CALIFORNIA TUMOR TISSUE REGISTRY

"Tumors of the Breast"

Study Cases, Subscription A

September 2005

California Tumor Tissue Registry c/o: Department of Pathology and Human Anatomy

Lom.a Linda University School of Medicine 11021 Campus Avenue, AH 335 Loma Linda, California 92350

(909) 558-4788 FAJC: (909)55~188

E-mail: clt!@linkline.com Web page: www.cllr.org

Web site & Case.ofthe Month: www.ettr.org

/111-

Targd audience: Practicing pathologists and pathology residents.

Gnl: To acquaint the participant with the histologic featuies of a variety of benign and

malignant neoplasms and tumor-like conditions.

Objectives: The participant will be able to recognize morphologic featuies of a variety of benign

and malignant neoplasms and twnor-like conditions and relate tb.o.se processes to pertinent references in the medical literature.

Educational methods and media: Review of representative glass slides with associated histories. Feedback on consens<L• diagnoses from participating pathologists. Listing of selected references from the medicallitJ:rnture.

Principal f!cu!!y: Weldon K. Bullock, MD Donald R. Chase. MD

CME Credit: Lorna Linda University School of Medicine designates tbis continuing medical

education activity for up to 2 hour.~ of Category I of the Physician's Recognition Award of the American Medical Association.

CME credit is offered for the subscription year only.

Accreditation: Lorna Linda University School of Medicine is accredited by the Accreditation

Council for Continuing Medical Education (ACCMB) to sponsor continuing medical education for physicians.

Contributor: K. Greg Peterson, M.D. Case No. 1 - September 2005 Sioux Falls, SD

Tissue from: Breast Actession #29250

Clinical Abstract: A 65 year old woman was found to have a breast mass, which was excised.

Gross Pathology: The breast resection specimen contained a 5.1 x 4.7 x 3.9 em yellow-red hemorrhagic, focally

cystic mass.

Contributor: Mark Janssen, M.D. Case No. 2 - September 2005 Anaheim,CA

Tissue from: Rigbt breast Accession #29476

Clinical Abstract: Following diagnosis and counseling for neurofibromatosis, this 34 year old woman was found

to ·bave a nodule in her right breast.

Gross Pathology: The 4.5 gram, 2.5 em resection specimen contained a 2.0 x 1.5 x J .5 em denSe yellow-white

nodule with an adjacent0.5 x0.5 x 0.3 em calcified white area. ·

Contributor: Roger Terry, M.D. Case No. 3 - September 2005 San Gabriel, CA

Tissue from: Left breast Accession #30000

Clinical Abstract: A screening mammogram showed an ill-defined solid mass in the upper outer quadrant of the

left breast of this 71 year old woman. She bad a strong family history of breast cancer.

Gross Pathology: A 4.2 em diameter firm white mass was sent for frozen section. The mastectomy specimen

included a biopsy cavity but showed no dominant mass. Study set slides are taken from the mastectomy specimen.

Contributor: Mark J anssen Ana beim, CA

Tissue from: Right axillary node

Clinical Abstract:

Case No. 4 - September 2005

Accession #28092

This 72 year old woman presented with erythema of her right breast and subsequently developed a right axillary mass. Breast biopsies were non-diagnostic. The axillary mass was excised.

Gross Pathology: The 5.1 gram, 3 x 2.5 x 1.5 em ovoid lymph node had a variegated cut surface with areas of

firm white tissue and focal necrosis.

Special Studies: ERIPR negative

Contributor: 'Morteza 'Moussavi, M.D. Case No. 5 - September 2005 E l Centro, CA

Tissue from: Rigbt breast Accession #29467

Clinical Abstract: During self-examination, a 39 year old woman noted a mass in the upper outer quadrant of her

right breast. She had no family history of breast cancer. Physical examination showed a smooth, freely moveable 6 em mass.

Gross Pa thology: The 6 x 6 x 4.5 em, soft, weU-encapsulatcd mass had a lobular pink-tan cut surface.

Contributor: 'Mark DeMeo, M.D. Case No. 6 - September 2005 San ta Rosa, CA

Tissue from: Left breast Accession #29078

Clinical Abstnct: A nodule was discovered in the left breast of this 44 year old woman.

