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CAIJFORNIA TUMOR TISSUE REGISTRY

LOMA LINDA UNIVERSI1Y

PROTOCOL

FOR

MONTHLY snJDY SliDES

JANUARY 1993

OV ARJAN TUMORS

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CONTRIBUTOR.: W.E. CaaoU. M.D. . Santa BarbaD. CA

CASE NO. 1 ·JANUARY 1993

TISSUE FR. OM: Ldl ovuy and omentum ACCESSION NO. 27195

OJNICAL ABSTltACT:

History: Thls 44 year-old graVida 3, pu-a 2 CAucasJan female presented with a one month history of mooting suprapubic pain. spontaneous incontinence, and occasional joint pain. She was found to have a tender ma. filling the lower pelvis. A pelVic ultrasound ahowed cystic enlargement of the left ovary, with the largest cyst measuring 7.5 x 4.5 CDI, and containing a solid area. The nght ovary appeared normal. A CA-125 was elevated at greater than 200.

Past History: Fourteen yeus preViously she had undergone a hysterectomy for fibroids and endomel:rioels. lhat surgery was complicated by deep vein thrombooris of the left leg requiring heparin therapy.

SURGERY: (October 7, 1992)

IApu'UCOpy revealed bilateral pelVic,_ with excrescences. An e>cploratory laparotomy wu then performed. and a bilateral salpingo-oophorectomy, lysis of adhesions, left ureteral lysis and omentectomy were perfo.rmed.

GROSS PATHOLOGY:

The nght ovary with attached tube weighed 20 grams. The ovary was 6.0 x 3.8 x 1.6 em with a cyst containing clear fluJ.d. The inner lining of the cyst showed a 3.0 x 2.0 x 1.0 em area of pink-tan exaeecences. The left ovary with attached tiseue weighed 130 grams. The ovary was partially cystic with cysts up to 6.8 x 4.5 CD\. The cysts contabled pale yellow fluid with excrescences on the cyst lining that were up to 1.5 em in diameter and 0.5 em high. A portion of omentum weighed 560 grams, and was 39.0 x 24.5 x 1.9 em. It was pale yellow and hemorrhagic, without prominent ,__

CONilUBUIOR: Suan Mamhm! M.D. CASE NO. 2- JANUARY 1993 Puade .... CA

TISSUE FROM: Left ovary ACCBSSION NO. ~71

CLINICAL ABSTRACT:

Histozy: This 67 year~ld. gravida 1, para 1 woman presented with a history of vaginal apottlng for three montlw. She ls post-menopausal and hu no history of estrogen thenlpy. A cr ecan of the abdomen showed a large abdominopelvic mass virtually filling the pelvis, and extending 8 an above the umbiliau. It had both solid and cyatic components. There was UIIOC:i.llted ascites. A CA 125 (drawn three days post~peratively) was 335 U/mL (reference range: less than 16).

PMt History: Shfl had breast cancer ten years previously, treated with a left mastectomy and radiation.

Pbys!cal'Ex•mlnetion: 1he abdomen was protuberant with a 14.0 an diameter abdoutinalmas8 which began In the suprapabic region and extended in the left lower quadrant to about 2.0 an above the um'blliau. It was firm, solid and slighily movable. A rectal exam showed no luminalll'IUf. 1he pelvic mass could be palpated. Stool was guaiac negative. 1he left breast was absent.

SURGERY: (September 20, 1990)

An exploratory laparotomy with total abdomlNU hysterectomy and bilateral aalplngo­oophorectomy was performed.

GROSS PATHQLQGY:

1he left ovarian mass weighed 3500 grams and was 25 x 20 x 12 em. Approximately hall of thls volume was a cyst filled with thin serous .fluid. The lining was smooth and glistening. 1he remaining half of the mass was solid pink-white tissue with a few cyatic areas. Stretching over the mass was a 15 x 0.3 an fallopian tube. The uterus and right ovary weighed 372 grams. 11l.e uterus was 11.5 x 10.0 x 6.5 em and obviously distorted 'by an intramural leiomyoma up to 65 an In diameter. The right ovary was 2.2 x 1.5 x 0.4 an, and grossly unremarb'ble.

CONTRIBUTOR: P. L Mcnda, M.D. CASE NO.3· JANUARY 1993 Santa Barbaza, CA

TISSUE FROM: Left Ovuy ACCESSION NO. 26698

CLINICAL ABSIRACI:

Histozy: This 24 year-<~ld female had a two year history of lower abdominal and pelvic pain. Further studies revealed a 15 em pelvic mass. No further pre-<~p history available.

stJIGEJY: Oanuary 26, 1990)

A left salpingo-oophorectomy and omental biopsy were performed.

GRQSS PATHOLQGY:

The ovary was cystically enlarged, and measured 14.0 x 13.5 x 6.5 em. Its outer aspect was smooth and pink-white with l!lalttered pink-purple cysts vislble through the intact capsule. A roughened mucoid area on the capsule measuring 6.5 x 5.0 em was present. On sectioning, a plitially cystic mass which almost completely replaced the ovary was noted. The cyst contained ~~~~nguenous to tan serous fluid. The cyst walls were focally smooth and focally papillary. The cysis were ~ated by nodular to slightly papillary mucoid, pink-tan, solid parenchyma. Within the solid areas, regions of black discoloration were found. The accompanying oviduct, meso,ovarlan ti.sssue and omental biopsy were free of apparent pathology.

CONTlUBUfOR! D...pu Kalul, M.D. CASE NO. C • JANUARY 1993 Sylmu.CA

TISSUE FROM: Ovazy ACCESSION NO. 26927

CLINICAL ABSIRACI:

History: Thls 51 yeaM~Id female had a three year history of epigastric paln, nausea, and vomitting, with a 40 lb. weight toes. Prior to admission she had an endoscopy showing no evidence of malignancy. A repeat endoscopy on 12/90 showed friable mucosa and an irregular ulcer. Biopsy revealed moderately to poorly differentiated adenocarcinoma.

Physical Examlnt!t!on: Pre-wrgical physical examination not available.

