* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * CALIFORNI A TUMOR TISSUE REGISTRY

HUNTINGTON MEMORIAL HOSPITAL

PROTOCOL

FOR

MONTHLY STUDY SLIDES

SEPTEMBER 1991

GENITO-URINARY TUMORS

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CONTRIBUTOR: Susan Murakami, M. D. SEPTE1·1BER 1991 - CASE NO. 1 Pasadena, Cal i fornia

TISSUE FROM: Right testis ACCESSION NO. 26718

CLINICAL ABSTRACT:

History: This 66-year-old man was admitted to the hospital for orchiectomy.

Past history: He was seen in 1985 with a firm enlarged prostate ~thich was biopsied. Acid phosphatase was noted to be 19.4 (normal range 1. 2 - 8. 2}. He was in retenti on and on catheter removal fo ll owing an injection of Estradurin he started voiding again. Bone scan and MR revealed some involvement of the right seminal vesicle without significant findings ()n the bone scan other than degenerative uptake of the right shou lder. In May 1986, he received 7,000 rads to the prostate and 4,500 rads to pelvis.

On fo llow-up f rom time to time he continued to have elevated acid phos phatase but went back to norma 1 in 1987. Repeat bone scan (Apri 1 1987 ) was consistent with moderat e metastatic involvement of fi rst right anterior rib, T2 thru T4 and T8 thru Tll, with t horacic xrays confirmi ng the osteoblast ic metastases with the great est areas involving the fi rs t right anterior rib, T4 and Ti l.

In November 1989, he devel oped marked elevati on of PSA of 50 with acid phosphatase of 9. DES di scontinued because studies verified the fact that he may have become refractory to the stilbestrol .

SURGERY: (February 23, 1990)

Bilateral orchiectomy was done under local.

GROSS PATHOLOGY:

The specimen labeled right testis weighed 30 grams and measured 6 x 3;5 x 2.5 em. The tunica was smooth and glistening . When bisected, it revealed a testis, 4.9 em. in greatest dimens ion with an irregular f i rm area, 3.5 x 1.5 x I em.

CONTRIBUTOR: Peter L. 11orris, M. D. SEPTHIBER 1991 - CASE NO. 2 Santa Barbara, California

TISSUE FROt1: Testi s ACCESSION NO. 25286

CLINICAL ABSTRACT :

Hi story: This 33-year-old mal e was admi tted for a left testicular mass of one month's duration. This was accompanied by pain and mild hematuria. He was given ant ibiotics without improvement. For three days, mucopurulent material had drained f rom the overl yi ng .scrotal skin,

Physical exami nation: There was a 5 x 10 em. l eft scrotal mas s, warm and tender to palpation, dra ining a moderate amount of f rank pus . The right testi cle was normal. Prostate 1-tas normal size and consistency without nodularity or tenderness.

Laboratory data : The white cell count was lB,OOO cu mm . ~lith 12% bands, 57% polys and 23% lymphs . Uri na lysis ~1as normal and urine cultures were negative. Tuberculi n s.ki n test was negative.

Radiograph: Ultrasound performed sever.a l weeks before admission showed evidence of genera·l i zed inflammatory reaction.

SURGERY: (May 30, 1984)

A l eft orchiectomy and debridement of scrotum were performed.

GROSS PATHOLOGY:

The firm, enlarged testicle with surrounding soft tissue measured 6 x 4 x 4 em. The outer ·Surface of the soft tissue was covered by tags of hemorrhagic, f i broadipose tissue. At one margin there was a hol e in the tunica which was 2 em. i n di ameter and fi lled with soft yellow-tan t i ssue. Sectioning showe.d a central stellate abscess cavity measuri ng 2 x 1.5 em. fil led with hemorrhagic soft yel l ow tissue. This cavity and necrotic-appearing t issue communi cated with the necrotic t issue seen on the external surface of the testis which represented necrotic testicular parenchyma.

CONTRIBUTOR : Mi l t on Bassis, M. D. SEPTEI~BER 1991 - CASE NO. 3 Joelle Lambert, M. D. San Francisco, California

TISSUE FROM: Testis ACCESSION NO . 26287

CLINICAL ABSTRACT:

History: This 30-year-old gay male was seen in February 1987 with complaint of right inguinal pain .

Past History : At age undescended right testis. which resolved.

2 years, he underwent an orchiopexy for an In 1985 , he was treated for an epididymitis

Physical examination: A sl ightly tender 2.0 x 5.0 em. hard mass medi al to the right inguinal l igament in the right l01~er quadrant was palpated . The testis reveal ed no palpable nodule.

A fine needle aspirate was obtained.

Radiograph : ACT scan revealed a retroperitoneal adenopathy in the periaortic and pericaval regions as well as in the right inguinal area.

SURGERY: (March 4, 1987)

A right inguinal lymph node excision and a right inguinal orchi ectomy were performed.

Postoperative: He was treated with cis platinum, bleomycin, and vel ban .

