I

/2(f0

PBOTOCOL

FOR

l40N'ffiLY SLIDES

December,l956

lOS ANGELPJS COUN'l'Y HOSPITAL

CASE NO. 1

ACCESSION NO , ~5

NA~lE : A. W.

'AGE: SJ SEX: Female RACE : Cauo ,

CONTRIBUTOR: D. A. DeSanto, M, D,, Mer cy Hospi t al , San Diego, Californi~.

TISSUE FROH: Thyroid tU!llOr .

CLWICAL ABSTRACT:

December, 1956.

OUTSIDE NO . 723-56

History: This patient ente r ed the bospi~~l on February 9th, 1956 , for removal of a solitary no~ule ~t the jUnction. of the right lobe and isth­mus of the thyroid. Her physical e:xl<lml.Mtion 11as otherwise noncontribut ory.

Surgery: On February lOth, 1956 , the nod1.!le ~lt3.S excired, On February 15th, 1956, ~ tot~l thyroidec~o~ w~s performed.

Gross ~thology: The first specimen consisted of a mass of thyroid tissue me~suring ~ x 2 x 1 em. nnd weighed 6 ~~ams . In the middle of the specimen there ~tas a •·tell encapsulated nodular, yello~i-tan lesion measuring 1.5 em. in d.iameter . It was ~<ell differentiated from the surrounding reddish­tan thyroid tissue,

'lhe remaining thyroid r eooved on Febn:ory 15th, was free of t umor .

CASE HO , 2

ACCESSION NO, 8.549

NAME : A,P.

AGE: '71 SEX: Feme.le RACE: Ca.uc .

CONTRIBUTOR: Robert A. Blossom, M,D, , 3291 Vis ta Dr i ve , Vent ura, Californ~ .

TISSUE FROM: ~~ss i n br~st.

CLINICAL 3llSTRACT:

December , 19.56

OUTSIDE NO , .56-T-193.

History: episodic bleeding jury.

This patient ~s seen in February, 19.56, with ~inless non­from the right nipp::.e of unknown duration. She denied in-

On physical examinati on,a sm~ll mass measuring 3 x 3 em. was palpated i n the lo~rer outer quadrant j ust peripher11.l to the ar eola.

Surgery: 'l.'he cystic lll'I.SB was removed on (ll..g,r ch 19th,l9.56 .

Gross pathol ogy : The specimen consis t ed of a solita rY globoid st r uc­ture measuring 3 em. in di11.met er . On cross sect ion a centra l oavity lined with a layer of or ganized blood W!l.B found . In one area a raised, firm, white, f usifor m mass measuring .5 mm. in elevation , was seen, A second solid, firm, gray- white lll'I.BS m&P.suring l _cm. in diametet was separatel y submitted.

Follow-up: Postoperatively, this patient r eceived A-r~y ir~diation to the r egion. The patient was seen on October 29th, 1956 ~d appeared to be in good health with no complaints ,

CASE NO, 3

ACCESSIO!! NO . 8719

NAME: B. R.

AGE: 18 SF~ : Fe~le RACE: C~uc .

CO!ITRilllJrOR: •

TISSUE FRml:

Geort;e J . H=er, M. D., St , John 1s Hospitn,::., S~nt~ Monica, C~lifornia ,

Endometrium - myometrium.

CLINICAL ABSTRACT:

December, 1956 .

OUTSIDE NO, S-4882-55

History: This ~tient. W'\B seen on July 21st, 1955, at 12 weeks 'gest-<1-tion . Her l~st menstr~l period h'\d been April 28th, 1955. She h~d had marked ~usea and vomiting during the first trimester, Prior to her pre~ncy she weighed 140 pounds ~t_i t h a gain t o 155 pounds and su"~?s equent loss to 110 pounds .

In June she ~ad hAd an onset of ~inless, sc~nt but continuous bright red blee~i~. culmi~ti~ in ~ss~ge of mol~r t issue on A~ust 24th qt 17 wee~s gestation, 735 grqms of tissue w~s curretted ~d classified ~s group II , (Hertig -u1d S'neldon) hydatidiform mole . Her hemoglobin on "'dmission w~s 10 grams It fell to 7, 7 g~ms postoperqtively. Three weel~ post operatively, her serum goAA.dot ropin titre W'M positive in dilutions 1:4, Six weeks postopera. tively it WI\B positive in ~ 1: 36 dilution .