SURGERY: (December 28, 1990)

An exploratory Laparotomy, right salpingo-oophorectoxny, and gastric tube placement were performed.

GROSS PATHOLOGY:

The right ovary and oviduct together measured 7.0 x 6.0 x 3.5 em. and appeared as a gray-tan and purple, nodular portion of tissue. On se<tloning. the parenchyma was gray-tan, glistening. and slightly mucoid.

CONJ'JUBUTO.R: lJllbflh Ga.lzdo-Mhuul.t. M.D. CASE NO. 5 · JANUARY 1993 BU:ftSIJ• Icl, CA

TISSUE FROM: IUght Ovuy ACCESSION NO. 25896

CLINICAL ABSTRACI':

Hlstoa: This 25 year-old gravida 0, para 0 woman presented with a two week history of increMing abdominal and pelvic cU.comfort. Her last me,..trual period had been approximately four weeks earlier. A beta HCG was negative. She had been on oral contraceptives for seven years. 1here wu no history of any previous abdominal or pelvic almonna.lities.

Physical Examination: A 20 em diameter, firm, mely movable, extremely tender abdominal mass was palpable.

SQRGBRY: Omwuy H, 1987)

An exploratory laparotomy wu performed with right oophorectomy and partial omentectomy. Two areas of rupture of the ovarian tumor were identi.Sed. A portion of omentum was adherent to one of the areas of rupture. The uterus and left ovary were grossly IKll'IIUI1. Peri-aortic and pelvic lymph nodes were palpated and appeared normal.

GROSS PATHOLOGY:

A 1081 gram ovarian mass was 17 x 15 x 8 em. The capsule was smooth and intact, except for two thin hemorrhagic areas. The cut surface showed a fleshy yellow lobulated tumor with areas of hemorrhage and groesly a.pparent neaosis. The portion of omentum was 5.5 x 5 x 1.5 em with adherent blood clota but no discrete nodularity.

CONTR.IBUTOlt: Jolla Vigjano, M.D. CASE NO.6· JANUARY 1993 Lo•Aqdn,CA

TISSUE FROM: IUght Ov;uy ACCESSION NO. 25785

g.INICAL ABSTMCI:

History: A 32 year-<lld female was found to have a large pelvic mass. During her third pregnancy in 1981, a rapidly enlarging popliteal sldn lesion had been biopsied, ft1vealing a malignant melanoma (1.7 mm). At Cesarean section. no intra-abdominal melanomas were found.

Physical Exam!Mtion: A large, freely movable, non-tender mass was present In the pelvis, not attached to bladder or uterus.

SUilGER.Y: (August 8, 1986)

A unilateral oophorectomy was performed.

GROSS PATHOLOGY:

11te spedmen consisted of the right tube and ovary, measuring 18 x 12 x 12 em. It was entirely surrounded by a pinklsh white fibrous capsule which measured approximately 0.1 em In thickness. Titere was an attached fallopian tube measuring 5.0 em in length and 0.6 em in dJameter. 11te serosal surface was pinkish tan and gUatening. Sectioning of the tumor revealed variegated areas of tan to pinklsh brown friable tissue and areas of cystic change. 11te largest of the cysts measured 3.5 em In greatest dJameter. Some of the cysts were filled with clear fluid; others were filled with clotted blood.

CONTJUBUfOR: Nelson J. QaJsley, M.D. CASE NO. 7- JANUARY 1993 Anaholm.CA

TISSUE FROM: Ript ov;uy ACCESSION NO. 26274

CLINICAL ABSTRACT:

Hlstozy: This 53 year-old poet-menopausal.woman noted abdominal swelling while liftU1g a heavy object in January 1988. A workup, including a pelvic ultrasound revealed a pj!lvic mass, Surgery was advised, however, i~ was poetponed because of an upper respiratory tract infection. A repeat ultrasound of the pelvis ln March 1988 showed a heterogeneous 13.0 c;m mass superior to the uterus. 1he patient declined cr -scan.

Pbysis;al f!x!!!!!ln!tion: This was essentially negative, except for the genitourlnary system, which showed an abdominal pelvic mass extending from the pelvis upward to the lower·abdomen.

SURGERY: (May 12, 1988)

An exploratory laparotomy, total abdominal hysterectomy and bilateral salplngo­oophorectomy were performed.

GROSS PATHOLOGY:

1he right ovary weighed 488 grams, and was 12.5 x 10.0 x 7.0 em. It hacl a glistenlng. pinkish-tan capsule with some stringy, hemorrhagic adlwsions along one surface. On sectiOning, the parenchyma was solid and yellow-orange.

CONTIUBUTOR: Patdck W. lUiey, M.D. CASE NO. 8 • JANUAltY 1993 Rn10, NV

TISSUE FROM> RJpt ovuy ACCESSION NO. 26751

CLINICAL AQSTRACI;

Hlstoty: 'fhiB 70 yelll'-old female presented in March 1990 with a 1 -month history of intermittent, aampy lower abdominal pain. On the day of admission, she awoke with diffuse, severe abdominal pain, followed by Nlll5ea and vomitting.

Physical Examination: The patient had a dlHusely tender lower abdomen with fullness extending to the level of the umbulicus. Organomegaly was not appredated, and bowel soUllds were inaudible. On bimanual pelvic exam, a boggy DIAM high in the pelvis was noted. An ultrasound of the abdomen and pelvis revealed a 15.0 x 11.0 em pelvic mass. The oviducts, ovaries, and uterus were not well seen. Flexible Bigmoldoeropy was negative.

SUBGERY: (Much 12, 1990)

An exploratory laparotomy, total abdominal hysterectomy, and blla.teral s.alpingo­oophorectomy were performed.

GROSS PATHOLOGY:

The right ovary and oviduct together weighed 488 grams, and the cystic ovarian mass had overall dimensions of 15.0 x 15.0 x 129 em. The C)'llt was opened at the t:lme of surgery, and contained clotted blood and a fleshy tumor mass attached to the waD. The surface of the mass wu smooth, with no paplllations. The hillopian tube has a delll' fluid-6lled cyst near the fimbriated edge.

