FOLLO\.V-ti? Si.D.VEY

DECE£/JBER 10, 19 5o

SAN FRANCISCO

Conference

Mallory C or>..fercncc (Docor:lbsr 1949)

11

I!

11

II

II

Pathologist

E. J. Bonnett

B. G. Fishkin

C.M.Bltllilcnfold

Leo Kaplan

Reuben Straus

H. J. Schneider

I I'

FOLW,7-UP SUR'h::Y

Recent follmT-Up dntn;v:ith initinls of patient ~nd slide number, if' possible.

Slide ~!1 1106-49

Slide #3 N.P. Sl321-h9

Slide ~!5 BJ582-49

Slide f/6 Ers. I.:. L 35819

Slide #9 D.,F.G •. "Bl243-l

Slide /,~12

Slide /!13 G. A., 49-653

Follo;·r-up received 1:ay 31, 1950 fron p8.ticnt. Condition at· this tililc: 11 no bottcr. 11 Patient's horae adC.rcss is ll Santononi Avenue, Saranac Lako, N(.;"''I York.(Formor diagnosis: Aneurysmal bone cyst).

This pntiunt has. rcmDinod well an:::l. is symptomless to date.

Tho patient vm.s last observed July 11, 1950. He had no subjective cor:rplaints and. cx2.r:Unation rovoc:::lcd a vroll-h

Page 2 .. _

Confcr onco Po.thologist Recent follm·~-up dc.tc.., r:ith initi2.~s_ of pi'.timt o.nd slid.J nunbcr,, if possibl e. ~~~~~------~--~----~------~-------

t'inllory Conference (Dcccr.:bcr 1949)

tl

Foot Conference (i..it.y 1949)

rr

II

II

H. J,. EdL1ondson

D. A. DoSnnto

B. E. Kom.rc.lcr

D.J,. DcSnnto

E. Lo','!cru1.u.upt

Slidc ifl7 F. H.-43-9206

Slide i¥18 K. W. l•i.H.3495-49

Slide #1

To be pres ented 2.t Conference. (C2.sc #6)

I "Follm:ing the surgery tho pnti .mt r e ce ived a protracted course. of x-ray thcrnpy to the pc..rr.ve rtc'Jrt..l vrc2.s. Rctrogrr:.dc pyclogr .:'.r. ,s sho:·:cd sor.;o distortion of the curve of the right ureter, t":.nd it -...,o_s. suspoctc::d thc.t this r epresented r;.;troperi.tonc

Conference

Foot ConfercncL (i:.Iny 1949)

11

Pnthologist

R.W.Huntington,Jr

!: .... G. Foord

Pngc 3t. Rocont fo1lm7-up datu, nith initinls of p:-tticnt rmd slide nuubor, if possibl e: .

Slide ff7 o.:rr .c. 1020-48

lido {/12 .c.

9940-P'

This patient. Y:ns seen on 7-11-47 be:cnuso of n tu:r:10r of the right arm, present, for 3 months. .~ biopsy dono outside the hospitd re-sulted in the diagnosis of nr;xo-li~osnrcomn. Examination rcvcnlcd n wull d._;vclopcd nnd ·.roll nourished 1·:hi tc r.1-".lo of 46 yc£>.rs. On raicroscopic£'.1 oxru:..:inntion of tho mass ronovcd .:tt this hospitd, th:J' dicgnosis of 11 Rh.:-;bdom;rosc::.rcmr...:.1.11 Y!;:>.S nr:dc. On October 29, recurrence of the tUr~or ~·:ns noted. This time tho diagnosis 1;ns HJ,·yoeer nic s

Pnge ll

Confcrcnc~c------~~p~~~t~h~o~l~o~g~i~s~t~----~R~c~c~c~n~t~f~o~l~l~o'~1--~-=d~r.~t~n~,~~~i~t~h~i=n=i~t=i~n=l~s~o=f-£p~n~t=i~c~n~t~a~n~d~s-l_i_d_c_n~~~-'~--c_r~,--i_f_n~,-o_s_s_ib __ l_c.~---