'lh~ ~~ient continued to spot daily. A r epeo. t D & C Wll.S done on October lOt~. It showed no mol~r tissue . On Vctober 24th, she hqd a profuse hemorr­~ge . ~miAA.tion of the tissue reveqled -blood clot onl y . Ber uterus w~s not enl~rged , She received 500 cc of blood ~nd the hemorrh~ge receded spontan-eously, · ·

On October 26th , her serum gonqdotropin titre W'lS 1:512 , On November 22nd, her serum gon~dotropin titre wqs 1:256 . On December 14th , her serum gon~dotro~in titre was 1:512.

On December 18th, the ~tient wqs re-admitted to the hospital with con­tinuous or~nge-brown vagi~l disch~rge . Her he~oglobin W~S 9 .7 grqms . 'lhe uterus ~s enll\rged to 8 to 10 weeks gest~tion , definitely lll.rger thqn in the prior two months , Her chest X-r~y w~s ne~tive .

Surgery: On December 19th, 1955, ~ D &C, hys terotomy, total abdominal hys t erectomy ~nd ll.ppendectomy were done ,

Gross ~thologr: The specimen w~s prese~ted in f our pOrtions , The first consis t ed of 35 gi'1\I!ls of pink-brown ..,.nd red hemorrhagic membr'lnous t issue, a portion of which contained tiny cystic, ~y-bl~ck struc~ures ,

The second consisted of ~ biopsy of myometrium measuring 2 .5 em. in greatest di'lmeter,

'lhe third J10rtion consis t ed of a uterus ...nd cervix amput.11ted supravagi­ll'llly, weighing 166 grams li!ld lii8<\Buriug 10 ,0 X 8 X 3 CO , The fUndUS Wa.B the site of ~ hemorr~gic, friable , gray-tan lesion which extended from isthmus to isthmus 'llld wq,s noted to be inv~di_ng the uterine w~ll extending f rom the uterine

--2-

C~se No. J, Accession No . 8719 -continu~d,

c~vity nearly to sero~. This hemorrh~gic ~ss measured 5 em. in .greatest diameter . The overlying .9.J:!d <J,djacent endoJJlE!trium l>"as smooth 'l.nd glistening.

• The fourth portion was an inc.identq_l awendix, _

Course: On December 25th, 19.55, ·she W<tS d.ischuged from the hospital trith <t negative titre,

CASE NO . 4

ACCESSION NO . 8542

NAI<IE : J. G • • AGE: 67 SEX: l·!de RACE: Cauc ,

COHTRIBUIDR: B, A. Ball, M,D,, 2JJ - A Str eet, 51\n Diego, California,

TISSUE FROM: Left 5th met!:\M.r:pe.l .

CLINICAL ABSTRACT:

December, 1956.

OTJ.PSIDE NO , GroSBJllOnt 28),

History : In April , 1955. this patient noted a "bwnp" on the back of the left 5th metacarpal . In June, 1955. h e was i n an automobile accident at which ~!me t his arm-and forearm were severely bruised, He stated that the bump had been increasing in size since tht\t ti.me . It ~<as a hard, tennis r11quet shaped enl'C!.rgement , ¥ X...ny sho•,tea. loss of the cortex of the distal part of tbe 5th metacarpal , The patient had had an i nc idental tumor removed from the right angle of the ja~r which h_<td been diagnosed a.s mixed tumor of the parotid,

Surgery: On October 11th, 1955, the left 5th finger and distal one­third of the 5th metacarpal were !!.fll~uta.ted,

Gross pathology: and th e marrow cavity was or destroyed,

The metacarpal was e~nded to a diameter of J em. replaced by tumor. The cortex did not appear thin

Follow-up: On ~~y 28th, 1956 . the ~tient was reported t\S having a healed hand and being free of symptoms ,

CASE NO, 5 December, 1956

ACCESSIOU NO. 8222 OUTSIDE NO . 55-13050

HA!<4E: F, R, •

AGE: 78 SEX: Hale RACE: Cauc ,

CONTRIBUi'OR: \~eldon K, Bullock, ~~.D ., LACH, . Los Angeles, Californi~ .

