroiSTRY CO?.'NITTEE

October 26, 1955

LOS ArtOEIZS COIJ}'TY OOSPITAT-

Dinner in the Doctors' Dining Room at 6:00 P.!!.

/Z~3

CASE NO , 1

ACC~SSION NO, 8028

~ . s •

.!\a":: 40 SF.X: Female RAro: : 'Jauc.

CONTRIBU'IOR : Paul Michael, M. D. , 450-)0t h Str eet, Oakl a nd, Cll.lifornia ,

TISSUD FROM: Tumor from esopha gus .

CLilHC.1 L 'JJSTRACT:

October 26, 1955

OUTS!Ub NO , S55-)265

History: For tl-lo months prior to ... dmiss ion to the hospita l on 14-.y 22 , 1Q55, the pe.tient had h<!.d pe.in in the chest, 'tk'!.ok and. upper abdo­men , weakness, inability to SW&llow solids and occe.siona l n2.usea, 1<1 th some weight l oss , There lii'LS no cough e.nd no shortness of breath on exertion . T~<o vteeks prior to admission, the pe.in bece.111e so severe that she consulted her physician . ·' ge.stro-intest inal series was done e nd a.n X-ray diagnosis 1..ae made of carcinone. of the lower t hird of the esophagus . There had been no previous surgery, one pregne.ncy 12 yee.rs previously and the family history Wl S non-con tributory,

Surgery: On M!\y 28 , 1055, an esopb!!.geo tomy ..as performed, with end to end a nastamosis of esopre.gus to t he fundus of the stomach. The liver ~;a s gross l y free of t umor , There 1e.s a l a rge, firm , hard group of nodes .rhich were grossly very definitely characteristic of metasta tic car­cinoma , Iar~e nodes were no ted a lso in the l!ledie.stinum and a l ong t he course of the esophagus , No nodes were removed.

Gross p:>.thology : Tho specimen consisted of a. 3 x 2,5 em, fusi form tumor which e.lmost completely obstruc ted the esopha.gus ,

CASl!l NO . 2 October 26, 1955

ACCESSION NC . 8030 OUTSIDE NO , 555-1799

NIHE : ,., • G.

fiGS : 44 STIX: ~fe.le RACE : Cli\UOMian

CO!lTRIBUTOR: Louis Hirsch, f.! , D. , St . ~b> ry 1 s F.ospital end Sanitarium , Tucson, ArizonE! . •

TISSU"1 FROio! : Tumor of right foot

C!.TIHCn A:BST!!l CT:

History: This ~tient tms admitted t o the hospite l on Je.nuar~ 20, 1955. •lith the ch!.ef oompl <>. int of "lump, sole of right f oot . " 1•/hen first noted , a bout thr e e 1~ee1<a previously, the ma.ss ''"'·s "about the size of a pea" : t her e was a subseouent s light increase in size , 'Ille J!t',as l't:.ts excised a t t h is time but, because of "recurrence" of the tumor, t he p>.tient 1~s re­a dmitted on ~l?.y 26, 1'155.

Gross pe.thology : Tl1e s pec imen consisted of a spindle-shaped frag-ment of cuta neous r nd subcute.neoua tissue. 'llle spindle-el-.<~.ped epiderrne.l surf 'l.ce measured 2 . 5 em . in its grer.test dimension e.nd 1.5 em . in greatest 'lfidth , The membr!.'.ne a veraged about 0 , 6 e m, in thickness , The epidermis ~>as intact. 'there Wl!.s .q.n ill-defined region of epiderm l JBllor and possi­ble slight elevation overlying An ill -defined r egion of induration of the subepider~~l support ing t i ssue .

CAsr. NO . 3

}CCUSSION NO , 8037

NAI·l': : M. V.

AGE: 71 SEX: Female RPCE: Ca uc .

CONTRIBUTOR: R~ymond L, Teplitz, D, 0 , 1140 !>lapl e Street, Burbank , Coliforn ie. ,

TH'Strr. 'F'ROM: Righ t gluteal a r ea .