Foot Conf~rcncc J.c.c~.rr & F. Drnpcr

Slide #14 G.F., ss48-I448

uspccimc..n: Consists of left testicle and nttachod portion of cord. On opening the tunic"- o.lbuginca there is noted to be a small e.eount of fluid bctv;cc..n tho visceral and pnrietcl layers. In the.· rog:ion of the globus minor of tho cpidid~tds and exit of tho spcrm~tic cord fror:J. tho tosticulnr structurc.., the parietal turiic and -r:all arc th"ickcncd, and on section shotrs a rather firm, grey-white appc:1r~co. Careful dissection of the lesion f::J.ils to .shm-r the involvcUJ.cnt of the epididymis or tturcs.

liicroscopic: Section or tho pnriutnl albuginon and underlying "';:nll shmT it to be lined by a flattened mesothe:lial type of cells, th.l cells. In spite of th::t, this o.dcnocnrcinor.ln sccr.1s to be nrising fro.n these cells. Diagnosis: Cysk.dcnoc~rcinoma, tunica vngii-k.'11 is. Note: Tho pntiont is still living( no fur-thur biopsies or op orntions.1'1

page 5,. Conference Pnthologist Irocent follot:-up dntc., Trith initir-.ls of p2.tiont

Page 6. · c onforence Pn tholo g~i1~s~t:......._-r-_;R~o c~o~n~t.':'.:.' r,f~o:::l:::l:::.,:o::::r:...,'--1Ufip~d~r:.Ttll::lr:'-i'"0;:. ~t:::h~iru.F· t:;=i;:r:r:.l;;:s~o~f~p~a~t~i-;c~· n+t:;-;:2.;-;:n;;;d;-:-sJ..~id~o?"· ·,.nJwl.i.,.,:f,.b:-o_r"l,tr:;i;-;,f~n;;o:-sr.sl"i":ib;:lr'f..- -;::"' :-Stout C onforcn e 1.. ~rs ~ H. t,_ Slidr> ,-2 ~17- : Removal intr2.-thoracic tu.v:1or. }-23- 9: Er:1pyc:r.w: Clinic: (Nov. 1948} 48-6618 11 L2.tost chest film clo,':'.r. Wound! entirely hcill.od. Return six

Eonths."' Patie:nt 1 s vitonth int.:..rvnls and is free of disco~sc M of B-1-50 •.

Physici~n sec:: h•.Jr lust nbout June: 1, 19)0. X-r:'.yst t~kcn. tb evidence of rocurronco.

Slide //20 Follo~·;-up 7-28-48: 1 yom' r.ftcr rc...:.:.lovnl, shorrc.d no evidence of rc-H.S. ,47S-l201 currc.ncc.. Patic.nt then tr.msfcrrcd to Sonojii

~onfcrcnce ~tout Conforcncc (Nov. 1948)

II'

II

II

pn.ge 7.

Pr.thologist Recent follow-up dD.ta, 1'~ith initicls of p:'..ticnt D.nd slide nur.1bc:r, if possible. •. Slide ·#· 8 UThis patio:1t ... ::.:1-s subjcct.:.:d to surgery on Scptcnbcr l l~ , R ... w.;:Huntingt on,Jr.

o.B.Pr2.tt

D •. 1 ..• DeSanto

P.J.rclnick

c. s. Small

G.J.HUl'illllor

Slide 1/13 tlrs. li.P. 48-2599

Slido //27 J.J.B. 1.TII 2931-48

Slide #28

Slide· if29 J •· B •. Cl.iE48-1681

V.L.R. 1948 for a lD.rgc rctropuritono['..l tur.10r .:ran.ss .. Dr. Kirshb.-:-.ur::. 's Slf319-h8 diPatient of J.C.i:cnd of San Jacinto, Cflliforni"' P"tJ.· ont · ff" u.•