TISSUE FROM: Prostate.

CLINICAL ABSTRACT:

History: This patient was s een on September 22nd, 1955 at the Loe An~elee County Hospital, ~n~h compl~ints of progressive difficulty in voiding, dysuria, nocturi9. and occasiOn-'ll inoontinance and dribbling, On physical BXJ\miM.tion. his prostate w~s felt to be en~rged Grade II, smooth, firm and s ymD!trica.l .

Surgery: On October 13th, 1955. a perine~l prost atectomy was done with minim"l bleeding,

Gross pathology: The specimen consisted of a prostate gland weighing 50 grams . There w~s eDlargement of both lateral lobes which on section were occupied by multiple gr:;.yish-white nodules, averaging 1 em. in diameter , In the post erior lobe there was a. firm, irregulqr nodule ~thich 1-/!lS lighter in col­or t~ the rest ,

CASE NO. 6

ACCESSION NO, 8662

NAME: H .H.S • • AGE 1 69 SEX: Hale RACE: Caue.

CONTRillUTOR: D, A. DeSanto, M,D, , l~ercy Hospital, Sa,n Diego, Californill, ,

TISSUE FROM: t;fass in buttock.

CLINICAL ABSTRACT:

December , 1956

OUTSIDE NO , 2352-56

History: At about t he age of 40 :years, this }:atient had noted the formatiqn o~ multiple fatt:y lumps in the subcutaneous tissue of the trunk and extremities . No "coffee" spots were noted. Several months prior t o the pre­sent examination the patient had noted a l~rge, enlarging mass in the right flank, Pain in this re·gion was severe enough to prevent sleep,

Surgery:_ On May 16th, 1956 , a mass 'W'!.S removed from.the right buttock.

Gross ~thology: The specimen consisted of a firm appearing mass of f a tty tissue weighing .2JO grams and measuring 14 em. in diameter. The mass was covered by fibrofatty and f ibrous tissue.

Sections of the mass r evealed a yellowish- lobulated t1ssus separated by fine strands of connective tiSsue , In lll'lllY areas there appeared to be softening and a deep yellow change. A second piece showed m'!.r ked edema and fleshy qeh-lilre appea~e . '!here VI\& some hemorrhage within the tumor,

Later received w11s a large ID!l88 of similar tumor tissue measuring 27 om. in extent and weighing 450 grams. 'lhia tumor ~was separated into nodules and lobes by hemorrhagic and edematous t issue and areas of fibrosis ,

CASE NO , 7

ACCESSION NO . 8315

NAHE: D,'D , •

AGE: 4t yre. SEX: MP..le RACE : C'>.UC .

CONTRIBUTOR: vi , lt . Hall, M,D., Mercy l!ospi t a l : Baker sfield, C~liforni~ .

TISSUE FROM: Testic\ll,q,r t~r .

CLI!IICAL ABS TRACT:

December , 1956.

OUTSIDE NO . M-330?-55

History: One week pri~r to hospit'l.l iz'l.tion, the mo t her of this child noticed t~t the left side of t~e scrotUD W'I.B swollen , There W'I.S no history of i n jury or subjective complai nt of ~in.

Surgery: On November 30th, 1955. '1. complete orchiectomy I~'I.S done with removal of the cord as high ~s Eossible .