CLINICAL ABSTRACT:

October 26, 1955

OUTS IIE l:lO . 7156-55

His tory: THs I!IE'.ss bad been present for thre e yEY'.rs, ltith a noted increase in size during the 19-e t two to three -r:onths !l.nd increase in the temperature loestlly. It >IE•S non- tender.

SURG1"RY: A .ha rd !li?S S t>Els found fixed to the d eep tissues a nd excised on June 15th, 1955.

Gross pathology : The s~ecimen consisted of an eeg-shaped nodular me.ss, p:!.rt ially bisected, 1~hich mea.sured approximately 5, 5 x 4, 0 x 3. ? om ,, in grea t es t over-a ll di mens ion '-'-nd vteighed 44, c; grams , The external sur­fAces >Tere covered by g roups of '\dipose cells, On the cut surfa.ce there wns a firm , grayish- >thite ba.cl~ground t hrough which yellm·tish streaks wer e distributed a nd occa sionally reddish-brotm pin -point foci appear ed. Sec-tioning yielded a gritty sensation. Although of irregular outline, t he llflSB was ap~rent1y si>.arp1y circumscribed. A capsule could not be demon-strated extern.?.lly.

CbSP. NO. 4

~CC~SSION NO , 8172

NP!fl!: : D. L ,

CONT'l.IBUTOR:

TISSU" FROM:

H, Russell Fisher, M, D. , Huntington l<femorial Hospita l, Pr. sadena, C~1ifornia ,

Tumor, base of tongue ,

CLI'JICAL J.BST!VCT :

October 26, 1955

OUTSI DE NO , 3395-55

History: The patient first entered the hospital on August 28th, 1955 , 'lith compla.ints of soreness of the right side of the throat a nd a lump in the bac k of the tr.roe.t of four 1·1eeks 1 dura tion. Patien t sta ted she ba.d ex-!l.mined her throat ~11th her finger and found I"" small lump, A nurse friend h2d swabbed her throat severa l times, but this did not seem to a lleviate her suffering, so she consulted her doctor .

Physical exa:nin3 tion: TI:xamina tion revell led a 3 em, in diam etcr, rounded., 14ell circumscribed mP.ss protruding froo the posterior one-third of the tongue, just to the right of t he midline . To the r ight of this mass 1~s a s Jre.ll, 0,5 em. rounded 11nd firm m9.ss . Se:tnra.te was another simi lar sized lesion r.>.t the junction of the tongue ·111 th the e.nter ior tonsille.r pillar . There \>P.s a bila teral cervical lympl:-.adeno:Jnthy .

Surgery: On ~ugust 29, 1955. under intertracheel anesthesia, a. l~rge t\ll!IOr with a djacent nodule wae grasped with a tenacul\ll!l a.nd the base excised with cutting cauter y , Bleeding •~s controlled by e lectroooa eutation, The small tumor anterior a nd lateral to the l"tr ge one, 1,-a.s then grasped >~i t h a tenaculum and excised ·,1i th cutting c3.utery.

Gross pathology: 'nle s pecimen 't.e.S submitted in two portions . The largest was 3 . 3 x 2 . 8 x 2 , 3 om, , moderately firm, pol~id, smooth, pink ­gray- tan and t'.l:lRtening. It had a bro.~d b!Lse ~<h ich tots c!Ytrred. P.djacen t to the polypoid lesion •~s another smaller, round,firm prot uberance 0,4 x 0. 3 x 0,2 em .

NOTF.: The other submitted tissue conta ined the nodule from the la teral side of the tongue e~d was similar to the small nodule on the slide,

CASE NO , 5

J.CGr.SS ION NO , 8017

~lA~IF : U. H.

AGT': 18 mo . sr.x: Male RACF. :

CONTRIBUTOR: Pe ul J.ric be.el, t.i,n , , 450-JOth Street, 0Pkl e.nd, C"-lifornia.,

TISS~ FROM: Biopsy, left adrenal t umor .

