Case 1

submitted by:
Paul Wakely, Jr.
Ohio State University
Columbus, OH

Clinical Summary:

A 66 year old man presented with slight difficulty in swallowing. Endoscopy revealed a fullness in the posterior pharynx and CT scan confirmed the presence of a mass in this region. Fine needle aspiration biopsy was performed followed by resection of the lesion.

Case 1 - Figure 1 - Scanning magnification showing sheets of large cells with abundant eosinophilic cytoplasm.

Case 1 - Figure 2 - Mixture of large epithelioid cells with eosinophilic cytoplasm admixed with cells showing optically clear cytoplasm.

Case 1 - Figure 3 - Higher magnification showing cells with abundat eosinophilic cytoplasm and longitudinal cytoplasmic striations.

Case 2

submitted by:
Cesar A. Moran
Anderson Cancer Center
Houston, Texas

Clinical Summary:

A 57 year old man presented with chest pain and shortness of breath. A chest X-ray demonstrated a large anterior mediastinal mass. A complete surgical excision of the mass was performed.

Case 2 - Figure 1 - Scanning magnification shows lymphoid tissue with a scattering of nodules composed of sheets of epithelioid cells.

Case 2 - Figure 2 - Lymphoid stroma surrounding the cell nodules shows lymphoid hyperplasia with prominent germinal centers.

Case 2 - Figure 3 - Higher magnification of cell islands showing bland-appearing oval to spindle cells with abundant cytoplasm.

Case 3

submitted by:
Maria Merino
National Institutes of Health
Bethesda, Maryland

Clinical Summary:

A 52 year old woman with a prior history of infiltrating ductal carcinoma of the breast 10 years ago and bronchioalveolar cell carcinoma of the lung 4 years ago is now seen for hematuria. CT scan revealed a large right kidney mass. The kidney was resected.

Case 3 - Figure 1 - Scanning magnification showing fibrous connective tissue overrun by sheets of atypical tumor cells with extensive areas of necrosis.

Case 3 - Figure 2 - Poorly-differentiated tumor cells are seen entrapping nerves.

Case 3 - Figure 3 - Higher magnification shows atypical, round to oval tumor cells with small nucleoli.

Case 4

submitted by:
Robert Young
Massachusetts General Hospital
Boston, Massachusetts

Clinical Summary:

A 36 year old woman with vague abdominal pain underwent laparotomy. This disclosed a polypoid mass attached to the serosa of the uterine fundus. The mass was dissected from the uterus. Pathologic examination disclosed a 16x14x7 cm., 780gm, bosselated mass that was solid and cystic on cut section. The cysts contained serous fluid. No papillary excrescences were noted within the cyst.

Case 4 - Figure 1 - Low power view showing biphasic neoplasm with cleft-like spaces and cysts lined by a single layer of epithelial cells and an intervening mesenchymal compartment that varies from hypocellular to hypercellular.

Case 4 - Figure 2 - Medium power view showing small ball-like hypercellular areas within mesenchymal compartment.

Case 4 - Figure 3 - High power view showing mullerian type epithelium with bland cytologic features and myogenic nature of mesenchymal component.

Case 5

submitted by:
Dominic V. Spagnolo
The Western Australia Centre for Pathology
Nedlands, Australia

Clinical Summary:

A 58 year old woman was seen for a slow growing soft tissue mass of 5 years' duration located on the instep of the right foot. The mass was subcutaneous and had no neurovascular, muscular or fascial attachments. There is no evidence of recurrence 2.5 years after excision.

Case 5 - Figure 1 - Scanning magnification showing a well-circumscribed, lobulated lesion composed of alternating cellular areas with hypocellular, myxohyaline areas.

Case 5 - Figure 2 - Higher magnification from hyaline area showing scant epithelioid cells set agains a densely collagenized stroma.

Case 5 - Figure 3 - Higher magnification from more cellular area showing proliferation of bland spindle cells adopting a whorling pattern and embedded in a myxoid stroma.

Case 6

submitted by:
Saul Suster
Ohio State University Medical Center
Columbus, Ohio

Clinical Summary:

A 56 year old man was seen for a slow-growing, indolent subcutaneous mass on his left back. The tumor measured 9 x 7 x 5 cm, was well-circumscribed but unencapsulated, and was located above the fascia. The lesion was completely excised.

Case 6 - Figure 1 - Scanning magnification showing sparsely cellular lesion composed of areas showing dense collagen bundles admixed with mature fat, and areas composed of sparse collagen bundles against a prominentl myxoid background.

Case 6 - Figure 2 - Predominantly myxoid area showing admixture of collagen bundles and mature fat surrounded by a proliferation of bland spindle and stellate cells.

Case 6 - Figure 3 - Higher magnification showing small spindle cells with hyperchormatic nuclei and occasional elongated cytoplasmic prolongations (center).