GROSS PATHOLOGY:

The specimen consisted of a 27 gm. (4.2 x 2.8 x 1.5 em.) orchiectomy, including an unremarkable spermatic cord. The outer surface of the testicle and epididymis was smooth. The testicle had an indistinct, firm mass at the superior pole that measured 1.1 x 1.5 x 0.6 em. This contained a central white-yellow soft region . A more discrete, firm fleshy mass extended from the midportion to the lower pole that measured 1. 5 x 1.1 x 2.1 em . These two masses occupied approximately l/3 of the testicular parenchyma . Another firm, centrally located, white fibrous lesion was present that measured 1.0 x 0.6 em. A thin-walled 0.6 em. clear fl uid-filled cyst was present on the inferior pole.

A 4.5 x 3.5 x 2.7 em. lymph node when sectioned revealed a variegated white-tan tumor with focal areas of hemorrhage and flecks of yellow through­out the parenchyma.

CONTR IBUTOR: Jozef Kol lin, M. D. SEPTEMBER 1991 - CASE NO. 4 Long Beach, Cal ifornia

TISSUE FROM: Testicl e ACCESSION NO. 26701

CLINI CAL ABSTRACT:

History; This 52-year-old Caucasian male was seen in the office of his referring physi ci an because of urinary f requency, urgency , rectal pa in and dif ficu lty with urination. On rectal exami nation a slightly enlarged prostate was palpated. Examination of the genitalia revealed a very large, fi rm, non-tender mass in t he left testicl e, 1~hi ch he noted the past year but because it was not pa inful he did not think it was of any significance .

Physi cal examination other ·than above ~1a s essential ly wi thin no rmal limits in the well -developed and well-nourished patient who was in no distress .

Ultrasound which followed immediately upon finding the enlarged testicle showed a large scrotal mass suggesting a carcinoma.

SURGERY: (July 20, 1989)

An orchiectomy with at tached cord was performed after a testicular biopsy was done.

GROSS PATHOLOGY ;

The left testicle measured 10 x 7 x 6.5 em. and wei ghed 290 gm. The a.ttached cord measured 8 em. i n l ength x 2.8 em. in greatest diameter. The testis when sectioned revealed a somewhat compartmentalized tan-orange tumor with fibrous bands dividing the compartments. Some of the nodules were hemorrhagi c. There was no evidence of capsular violation.

CONTRIBUTOR: Guillermo Acero, M. D. SEPTEMBER 1991 - CASE NO. 5 Santa Paula, California

TISSUE FROM: Prostate ACCESSION NO . 25309

Cl iNICAL ABSTRACT:

History: This 84-year-ol d male had increas ing sympt oms of prostatism. Work up pri or to admi ssion consist ed of cystoscopy exami nati on whi ch revealed prostatic obstruction, a residual urine of 150 cc. and 3+ trabeculation of the bladder. A prostate biopsy showed glandular hyperplasia. IVP demonstrated calcification in the area of the prostate of considerable aDOunt.

Physical examination revealed a hard prostate of both lateral lobes . Good sphincter t one.

SURGERY : (August 23, 1984)

A transuret hral resection of the prostate was performed.

GROSS PATHOLOGY:

The specimen consisted of multiple portions of granular pink- tan and gray- tan firm prostatic tissue, varying in size from 0. 2 to 2.8 em. and with an aggregated weight of approxima t ely 20 gm.

CONTRIBUTOR: Joseph Carberry, M. 0. Los Angeles, California

SEPTEMBER 1991 - CASE NO. 6

TISSUE FROM: Prostate ACCESSION NO. 26197

CLINICAL ABSTRACT:

History: This 75-year-old Filipino male was re-admitted on June 10, 1986 for chills and fever. His previous admission a month ago was for bouts of transient left-sided weakness that was thought to be due to cerebral ischemic attacks, but later it was more likely due to paroxysmal atria.l fibrillation. A kidney study revealed a non-functioning right kidney and a left kidney with hydronephrosis for which a percutaneous nephrostomy was performed.

Past history: Approximately eight years ago a diagnos is of carcinoma of the prostate was made from the tissue removed by TURP. A bilateral orchiectomy and Stilbestrol therapy followed.

Physical examination: The patient's temperature on admission was 101°F. He had intermi ttent vomiting, his eyesight and hearing were fair, no chest pain but slightly tachypneic, no peripheral edema, and good femoral and popliteal pulses. No neurological deficits were noted .

Endoscopy : The external urethral meatus had to be dilated with sounds and some narrowing in the bulbous urethra without any definite stricture was noted. The prostatic urethra was partially obstructed by prostatic t i ssue. The bladder mucosa was unremarkable with the indwelli ng nephrostomy tube coming out of the left ureteral orifice. The right ureteral orifice could not be identified.

SURGERY: (June 16, 1986)

A 24 resectoscope sheath was introduced and TURP carried out at the bladder neck circumferenc ially and then lowered down starting at the floor, around both sides, lateral side and roof. Final stage of disection was at the apex taking care to reserve the verumontanum.

GROSS PATHOLOGY:

The specimen consisted of 19 gm. of multiple prostatic chips of pink tissue. Most of the fragments showed fe~t tan areas, must of which were pink-gray.