CLINICA L ABSTRACT :

October 26, 1955

OUTSI'ii: NO . SC55-14)0

History: The 20ther stated that four months prior to a dmission she had noted a s111ill l ump in tba left side of the boy 1s a bdomen <'.bout the size of a hen's egg, This \f!tS not noted ~in -until a week before a d-mission. when he had a vomiting spell from ingesting machine oil . Since tha t time the abdomen had been very fl'\ t '\nd soft but the mus had been ve ry h?rd a nd l'e.d "been prominent . The p!l.tien t was seen by the physician four days prior to a dmission .

On Me.y 2Jrd, 1955. the m.•.as Ml. 8 s t i ll present and the p9.tient 1-lll.B

admit ted to the hospital , There bnd been no other symptoms a nd the patient had continued to ~in lteight, with no vomiting or b01tel difficulty. Physical examination on admission r evea l ed a large, firm , fixed mass, 4 to 5 inches in diameter, located in t he supra pubic ~> rea , extending from the pelvis to the umbilicus, mostly on t he left out a lso on the right , It seemed to ex­tend up16rd in the left flank and there t1'.s a. ques tionable firm 11)3.SS in both kidneys . Reo tal e~min,.,tion reveal ed a firm, round, im.!l!ova.ble mss which "fel t like a l P.rge ort'.,ge . "

X-re.y examinAti on revealed a l P.rGe C3>lcium-containing ~'\ss whkh filled t he bony pelvis a nd extended up to the r egion of the kidneys, espe-ciP.lly t he left k idney. '!be urina ry ble.dder •·r.>.s m'lrkedly displMed ~.nd deformed by t he m?.ss and t here e.,pear ed to b e ,. slight displacement of the lower portion of t he left k idney by the mass .

Surgery: Explore.tory l aparotomy 1119.y 28, 1955. biopsy.

Surgical findings : Upon opening the per itoneal ca. vi ty, there was an irregul" r, knobby , ver y c ellul!•r tumor v1hich completely filled tho pel vis and e xtended on up to the kidney on the l ef t side a nd covered the entire lower ..,bdomen on the l eft. This 1!11\ss was very irr eguhr and apparently had its origin extraperitoneally , /'n llttC'III))t >1!\s m!!.de to dissect a round it, but the cleavt-ge planes wer e l'.lmost obliterated :~.nd the iliac vessels passed directly over this tumor DP.ss as well a s the colon . It w.?s deemed inadvis­a ble t o try to r emove i t entirely.

CASE NO . 6

ACCP.SSION NO . 8029

S . G.

AGTi : 56 S":X: Female RACJl : Cauc •

OONTaiBU'IOR: Ja mes P . :auger, f.l , D., Joseph J , Li kos, M.D. , Good samaritan Hosp i tal, Pho enix, firizona ,

TISSIE FRO!of : Tumor, right l~g

CLINICAL ABSTRACT:

October 26, 1955

OUTSIDE NO . 555-2694

Phtor y : This patient, who h:~ s never scoked , md a productive cough for several •·reeks prior to admission . X-rc>.y showed an a bnonnal shadow in the right l o"er lune field. Bronchoscopy sho• . .,ed a tumor in the r ight l ower lobe b r onchus. A biopsy 1.as reported malignant . Family his-t ory non-contributor y .

laboratory f indings: Hg . 14,2 gms,, herratocrit 44, 0, wbcs 6,500 , normal differ entia l. Urinalysis normal.

Surgery: llth,l 9SS.

Right middle and. lOiofer lobectomy •;;as performed on May

Gross }:P. thology : The right middle a nd l o11er lobes 1·1ere submitted in t 1.,0 portions . The l a rger 11\9.8 composed of the lower lobe ~nd. a portion of the middle lobe a nd measured 10 . 5 x 12, 0 x 2.5 em, The smaller measured <l . 5 x 2 x 1 . 5 em . They had 'I combined ,.,eight of 150 grems . In the bronchus to the middle lobe, wi th its proximal end 1, 5 om . f rom t he line of excision, there 11'!.8 e soft red-gra y tumor •.1hich filled a nd completely occluded the bronchus and measured 2.2 e m, long a nd 2, 0 em. in diameter . The cut sur-fa.oes were lobula r gra y-red, The bronchi , distal to the tumor, 1·1erc dila ted •.nd filled with yellow-gray mucoid fluid , The p3.renchymal sub-stance of the middle lobe was dar k red, rubbery nnd appeared collapsed, The right l ower lobe had smooth pleural surfa ces . 'Lbe cut surfa ces >tere mottled light and dark red a nd showed well expanded pulmona ry a rchi t ecture.. The smaller segment of l ung bad smooth, dark red pleural surfaces . The cut surfaces ~<ere dark red a nd appear ed collapsed.