Conference San Francisco (!\

Conference Parholo ist

Stewart Conference 1 L.Tragenaan (February 1948)

II R.Shoemaker

fT A.G.~Foord

., ~ L .. Guiss

II !.Macdonald

Recent follmv-

Slide f,~l A2892-47

Slide //2 824690

Slide: /,18 R.P. ,3395-47

Slide #11 N.A.-24681

Slide /,113 A..F. ,#24567

Page 9.

s lide nu..'"aber, if possibl e. llThe patient. was follO'vred intervals by his phy-sician(Dr~. Victor Goodhill). There was no evidence of local recurrence on a follow-up visit in August 1949. The patient returned in June 1950. At this time he shovmd what anneared to be nm'r tumor in the anterior cor.t'ilis-sure of the larynx. There was no evidence of recurrence at the site of initial rei:!oval at the vallecula. The tumor of the anterior cornr.ris sure was rm.:oved on August 1, 195'0, It was studied pathologi cally by Dr. Russell Fisher and reported to have the same histology as the

· original tumor herein referred to. There has been no further change in the patient1 s condition since this procedure. "

"The patient has been examined laryngoscopically at frequent inter-vals... There is no sit;n of disease as of 9-1-50. 11

rrThis boy still shows some disease in the bone according to his attending physician. Last films were made on September 25, 1950. It is hard to interpret whether this is reaction following surgery, but Dr. Donald Laing, radiologist, thinks it is residual disease or recurrence."

"Patient subsequently ad.J1litted to L.AoC.G .. H. where she presented S}~toms suggestive of an extra dural vertebral tumor with spinal cord compression and x-ray evidence of esophageal tumor. Patient expired 4-11-48... Autopsy showed these areas of involvement to be metastatic in nature, apparently from the primary site previously described. (See autopsy at L.A.C .G. H. //39166- P .. F. 1073-357) •''

To be presented at Conference. (Case #2).

II

S;:;YJb=t Barb;ora ·> r.: ~ere nee :u.', c:r ~nber 174 7

Pathologist H. Edmon son

S.L.Perzik

E. Lowcnhaupt

H. Schneider

Page 10. Recent follow-t..'P data with initials of patient and slide number_, if possible ..

liThe pa ient entere the hospital >'ri th recurrence in the soft tissue ar01.md the amputation stump on January 26, 1948 and remained in tho hospital until he diad on August 8, 1948. During the course of the disease thf; tumor grew lee ally at the &"l'lputation site into a funga-ting r.lass which at times would! bleed. No further x-rays of ti1e chest were done . The alkaline phosphatase was 9.,4 units on February 18, 1948(normal in our laboratory is 2-3 units).. At autopsy there i':as a mass 15' x 6 em. at the site of the operation. In its center was a deep ulcer. The tum~r had spread into the parietal pleura botvre cn the first and s econd interspaces, p osterola terruly.,. There vrcre

F~B.R.

0.7-2552

Slide #18 Flll-48

Slid0· #2 c . T. ,c-14U381 Sp47-2763

Slide #4 A-286-46

four or five mctast2.tic nodu.les in each lung: vd th a mc>.ximum diameter of 1. S em. These had. a gritty consistency,, No other metastases: were noted. Some arsas of bronc11opneUt'TI.onia were presont.u

11The patient had no furt"'lcr recurrences and required no subsequent treatment. She died in Juno 195o of a spontaneous intracerebral het1orrhago without evidence of recurrent disease,."

"Patient la~t hoard from in Earch l9h9(Solcen had been renoved in October 19h7-angiosarcor:w. with metc.st

Page 11 ..

Recent follow-up data ·with initials of patient and slide number, if possible. ,;.:.:.::;:..~~T--:::-~:-t-7.--::,..-:T.:":":"::":;-:,-:-::::--t--;Slide "114 secondarily fibrosed this peculiar and striking pattern is losto

II' D.J .. DcSanto

II R. Straus

n J.L.Zundoll

continued It is ~uggested in your sections but is much more striking in the· sections I pr0apred and. the Laidlaw silver connective tissue stain demonstrtitcs it to tho best advantage.