CONTRIBUTOR: John Gmel ich, r~. 0. SEPTEMBER 1991 - CASE NO . 7 Pasadena, California

TISSUE FROM: Testis ACCESSION NO. 26826

CLINICAL ABSTRACT:

History: This 30-year-old male was seen on July 19, 1990 with history of noting a swelling of the left testicle, one week's duration . He has an identical twin brother living in San Diego .

Physical exami nati on revealed a hard firm left testis ~li th minimal tenderness .

Laboratory report: Alpha fetop~otein 22 .7ng/ml (normal less than 18.0).

Ultrasound reported as solid testis tumor. There was no evidence of obvious metastatic disease on CAT scan.

SURGERY: (July 21, 1990)

A left radical inguinal orchiectomy was performed.

GROSS PATHOLOGY:

The specimen was a 100 gram t estis with attached spermatic cord . The testi s alone weighed 54 grams. The testis measured 7 x 3.7 x 5 em. in diameter which was replaced subtotally by a raised, nodular white gray cystic mass, focally tan-yellow, measuring 4.7 x 4.2 x 1.4 em. On sectioning, the white gray tumor which was focally cystic with zones of cystic transformation measured up to 4 mm. in diameter. White-gray firm zones, possibly representing cartilaginous-like tissue, was present.

CONTRIBUTOR: Kenneth Frankel, M. D. SEPTENBER 1991 - CASE NO. 8 Covina, Cal ifornia

TISSUE FROM: Bladder ACCESSION NO. 25836

CL INICAL ABSTRACT:

Historr This 58-year-ol d male 1~a s seen on October 21 , I986 with a two weeks hi story of increasing ur i nary frequency , urgency , dysuri a, suprapubic pressure, and passage of a small amount of blood in the urine on two occasions.

He 1~as seen a year ago with sympt oms of some mild frequency, nocturia and slowness of the urinary stream. Urine was essentially clear and felt it was secondary to mild prostatic hypertrophy. Because of persistent dif ficul ty voi di ng , cyst oscopy was carri ed out i n t he office. Upon ent eri ng the bl adder, one coul d see what appeared to be a bladder t umor i n the trigone but could not distend t he bladder because of marked discomfort to the patient and the procedure was discontinued.

Physi ca l examination: Testes were normal . There were some cystic changes i n the head of t he right epididymis easily transilluminable. Prostate was 1+ enlarged, soft, regular and non-tender .

SURGERY: (October 24, 1986)

Cystoscopy revealed a large pseudopapi l lary tumor arising from the left lateral bladder wal l ext ending int o t he left hemitrigone, cover ing pretty much the entire l ef t side of the bladder. There were areas of recent bleeding in the tumor site. A transurethral resection of the bladder was performed and as t he resection progressed one coul d clearly see t hat the tumor was ext endi ng into the muscl e wal l of the bladder . The bulk of the tumor was resected. However, there was obvious evidence of residual tumor still remaining.

GROSS PATHOLOGY :

The specimen consisted of 4.5 em. aggregate of pale gray to light tan pi eces of soft ti ssue.

CONTRIBUTOR: Mashaharu Ji nguj i, M. D. SEPTE~IBER 1991 - CASE NO. 9 Sacr.amento, California

TISSUE FROM: Paratesticular ACCESSION NO. 15703

CLINICAL ABSTRACT:

History: This 16-year-old ma le was admitted to the hospital circa June 1, 1967. He had noticed a mass in the l eft scrotal compartment for approximately two months. This mass was painiess and progressively became 10 to 15 times the normal size of the testicle.

Laboratory da ta : Urinary gonadotrophin studies were negative.

Radiograph: Intravenous pyelography and chest xray prior to surgery were norma 1 .

SURGERY: {June 5, 1967}

An orchiectomy was performed and revealed a large scrotal mass involving the testis and spermatic cord.

Post operative: Four days following surgery, radiation therapy was started and continued as an outpatient.

GROSS PATHOLOGY:

The testis with attached. spermatic cord weighed 120 gm. and measured 8 x 7 x 4 em. An extratesticular mass was present in an edematous foca l hemorrhagic tissue which measured 2 em. in diameter. The testis was separate from this mass and the tunica vaginalis was not significantly adherent to the separate mass. The testis measured 3.5 em. in length an.d exhibited on the cut surface 1 ight yellow-tan testicular parenchyma which stringed with ease, The epididymis was well delineated. The spermatic cord measured 8 em. in length and was closely associated with the large extratesticular mass.

CONTRIBUTOR: E. DuBose Dent, M. D. SEPTEMBER 1991 - CASE NO. 10 Glendale, California

TISSUE FROM : Prostate ACCESSION NO . 24209

CLINICAL ABSTRACT:

History: Thi s 94-year-ol d male was in a board and room care facil ity for quite some t ime following a transurethral resection 4 years ago for a carcinoma of the prostate. He got along quite well until 2 days ago when he became confused, wea k, incontinent of feces and urine for which he was transferred to the hospital on April 23, 1981 .