CASE ~TO . 7

ACCF.SS!ON NO, 8050

~lANE: l.frs. M. S ,

JIGT': 28 S>:X : FelllB.le RJICF. --

CONTRIBUTOR : Albe r t F . Brown, M. D. ,

October 26, 1955

OUTSIDE NO , GSH 55-1282

Glendale Hospita l !l.lld Sani tarium, Glendale, Cn.lifornia ,

TISSUP. F!lOM: Left breast.

CLUHCAL .•BSTRACT:

History: the left b;reas t period.

Surgery:

Patient bP-d noted p1-in in the inner upper q1lAdra.nt of for t hree months, •·•hich incre('.sed at time of menstrual

June 14, 1955.

Gross pl-thology : The lesion was diffusely present in a 3 x 5 em, portion of the left breast tissue tpY.en from t he periphery of t he upper medie.l quadrant . The surgeon st11. t ed tha t the remaining breast tissue showed evidence of cystic disea-se ~.nd th~ t the opposi te breast appea red to be s i milarly i nvolved, but the resected lesion •11\s the only indurated e rea of its kind,

r,ll S!': NO , 8

ICC~SSION NO , 8007

NAl·P' : G. R.

AGP. : 83 S"X: Mnle RACF. 1 Ca.uc ,

C Olf'I'R ll!UTOR:

TISStR FRO!~ :

~ . K. Bullock , lt. , D. , L . ~ . C.H. Los Jl ngeles 33 , California ,

Right p9.rotid gland.

CLI~ICftL ABSTRACT:

Oc tober 26 , 1955

OUTS lUI': t!O , 55-6857

History: The :r:atient entered L.A.c .H. on He.y 2Jrd , 1955, 1rlth complaints of a slowly enla rging mass in the right pre-auricular a r ea which had been noted for >Lpproximately t >ro years , but was enti r ely asympto­matic ,

Phyaica.l examina tion revea l ed a 3 t o 4 em, sNelling in the right parotid area, freely movable, non- t ender, with no apparent involvement of the 7th nerve.

Surgery: A tot a l rir,ht parotidectomy 'J!Is performed on ~lay 27 , 1955·

Gross p!.thology: The ~.rotid gland meP.sured approxillll'-tely 6 x 4 x 5 em. a nd was replaced at one pol e by a 4 x 3 em , oval, enca psula ted, firm, nodular growth , \/ben sectioned, the salivary gl~nd tissue •11!!-s compressed, lobul'l. ted, ye llow and the cut sur faces ho.d pm~c b. te areP.B filled with gru­mous m~. terial l•lhicb, ~1hen expressed, left spe.oes 5 mm . or less in greates t dimens ion .

CASE t!O. 9

ACCESSION NO. 4829

c--cto!>cr 26, 1955

OUTSIDE NO. 40871

NAilE: J • H.

AOE: 9 SEX : l lale RACE:

CONTRI BUTOR : James E. Kahler, !'!. D. 1

St. Vincent's Hospital , Los Angeles , Califor nia .

TISSUE FROii: Orbital tunor.

Cl.I!IICAL ABSTRACT :

Hist ory: This patient had noted a progressively enlarging, non­tender , swellino; C.eop to the right uppor e~'olid for about tno mont hs prior to hosoi tal adtlission on Dccenber 30th, 1? 52 . Swelling had continued until the patient could not open his right eye. Ther e was no pain, tenderness or increased temperature over the swellin~;, wit h no other symptoms or signs .