Slide #6 ' !.:rs. 1.~ . rr. 2933-47

Slide #8 J.L. Slide #7 T .A. ,847-1829

I believe this tumor belongs to the group of what I like to call soli-tary mesotheliomas of the pleura. These tumors are quite different in appearance from the classical spreading mesotheliomas and they are also much less J!lalignant, several smaller ones have been success-fully removed at operc>.tion. I judge that this-- this tumor although it grew through the diaphragm did not metastasize. The reason for it to be mesothelial in origin is based upon tissue culture studies., If it is not a solita!"'J mesothelioma of the pleura,. tho only other sug-gestion I can offer is to classify it ~ a mixed mesodermal t~~or or mcsenchJmomao This I am loath to do because I am not able to recog-nizo norc than one t~rpc of mal. i.gnant tissue. On tho vJholc I believe that this tumor can best be explained as a solitary mesothelioma. ru

uurs,. W. died on January 1), 1?48. Before death she developed sevcr.:tl subcutaneous metastatic noC::ulos on tho loft arm, in the right axilla,

. Conference Santa Barb.Confa Dec. 19b7

n

n

II

II

I!

n

Pathologist R ... ·Shoemaker , . . . .., ; . .

A.G.Foord

B.C.Shackford

H.1' .... Ball

.S.Small

Page 12 Recent follow-up data 1•:ith initials of patient and slide number, if ossiblo. Slide ~~3 HThis :pe.ticnt died in S:;pternbcr 1950 •. No autopsy vras performed but H.B. ,s24270 attending physician believes that death was due to senility and

that there was no recurrence or r.1etastases of the sarcoma. 11

Slide #5 H.M. ,2934-47

Slide #11 #370)6

Slide t,tl2 l.!rs. B,B2782

Slide #13 I.:rs. G. B8094

Slide ;n5 r.:rs. LP., B9494

Slide ~~15 I\lrs .s .c. B9405

11 This boy is1 clinically vroll as far as tho bone is. concerned and x-rays taken on 6-9-49 showed a healed lesion. He has dcvolopcd diabetes insip idus, but. has gained 7might from 93 to 122 lbs. up to now. 11

11 This case 1•ms one of osteogenic sarcoma of the right femur in a pregnant 1!1hi te housewife~ of 29 years, for v,rhich amputation 1':as per..:.. formed on July 26,1947 o· She was delivered of a normal child Dec. 7, 1947 ~ During the next fev-r months she developed dissemin2ted metas-tases, including pulmo·.1ary lesions, and died about mid-1948~ Sli.e· had moved away from th i.s locality a fe-.•r months before1 her death.. Vre vrere informed later that no necropsy was performed."

"Recent ccnt

"Because of' verJ poor cardiac status no further surgery(wider resection) were done. Interstit ial radiation ~·re.s given, and recent contact ~T:i.th~ in 3 months,- indicates absence of residual or recurrent disease •. Dr·. J. Flai z, Escondido, California, was referring physician • ."

".hdvised to have x-ray for carcinoma of cervix. Refused,and has not responded to any inquiry. 11

nour diagr.osis vra.SJ chronic cervicitis with squamous metaplasia. Last seen February 1948, ap)arently well.n

Page 13. Pathologist Recent follow-up data with initials of patient D.nd slide number, if possi'l3le,

;;.:::.:.:;:..::.:..,,;::.:;;..__,,...--:,..;;;..::,;;,:....::..,.:..;:t:.:e;...rm~an~--r--:s"'I\"":~~·· :re::--:,~'~"~. ·o---i'The pat~ent died on JUly 7 ,. 1~JL~B . Cause of death: Generalized car-Iospital E.~'I .,S32805 cinome.tosis, site of origin nndetennined.!' A brief resume of the

