Case 1

SYLVIA L. ASA
University Health Network
Toronto, ON, Canada

Clinical Summary:

This 66 year old woman presented with a neck nodule. She had a history of a long-standing goiter. She was euthyroid; the goiter had been painless and non-tender. She had noted a sudden and rapid increase in size of her right neck in the preceding few weeks. On examination she had an assymetrical large goiter with a fixed 6 cm right nodule. She underwent thyroidectomy. The right lobe measured 6 x 5 x 5 cm and weighed 60 grams. It was multinodular with obvious infiltrating tumor. The left lobe weighed 6 grams and measured 4 x 3 x 1 cm with multiple small nodules measuring up to 5 mm in diameter.

The slide submitted is a representative section of the right thyroid.

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Case 2

DAVID GRIGNON
Wayne State University
Detroit, MI

Clinical Summary:

A 70 year old man was found to have mass involving the right kidney during work up for right upper quadrant pain. There was no significant past history. A radical nephrectomy was performed. The gross description from the pathology report indicated that the kidney contained a "2.0 x 2.0 x 1.8 cm white-grey, fleshy tumor. It is located within the center of the specimen, and appears to involve part of the cortex and an entire pyramid."

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Case 3

CARMEN TORNOS
Memorial Sloan Kettering Cancer Center
New York, NY

Clinical Summary:

A 38 year old woman with a 3 cm palpable mass in the right axilla. The mass was excised. The photos are from this lesion.

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Case 4

DAVID OWEN
Vancouver General Hospital
Vancouver, BC, Canada

Clinical Summary:

The patient is a 38 year old man who came to Vancouver from Hong Kong to seek treatment for a liver tumor which he had been told was unresectable. 18 years prior to this presentation he had an orchidectomy for a teratocarcinoma. At the present time his only symptom was recurrent febrile episodes. On examination he was found to have a mass in the liver. This measured 20cm in diameter and involved most of the left lobe and caudate lobe with compression of the portal vein and common bile duct No extra-hepatic lesions were identified.

Radical surgical excision was considered feasible. A mass weighing 1.5kg was excised. It was poorly circumscribed and the cut surface showed multiple necrotic and hemorrhagic foci interspersed with tan-grey tissue. The areas of background liver were non-cirrhotic.

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Case 5

GREGORY N. FULLER
MD Anderson Cancer Center
Houston, TX

Clinical Summary:

A 56-year-old man presented with a history of a left parietal lobe glioblastoma that was surgically resected three months previously at a referring hospital, followed by radiation therapy. He reported increasing frequency of severe headaches and progressive motor and sensory changes on the right side of his body. A subsequent MRI scan revealed a new contrast-enhancing mass in the left parietal lobe at the site of his prior tumor, which was associated with extensive edema of the surrounding brain. The clinico-radiologic differential diagnosis included recurrent glioma, radiation necrosis, abscess, hemorrhage into the tumor bed, and venous infarction. Re-operation was performed for resection of the lesion to relieve the mass effect and provide tissue for a definitive diagnosis so that appropriate treatment could be instituted.

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