CONI'IUBUIOR: Jull& PhJWpscm, M.D. CASE NO. 9· JANUARY 1993 Sylmar,CA

TISSUE FROM: Ri&ht ovary ACCESSIPN NO. 27069

CLINICAL ABSTRACT:

HlstoJ:Y: This 30 year-old female was admitted in November 1991 because of acute lower abdominal pain and .Increasing shortness of breath. Her WBC were 14,000. In the course of her workup, she was found to have a 13.0 em partially solid, partially cystic right ovarian ma88 thought to be a twisted ovarian cyst.

Physical Examination: Original physic& examination not available.

SUJtGERY:

The first surgery was in November 1991, The.rerordiJ are not availAble but by history she underwent GYN ~gery lor a right ovarian cyst.

The second surgery was on January 16,1992. She underwent total abdominal hysteredomy, bilateral salpingo-oophorectomy, tumor debulking. partial omentectomy and appendectomy.

GROSS PATHOLOGY:

. The tissue was received in January 1992. It consisted of the uterus with attaChed fallopian tubes and one attached ovary. The serosal surfaces of the ovary, oviduct and uterus W'm;! studded with tumor nodules which were white, focally friable, and hemorrhagic. In addi.tipn, the 9.0 x 9.0 x 4.0 em omentum was· submitted, and was entirely firm and white with IteM of cystic change and hemorrhage.

CONTRIBUTOR! Robftt H. Zadl. M.D. CASE NO. 10-JANUARY 1993 Woodland HfiJJ, CA

TISSUE FROM: Left ovary ACCESSION NO. rnt17

CLINICAL ABSTRACT:

ffistoey: The patient l$ a i'9 year-old gravida 2, para 2, Caucasian female who initially preeentedior the evaluation of urinary incontinence that began approximately in September 1992. During the OOW'IN! of a workup a pelvic maas was dlscovered.

Past HistorY: The patient underwent a hysterectomy in 1961 for bleeding .fibroids. That aurgery was oompllcated by an epi&ocle of bowel obatruction, which wu treated by nasogastric euction. Three months later, the pa\ient experienced another epi&ode of bowel obatructlon which was felt to be related to a hernia. The patient had a I!Witectomy for breast cancer four years previoUBly.

l'!uarirnl f"•mln!t!on: The patient had an ultrasound done on fYJ/Zl/92 demonstrating a~~eptated, predominantly cystic mass, which was oon.flnned by cr scan on 10/0S/92. There was no ascites, adenopathy, liver metastases or panaeatic abnormalities.

SURGERY: {October 26, 1992)

Exploratory laparotomy, right salpingo-oophorectomy, left oophorectomy, and an omental biopsy was performed.

GROSS PATHOLOGY:

The )eft ovarian specimen oonsi8ted of a large ovoid, cystic maas measuring 15 x 15 x 9 em. The cysls ranged from 0.2 to 14 em in greatest diameter and were filled with thiclc mucoid material The cyst lining was focaily thickened but me of papillationll. On Q'Ofl8 sedion. the tumor had a fairly uniform, almost rubbery yellow-white appelll'IU\Ce. The right tube and ovary were received as two Irregular portions of tissue meuuring 2.0 x 1.0 x 0.5 em and 4.0 x 5.0 x 1.2 em. Sectioning revealed a patent lumen within the fallopian tube, and the right ovary appeared white-gray with one ape)( containing a focal area of yellow calcification measuring 1.0 em. The omental specimen failed to reveal any nodules or other abnormalities.

CONTIUlJUfOR: B. DuBoM Dent. M.D. CASE NO. 11 -JANUARY 1993 Glenda!~, CA

TISSUE FROM: IUpt ovuy ACCESSION NO. 26466

q !NJCAL ABSTRACI:

Hi!tory: The 7'3 yeAr~ld gJ'avida 0, para 0 female complained of aevere abdomlnal pain and wiJiary retention. A pelvic ultrasound revealed a 17.0 an cystic tumor. GI studies were normal. Az\ NP showed dlsplacement of the ureters. Her alpha.fetoprotein was markedly elevated at 138. Her CEA was elevated at 125. She was also roW\d to have elevated serum androgen..

Pbysical l!xamjnation: Palpation of the abdomen revealed a spherical mass extending to the umbilicus. On pelvic exam, a large cystic mass, approximately 20 an in diameter, was palpable.

SURGERY: (February 7, 1989)

Az\ exploratory laparotomy, total abdominltl hysterectomy, bilateral salpingo­oophorectomy, omentectomy and placement of ureteral stent were performed.

GROSS PAIHOWGY:

The right ovArY measured 17.0 x 14.0 x 8.0 an and weighed 480 SJ'AmS. The surface showed irregular excrescences of yellow-white to ptnldsh-white tissue. The ovarian mass was pu'lially cystic and contained multi-loc:ulated units, some of which were up to 8.0 an in patest dlmeswion. Half of the mass was solid and pale yellow-brown to red-brown in color. Focal lftM of hemorrhage were noted. The left OVAJ'Y was unremarbble. The uterus was anremarkable, except for scattered leiomyomas.

CONTIUBUTOR: W. E. Carroll. M.D. CASE NO. 12 -JANUARY 1993 Santa Barbara, CA

TISSUE FROM: Ovary ACCESSION NO. 26697

O.JNJCAL ABSJ]lACT:

Wstory: This 54 year-old female had a long history of uterine fibrolds. Because of Increasing abdominal pain she undeJWent an evaluation which revealed a large fibroid uterus, a right ovarian cyst, and a normal left ovary.

Phvslcal fnmtnatlon: No pre-surgical physical e."amlnatlon In our records.

SUBGERY: Oanuary 1990)

She undeJWent supracervical hysterectomy and bllate.ral salplngo·oophorectomy.

GROSS PADfOLQGY:

The right ovary welghed 70 grams, and was 10.3 x 6.8 x 2.8 em. One end of the ovary consisted of a well-demarcated, soft, fleshy, tan-brown mass which was up to 2.4 em In Its greatest dimension. The remalnde.r of the ovary contained a smooth-lined cyst, and a separate hemorrhagic cyst, which appeared to be an endometrioma.