Los Angeles Conf. •. E. Kahler J';.pril 1947

II .TI.Dudd

II .f •• Kosky

Slide #2 E •. J ~ ,S2064 7

Slide~ ~~3 P.,D.,ll395

ru topsy is. as follorrs:

The body is1 that of a rrell developed, etJ.aciated Tihite :mcle 11eighing 110 pounds. There are nul tiple, firm nodules noted ovar the entire scalp., 1~ tumor ma"Ss is noted in the right axilla extending from the anterior axi..llnry line• to the midline of the back., :r:ultiple tunor nodules are noted over the ru1terior aspect of the thor me and at both inguinal regions and right lovrer quadr.:mt, The mediastinum contci ns numerous tur:-;or nodules. Both lungs contain multiple t·umor lesions" The bone nmrrow shovvs no lesions. The stomach and small intestine. show· no tumor., In the cecum is a crater-like area mec:-.suring O, 5 em. in diN.tetero Othen·rise the lnrge intestine is nege.tive. The liver weighs 2705 grams and contains ~ultiple tumor nodulesd No tumor is noted! in the gallbladder or ·pancreas. The kidneys contain multiple tumor nodules, The bladder, pirostate and testis show no tumor, The thyroid shows numerous tuntor TI1c".Sses over the, surf~.ce. The adrenals show no tumor. There is a metastatic lesion in the left pariet

Conf8rence Pathologist Los Angeles Co • A.G.Foord (i..pril 1917)

Pcge·· 11., Recent follurr-up dnta. with initials of patient and slide humber, if possible.

·7 "This patient had developed hypertension 21,...,(110 vrhcn examuned in r.:rs.U.K.. lJarch 1949, and became a cardiac invnlid with angina, requiring nitro-3022-45 glycerine. I:deraa was combo.tted by I.~crcubydrin.. Finally on 1~pril 22, ·

1950 she died suddenly of coronary occlusion. No recurrence of turr1or, axillar,r metastases: found. Lungs were negntive for tumor by fluorosc opy on severcl occ.:1.sions. lJo aut::>psy vr;;.s done. This appears to be · 2 dec:>th from coronary and hypertensiva· he.:'.rt discc.se without metn.stasis. 11

L. J. Trngorwm Slido;;~9 I.~.Q.B962-47

11The patir.mt hns been seen only once since surge:rj'. Thnt in June, 1?47, only trro 1nonths after the operction.. Her condition vw.s considered snt-isfactory ~t thnt time. There is no further follow-up. 11

It Leo· ·Kaplan

"' D.A.DeSanto

11 R. Straus

II' G.J.Hummer

S1ide#11 Hrfc have not seen this p2. ticmt for nlmost a year ncr-:r ,. nor do Yie know of L.J1. ,E223-47 his whereabouts. Diagnosis: Reticulo-endothe1iosis. "

Slideffl2 n~· Following his reoper~,tion for r~current tuinor in Harch 1947 the patient C.F.~ ,1860-46. has failed to report for folloYH.lp exmninations. ,\ letter received from

his son dated June 1947 states that the patient is well except for '.ver.k-ness in his left arm. A folloy.;-up questionaire has been sent the patient andl any additional informc.tion will be forwarded to the board. The his-tole gical appearance of' the. recurrent tunor WP.s identical vri th the.t of the original tumor.(Information frora Dr. D.H.'r.rerden, San Diego) •·"

Slide lf13 D.P.,Dl028-47

Slide i:~15 I-F-G... S1_%G-L.6

11 Patient returned for observation on lilay 9, 1950. HCl.s made amn 7 ing de-velopment as far as physical conditi on is concerned, which was entire-ly normn:l, both fran the sb.ndp:dnt of physical development L..nd nent2.l development.. He shows only slight incoordination in extrenitics and is c::.ble to play a fnirly respectable garne of bnsketball. He ht:1.s: left ho-monymous hemianopsia; r.mcular vision, fL..ir~; he reads fine print fron his newspaper and telephone director'J •- He still shovrs on an ophthalmic exam-ination very pale .optic discs. He has no co;-:rplaints.n

"This infant died sevGrcl months after she 1·ras treated in this hosoital. She died in Riverside·, Ca.lifornin. I understand th2.t postmortem exam-ination was not obtainable."