Gross p...thology: The ~sa me~sured 4. 5 x ·2.6 em. I t was firm, al mos t C'>.rti~ginous in consist ency. At the ~pper end a lobul ... ted m~se, pr esumed to 'oe the t esticl e, projected. This <ne'l.sured l x 0.6 x 5 em., W'\S pink i n color .._nd soft in texture . ~e l 'l.rge mass W'I.B homogeneous in structure, firm, white <~.nd e~stic in texture, with some evldence of lobul'l.tion. ·When 2 to 3 mm. blocks were ciut, the 111<\ter h .l llt-'.int,..ined its firmness but li'I.S no longer cartila­ginous in ch.._r ... cter . ~e surf'l.ce w.._s soft 'l.nd slippery. The v<~.s def er ens could be identified in some of the 'l.dvent i t i'Ll tissue but its point of 'l.ttach­ment could no t be ~de out, It seeoed to r un into the posterior surface of the l.._rge m...se, presumed to h'I.Ve '!.r i sen in the epididymi~ .

Foilow-up: As of July 20th, 1956. the child .._ppe ... red well by X-r.,y .,nd direct ex.,mi~~tion.

CASE NO , 8

ACCESSION NO, 8505

NAf.!E : R. S • •

AGE: 39 SEX: Fem~le RACE: C~uo .

CONTRIBUTOR : R. H. Osborne, l•t, D, , 1052 rlest 6th 5treet, Los Angeles , C~lifornia .

'li!SSUE FROM: Cervix.

CLINICAL ABSTRACT:

Dec ember. 1956

OU'l'SIDE NO. 56-262

History: This ~tient w~s ·~dmitted to the hospit~l on ~rob 4th , 1956. for~ tot~l hysterectomy. She h~d complPined .of" sense of fullness in the lower 'lbdomen for six to eight months . She dso bad had ble!!ding 'lnd BJ10t-t i ng between per iods ~nd <\ profuse incre'lsing leukorr hea . Her ~st menstrual period h9,d been Febru'l.rY 18th, 1956. She lf<\S "' Grt;lvi&.!. II, Pl\r'l II, no ll.bOr­tions,

Pbye'ic<tl 1 eX~~.mill'l.tion W<\S negp.tive except for some right lower Q.Wl.drq,nt tenderness <\nd "'hq,rd .nodule ~lP<tted in the posterior uterine W<\11 .

done . Surgery: On March 5th a tote.l .hysterectomy _~;~nd ~;~n appendec t omy 1~ere

Gross ·~thology: The uter us 'lnd cervix mO').sured 11 x 6.5 x 4 .5 em. The fundus W'lll smooth, slightly congested q.nd mildly thickened, The vqgind portion of the cervix was 3, 8 x j em, with <\ ~rg-9 triqng.U<\r exterMl os 1.4 em, wide , On the cervix were rAdi'lting lines consistent with deep l'l.cer qtiona, one reaching the vqgi0'3.1 fornix on the right. 6n the up·.l8r cervix W'lS a ragged OV'll ~88 5.5 X s"x ).S em. , bulging into <tnd ~rtiaily ~bstrUoting the inter­D<\1 os . Its surfttce W'l.S torn, presenting bulging gra.nul~r fragments of yellow­ish tissue . The mrgins of t he mss •tere otherwise sharply defined e.nd firm to p~;~l~t1on .

The uterine muscle 'tas 2,4 em. wide, the endometri.um 0,4 em . , the le. tter quite p.q,le.

Deep in the fundus were two nodules, ~ 0.7 em, fibromyom ~nd a 1. 5 x 2 em . e.dano~ with brownish spots,

The 'lppendix wa s not re~rkable .

Fbllow- up: The p').tient w~s seen on October 25th, 1956 And ~ppe~ed to be in good beql th .

CASE NO. 9

ACCESSION NO. 8564

NAl·tE : J, M.

AGE: 3 yrs SEX: FetJRle RACE: C,q,uc .

CONTRIBUTOR: 1ifeldon K, Bullock, ~1 .D., LACH, Los Angeles, C~li f •

• TISSUE FROM: !>!ass, left fore~J.rm.

CLINICAL ABSTF.AC T:

December, 1956.