Physical examination: The patient was well nourished, extremely confused , l ethargic and in distress . Blood pressure 150/80. Pulse 88 . Chest configuration was emphysematous and a pansystol ic murmur was present over left sternal border, second intercostal space . The abdomen was somewhat distended; liver and spleen were nonpalpable. The kidneys were difficul t to palpate . There was marked tenderness between t he umbilicus and symphysis. Rectal: Prostate was f lat except for an irregular slightly nodular area.

SURGERY : (April 30, 1981)

Cystoscopy revealed a tremendous amount of fossa and trigonal tumor with some irregulari ties al ong the posterior urethra. A small core of tumor had to be removed before the partia l resection could be performed. It was obvious that there was a large amount of tumor along the fl oor and wal ls of the bladder.

GROSS PATHOLOGY:

Sixty grams of multiple soft-pink- tan small prostatic chips was all the t issue removed .

CONTRIBUTOR: Ted Nicholas, M. 0. SEPTEHBER 1991 - CASE NO. 11 Palm Springs, California

TISSUE FROM: Testis ACCESSION NO. 24054

CLINICAL ABSTRACT:

History: This 52-year-old white male was seen on September 2, 1980 1~ith a painful swelling in his right hemiscrotum, six months' duration.

Past history: His left testis had not developed and he had a hydrocele removed as well as a hernia repair on the right inguinal area and testis 12 years ago.

On examination a week ago, he had a hydrocele formation about the scrotal mass aspirated which yielaed 30 cc. of straw-colored fluid. A nodular testicular mass was palpated.

Physical examination: The left hemiscrotum had a rudimentary testis. The right hemiscrotum was occupied by a nodular mass surrounding the right testis, part of which transilluminated light and part of which did not. The mass was heavy. Prostate was 1+ enlarged, nontender, non-nodular nad nonindurated. Abdominorectal compression demonstrated slight post-void bladder residual.

Laboratory report: Alpha-fetoproteins and choriogonadotropins were negative.

SURGERY: (October 21, 1980)

Inguinal exploration and right radical orchiectomy were performed.

GROSS PATHOLOGY:

The specimen consisted of a previous incised testicle which upon on reconstruction measured approximately 7.0 x 4.5 x 3.0 em. The cut surface revealed large portions of seminiferous tubule's completely irradicated by an irregularly bulging tan mass with areas of central reddish, slightly depressed apparent necrosis. The mass involved 80% and more of the substance of the org.an.

CONTRIBUTOR: Douglas Kahn, 11. D. SEPTE1·1BER 1991 - CASE NO. 12 Sylmar, Cal i fornia

TISSUE FROM: Bladder ACCESSION NO. 26668

CLINICAL ABSTRACT:

History: This 60-year-old female with history of epilepsy was admi tted to the h.ospital on December 18, 1989 because of intermi t tent hemat uria s ince September . A cystoscopy disclosed a bladder tumor along the left l ateral ~1all of t he bl adder.

Familial history showed two sisters, one with lung cancer, another with breast cancer . The father died of dro~ming, ahd the mot her had mild cardioinfarction. ·

Physi cal examination: The pat ient was well-nouri shed but was fatigued. Head, neck and chest was without significant findings. Abdomen revealed a diastasis recti without palpable enlargements of liver, spleen and kidney. Pelvic examination was deferred. Bi lateral pedal edema 1+.

SURGERY: (December 19, 19B9)

A urinary diversion via continent ileoceca l pouch was performed, as well as a radical cystectomy, total abdomi nal hysterectomy, bilateral salpingo-oophorectomy and appendectomy.

GROSS PATHOLOGY:

The uri nary b l adde·r measured 12 x 12 x 4 em. in maximum dimension. The open bladder revealed in the left side a gray-tan focal ly friable and firm tumor that measured 6 x 4 em. in maximum dimension. It extended up t o 1 em. above t he level of the adjacent bladder. It measured i n maximum th·ickness 2.5 em. The bladder in the region of the neoplasm was thick and abutted a rel atively smooth neopl.astic border. However, a f ew irregu lar tongues of the neoplasm were note(! in the adjacent fibroadipo$e t i ssue. The orifice of the left ureter was obscured. The remainder of t he bladder was relatively unremarkable. The right ureter was unremarkable. The fibroadipose tissue reveal ed two lymph nodes i n the regi on of the tumor, one of which was gray-tan and friable; the ot her was unremarkable . The left ureter was grossly unremarkable.

RECOMMENDED READING:

STUDY GROUP CASES FOR

SEPTEHBER 1991

MURPHY WILLIAM M: Atlas of Bladder Carcinoma. American Society of Clinical Pathologist Press, 1986.

YOUNG ROBERT Hand SCULLY ROBERT E: Testicular Tumors. American Society of Cli nical Pathol ogi.s t Press, 1990.

BRAWN PETER N: Interpretation of Prostate Biopsies . Raven Press, 1983 .

AMERICAN CANCER SOCIETY: Ca - A Cancer Journal for Clinicians. The Early Detection and Diagnosis of Prostate Cancer . Vol. 39, No. 6, November/December 1989.