STUDY GROUP CASES

FOR

JANUARY 1993

OVARIAN TUMORS

Selected reading:

van Ginneken AM, BaakJPA, Jansen W,-Smeulders AWM: Evaluation of a Diagnostic Encyclopedia Workstation for Ovarian Pathology. Hum Pathol, 1990; 21:989-997.

Henry JB: Computers in Medical Education: Information and Knowledge Management. Understanding, and Learning. Hum PathoJ. 1990; 21-998-1002.

Rossiter BJF, Caskey cr: The Human Genone Project and Clinical Medicine. Oncology, 1992; 6(11):61-68.

Bowcock AM: Rossiter/Caskey article revised. Oncology, 1992; 6(11):71-75.

Frebourg T, Friend SH: Rossiter/Caskey article revised. Oncology, 1992: 6(11):76.

CASE NO. 1- ACCESSION NO. 27195 JANUARY 1993

LOS ANGELES - Borderline serous cystadenocarcinoma (I); Serous cystadenocarcinoma (2).

SAN BERNARDINO <INLAND)- Serous tumor oflow malignant potential {borderline malignancy} (7).

LONG BEACH - Serous papillary tumor of low malignant potential (9).

SAN DIEGO- Serous papillary tumor of low malignant potential {borderline tumor} (16).

GRASS VALLEY - Borderline papillary serous neoplasm (I).

SANTA BARBARA- Serous cystadenomaofborderline malignant potential (1).

OAKLAND - Serous tumor of low malignant pOtential (9).

OHIO- Borderline serous tumor (5); Borderline mucinous cystadenocarcinoma (1).

SANTA ROSA- Borderline serous tumor of low malignant potential (!); Papillary serous cystadenocarcinoma (2).

SPECIAL STAINS:

No documentation of special stains.

FOLLOW-UP:

Patient is currently receiving chemotheraphy and is doing well. However, the patient recently had a papillary carcinoma of the thyroid removed. ·

DIAGNOSIS:

BORDERLlNE SEROUS CYSTADENOCARC1NOMA.

REFERENCES:

Russell P: Borderline Epithelial Tumors of the Ovary: A Conceptual Dilemma. Clin Obstet Gynaecol, 1984; 11:259-277.

Bostwick DG, Tazelaar HD, Bailon SC, Hendrickson MR, Kempson RL: Ovarian Epithelial Tumors of Borderline Malignancy. · A Clinical and Pathologic Study of 109 Cases. Cancer, 1986; 58:2052-2065.

Bell DA, Scully RE: Ovarian Serous Borderline Tumors With Stromal Micro-Invasion: A Report of21 Cases. Hum Pathol, 1990; 21:397-403.

Qershenson OM, Silva EG: Serous Ovarian Tumors of Low Malignant Potential With Peritoneal Implants. Cancer, 1990; 65:578-585.

Bell DA, Weinstock MA, Scully RE: Peritoneal Implants of Ovarian Serous Borderline Tumors. Histologic Features and Prognosis. Cancer, 1988; 62:2212-2222.

Segal GH, Hart WR: Ovarian Serous Tumors of Low Malignant Potential: The Relationship of Exophytic Surface Tumor to Peritoneal "Implants". Amcr J Surg Pathol, 1992; 16:577-583.

BellDA: Ovarian Surface Epithelial-Stromal Tumors. Hum Pathol, 1991; 22:750·762.

Lage JM, Weinberg OS, Huettner PC, Mark SC: Flow Cytometric Analysis of Nuclear DNA Content in Ovarian Tumors. Association of Ploidy With Tumor Type, Histologic Grode, and Clinical Stage. Cancer, 1992; 69:2668-2675.

Hata K, Hata T, Manabe A, Kiato M: Ovarian Tumors of Low Malignant Potential: Trans· Vaginal Doppler Ultrasound Features. Gynecol~gic Oncology, 1992; 45:259-264.

Padberg BC, Alps H. Franke U, Thiedemann C. et al: DNA CytomOipboiOmetzy and Prognosis in Ovarian Tumors of Borderline Malignancy: A Clinicomorphologic Study of 80 Cases. Cancer, 1992; 69:2510-2514.

. '

. .

CASE NO. 2 -ACCESSION NO. 26871 JANUARY 1993

I;OS ANGELES- Mucinous muilerian cystadenocarcinoma (l); Endometrioid carcinoma (l); Mucinous endometrioid carcinoma (1).

SAN BEBNARDINO fiNLAND>- Endometrioid carcinoma (7).

LONG BEACH- Adenocarcinoma, endometrioid (7); Mucinous adenocarcinoma (1); Cyst adenofibroma (1).

SAN DIEGO- Endometrioid cystadenocarcinoma (15); Mucinous cys!Jldenocarcinoma (1).

GRASS VALLEY- Borderline endometrioid neoplasm (1).

SANTA BARBARA - Endometrioid carcinoma (1).

OAKLAND- Endometrioid carcinoma, Grade I (7); Endometrioid tumor, low malignant potential (I); Adenofibroma ( 1 ).

Q!llil- Proliferating endometrial adenofibroma (I); Serous cys!Jldenocarcinoma (1); Mucinous cySIJldenocarcinoma (l); Endometrioid cystadenocarcinoma (3).

SANTA ROSA - Mucinous tumor of low malignant potential with struma ovarii, r/o endometrioid carcinoma (1); Endometrioid carcinoma vs struma ovarii (l); Mucinous adenocarcinoJ;na vs struma (!Varii (1).

SPECIAL STAINS: (Contributor)

Hormonal receptor analysis: ER- mildly positive; PR- strongly positive.

FOLLOW-UP:

The patient was last seen on 01/22/92. At that time, she was free of both cancers.

DIAGNOSIS:

ENDOMETRIOID CARCINOMA. X-FILE: 1\olUCINOUS ENDOMETRIOID CARCINOMA.