OUTSIDE NO, 6757

History: 'l:his child ~I ... S ~Tell until six months of a ge 11hen she fell and fractured her right clavicle. Shortly al'ter this a small lump was noted on the dors:um of her left forearm . m ere was a very s lot·/, gradU9.l increase in the size of the lumP tiithout ~in or limita t i on of motion . .1{-r'J.ys 11ere taken of the left for~arm at the age of 18 w~nths. They reveale4 a healed fracture and some bo•Aing of the left ulllr:l . In July, 19~4, when the child was 21 months old, an osteotomy was performed on the left ul~~. A long arm c~st was !!,PPlied for six 1·1eeks. Follotiing removal of the cast, a smll lump ~las noted at the site of the surgery , although the liOund ~1as well healed, X-rays revealed that the ~iire retaining the tliO sides of the cortex on either side of the osteotomy had :Pulled fr.ee, It was also suggested that the left radius was subluxated proximally,

The child receiv·ed no further tre~tment until Harch, 1956, at the age .of ) years, when she--s brough~ in beca.use of increase in size of the lump in the left forearm and sli~t ~in i n t he left v~rist a nd hand,

Ph~sic~l examination at t.'lis time ltll.s norlll9.1 except for the dorsum of the left forell.rm, >~here there t</Jts "' hrge elev'l.ted mss measuring ) inches in dlll.meter and one inch in height" On pq.lp<ttion, the mass Wll.B firm 'l.nd attached. to the uln.ll. in its proxinnl one-h'l.lf, There wq,s "' ) in.ch surgic.<tl sc'l.r over tne lll.<tss ~d slight prominence of the veins ov.er 'l.nd a round the mss. The rq,dial he'l.d W'l.S felt to be disloc'l.ted posteri orly, X~r~ys revealed irregula ri-ty in shA.pe of 'l.ll of the bones of the left forearm v1ith dislocation of the r'l.dius, - The bones ~rere mottled 'tnd there w.q,s irregula rity of the bony strllC­ture .of ~;J.n area 2 inches in le~th at the level of the upper and middle th:\.1·:18 of the UJ.nq, . A l~ii'e .. loop ·lill.s present . The cortex of the ulna in this region was irregulll.rly elevated ~;J.nd gave the 'tppe'l.r'l.nce of subperiosteal new bona for-mation, In the A-P view there >I'I.S a suggestion of l<tmination of the peri­osteum overlying the later'l.l cortex of the uln'l.,

Extending posteriorly from the bony ll.bnorJ!!<tlity there w~.s a large loca.'lized roun·ded shadow of soft tissue density and thin layer of calcified periosteum on a: portion of the upper Hmi t of the tumor-like roo. as. T'nis .. periosteum was still attached to the bone.

Surgery: On ~ay 4th, 1956, the soft tissue tumor W<ts excised en toto.

Gross Pathology: The specimen consisted of a single piece of tissue Which measured 7 X 7 X 5 em, The tissue Wll.S 'very firm, solid and cut clean with a faintly gritty sensa tion. There was no retraction, It ~r'lS composed of dense, hr>.rd, grayish-white tissue. which w;~,s uniform throughout. It lias nonenca.psulated,

CASE NO . 10

ACC!ilSS ION UO . 8398

NAME : G, B,

AGE: 46 SEX: Female RACE: Cauc ,

CCliTRIBU'IOR: J . L. Zundell, t4 ,D., St. Francis t~emorial Hospital, S~n Fr~ncisco, ~lifornia,

TISSUE FROM: !'ass in tric!!PB ,

CLINICAL ABSTRACT:

December. 1956.

OUTS IDE NO , 56-467

History: On J'l.nuary 7th, - 1956 , thia patient developed pain and lympbatic swelling of t he ri&Lt arm,

Surger y : On Jl!..'luary 27th, 1956, at surgery , an infiltrating tumor ~as was found to be invading the ~idd1e head of the triceps,

Gross P!,thology: 'Ihe tumor W/'\S irregull\r ,measm·ing 5,0 em. in length 'l.nd 3.5 em. in thiclmeaa . It \iA-S llOnenc~J.peula ted and. the eurface ~las hyalin gray-tan . It cut >~i til the consistency of ca rtilage ,

loi!NUTES OF \

IDS ANGELES SElHOR STUDY GROUP

~!ON.THLY MEETING

December 19, 1956 •

The regular meeting of the Loa Angeles Senior Study Group of the Tumor Tissue Registry was called· t o order by H1.l,gli Edmondson, !.!, D. , chairn:an, a t 7:·10 P, M,

'

!{embers present included: Drs . Budd, Bull ock, Edmondson., Fisher, Fried­~an. Kahler, Kaplan , Keasbey, Kimball , Pratt, Smal l ,

Members absent and excused: Drs , Brown, Butt, Fooro .• Hall, Hummer, Konwaler, Lichtenstein, I•fadden and Tragerman .