CASE NO. 1 - ACCESSION NO. 26718 SEPTEf~BER 1991

LOS ANGELES: Metast at ic carcinoma , t estis - primary prostat e - 5

SAN BERNARDINO (INLAND): Metas tati c adenocarcinoma of tes t is- 4; mal ignant Leydig cell tumor - 1

LONG BEACH: Metastatic prostati c carci noma - 7

SACRAMENTO : Prostate carcinoma metastatic to testis - 1D

GRASS VALLEY: Me tastat ic high grade prost atic adenocarcinoma - 1

SANTA BARBARA: Seminoma - 1

NORTH DAKOTA : Metastati c prostate carcinoma - 1

SPECI AL STAINS: (Contri butor)

Tumor negative for leukocyte common anti gen and alpha feto protein . Tumor pos iti ve for prostatic specific antigen, prostatic acid phosphatase ,

and neuron speci fi c enolase .

FOLLOW-UP:

Bone scan in August 1991 revealed multi pl e metastat i c diseases (skull , spine, ribs , femora, humeri and pel vi s). He expired May 31, 1991.

DIAGNOSIS :

Metastat ic carcinoma, testis - primary prost ate

REFERENCES :

PRICE EB and MOSTOFI FK: Secondary Carcinoma of the Test is . Cancer 10 : 592-595, 1957.

TILTMAN AJ : Met ast ati c Tumor s in the Testi s . Hist opathology 3:31-37, 1979.

HAUPT HM, MANN RB, TRUMP DL, and ABELOFF MD: Metastati c Carcinoma Involving the Testi s: Clinical and Pathologic Distinction f rom Primary Testicular Neopl asms. Cancer 54 :709-714, 1984.

CASE NO. 2 - ACCESSION NO. 25286 SEPTEMBER 1991

LOS ANGELES: Malakoplakia - 5

SAN BERNARD INO (INLAND ) : Granulomatous orchi t is- 5

LONG BEACH: Malakoplakia with abscess - 7

SACRAMENTO: Malakoplakia - 10

GRASS VALLEY: Granulomatous orchitis - 1

SANTA BARBARA: Chronic epididymitis wi th fibrosis - 1

NORTH DAKOTA : Orchi t i s - 1

SPECIAL STAINS: (CTTR)

Von Kossa: positive for calcium in Michaelis-Gutmann bodies

FOLLOW-UP:

Patient last seen by physician in November 1984, at ~1hic h time he was doing well. Patient then lost to follow-up.

DIAGNOSIS :

Malakoplakia, testis

REFERENCES:

McCLURE J: Malakoplakia of the Testis and i ts Relationship t o Granulomatous Orchitis. J Pathol 140:275-330, 1983.

CASE NO. 3 - ACCESSION NO. 26287 SEPTEMBER 1991

LOS ANGELES: Anaplastic seminoma - 5

SAN BERNARDINO (INLAND) : Anaplastic seminoma - 5

LONG BEACH: Semi noma - 7

SACRAMENTO: Anaplas tic seminoma - 10

GRASS VALLEY: Seminoma - 1

SANTA BARBARA: Semi noma - 1

NORTH DAKOTA: Seminoma - 1

FOLLOW-UP:

Last seen May 10 , 1991, at which time there was no evidence of recurrent and/or me tast atic tumor.

DIAGNOSJ S:

Anaplastic seminoma, testis

REFERENCES :

PERCARPJO B, CLEMENTS JC, ~lcLEOD DG et al: Anaplastic Seminoma: An Analysis of 77 Patients . Cancer 43:2510-2513, 1979.

ZUCKMAN MH, WILLIAMS G, and LEVIN HS: Mi tosis Counting in Seminoma: An Exercise of Questionabl e Signifi cance. Hum Pathol 19:329-335, 1988 .

VON HOCHSTETlER AR and HEDINGER CE: The Differential Diagnosis of Testicular Germ Cell Tumors in Theory and Practice: A Critical Analysis of Two Major Systems of Classification and Review of 389 Cases. Virchows Arch A 396:247-277, 1982.

CASE NO. 4 - ACCESSION NO. 26701 SEPTEMBER 1991

LOS ANGELES: Spermatocytic seminoma - 5

SAN BERNARDINO (INLAND): Spermatocytic seminoma - 5

LONG BEACH: Spermatocytic seminoma - 7

SACRAMENTO : Spermatocytic semi noma - 10

GRASS VALLEY: Yolk sac tumor - 1

SANTA BARBARA: Seminoma - 1

NORTH DAKOTA: Carcinoid - 1

FOLLOW- UP:

Patient well without evidence of disease as of July 1991. He did not receive any chemotherapy.

DIAGNOSIS:

Spermatocytic seminoma, testicle

REFERENCES:

TALERMAN A: Spermatic Semi noma: Cl inicopathologi cal Study of 22 Cases. Cancer 45:2169-2176, 1980.

MATOSKA J, ONDRUS 0, and HORNAK M: Metastatic Spermatocytic Seminoma: A Case Report with light Microscopic, Ultrastructural, and Immunohisto­chemical Findings. Cancer 62:1197-1201, 1988.