REFERENCES:

Watkin W, Silva EG, Gersbenson DM: Mucinous Carcinoma of the Ovary: Pathologic Prognostic Factors. Cancer, 1992; 69(1):208-212.

Rutgers JL, Scully RE: Ovarian Mullerian Mucinous Papillary Cystadenomas of Borderline Malignancy. Cancer, 1988; 61:340-348.

Young lUI, Gilks CB, Scully RE: Mucinous Tumors of !he AppendL~ Associated Wilh Mucinous Tumors of !he Ovary Pseudomyxoma Peritonei. A Cllnicopalhological Analysis of 22 Cases Supporting An Origin in lhc Appendix. Am J Surg Palhol, 1991; 15:415-429.

Surnilh.ran E, Susil BJ, Looi LM: The Prognostic Significance of Grading in Borderline Mucinous Tumors of !he Ovary. Hum Palhol, 1988; 19:15-18.

Ulbright TM, Rolh LM: Common Epilhelial Tumors of !he Ovary: Proliferating and ofLow Malignant Potential. Sem Diag Palhol, 1985; 2:2-IS.

Nagano T, Nakai Y, Taniguchi F, Suzuki N, et al: Diagnosis of Para-Aortic and Pelvic Lymph Node Metastasis of Gynecologic Malignant Tumors by Ultrasound-Guided Percutaneous Fine Needle Aspiration Biopsy. Cancer, 1991; 68:2571-2574.

CASE NO. 3 -ACCESSION NO. 26698 JANUARY 1993

LOS ANGELES·- Immature teratoma- mixed germ cell (1); Teratoca~cinoma (I); End.ometrioid tumor, rio low grade malignant teratoma or adenocarCinoma with endometrioid features (1).

SAN BERNARDINO <INLAND\ - Primitive neuro-«todermal tumor {melanotic progonoma, retinal arilage tumor} (7).

LONG BEACH- Mixed germ cell tumor {endodermal sinus tumor with embryonal carcinoma} (9).

SAN D.IEGO- Mixed germ cell tumor (10); Mucinous cystadenocarcinoma (5),

GRASS VALLEY -Papillary serous cystadenocarcinoma (1).

SANTA BARBARA- Yolk sac tumor (1).

OAKLAND - Mixed germ cell tumor with yi)lk sac tumor and mature teratoma (9).

OHIO- Serous cystadenocarcinoma (4); Mucinous cystadenocarcinoma, intermediate grade (I); Sertoli-Leydig cell tumor (1).

SANT-A ROSA - Endometriosis vs endometrial tumor oflow malignant potential YS endometrial carcinoma (I); Atypical endometriosi.s vs low grade malignancy, r/o·teratoma (1); Alfenocarcinoma with endomctrioid features (1).

SPECIAL STAINS: (Contributor):

AFP -Multiple areas of positive staining of the· neoplasm. This reaction would be in support of a diagnosis of cndodermal sinus tumor. HCG -Demonstrates a small focus of positive staining in cells which appear to be syncytial trophoblasts. The vaSt majority of the neoplasm does not stain. This would indicate there i s a trophoblastic componcnno this mixed germ cell neoplasm and would account for the evelated serum HCG.

FOLLOW-UP:

The patient delivered a term birth, living child 121.91. Patient is alive and well.

DIAGNOSIS:

IMMATURE TERATOMA WITH MIXED GERM CELL TUMOR

REFERENCES:

Scully RE: Atlas ofTumqr Pathology (Second Series Fascicle 16): Tumors of the Ovary and Maldeveloped Gonads. Armed Forces Institute of Pathology, Washington, D.C., 1978; pages '274-277.

Norris HJ, Zirkin HJ, Benson WL: Immature (Malignant) Teratoma of the Ovary. A clinical and Pathologic Study of 58 Cases. Cancer, 1976; 37:2359-2372.

Kurman RJ, Norris HJ: Malignant Mixed Germ Cell Tumors of the Ovary. A Clinical and Pathologic Analysis of30 Cases. Gynecol, 1976; 48:579-589.

Falerman A, Haije WG, Baggerman L: Serum Alpha Fetoprotein in Diagnosis and Management of Endodermal Sinus (Yolk Sac) Tumor and Mixed Germ Cell Tumor of the Ovary. Cancer, 1978; 41:272-278.

CASE NO.4- ACCESSION NO. 26927 JANUARY 1993

LOS ANGELES -Krukenberg tumor (3).

SAN BERNARDINO !INLAND>- Krukenberg tumor (7).

LONG BEACH - Metastatic gastric mucinous signet-ring cell adenocarcinoma {Krukenberg} (9).

SAN DIEGO- Metastatic adenocarcinoma {Krukenberg tumor} (16).

GRASS VALLEY- Signet-ring cell adenocarcinoma- Krukenberg tumor(!).

SANTA BARBARA - Krukcnberg tumor (1).

OAKLAND- Metastatic adenocarcinoma {Krukenberg tumor} (9).

OHIO - Metastatic signet-ring adenocarcinoma (6).

SANTA ROSA- Malignant, rio Krukenberg tumor(!); RIO Krukenberg tumor (1); Metastatic adenocarcinoma {Krukenberg Tumor} (I) .

SPECIAL STAINS:

No documentation of special ·stains.

FOLLOW-UP:

Patient was given a poor prognosis at the time of discharge. Patient was last seen in clinic on 03191, at which time she had a clogged J-tube. It is unknown whether the patient has expired or not.

lliAGNOSIS:

KRUKENBERG TUMOR

REFERENCES:

Bullon A (Jr), Arscnau J, Prat J, Young RH, Scully RE: TubularKrukenberg Tumor: A Problem in Histopathologic Diagn_osis. Am J Surg Pathol, 1981; 5:22S-232.

Pilotti S, Sikle F, De Palo G: Krukenberg Tumor: Letter to Editor. Am J Sur!! Pathol, 1982; 6:486-488.

CASE NO. 5 - ACCESSION #25896 JANUARY 1993

LOS ANGEtcS- Yolk sac tumor (3).