Gros.1 Pathology: The specimen consisted of a 3 x 2.5 x 2.5 em nodular portion of soft, white-tan tissue.

Contributor Alexander Lyster, M.D. Case No. 7 - September 2005 Victoria, TX

Tissue from: Right breast Accession #30238

Clinical Abstract: A 25 year old woman presented with a mass in herright breast Physical examination showed a

large mass with an adjacent satellite nodule.

Gross. Pathology: · The I U gram, 8 x 6 x 4 em fmn mass was well circumscribed and had a solid, golden tan cut surface. Adjacent to it was a 1.5 em, well circumscribed hard gray nodule.

Contributor: Xuedong Wang, M.D. Case No. 8 - September 2005 Pasadena, CA

Tissue from: Right breast Accession #29661

Clinical Abstract: Six weeks prior to admission, this 86 year old woman noticed a mass in her right breast.

Mammogram showed a large mass with features suspicious for carcinoma. Physical exam showed a 5 em mass with indistinct borders and overlying dimpling of the skin. An axillary nodule was also noted.

Gross Pathology: Deep within the mastectomy specimen was a 5.5 x 4.5 x 2.5 em, fillt), pink-tan mass with

irregular borders. The cut surface was generally solid with small foci of necrosis.

Contributor: Henry Tesluk, M.D. Case No. 9 - September 2005 Sa.cramento, CA

Tissue from: Left breast Accession #29138

C linical Abstract: After developing a cough, shortness of breath, chest pain and weight loss, this SS year old

woman, with a long history of alcoholism, presented for medical care. She was treated for pneumonia but deteriorated rapidly and died. During her hospital stay, she was noted to have an ulcerating breast tumor.

Gross Pathology: Autopsy findings included the ulcc;rating left breast tumor with widespread metastases,

including axillary nodes, lung, tiver and vertebral marrow.

Suecial Studies: Cbromogranio strongly positive

Contributor: Jin Mei, M.D. Case No. 10 - September 2005 Haogzhou, China

Tissue from: Right breast Accession #30328

Clinical Abstract: This 20 year old woman had a right breast mass that gradually enlarged for more than a year.

Physical examination showed a large, richly vascular mass that displaced normal breast tissue.

Gross Pathology: . Within the mastectomy specimen was an 8 x 6 em dark red mass with a spongy cut surface and

ill-defined borders.

. .

CALIFORNIA T UMOR TISSUE REGISTRY

BREAST PATHOLOGY

Minutes- Subscription A

September, 2005

SUGGEST ED READING (General Topies from Recent Literature):

Update on Detection of Sentinel Lymph Nodes in PatientS With Breast Cancer. Aarsvold JN, and Alnzraki NP. Scm Nucl Med2004; 35: 116·128.

Nulritional Genomics in Practice. Where Do We Begin. DeBusk RM, Fogarty CP, eta!. J of Am Diet Assoc 2005; 105:589-598.

Introduction. TtanSiating New Biology Into Clinical Practice. Tefferi A. Gene in Clin Prac 2005; 80(1 );61-62. Lymphatic Mapping and Sentinel Node Biopsy. A Surgical Perspective. Koleya RN, Heckman JT, Most M, et al.

Semin Nucl Med2004; 35:129-134.

California Tumor Tissue Registry c/o: Department of Pathology and Human Anatomy

Lorna Linda University School of Medicine 11021 Campus Avenue, AH 335 Lorna Linda, California 92350

(909) 558-4788 FAX: (909) 558-0188

E-mail: C!ll@linkline.com Web site & Case of the Month: W\YW.cttr.org

Case 1:

Case2:

Case3:

Case 4:

Case 5:

Case6:

Case7:

Case 8:

Case 9:

FILE DIAGNOSES

CTTR Subscription A September, 2005 (If possible, submit answers on website at www.cttr.org.

Click "subscriptions", then click submit answers".)