Surgical findings : On December JOth, 1952, a large orbital tumor, measur ing 6 x 3 x 1 em., was r emoved t hrough t he bulbar conjunctiva and formix . The tunor l7as soft, pale-pink, r esembling lymphoid tissue and was encl osed i n an easily ruptured capsule. It apparently extended from the lid, past the position of the lachr)~oal gland and posteriorly al ong the upper lateral aspect of globe to the orbital fissure . It was incompletely re­moved in fragment s by blunt dissection.

Gross pathology: The speci men was r ecei ved in t wo major fragments, each measuring 3 x 3 x 1 . 5 em. Ihey were flattened and lobulated in outline .

On :!ay 22, 1953 , exenteration of globe was done.

On July 24, 1953, a 4 em. r ecurrent mass under the skin of t he right temple was removed. A recurr ent tunor in the orbit was also biopsied.

Subsequent follow- up on this patient disclosed that he January 18th, 1954 and .,as thought to have died of disease . autopsy .

e:r.pired on There was no

CPS" NO . 10

AC CT::SS ION NO , 8014

N.t l~ : If • R,

J.OP. : 84 S"X: Male RACP. : Cauc .

CONTRIJltr.roll : cl . K. Bullock , M, D, , L. A. C. H. Loa Angel e s 33 , California ,

October 26, 1955

OUTS In:& }TO . 55-6222

TI< sur: FROi-1: Tumor , superior aspec t , l eft shoulder.

CLINICAL IBSTRACT:

History: This tumor of the l eft shoulder, bad been present for fo rty yea.rs, There had been a g radual i ncreo.se in s i z e t he l a st few yeP..rs 11ith a more rapid increP..se •tlithin the l a s t six months. During t h is la t­ter period , :r;e.in •I!J. s noted in the dorsa l aspect of the cer vi oa l spine.

Physica l eXRmination revealed sn 8 x 10 em. elevated soft, n on-tender, well circuoscribed tumor in the superior a spect of the left shoulder .

Sur gery: A l a.rge mul tilobulat ed , soft, enc.o.psula ted fatty t umo r in t he s ubcu ta neous n r ea over thG l eft shoulder e nd upper scapula ,,as excised on May 13th, 1955.

Gr oss :r;e. tbology : The specimen consisted of a 14 x 1 . 2 x 1 em. skin elli pse with a. 13 x 10 x 2 . 5 em. fl~.ttened oval anss of adipose tissue, the capsule of ~hich was glistening blue- white. On multi - sections , there were ar~s of gray mucoid t issus, but the ll"i'.jor portion 1-.a.s granular, ;rellow­f,q, tty tissue .

'l'U!IJJR 'I'ISSUE REG IS TRY MEE'l'ING

October 26, 1955.

!!he October meeting of the Tumor '!'issue Registry was called to order by Hugh Edmondson, ~I.D, , at 7: 20 P, H,

!·!embers present: Drs , Bullock, Butt, Dl.mondson, Fisher, Foord, Friedman, Hummer, K'ahler, Kaplan, Konwaler a.nd Pratt ,

Excused: Drs , Kimball a nd Lichtenstein.

OLD BUS !NESS 1

1, Accession No. 7845.· It was decided to label this Accessioned Case as juvenile xanthogranuloma following Siliphant's classification of the ! , F, I.P. 'Ibis child, it has been determined, has normal blood circulating lipids, ( Case No, 1 for the July, 1955 Conference) ,

2, Accession No, 7768. Deoignation: adenocarcinoma. Primary site undetermined, ( Case No , 7 for the July, 1955 Conference),

3. Accession No. ?856. Follow-up data determined that clinically liver, spleen , mediastinal nodes, blood count, and heterophil antibody deter­minations were all normal, Patient subsequently died, No autopsy was ob­tained, Majority of opinion favored the diagnosis of giant follicular lymphosarcoma of Brill-Symmer'a type, However, it was decided to defer final diagnosis of this lesion to await a second look and complete reView, (case No . 9 for the July, 1955 Conference ) ,

4. Accession No. 5586. Follw-up data disclosed that this was a huge nodular goiter and the nodule under discussion '"as found in one-half of the right lobe of the thyroid. Final diagnosis: Hurthle cell adenoma of thy­roid, ( Case No. 10 for the July, 1955 Confore4ce,)

5. ~ccessj.on No, 7838. S:r;ecial stains for presence of fat and P , T, A, H. stains ~<ere made, Fat s tal.r.s are positive. Therefore, this tumor is de­signated as myxolipo sarcoma. ( Case 1~o. 2 for the August,l955 Conference) .