SAN'BERNARDINO fiNLAND>- Yolk sac tumor (7).

LONG BEACH - Endodennal sinus tumor (9).

SAN DIEGO- Yolk sac tumor (16).

GRASS VALLEY- Endodermal sinus tumor {yolk sac tumor} ( I)

SANTABARBARA- Endodennal sinus tumor(!)

OAKLAND- Yolk sac tumor (8).

OHIO- Yolk sac tumor (5); Juvenile granulosa cell tumor(!).

SANTA ROSA- Endodermal sinus tumor {yolk sac, rio genn cell and others} (I); Germ cell tumor­endodennal sinus pattern (I); Endodermal sinus tumor (I).

SPECIAL STAINS:

No documentation of special stains.

FOLLOW-UP:

Unable to obtain follow-up information.

DIAGNOSIS:

YOl.K SAC TUMOR.

REFERENCES:

Gonzalez-Crussi F, Roth LM: The Human Yolk Sac Carcinoma: An Ultrastructural Study. HumanPathol, 1976; 7:675.Q9L

Huntington RW (Jr), Bulloc~ WK: Yolk Sac Tumors of the 0vll1)'. Cancer, !970; 25:1357-1376.

Teilum G: Classification ofEndodermal Sinus Twilor (Mesoblastoma Vitellinim) and So-Called ''Embryonal Carcinoma" of the Ovacy. Actu Pathologica et Microbiologica Scandinavica, 1·965; 64:407-429.

Slayton RE, Hrescheyshyn MM. Silverberg SC, Shingleton MM, et.al: Treatment of Malignant Ovarian Genn Cell Tumors' Response to Vincristine, Doctinomycin and Cyclophosphamide (PrelimiDlU)' ReJl<1rt). Cancer, 1978; 42:390-398.

Rutgers JL, Young RH, Scully RE: Ovarian Yolk Sac Tumor Arising From an Endometrioid Carcinoma. Human Pathol, 1987; 18:1296-1299.

Nakanshl I, Kawahara E, Kajikawa K, et al: Hyaline Globules in Yolk Sac Tumor. Histochemical. lmmunohistoebemical, and Electron Microscopic Studies. Acts Pathol, 1982; 32:733-739.

Stewart KR, Casey MJ, Gondos B: Endodermal Sinus Tumor of the Ovary with Virilization. Light and Electron Microscopic Study. Am J Surg Pathol, 1981; 5:385.391.

CASE NO. 6- ACCESSION NO. 25785 JANUARY 1993

LOS ANGELES- Stromal tumor, r/o granulosa cell rumor (1); Stromal tumor, r/o granulosa cell rumor or melanoma(!); Stroma! tumor, r/o melanoma(!).

SAN BERNARP!NO IJNLANDl - Metastatic melanoma (7).

LONG BEACH - Metastatic malignant melanoma (6); Juvenile granulosa cell tumor (3).

SAN DIEGO- Metastatic melanoma (16).

GRASS VALLEY - Metastatic malignant melanoma(!).

SANTA BARBARA - Metastatic melanoma (I).

OAKLANP -Metastatic melanoma (8).

OHIO - Metastatic malignant melanoma (6).

SANTA ROSA- Stromal rumor, r/o gmnulosa, melanoma, etc.(!); Stromal tumor - granulosa cell positi•·c (1 ); Stromal tumor vs melanoma ( 1).

SPECIAL STAINS: (Contributor)

Toluidine blue - shows sheets of neoplastic cells with oval, slightly irregular nuclei, prominent nucleoli, and ample, pale cytoplasm.

FOLLOW-yp:

A large chest wall mass was detected concurrently with the ovari.an mass. A biopsy revealed metastatic melanoma. The patient was treated by mdiation therapy.

DIAGNOSIS:

METASTATIC MELANOMA.

REFERENCES:

Young RH. Scully RE: Malignant Melanoma Metastatic to the Ovary: A Clinicopathologic Analysis of 20 Cases. Am J Surg Pathol, 1991; 15(9):849-860.

Fitzgibbons PL, Martin SE, Simmons TJ: Malignant Melanoma Metastatic to the Ovary. Am J Surg Pathol, 1987; 11:959-964.

Morrow CP, Di Saia PJ: Malignant Melanoma of the Female Genitalia; Clinical Analysis. Obstretrical and Gynecological Survey, 1976; 31:233-271.

Thaus KT, Ma PH, Kung TM: Malignant Melanoma in an Ovarian Teratoma. Human Pathol. 1981 ; 12:577-579.

E1 Minawi MF, Hori JM: Malignant Melanoma in Bilateral Dennoid Cysts of the Ovary. Int J Gynec Obstet, 1973; 11:218-222 .

Young RH, Scully RJO: Malignam Melanoma Metastatic to !.he Ovary. A Clinicopathologic Analysis of 20 Cases. Am J Surg Patho1, 1991; 15(9):849-860.

CASE NO. 7 · ACCESSION NO. 26274

LOS ANGELES· Thecafibroma (3).

SAN BERNARDINO CJNLANDl ·Thecoma (7).

LONG BEACH ·Thecoma (9).

SAN DIEGO- Fibroma - Thecoma (II); Fibroma with edema (5).

GMSS VALLEY - Fibroma -Thecoma (1).

SANTA BARBARA- Thecoma {I).

OAKLAND • Thecoma (8).

QID.Q - Fibrothecoma (I); Thecoma (4); Luteinized thecoma (1).

SANIA ROSA· Thecoma- Fibroma (2); Thecoma vs fibrothecoma (1).

SPECIAL STAINS: (Contributor)

JANUARY 1993

TricluQme stain shows a delicate fibrocollagenous network surrounding the thecal cells.

FOLLOW-UP:

Follow-up histOry unavailable -patient's attending physician bas not seen her for a couple of years.

DIAGNOSIS:

THECOMA-FBROMA.