FLOYD C, AYALA AG, LOGOTHETI S CJ et al: Spermatocytic Seminoma with Associ ated Sarcoma of the Testis. Cancer 61:409-414, 1988.

CASE NO . 5 - ACCESSION NO. 25309 SEPTEMBER 1991

LOS ANGEL ES : Ductal carcinoma - 5

SAN BERNARDINO (INLAND): Adenocarcinoma of prostate - 5

LONG BEACH: Adenocarc inoma - 6; adenocarcinoma with osteogenic sarcoma -1

SACRAMENTO: Intraductal prostate carcinoma - 10

GRASS VALLEY: Papillary intraducta l prostatic adenocarcinoma (Gleason 's Grade 3C) - 1

SANTA BARBARA: Adenocarcinoma - 1

NORTH DAKOTA: Endometrioid type of prostatic adenocarcinoma - l

FOLLOW-UP:

Patien t died in 1985 - cause unknown by surgeon.

DIAGNOSIS:

Ductal carcinoma, prostate. In the multiple blocks that were used, some sections had intraductal, focus of either cartilage, chondrosarcoma or osteosarcoma. The main carcinoma was a ductal (endometrioid type) infiltrati ng carcinoma of the prostate.

REFERENCES :

t1cNEAL JE: Normal Histology of the Prostate. Am J Surg Path 12.(8) :619-633, 1988 .

McNEAL JE , REDWINE EA, FREIHA FS et al: Zonal Distribution of Prostatic Adenocarcinoma. Correl ation with Histol ogic Pattern and Direction of Spread. Am J Surg Path 12.(12):897-906, 1988.

KUHAJDA FP, GIPSON, T and MENDELSOHN G: Papillary Adenocarcinomas of the Prostate: An Immunohistochemical Study. Cancer 54:1328-1332., 1984 .

NADJ I M, TABEI SZ , CASTRO A et al: Prostatic Origin of Tumors: An Immunohistochemical Study. Am J Clin Pathol 73:735-739, 1980.

McNEAL JE: The Prostate Morphology and Pathobiology. Monogr Ural 4:3-33, 1983 .

WHITMORE WF Jr: Natural History and Staging of Prostate. Ural Clin N Am 11:203-220, May 1984 .

Manual for Staging of Cancer (3rd Ed.) . Ameri can Joint Committee on Cancer. J 8 Li ppingcott Co. Phi l adelphia.

McNEAL JE and BOSTWICK DC: Intraductal Dysplasia. A Pre­malignant Lesion of the Prostate. Hum Pathol 17:64-71, 1986.

CASE NO . 6 - ACCESSION NO. 26197 SEPTEMBER 1991

LOS ANGELES: Carcinoma, prostate with metastasis to breast (qns for conf .) -5

SAN BERNARDINO (INLAND): Poorly differentiated adenocarcinoma of prostate -5

LONG BEACH: Poorly differentiated adenocarcinoma (si gnet-ring cell type) -7

SACRAMENTO: Poorly differentiated carcinoma - 10

GRASS VALLEY: Poorly different i.ated prostatic adenocarcinoma - 1

SANTA BARBARA : High grade prost ate carci noma - 1

NORTH DAKOTA : Prostatic adenocarcinoma - 1

SPECIAL STAINS: (Cont ribut or)

There were few areas of weak positivity for PSA in the prostate tissue but not as pronounced as in the breast . On the PAP stain there were areas interpret ed as weakly pos i t ive in bot h the prosta t e and breas t t i ssues . The immunoperoxidase stai ns confi rmed t hat t he breast tumor was metastatic f rom t he prostate primary.

FOLLOW-UP :

Pati ent expired on September 8, 1988 with termi nal widespread metastat ic carcinoma of the prostate .

DIAGNOSIS:

Carcinoma, prostat e, with met astas i s t o breast (qns for conference)

REFERENCES :

SALYER WR and SALYER DC: Metastases of Prostat i c Carcinoma to the Breas t . J Uro l 109:671 -675, 1973 .

LOME LG and AUSTEN G Jr: Metastatic Breast Carc inoma of Prostatic Origin . Am J Surg 120: 113-115 , 1970.

DRELICHHAN A, AMER M, PONTES E et al : Carci noma of Prostate t~etastatic t o Breast . Urol 16:250-255, 1980.

CASE NO. 7 - ACCESSION NO . 26826 SEPTENBER 1991

LOS ANGELES: Malignant mixed germ cell tumor {teratoma and embryonal carcinoma} - 5

SAN BERNARDINO {INL AND): Teratocarcinoma (teratoma+ embryonal carcinoma) -5

LONG BEACH: Teratoma with embryonal carcinoma (teratocarcinoma) - 7

SACRAMENTO: Mixed germ cell tumor (teratoma and embryonal carcinoma)- 10

GRASS VALLEY: Yol k sac tumor - 1 .

SANTA BARBARA: Embryonal carcinoma with tera toma - 1

NORTH DAKOTA: Teratocarcinoma and yolk sac tumor - 1

FOLLOW-UP:

Repeat CT scan and chest x-ray on May 30, 1991 was negative. Repeat HCG consistently negative (l ess and 3.0). He had circumcision on July 2, 1991.