6. Accession No. ?8?Q~ showed adenosarcoma pbyllodes.

!t is det.armined that the original slides ( ~~£ ~o. 4 for the August, 1955 Conference).

7. Accession NoJ;?If2,, It is d.etermined that the child in this case was aged six montho and that ';he mucou:J" m<lmorane on the slide is moat pro­bably pharyngeal. Final di&.<~osis : Fib~.I!lQ ( Case No, 8 for the August, 1955 Conf erence) .

8, Accession Nor .J.Jfl!.o.. The majority vote favored diagnosis of leiomyosal'Ct'=• ( Case Ko. 9 f•:.~ the Au.g.1.1t , 1955 C<;nf.3rence).

lir.ll' l!US INESS :

CASE !10, 1, Accession lTo. 8028, submitted by Dr. Paul mchael,

Dr, Kahler discussed this case. Differential diagnooes considered

case No , l - continued.

were: (l ) neurocytoma, (special silver stains were unproductive of additional i nformation ); (2) neuroblastoma; (J) oat-cell carcino::la of lun&. This tumor is very necrotic , usually, Suoh feature does not mark the present case under discussion; (4) malignant carcinoid and (S) carcinosarcome. or Grade IV epithe­l ioma of esophagus , Final diagnosis was deferred .

The Oakland group sub~itted the following votes: Carcinoma, including oat-cell 7, sarcoa>a , inclucl.ing neuroblastoma. S. undifferentiated caroinoma 1 and 2 members not vot i ng,

The following votes were submitted from the San Francisco Tumor study group: Poorl}' differentiated car cinoma of esophagus 7, of lung -9, of un­recognized origin -S. of stomach -1 .

Case deferred,

Q~SE NO, 2, Accession No . 80JO, submitted by Dr. Louis Hirsch ,

ThiEl case was discussed by Dr , Leo Kapl an.. His differential diagnoses include benign sclerosing hemangioma , Kaposi 's sarcoma, fibrosarcoma, nodular fa soiitie of Duputrens , dermatofibroma, hemangiopericytoma. Dr. l~plan favored the diagnosis of benign sclerosing llemangiom. All present agr eed that the tumor under discussion is a true t~or of or about blood vessel ori­gin, Final diagnosis, however, was deferred for results of special stain­i ng, including silver stains .

The Oakland group voted: Vascular leiomyo:JB 6, sclerosing he111angioan 7, neurofibroma 1 and subepidermal nodular fibrosis ,

The votes of the San Francisco group were as follows: Benign vascular tumor: hema.ngiopericytoma. - 7, angio-endothelio!llB.-4, sclerosing hernangioma-4; ma.li~nt vascular tumor: >!ali{nant endothelioma-2, Eaposi 's -1. Plantar fibroma ( fibromatosis) - S.

Case deferred.

CASE NO , 3. Accession No , 80J7, submitted by Dr , Raymond Teplitz.