REFERENCES:

Dackerty MB, Masson JC: Ovarian Fibromas: A Clinical and Pathologic Study of 283 Cases. Am 1 Obstet Gynecol, 1944; 47:741. (Classic description)

CASE NO. 8 -ACCESSION #26751 JANUARY 1993

LOS ANGELES- Brenner rumor, malignant ( I); Prollferating BreMer ( I).

SAN BERNARQJNO <INLAND> - Prollferating/Borderline Brenner tumor (7).

LONG BEACH- Malignant Brenner tumor (8); Transitional cell carcinoma (1).

SAN DIEGO - Granulosa eell rumor (9); Malignant Brenner rumor (7).

GRASS VALLEY - Granulosa eell rumor (1).

SANTA BARBARA -Malignant BreMer tumor (1).

OAKLAND - Prollferating Brenner tumor (2); Malignant BreMer tumor (6).

OHIO- Malignant BreMer tumor (4); Proliferating BreMer tumor (2).

SANTA ROSA - Probable Brenner tumor with ai)'Pia. possibly malignant (r/o transitional carcinoma}(!); Proliferating Brenner tumor (I); Brenner rumor (probably malignant} vs transitional eel! carcinoma (I).

SPECIAL STAINS:

No documentation of special stains.

FOLLOW-UP:

The patient did well following surgery, and is asymptomatic exeept for a rising CA-125 in the -100-500 range noted by her oncologist CT -scan studies of the pelvis were unremaikable, while X·rays and CT-scan of the chest from November 1992 revealed a right hilar mass with adjacent lung density, fine needle aspiration of which revealed large malignant cells with some adenocarcinoma features. Of interest, the patient has a long history of heavy smoking. Since this is a solitary lung lesion and different in appearance from the patient's ovarian primary, it is fel~ that this most likely represents a second primary, but the rising CA-125 level is more in keeping with an ovarian malignancy.

"• ' .

DIAGNOSIS:

MALIGNANT BRENNER TUMOR.

REFERENCES:

Austin RM, Norris f!J: Malignant Brenner Tumor and Transitional Cell Carcinoma of the Ova.ry: A CompaJ"!son. lnt Nat!J Obstct Gynecol, 1987; 6:29-39.

Santini D, Gelli MC, Mazz.aleni G, Ricci M, et al: Brenner Tumor of the Ovary: A Correlative Histologic, Histochemical. and Ultrastructuralln•·estigationr Human Pathol, 1989; 20:787-795.

CASE NO. 9- ACCESSION NO. 27069 J ANUARY 1993

LOS ANGELES - Malignant mixed tumor (I); Malignant germ cell tumor (I).

SAN BERNARQINO (!NLANDl- Immature teratoma (7).

LONG BEACH - Immature teratoma (8); Transitional cell carcinoma (1).

SAN DIEGO- Teratoma with malignant transformation {adenocarcinoma} (11); MMT with heterologous elements (4); ltumature teratoma (I).

GRASS VALLEY -Mixed Mullerian tumor {carcinosarcoma} (1).

SANTA BARBARA - Immature teratoma wilb foci of embryonal carcinoma (I).

OAKLAND - Immature teratoma (8).

Q!j!Q- Malignant (immature) teratoma (5); Sertol.i cell tumor with heterologous elements (1).

SANTA ROSA- Malignant mixed Mullerian tumor (I); Heterologous mixed Mullerian tumor(!); Malignant germ cell tumor vs MMT (I).

SPECIAL STAINS: (Contributor)

Vimentin - positive. Keratin- positive. GF AP- +f-. NSE- negative. 5-100- negative.

FOLLOW-yp:

The patient had a brief trial of chemotherapy. The patiemlu!s expired.

DIAGNOSIS:

IMMATURE (MALIGNANT) TERATOMA OF THE OVARY.

REFERENCES:

Norris HJ, Zirkin HJ, Benson WL: Immature (Malignant) Teratoma of the Ovary. A Clinical and Pathologic Study of 58 Cases. Cancer, 1976; 37:2359-2372. ,

Hughesdon PE: The Deduction of Tumor Histogenesis With Special Reference to Teratoma and Ovarian Tumors. Human Pathol, 1982; 13:1020-1027.

Oha.ma K, ¢tat: Origin o[Immature Teratoma of the Ovary. Am J Obstet Gynocol, 1985; 152:842-846.

Carleton RL, Friedman NB, Bonizc EJ: fu:perimenlal Teratomas ofTestis. Cancer, 1953; 6:464-473.

Theiss EA. Ashley DJB, Mostofi FK; Nuclear Sex of Testicular Tumors and Some Related Ovarian and Exua-Gonadal Neoplasms. Cancer, 1959; 13:323-327.

CAS.E NO. 10 ·ACCESSION NO. 27207

LOS ANGELES • Sertoli-Le)•dig cell tumor (3).

SAN BERNARQ!NO <INLANQl • Sertoli·Lcydig ceO rumor (7).

LONG BEACH · Sertoli·Leydig cell tumor (8); Metastatic cMcinoma {1).

JANUARY 1993

SAN DIEGO • Sertoli cell tumor (9); Sertoli-Leydig tumor (2); Se.'< cord stromal tumor (5).

GRASS VALLEY· Metastatic infiltrating ductal carcinoma (1).

SANTA BARBARA · Sclerosing stromal tumor (I).

OAKLAND • Sertoli·Lcydig cell tumor (8).

QH!Q • Sertoli cell tumor (3); Sex cord rumor ( 1); Lipid cell tumor (1).

SANIA ROSA· Malignant stromal (1); Malignant (I); Sertoli·Leydig tumor vs metastatic adenocarcinoma or other mucinous IUmOr (I).

SPECIAL STAJNS:

No documentation of special stains.

FOLLOW·Ul':

Patient is doing well, with the exception of spontaneous opening of her woWld and purulent drainage. She required drainage and irregation, and hospitalization. Ancef was given to the patient IVJPB. She remained afebrile through! her hospital course. Culrurc results showed staph epidermis.

CONSULTATION:

Drs. Robert Young and Robert Scully (Massachusells General Hospital): Endometrial stromal sarcoma of the ovary.