ClJRRlll~T CASE STUDIES:

CASE NO, 1, ACCESSIOl.f 1{0, 8~5. D, A. DeSanto, H. D, , Contributor.

Dr. Kimball opened the discussion on this case s tating that he was of the opinion that this '·ras a mixed follicular and pa:~;illary carcinoma.

Dr , Kaplan: 11~/hen you use the term papillary, the clinician hides be-hind a cloak of security. This is more aggressive than a papill!\l'Y carcinoma,

'lhe vote WM unanimous for follicular carcinoma v1i th pil.pillary charac­ter istics ,

lo!enibers and guests of the Central Valley Study Group voted unanimously for carcinoma of thyroid,

FIL.~ DIAGNOSIS: Follicular carcinoma of thyroid with papillary characteristics ,

CASE NO. ·2, ACCESSIObl NO, 8549, Robert A. Blossom, M.D., Contributor,

Dr, Fisher observed that this tumor appeared to be a variant of· a duct carcinoma, not a run of the mill ty;pe, it has a cylindromatous appearance . ~e further stated ihat there is a good deal of ·mucin excreted into the stroma. Despite the fact that it looks some1~hat different than the usual carcinoma, his diagnosi s was carcinoma of the breast ,

Dr, Pratt thought there was a resemblance to a salivary gland tumor.

Dr. Kahler stated that he had eeen a similar leaion in a fifty year old doctor which was definitely an intra.cystic le.sion, on a stalk and resembled the one in discussion. He had interPreted the intracystic Lesion as benign, however , after seeing the extra slides on ttds case he was of the opinion that

continued-

- 2-

case No. 2, Accession No. 8549 continued,

this was a carcinoma.

The vote was unanimous for duct carcinoma, breast, with a salivary gland ;pattern.

Meobere and guests of the Cent ral Valley Study Gr0up voted unanimously for carcinoma of breast , mixed hidradenoid type .

FILE niAGNOS IS : Duct carcinoma of breast .

CASE NO. 3. ACOESSIO}I NO . 8719. George J . Htwller, M.D. , Contributor.

Dr. Kahler: 0I think this has to be diagnosed by ita behavior rather than what it looks like . It is invading the uterine wall and bas been there siX months . The ;patient has had a high titre of gonadotropins. I think this ie a choric- adenoma deetruens . If it were a choriocarcinoma, it would have metastases . I believe you have to prove the choriocarcinoma by an autopsy. One cannot diagnose this lesion by curettage."

Dr . Pratt: "Six months is not going to tell the story. lYe had a case that was diagnosed ae a mole . Years later ( eight months after hysterectomy), she bad choriocarcinom metastnaea in the lung. "

Dr, Kimball: "I don't see why when something is black you don 1t call it black. 'lhis looks like carcino!!'.a. to me . "

The vote: Ohorio-adenoma destruens 8, choriocarcinoma J.

Members and guests of the Central Valley Study Group voted unanimously for ohorio-adenoma destruens .

FILE DIAGNOSIS : Chorio-adenoma destruens .

CASE NO. 4 , ACCESSION NO. 8,542 , Ho11ard A. Ball, M.D., Contributor.