'Ibis case was discussed by Dr. Louis Lichtenstein who pointed out that the tumor represented numerous ~esench~l elements, including fibrous tis­sue, moat probably fat, blood cells , plasma cells. smooth ouscle cells, bis­tiocytes and probably neural elements . Sections of the second block from this tumor look very different f ron the sli des under discussion. Ten votes favored diagnosis of mixed mesenchymal sarcoma. One diagnosis favor ed diag­nosis of reaction to injury,

Hembers of t he Oakland group voted unanimously for sarcoma., probably

-3-

case No, 3- continued,

several elements,

'!he San Francisco group submitted the fol.lovring votes: Sarcoma: Fibro- 13, type not specified -7, li]lo-2, chondro-1• Subcut aneous pseudo­sarcomatous fibromatosis ( "fasciitfs") - 1,

FILE DIAGNOSIS: Mixed mesenchymal sarcoma. ,

CAST-: 1~0. 4-. Accession I:o,e:.:(<l.eubmitt.ed by Dr, Russell Fisher ,

'!his case was discussed by Dr. Konwaler who pointed out that this tumor ~las derived. from salivary gland and represented essentially a cylin­droid type of adenoma of maligruL'lt t;vp.e, which is si ,1ilar to tumors derived from glands in the bronchial tree , Elements of identifiable mixed tumor are likewise present , Therefore, he thought the d.egree of mal ignancy in this :particular case ~~as mid.way bet1~een the.t of cylindroma or adenocystic carcinoma, and frank adenocarc i noma. i·ia.jority vote favored filing this tumor under the des ignation of cylindromatous tj~e of adenocarcinoma arising in a mixed tumor of minor salivary gland, It was felt that t his tumor was moderately radio s ensitive,

Votes submitted by the oakland group : ¥.ali .\_nant ( 11adenooystic 11 , amelo­blastoma, mixed tumor, adeno-) 12, benign 1 and 2 members· not voti ng,

The San Fra,ncisco group voted unanimously for adenoid cyst ic carci­noma of salivary gland

F ILE DIAGNOSIS: Cylindromatous type of adenocarcinoma arising in a mixed tumor of minor salivary gland,

CASE NO , '1 , Accession No. 801?, submi tted by Dr. Paul Michael ,

This case 1·1as discussed by Dr , l!athan Friednian. Those present fa:vored his diagnosis of i!lllliB.ture ganglioneuroma, malignant and metastatic_ t o lymph node. Dr. Friedman poi nted out that lymph node in this case ~1as atrophic, that the essential lesion here was a neuroblas toma tyPe of tumor, which was d.ifferentiated into a g'liUl6lioneuroma and which ~1as metastatic to lymph node,

The Oakland group voted unan imously for malignant ganglion and neural lesion, ( Large amount of glial tissue raised the question of ori-gin from teratoma, as ganglio_glioma. appeared limited to nose , )

Tho Silo J?rm~cinco group vo t ed unanimously for ganglioneuroblastoma. .•

FILE DIAGUOSIS : Immature ganglioneuro!!JS., malignant and metastat ic t o lymph node .•

CASE NO . 6. Accession No. 8029, submitted by Dr. Ja~es Barger .

This case was discussed by Dr, E. 1·1. :Butt. Those present a€;reed with· Dr. Butt's diagnosis of carcinoid of bronchus, ~lignant . Reference was made to the importance of staining this tumor by silver and following Mallory's technique as described by him in 1926, using ammoniacal silver, the amount of arranonia present must not be pe1•ceptible to smell.

The vote was unanimous for carcinoid of bronchus, malicnant .

'lhe members of the Oakland group voted: Bronchial adenom, malignant, 9 and adenocarcinoma 6.

The San Francisco group voted as follows: Bronchial adenoma 9 (includ­ing 6 carcinoid type) , malignant bronchial adenoma 13, adenocarcinoma of bronchus 3.

FILE DIAG!JOSIS1 Carcinoid of bronchus, malignant .

OASE NO . 7. Accession No. 8050, submitted by Dr. Albert Brown.

This case was discussed by Dr . Russell Fisher. In the differential diagnoses Dr. Fisher considered: (1) intraductal papillomatosis and sclerosing adenosis of breast, (2) cystic mastopathy ~lith exaegerated intraductal hyper­plasia; ( Dr. Fisher favored this latter term) ; (3) papillary intraductal car­cinoma in situ. Dr. Fisher pointed out that there ~B no evidence of in­vasion of this tumor and suggested that a ~asson's trichrome stain be made in this oase, Majority of opinion favored diagnosis of intrad11etal papilloma­tosis and sclerosing adenosis. Changes present are both of epithelial origin and of fibrous origin . It is doubtful which change is the reaction to the other.