DIAGNOSIS:

ENDOMETRIOID STROMAL SARCOl\'IA. X·FU.E: SERTOLI-LEYDIG CELL TUMOR.

REFERENCES:

Shakfeh SM, Woodruff JD: Primary Ovarian Sarcomas: Report of 46 Cases and Review of the Literature. Obstetrical and Gynecological Survey, 1987; 42:331·349.

Young RH, Prat J, Scully RE: Endometrioid Stromal Sarcomas oftbe Ovary. A Clinicopatbological Analysis of23 Cases. Cancer, 1984; 53:1143-1155.

CASE NO. 11 - ACCESSION NO. 16466 JAJiiUARV 1993

LOS ANGELES - Stromal neoplasia. possibly malignant, r/o granulosa cell (I); Stromal neoplasm, malignant (1); Stromal granulosa cell tumor (1).

SAN BERNARDINO (INLANDl - Senoli-Lcydig cell tumor (7).

LONG BEACH · Scrtoli-Leydig cell tumor (9).

SAN DIEGO - Combined germ celVsex cord-stromal tumor (II); Sex cord-stromal tumor (5).

GMSS VALLEY - Malignant mixed germ cell and stromal tumor ( 1).

SANTA BARBARA- Endodermal sinus tumor (ll.

OAKLAND - Heterologous malignant mixed mullerian tumor (8).

QHIQ- Poorly differentiated sarcoma (I); Immature teratoma (I); Malignant mixed mesodermal tumor (3); Adult granulosa cell tumor (1).

SANTA ROSA- Stromal neoplasm, possibly malignant, r/o granulosa cell tumor (1); Stromal neoplasm, possibly malignant granulosa cell tumor (1); Granulosa-stromal tumor (1).

SPECIAL STAINS:

No documentation of special stains.

FOLLOW-QP:

Patient e.x-pired the January following her surgery.

DIAGNOSIS:

SERTOLI~LEYDIG CELL TUMOR.

REFERENCES:

Young RH, Scully RE: Scnoll-Leydig Tumors: A Clinicopathologic Analysis of 207 Cases. Am J Surg Palhol, 1985; 9:543-569.

Young RH, Scully RE: Ovarian Sertoli-Leydig Cell Tumors With A Retiform Pattern: A Problem in Histopathologic Diagnosis: A Report of25 C1scs. Am J Surg Pathol, 1983; 7:755-771.

Young RH, Prat J, Scully RE: Ovarian Senoli-Leydig Cell Tumors and Heterologous Elements l: Gastrointestinal Epithelium and Carcinoid: A Clinicopathologic Analysis of36 Cases. Cancer, 1982(b); 50:2448-2456.

Young RH. Perez·Atayde AR, Scully RE: Ovarian Senoti-l..eydig Cell Tumor with Retiform and Heterologous Components. Report of a Case With Hepatocytic Differentiation and Elevated Serum Alpha Fetoprotein. Am J Surg Pathol, 1984; 8:709-718.

Roth LM, Liban, Czemobilsky B: Ovarian Endometrioid Tumors Mimicking Sertoli and Sertoli· Leydig Cell Tumors. Cancer, 1982; 50:1322-1331.

Jensen AB, Feclmer RE: UltraStructure of an Intermediate Sertoli-Leydig Cell Tumor. A Histogenic Misnomer. Lab Invest, 1969; 21:527-535.

Tavassoli F, Nonis HJ: Sertoli Tumors of the Ovary. A Clinicopathologic Study of28 Cases With Ultrastructural Observations. Cancer, 1980; 46:2281-2297.

<::ASE NO. 12- ACCESSION NO. 26697 JANUARY 1993

LOS ANGELES- Clear cell carcinoma (I); Papillruy serous cystadenocarcinoma (2).

SAN BERNARDINO (INLAND\- Serous carcinoma (4); Clear cell carcinoma (3).

LONG BEACH - Papillruy·serous cystadenocarcinoma (9).

SAN DIEGO - Clear cell carcinoma (9); High grade serous papillruy carcinpma (7).

GRASS VALLEY- P.apillruy endometrioid cystadenocarcinoma (1).

SANTA BARBARA- Papillary serous cystadenocarcinoma (I).

OAKLAND - Clear cell carcinoma (8).

omo -Papillary serous adenocarcinoma (8}.

SANTA ROSA: Papillruy endometrioid or clear cell carcinoma variant (I); Papillary serous cystadenocarcinoma (2).

SPECIAL STAINS:

No documentation of special stains.

FOLLOW-UP:

AIUtough additional surgery was recommended for accurate pathologic staging, the patient instead opted for six cycles of combination chemotherapy. The patient finished. two cycles of chemotherapy, then refused additional staging and chemotherapy. Patient presented with no evidence of disease at her six month check up.

DIAGNOSIS:

CLEAR CELL CARCINOMA, OVARY.

REFERENCES:

Czemobilsky B: Review A.nicle: Endometrioid Neoplasia oftltc Ovary. A Re-Appraisal. Intn'l 1 ofGyn, 1982; 1:203-210.

Czemobilsky B, Silverman BB, Enterline iiT: Clear Cell Carcinoma of the Ovary. A Clinicopathologic Analysis of Pure and Mixed Forms and Comparison With Endometrioid Carcinoma. Cancer, 1970; 25:762-772.

Kunnan RJ, Craig JM: Endometrioid and Clear Cell Carcinoma of Ovacy. Cancer, 1972; 29:1653-1670.

Silvergerg SG: Ultrastructure and Histogenesis of Clear Cell Carcinoma or the OvaJy. Am J Obstet Gynecol, 1973; 115:394-400.

Scully RE, Barlow JF: Mesoncphroma oflhe Ovary. Tumors of Mullerian Nature Related to Endometrioid Carcinoma. Cancer, 1967, 20: 1405-1417.

ADDITIONAL INFORMATION FOR NOVEMBER MONTHLY STUDY SET:

The follow up historv on Case #I · Accession #27159 is as follows:

The patient is doing well status-post radiation thempy. Patient did have eye pain for six months of unknown etiology but is being seen by an Ophthalmologist.