Adenoid cystic carcinoma, breast T-04000, M-82Q03

Inflammatory myofibroblastic tumor/pseudotumor, breast T ..{)4000, M-76820

Florid ductal hyperplasia and focal micropapillary DCIS, breast T-04000, M-72420

Metaplastic carcinoma metastatic to axillary node(s), breast T-04000, M-80106

Phyllodes tumor, breast T-04000, M-90213

fibroadenoma, breast T-04000, M-90100

Adenomyoepithelioma, breast T-04000, M-81400

Infiltmting high grade ductal carcinoma, breast T -04000, M-85003

Infiltrating lobular carcinoma with neuroendocrine feature, breast T -04000, M-85202

Case 10: Angiosarcoma, breast

T-04000, M-91203

CTTR, September 200$ "Minutes" (Subscription A)

Case No. t, Accession No. 29250

Alameda (Alameda County Medical Center) • Adenoid cystic carcinoma Bald>'jn P11!1< CKajser l'ennanentel - Adenoid cystic carcinoma (3) Fresno {St. A!!lJCS M¢jcal Center) - Adenoid cystic carcinoma Fontana lX•iv Pcmwtentel - Adenoid cystic carcinoma vs.. adcnomyocpithelioma Glendale - Adenoid cystic carcinoma HaV\wtd/Fremont - Adenoid cystic carcinoma Lorna Linda a.oma L.jnda Pathology Residents> - Adenoid cystic carcinoma. breast Long Beach (!.llkewoos! Regional M¢jcal Center\ - Adenoid cystic car<:inoma (7) Momerey CCommuoitv Hospital of Monterey Peojnsu1al - Adenoid C)'$tic carcinoma Mountain View <EI Camino Hospital) - Adenoid cystic carcinoma Oakland <Kaiser Peqnancntcl - Adenoid cystic carcinoma (4)

Oranoc <Omngc Cqynw Medical Group) - Adenoid cystic carcinoma Riverside <Kaiser Pormnnentcl • lnfilttating ductal carciJloma. adenoid cystic lyp<: San Diego !Naval Mcdjcu! Center) - Adenoid cystic carcinoma (2) Santa Barba!ll <Couaae HQSPitall - Adenoid cyStic carcinoma Saota Rosa CSI!n!a Rosa Memorial Hospital> - Adcnocystic carcinoma (3) Ventura - Adenoid cystic carcinoma Woodland HU!s - Adenoid cystic carcinoma ArizonA Phomjx - Adeooid cystic carcinoma Arkansas !UAMSI - Adenoid C}"Stic carcinoma. breast Colorado !Evcmm;ul - Adenoid cystic carcinoma Florida <Baotist Hospital! - Adenoid cystic carcinoma oflhe bn:nst (3); Secretory carcinoma (2)

Florida !Tal!abasscel - Cribrifonn carcinoma, invasive and in-situ Florida CWiotcr Uoycnl - Ade-noid cystic carcinoma Illinois (fairview Rjdgcs Hospilall - Adenoid cystic carcinom• (2)

September 2005

Illinois (Loyola UojyersiJy ofCbjcago) - Adenoid cysticcarcinom~ grodc 2. (e-kil and collagen 4 immunoperoxidase stain to confim1 diagnosis)

Illinois <Naval HO>lJiluVGreut Lakes! - Adenoid cystic carcinoma O!jnols COak llrnokl - Adenoid cystic carcinoma Indiana fKakomo Patholoaist llealth System\ - Secretory carcinoma Indiana fSt. Jo:;eph Hospilall - Breast papillasy carcinoma Louisiana <LoujsiMa State lJni\•ersitv Health Service Cen1erl - Adenoid C)'stie Cfltcinorna Louisiana COrlcan• Pnaisb Coronm Office) • Ductal ean:inoma. cribriform type MlJO·Iand I'Na!iona] NayaJ Mc4ica1 Centerl - Adenoid cystic carcinoma Maryland CNorthwest Hospj!al Center) - Adenoid cystic carcinoma ~fassaeh!JSC1!5 CBcr!ss!Jirc Mcdieal Centerl - Adenoid cystic carcinom:~ (8); lnfillraling cribriform <8rC:inoma (I) Michigan {J(AlgmpzMl - AdQioid c:ystic earcinoma Michigan COak;wOO<! Hosnitall - Adenoid cystic carcinoma Michigan CSt. Joseph Mcroy Hospjtall - Adenoid cystic careinom3 New York CLongJsl!l!ld Jewish Medical Center) - Adenoid cystic carcinoma New York {N!lSsau Uniycrnity Mpdical Center) - Invasive micmpapillnry carcinoma New York <Stony !lroo!c University HO>])ital Residents! • Col!u.gcnous (mucinou.•) spherulosis New york <SUNY oowm1u!c Residents) - Adenoid cystic carcinoma New York CWt:~tches1er Medical Center) - Adenoid cystic cnrcinornn vs. collagen spherulosis North Carolina CPi••ab Ass9cj81es of Pathology) - Adenoid cystic carcinoma Oklahoma. Oklahoma CilY - Adenoid cystic earoinoma Oklahoma. Thlsa - Adenoid cystic carcinoma Pennro,1!!li• CA)Icgbcny GcnC!J!! Hospjtall - Adeooid cystic carcinoma Pennsylvania !Conemaugh Memorial Medical Center! - Adenoid cystic carcinoma Pcnnsvlv!!!)iP fDrexcl Unjymitv College ofM¢jcjoe\ - Adeooid cystic carcinoma Penn,wlv!!!)ia !ML Nj!!¥y Medical Center) - lnvasi""' secretory c=inoma