DIAGNOSIS:

Malignant mixed germ cell tumor (teratoma and embryonal carcinoma), testis

REFERENCES:

ALDERDICE JM and MERRET JO: Factors Influencing the Survival of Patients with Testicular Teratoma. J Clin Pathol 38:791 -796, 1985.

AHMEIL T, BOSE GJ, and HAJDU SI: Teratoma with Malignant Transformation in Germ Cell Tumors in Nen. Cancer 56:860-863, 1985.

CASE NO. 8 - ACCESSION NO. 25836 SEPTEMBER 1991

LOS ANGELES: Urothelial carci noma with squamous carcinoma - 5

SAN BERNARDINO (INLAND): Poorly differentiated i nvasi ve trans i tional cel l carcinoma - 5

LONG BEACH: High grade transitional cell carcinoma with squamous elements -7

SACRAMENTO: High grade transitional cell carcinoma with areas of squamous di fferentiation - 10

GRASS VALLEY: Mixed transitional cell carcinoma and squamous carcinoma -moderate grade - 1

SANTA BARBARA: High grade transitional carcinoma - 1

NORTH DAKOTA : Squamous cel l carcinoma - 1

FOLLOW-UP:

The patient is i n clinical remission as of February 1991 .

DIAGNOSIS:

Mixed transitional (urothel ial) cell carcinoma with squamous carcinoma, high grade, bladder

REFERENCE$:

RICHI E JP, of the Bladder: 1976 .

~IAIS1·1AN J , SKINNER DG et al: Squamous Cel 1 Carcinoma Treatment by Radical Cystectomy. J Urol 115:670-672,

HAINAU B and OOMBERNOWSKY P: Histology and Cell Proliferation in Human Bladder Tumors . Cancer 33:115-126, 1974.

~IURPHY ~IM, NAGY GK, RAO MK et al: "Normal" Urothelium in Patients with Bladder Cancer . Cancer 44:1050-1058, 1979 .

FRIDELL GH, BELL JR, BURNEY SW et al: Histopathology and Classification of Urinary Bladder Carcinoma . Urol Cl in North Am 3:53-70, 1976.

RAGHAVAN 0, SHIPLEY WU, GARNICK MB et al: Biology and Management of Bladder Cancer . Medical Progress 322:1129-1138, 1990.

LERNER SP, TSAI YC, and JONES PA : Genetic Aspects of Bladder Cancer Progression. Worl d J Urol 6:69-74, 1991.

CASE NO. 9 - ACCESSION NO. 15703 SEPTEMBER 1991

LOS ANGELES: Embryonal rhabdomYosarcoma - 5

SAN BERNARDINO ( INLAND) : Embryonal rhabdomyosarcoma- 5

LONG BEACH: Rhabdomyosarcoma (embryonal)- 7

SACRAMENTO: Embryonal rhabdomyosarcoma - 10

GRASS VALLEY: Embryonal rhabdomyosarcoma - 1

SANTA BARBARA: Embryonal rhabdomYosarcoma - 1

NORTH DAKOTA: Rhabdomyosarcoma - 1

SPECIAL STAINS: (CTTR)

Myoglobin, desmin, and actin were positive

FOLLOW-UP:

Patient died on March 13, 1969. Autopsy revealed metastases to lung, retroperitoneal space, peritoneal cavity, lymphatic and skin .

DIAGNOSIS:

Embryonal carcinoma, paratesticular

REFERENCES:

BLITZER PH, DOSORETZ E, PROPPE KH, and SHIPLEY WU: Treatment of Malignant Tumors of the Spermatic Cord: A Study of 10 Cases and a Review of the l iterature. J Urol 126:611-614, 1981 .

CASE NO. 10 - ACCESSION NO. 24209 SEPTEMBER 1991

LOS ANGELES: Sma l l cel l neuroendocrine carcinoma - 5

SAN BERNARDINO (INLAND}: Small cell carcinoma - 4; carcinoid- 1

LONG BEACH: Small cell carcinoma - 6; undifferentiated carcinoma - 1

SACRAMENTO: Smal l cell carcinoma- 10

GRASS VALLEY: Smal l cel l undifferenti ated carcinoma - 1

SANTA BARBARA: Carcinoid - 1

NORTH DAKOTA: Smal l cel l carci noma - 1

SPECIAL STAINS:

NSE: Positive Chromogranin: Negative

FOLLOW-UP:

The patient died on May 27, 1981 with uremia and other complications .

DIAGNOSIS:

Small cel l neuroendocrine carcinoma, prostate RE FERENCES:

GLEASON OF et al: Predicti on of Prognosis for Prostatic Adeno­carcinoma by Combined Histologic Grading and Clinical Staging . J Urol 111:58-64, lg74.

GARDNER WA JR, COFF EY D, KARR JP et al: Nomencl ature of Prostati c Carcinoma. Arch Pathol Lab r1ed 111:898, 1987.

GAETA JF: Glandular Profiles and Cellular Patterns in Prostatic Cancer Grading: National Prostatic Cancer Project System. Urology 17 (Supplement):33-37, 1981.