Cgj:lforence Palo 1.1 to Conf. (Dec. , 1946)

"

" II

[I

n

,. .

Pathologist R. Strnus

I. U£!.cdonald

J.W.Budd

L.J.Trngermnn

R.J.Picl:nrd

Los lingeles Conf. Inn Eacdoncld (l.lny 1946)

II J.E.Kahlcr

Page 15 ..

Recent follorr-up dr:.tn ~·;i th initials of pnticnt and slide m.L'lilier, if possible ..

Slide i!l 11 Lnst seen by priv~.te physician in 1949 at which time patient's condi-Dl75'.5-46 tion -vms good and no rocurroncc of the disc2.se vms evident,.,Jt

Slide {}4 1;i. B. ,#1854 7

Slide /,!9 TT .0. ,10947

Slide/}16 Dl553-46

Slido /}18 B.A-. ,SPh6-226

Slide f/21 u. o •. Slide #1 J. ;H. ,1!524

Slide #2 vr ..F •. ,19927·

To be presented at Conference. (Cnsc //3).

"Platicnt lust exanined 3-19-48--No evidence of diseuse •. "

11The patient expired in Septonber 1946, four nonths after surgery-. An autopsy perforr.!Cld September 26 ,, 19h6(Cedf'rt:: of Leb.:Lnon ~·.utopsy # D.-\-138-46). Cnuso of death: Acute hepatitis, probr-bly homologous sor'Ull'' hcpn.t.itis. The nutopsy revealed no ovidenc£ of recurr(mt or mct~cstaticturnor. Anatomic Diagnos£s: 1. Benign turJ.or bf sto;;r. ch, unclo.ssified. and. operated~ 2-. Gastro-jojunn.l anastot1osis, henlect·. 3~ Jojimo-jejun.nl anastoiilosis, he,"~od~ 4. Hepatitis, acute~< 5. ;,scitos, ar.ount undetorr.iinedo- 6.. Jaundice. 7 •. Edenn. lower extremitis. Probo.ble Cause of Donth: l. Lcute heputi tis .. 11

"Report in l9h9( 3 ye.:--.rs postopor.:!.tivcly): uo· recurrence of tu,.._.-.or. Patient is doing hco.V'J fnm work( digs carrots, n:ilks 3 cows).. Occasion-ally ho.s to taka prostigninc bronidc tublets ·\'lhon vcr:l ovc::>r:orkcd,, as after pitching hay. n

To be presented at Conference. (Cnsc ~:'?).

11 The patient. has been under the care oi' another phy~ician for about 2 ycP.r~ •- Recent repo~t(ll.ug~t l95J) st2.tes thD.t there are m2..ny slur:-ly gravang mot.::>.stt'..ses 1n cervlc

Conference

Los Angeles (Uay 1946)

!!

!!

Pathologist

J .. Vi ••.. Budd

J.W. Budd

.\.. Wright

Page 16eo

Recent follm•r-up data vlith initials of "?ntient o.nd .slide number, if possible~

Slide #3 11 Hcaled--no evidence of disease--in 1948 had excision of precancerous Mrs. H.P. keratosos on right vulva(:~rigin:ll excision 1946 was loft side.n 10114

Slide /,t4 ;.". L., 10093

Slide {,~11 !.68-4h

'1:o ovidonco of disoc.so - 12-2-49.

"Diagnoses: Benign epiphysc~.l giant cell tunor of hu..T>Jerus. .~s of July 1950 this child is in good honl th.. Thoro is no cvidnoco of rocurrcncc,u