C1TR. September 2005 "Minutes" (Subscription A) 3

Pennsylvania CPewylvania Hospital Residents> · Seaetory C61'Cinoma l'llqto Rico fUnivcailll qfPveno Rico) • Adenoid cyslic can:inoma Texas fGeorgetOW!J licahllcare System) • Secretory carcinoma Texas. Houston .. Possible adenoid cystic carcinoma TcXIL'!, Lubb9ck • Mixed cribriform and adenoid cystic carcinoma TexM (ProP!Ilh A$19Cjntcsl • Adenoid cystic carcinoma (2) TexM. San Antoojo . Adenoid cystic carcinoma tau <Scon & White Memorial Hospital> .. Invasive aibrifonn carcinoma Texas !Wilford Hall Modica! Center) · Adenoid cystic carcinoma W!L<hington !Lower Co!wnbja Pntholoaim. PSl • Infiltrating carcinoma/differentinl between infiltrating duct (with prominent

cribriform pattern wtd adenoid cystic carcinoma) (I); Adenoid C)'Slic carcinoma (5) Wesl Virginia CGreenbder Valley Medical Center\ · Adenoid cystic carcinoma West Vinzinia fWet:tcl County Hosoitall • Adenoid cystic carcinoma Wj!!CO!lSin (Massh!ield Cljnicl · M3Dll1181)1 adenoid cyslic carcinoma AustraliaiNonh Queensland Pathology Group) · Collagenous spherulosis Auf.1ralia <Roval Pdnc;e Alfred Hosnita1l .. Adenoid cystic carcinoma' Austmlia (Su!ljwn Njcglaidcs l'athoiOiY) • Adenoid cystic carcinoma B!'lll.jl /Minas Gemls School ofMcdjcjnel • Adenoid cystic carcinoma, low grade Bruzil Sao Paulg • Adenoid cystic carcinoma (2) C.cnnanv CUKE, Kcmjn!!!jM fur Patholoaic) • Adenoid cystic carcinoma Jamaica C!bc UnivC!SiiV of !he West lndjC$) · Adenoid cystic carcinoma Jl'Mn CKyoto University Hrumitall - Adenoid cystic carcinoma Netherlands. Amstclyecn · lnfiltrnting ductal adenocarcinoma (salivary g!und·likc type) Onw (Hamad Me<lica! COmor>~tionl • Collagenous spbcruJosis associated with fibrocystic changes

Cm 1 . Diagnosis: Adenoid cystic carcinoma, breast

T ..Q4000, M-82003

Case I References: Lamovcc J, Us-Kmsovec M. Zidar A and Kljun A. Adenoid Cystic Carcinoma of the Breast. A Histologic, Cytologic and

Immunohistochemical Study. &min Diogn Potho/ 1989; 6(2): I 53·164. McCiennthall JH and de Ia Rou 0. Adenoid Cystic Breast Cancer. Am J Surg 2002; 1&3(6):646-649. Arpino G, C!arl< QM, Mohsin S, ct a!. Adenoid Cystic Carcinoma of the Breast. Molecular Markers. Trcatmcn~ and Clinical Outcome.