The vote wa.s unanimous for intraductal papillomatosis and sclerosing adenosis .

The Oakland group submitted the f ollowing votes: Dronchial adenoma, malignant 9 and adenocarcinoma 6.

The votes of the San Francisco group: Adenomatosis and papilloce.tosis 19 (local excision -13, simple mastectomy 6). Invasive carcinoma ( radical mastectomy) 5.

FILE DIAGl:lOSIS: intraductal papillomatosis and sclerosing adenosis .

CASE NO . 8, Accession No . 8007, Submitted by 1/eldon Bullock.

'!his case was discussed by Dr. Foord who dreli attention to two articles in the 11 tera ture concerning similar tumors : (1) "Sebaceous Gland Prolifera­tion in tarthin 'l'woor" found in Surgery, Vol, 27, pages 93 to 101, January. 1950. and (2) an article by Porter and Frazell, in Cancer, 1953, on this same subject, Dr. Foord stated that this tumor was essentially a l~arthin

-s-Case No . 8- continued ,

tumor occurring i n an elderly individual, which pre sented elements of squa­mat i zation and sebaceous like cell changes, These latter changes , he felt, were retrogressive in nature. The vote was unanimous for Warth in tumor wi tb squamous metaplasia and sebaceous cell formation ,

:the members of the Oakland group voted unanimously for cystadenoma lympbomatoeis, Warthin ,

22 members of the San Francisco group voted For oystadenolympboma sebaoeum ( variant of tertbin •s tumor) . Benign lYJl!Plo-epi tbelial lesion and muco- epidermoid tumor each received one vote,

FILE DIAGNOSIS : \~arthin 1 s tumor 11i th squamous metaplasia a nd sebaceous cell formation .

OASE NO , 9 . Accession No . 4829 , submitted by Dr . James Kahler ,

'!his case 1o1as discussed by Dr. Hummer, All those present agreed "'ith the diagnosis of embryonal rhabdO!JIYosarcoma of orbit , It "'as noted pa.renthe­tically by Dr . ~eldon Bullock that a case almost identical to the present case was received in surgery at the Los Angeles County Hospital on October 26, 1955.

Members of the Oakland group voted unanimously for sarcoma ( neuro­genic and unclassified) .

T'ne members of the San Fra.ooisco group voted as follows:. Sarcoma, unspecified type 10, embryona l rhabdomyosarcoma 5, rhabdomyosarcoma 5. myo­sar coma J and f i brosarcoma 1,

FI LE DIAGNOSIS! Embryonal rhabdcmyosarcoma..

CASE NO , 10, Accession !~o . 8014-, submitted by Dr , 'tleldon Bullock.

'lbie case was discussed by Dr . Pratt, All those present agreed with the diagnosis of liposarcoma occurring in a lipoma.

Votes of the Oakland group were as folloliS l Li posarcoma 9, lipoma 5 and l member not voting,

Votes of the San Francisco group were : Liposarcoma ( arising in pre­existing lipoma) 14, myxosarcoma (arising in pre-existing lipoma) 1. Fibro­sarcoma. ( arising in pre-exisiiing lipoma) 1. Lipoma 5 and no opin ion J ,

FILr. DIAGNOSIS: Liposarcoma occurring in a lipoma,

•

-6-

Dr. Pratt read the proposed Articles of Association for the Los Angeles study group, which will be voted on at the November meeting.

The November meeting liill be held one \leek later , on November :30th , instead of the usunl fourth 1·/ednesde.y.

There will be no scheduled meeting in December . The Committee will meet Januar? 18th, to discuss the December monthly slides.

It was decided to hold t1·1o meetings in February. The first mee ting 1'1111 be held on February 8th when the J!\nuary monthly slides will be discussed. The second meeting will be held on rebruary 29th at which t i me the Februar y monthly slides will be discussed.

There being no further business the meeting wa s ad journed.

George J . Hu;:ttner, H. D. , Secretary.