Dr , Edmondson was discussant ru:id stated: "This is a lesion of bone with proliferatioce of connective tissue, formation of giant cell and in some areas, large vascular spaces . Other areas are osteoid. 'lhe differential diagnosis lies between B.!leurysmal bone cyst and giant cell tumor. I did not think very strongly of hyperparathyroidism. 'Ihere have been several reported in the literature, but Dr. Lichtenstein did not have any in his book. "

Dr . Small: "'!here is a peculiar degenerative change in the adipose tieeue and muscle . "

, oontinusd.-

-3-

Case No , 4-Accession No, 8542 continued•

Dr, Edmondson: "There was a history of trauma l>'hich might account for thee e changes • "

Dr, Bullock called attention to tr~ fact that the blood vessels were thick-walled and not like those seen in a bone cyst but more like a giant cell reparative granuloma or as called by Dr, J. Vernon Luck- giant cell osteo granuloma.. It is not at all certain •#hether· these are neoplasms or not, but they certainly do not behave following proper treatment, as do many of the giant cell t umors . ,

The vote was as follows : mal bone cyst 4.

Giant cell reparative granuloma 7, aneurys-

The votes .submitted by the Central Valley Study Group were as follows: Members; giant cell tumor 3 ( 1 malignant, 2 benign), fibroma of bone 2, Guests; giant cell tumor 2, ·fibroma 1, no vote 1.

FILE DIAGNOSIS : Cross-file :

Giant cell reparative granuloma. Aneurysmal bone cyst .

CASE NO . 5. ACCESSimT NO. 8222, l~eldon K. Bullock, M, D. , Contributor.

Dr, Budd, the assigned discussant of this case, stated: "This is a · pro­cess that has intrigued me for a lo:1g time , It is commonly seen in hyperplasia of prostate and is not unlike the prostate of a male infant . I think it needs further study, but I tentatively clEissify this as atypical h;r.perplasia of the J?rostate."

The vote : Fetal adenomyoma., prostate 8, hyperplasia J ,

The Central Valley Study Grou,p sub:nitted the following votes: 14embers: Fibroadenoma, benign If, lo¥r-grade malignancy of cylindromatous type 1. Guests : Fibroadenoma, benign 3. lo~r-grade malignancy of cylindroma.tous type 1.

FILE DIAGNOSIS : Fetal adenomyoma., prostate . Cross-file : Hyperplasia ,

CASE NO. 6, ACCESSION ?10 , 8662, D. A. DeSanto, l•!,D., Contri'outor,

Dr . Kaplan in discussins this cas~ stated that r.licroscopically this lesion has a spongy l a ce.:.like arrangement 1~1 th cha racteristic giant cells in e. reticular stroma. , In other areas there are deposit.a of mature hyalinized tissue, A P, T, A.H , stain did not reveal striae or fibr i llae . He was of the opinion that this pattern resembles a liposarcoma .•

continued-

-.

Case No . 6 - Accession No . 8662 continued.

Dr . lrahler: "This, from the history, is a degeneration of a von Reck­linghausen1s disease . The other tumors were probably neurofibroma.

The vote: Fibroliposarcom 8, malienant von Recklingbausen •s disease, 3 votes .

!~embers of the Central Valley Study Grou;p voted: Liposarcoma. 3. fibrosarcoma 1, and neurofibroearcoma 1. Guests: Liposarcoma 3 and fibro­sarcoma 1.

FILE DIAGNOSIS: Fibroliposarcoma. Cross-file: ~lalignant von Reckl inghausen 's disease.

CASE ~TO . ?. ACCESSION NO . 8315, 11. W. Hall, ~!. D., Contributor .

Dr. Kimball, the assigned discussant of this case, stated: "This tumor is cartilaginous in appearance and is a mixture of spindle, rounded end polygonal cells. In .some areas there are definite formations of myoglobin. I cannot find stripes . A Masson trichrome stain au~ports the diagnosis of a myomatous tumor with cross striations . I eo along with Dr . Budd that whether they are forming striations or not, they are myomatous . "

Dr. Small : "''lhere do these come from? I assume they come from tara-toma. 11

Dr. Fried.~: "I agree that it is a myosarcoma. . It 1s derivation from a teratoma. would be second. Most liksly, it comes from adnexa. breaking into testis . From the description, it suggests that it was adnexal in origin.

:pro. Fisher : '";/hat tissue in the adnexa do these come from?"

Dr. Friedman: "I don 1t !mow. Certainly there is enough mesenchyme for this to oo~e from. Sternberg believes those in the uterus arise from fetal rests . "

The vote \tas unani mous for embryonal rhabdomyosarcoma.