OESTERLING JE: Prostate-Specific Antigen: A Valuable Cl inical Tool . Oncology 5(4):107-128, 1991.

CRAWFORD ED and NABORS W: Hormone Therapy of Advanced Prostate Cancer : Where We Stand Today. Oncology 5(1):21-37, 1991.

MURPHY WM et al: Pathol ogic Changes Associated with Androgen Deprivat ion Therapy for Prostate. Cancer 68:821-828, 1991.

McNEAL JE et al: Patterns of Progression in the Prostate Cancer. Lancet 60-63, 1986.

BRAWN PN et al: Prostate-specific Anti gen Levels from Completely Sectioned, Clinically Benign , Whole Prostate. Cancer 68:1592-1599, 1g91.

McNEAL JE et al : Microcarcinoma i n t he Prostate: Its Association with Duct-acinar Dyspl asi a. Hum Pathol 22:644-652, 1991.

CASE NO. 11 - ACCESSION NO. 24054 SEPTEMBER 1991

LOS ANGELES: Germ cell tumor - 1; lymphoma- 2; anaplastic seminoma- 2

SAN BERNARDINO (INLAND) : Seminoma - 3; lymphoma - 1; malignant gonadal stromal tumor - 1

LONG BEACH: Large cel l lymphoma - 6; seminoma - 1

SACRAMENTO: Large cell lymphoma - 10

GRASS VALLEY: Non-Hodgkin's malignant lymphoma, large cell, nodular and di ffuse (i ntermediate grade) - 1

SANTA BARBARA: Seminoma - 1

NORTH DAKOTA: Large cell lymphoma - 1

GONSUL TA TI ON:

F. K. Mostofi, M. 0., AFIP: Malignant lymphoma, lymphoplasmocyti c type, testis and paratesticular tissue.

Roger Warnke, M. 0., Stanford Medical Center : Undifferentiated malignant neoplasm. Comment: Drs . Dorfman and Rouse favored anapl astic seminoma. Drs. Kempson and Colby favored lymphoma over anaplastic seminoma.

George M. Farrow, M. D., Mayo Clini c: Anaplastic seminoma.

Peter M. Banks, 1~. D., Mayo Cl inic: Diffuse large cell lymphoma.

SPECIAL STAINS: LCA - Negative

FOLLOW-UP:

Alive and wel l without recurrence as of October 1983 after having chemotherapy and radiati on therapy. Lost to fo 11 ow-up after 1983.

DIAGNOSIS:

Anaplastic seminoma, testis REFERENCES:

PERCARPIO B, CLEMENTS JC, McLEOD DG et al : Anaplastic Seminoma: An Analysis of 77 Patients . Cancer 43:2510-Z513, 1g79.

ZUCKMAN MH, ~/I LLIAMS G, and LEVIN HS: l~itosis Counting in Seminoma: An Exercise of Questionable Si gni ficance . Hum Pathol 19:329-335, 1988.

SILVERBERG E and LUBERA JA: Cancer Statistics . CA 38:5-22, 1988.

BABAIAN RJ and ZAGARS GK: Testicular Semi noma : The M. D. Anderson Experience , an Analysis of Pathological and Patient Characteri stics and Treatment Recommendations. J Urol 139:311-315, 1988.

COCKBURN AG, VUGRIN D, BATATA M et al : Poorly Differentiated (Anaplastic) Seminoma of the Testis . Cancer 53:1991-1994, 1984.

CASE NO. 12 - ACCESSION NO. 26668 SEPTEMBER 1991

LOS ANGELES: Squamous cell carci noma - 5 .

SAN BERNARDINO (INLAND): Squamous cell carcinoma - 5

LONG BEACH: Squamous cell carcinoma - 7

SACRAMENTO: Squamous cell carcinoma - 10

GRASS VALLEY: Keratinizing squamous cell carcinoma - 1

SANTA BARBARA : Squamous carcinoma - 1

NORTH DAKOTA: Squamous cell carc i noma - 1

FOLLOW-UP:

Pat ient lost t o fol l ow-up.

DIAGNOSIS:

Squamous cell carcinoma, bladder

RE FERE NCES:

RICHIE JP, WAISMAN J, SKI NNER DG et al: Squamous Cel l Carcinoma of the Bladder: Treatment by Radical Cystectomy. J Urol 115:670-672, 1976 .

HAINAU Band DOMBERNOI~SKY P: Histology and Cell Proliferation in Human Bl adder Tumors . Cancer 33:115-126, 1974.

MURPHY WM, NAGY GK, RAO MK et al : "Normal" Urot hel ium in Patients with Bladder Cancer. Cancer 44:1050-1058, 1979.

FRIDELL GH , BELL JR, BURNEY SW et al : Histopathology and Cl assification of Urinary Bladder Carcinoma. Urol Cl i n North Am 3:53-70, 1976.

RAGHAVAN D, SHIPLEY WU, GARNICK MB et al : Biology and Management of Bladder Cancer. Medical Progress 322:1129-1138, 1990.