Members of the Centr3l Valley Study Group voted as follows: Teratoid tumor with conspicuous mesenclJY"te 2, rhabdomyosarcoma 1, malignant mesenchymal tumor, not ot~erwise specified, not of teratoid or embryonal origin 2. Guests voted: Teratoid tUJ:lOr with conspicuous mesenchyme 1, M!!.lignant mesenchymal tumor, not otherwise specified, not of teratoid o r embryonal origin 2, no vote 1 .

FILE DIAGNOSIS: Embryonal rhabdomyosarcoma.

•

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CASE NO, 8, ACCESSION NO . 8505, R. H, Osborne, M,D., Contributor,

In the absence of Dr, Brown, the assigned discussant of this case, Dr , Kimball started the diacru;sion. He stated: "The tumor in ':!¥ section is not connected with the mucosa, however, in a slide hand-ed to me it is . 11

Dr , Small: "'!his is both a sp.indle cell and giant cell squamous car­ci-noma, "

Dr . Kahler: "I think there is a sarco~~tous element here . This should be called a carcinosarcoma."

!!he vote: Carcinoma 10, carcinosarcoma 1.

'!he members of the Central Valley Study Group voted as follo11s : carci­nosarcoma J, carcinoma. , spindle cell type 1, deferred 1 , Gussta: Carcino­sarcoma 2, spindle cell type 2,

FILE DIAGNOSIS : Carcinoma .

CASE NO, 9. ACCESSION NO, 8564, l'leldon K, Bullock, M. D., Contributor,

In the absence of Dr. Konwaler, the assigned discussant, t~e following diagnosis and reference submitted by him 11as r ead to the group: Periosteal fibrosarcoma . Reference : Dr. Stout 's article in Cancer, Vol . l, page JO, 1948.

Dr . :Bullock lla.d previously seen a needle biopsy of t his and had called it a keloid, but the definition of keloid is confined t o the akin ,

Dr. Sonll : "'lhis certainly ia hypertropil1ed connective tissus like one sees in a keloid, I believe this is reaction to in j ury and not a tumor . Why can't we use the term keloidal fibromatosis?"

The vote was unanimous for keloidal fibromatosis ,

The votes submitted by the Central Val ley Study Group were as f ollo11s : Members - Fibromatosis 4, fibrosa rcoma 1, Gussts- Fibromatosis ), fibro­sarcoma 1.

FIIiE 'HAGNOSIS ~ Fibromatosis, keloidal type .

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CASE NO . 10, ACCESSION NO, 8398, J , L. Zundell, M.D. , Contributor.

Dr. Foord, the assigned discussant of this case, telephoned that he would be unable to attend the meeting, a.nd stated that he felt that thia was a good example of a reparative process following inSur.r to muscle ,

Dr , Small : "Does fasciitis apply to this?"

Dr, Keasbey: 111his is not what Dr, Stewart designated as fasciitis."

Dr. Edmondson: " I 11as i mpressed ~lith the creeping of the connective t issue between the muscle bundl es , 11

Dr. Kea.soey: "Doesn •t this resemble the repair of a ruptured muacle7 "

There were 10 votes for fibrosing myositis, l vote for reparative cyo­fibrosia ,

The votes of the Central Valley Group \tare as follows: Members: Fas­ciit ia 3. ~ositis ossifice.ns l, fibrosarcoma l , Guests : Fasciitia 3. ~osa.roome. l ,

FILE 0 IAGNOS IS : Fibrosing myositis ,

OLD BUSDIESS:

ACCESSION UO . 84.23, Ellen V, P , Feder, M. D. , Contributor , '!his cass was pressnted as Case No, 7 in the November, 19.56 monthly Conference. A further s t udy of special stains requested on this mater ial confirmed the diagnosis of a myosarcoma, most likely a rhabdo~osarcoma,

FILE DIAGNOS IS: Rhabdomyosarcoma ,

The meeting adjourned at 9:4.5 P. M.

Weldon K, Bull ock, M. D. , Secretary pro t em,