Cancer 2002; 15:94(8):2119·2127. Mi!!Rr BA, Kerba M, Youngson B, et nl. The Potcntial l{ole ofBrt!L<l Conservation Surgccy and Adjuvrull Breast Radiadon for Adenoid

Cystic Carcinoma oflhe Breast. Breast Cancer Res Treat 2004; 87(3):225·232. Shin SI and Rosen PP. Solid Vadant of Mntnmacy Adenoid Cystic Carcinoma with Basa!oid features. A Study ofNine Cases. Am J

Surg Patho/ 2002; 26(4):413420.

Case No • . 2, Accession No. 29476 September 2005

Alameda IA!amoda Coumy Me!liea! Ccn!Ct) · Atypical spindle cell proliferation (di~~gnosis requires immunoperoxidasc stains) Baldwin M!K•i• Pmnanentel • Ncurofibroma(2); Neurofibroma with chronic inflammation (I) fresno 1St. Agnes Msc!ical Center) • P!osma cell mastitis l'onlana (Kaiser Pennanente) • Inflammatory pseudotumor vs. rasciitis VS. neurofibroma G!L11dale • Metaplastic ossification Hoyward/Frcmonl • lnOammaloty pseudotumor (inflammutory myofibroblastomu) [,qma Linda fLcma Linda Pntholooy Residents) • Periphernl nerve sheath tumor V$. neurofibroma Lonolleoch O.allewooc! Rttiona! Mes!ica! Center\ • lnflamrnatocy pseudo(umor wilh ossification (7) Mpnterey <Communjty Hospjtal o[Montqcy Peninsula) - Metaplastic carcinoma Mnun!ain View ffil Camino Hospilltll · Spindle cell carcinomn Oakland rKaiscr Pcrmunentel · Neurofibroma witb mctap!u:;tic clements (4)

4 CTTR. Scpto:mbct 200S "Minutes" (S\obscripcion A)

Orange <Orange County Medical Group) - Neurofibroma Rjversjde (Kaiser Pennanentel - Osseous metaplas).a with dense plasmacytic infiltrate (need kappa/lambda immunos!ains for

monoclonality} San Diego !Naval Medical Center> - Inflammatory m~ofibrobla<tic tumor (1); LJ11lphoc)1ic mastitis (I) SantaBarbara (Cottage lfo;pitall - Atypical myxoid myofibroblastoma with plasmacytosis Santa Rosa <Santa Rosa Memorial Hospital) - Neurofibroma (2}; Benign focus of fibrosis, chronic inllammatioo, metaplastic bone

fonnation, and n.'l!Ctive stromal changes (I) Vonturn - Osseous metaplasia Woodland IDIIs - Myofibroblastic pseudotumor Arizona. Phoenix - Plasma cell mastitis Arltansas fUAMSl - Neurofibroma, breast COlorado !Evergreen) - lnflammatory myofibroblastic tumor Florida fBaptistHospitall - ~eurofibroma (5) Florida <Tallahassee) - Metaplastic carcinoma f lorida (Winter Haven) - Ma!>1itis with osseous metaplasia Jllinois (Loyola Univcrsitv of Chicago) - Neurofibromatosis with dense plasma cell infillrate (favor reactive), kappa and lambda light

chain immuooperoxidase stain to ~xclude plasma eel) dycrasia DiffDx: includes metaplastic carcinoma Jlljnojs t'Nnval HospitA] -Gre,-u LaKe.~) - Metaplastic carcinQma with osseous differentiation ll!jnois <Oak Brook) - Ancient schwannoma Jndjana CKa!como Pathologi<t Health Sv<tem) - Neurofibroma with osseous metaplasia Indiana <St. Joseph Hosoitall - Osteofibrous dysplasia Louisiana <Louisiana State Universitv Health Service Center) · Tncipient neurofibroma Louisiana COrJeans Parrjsh Coroners Office) · Neurofibroma with mucinous degenenition !v!aryland <National Nayal Me<ljcal Center> - Neurofibroma Mnrv!and !Northwest Hospj!J!l Center) - Peripheral nerve sheath tumor, favor malignant Massachusetts f lkrl<shire Medical Centctl - Osseous metaplasia Michigan !Kalamazoo) - lntlammatory myofibroblastic tumor Michigan (Oal\wood Hosoita!l - Plexifonn neurofibroma Michigan (St. Joseph Mercy Hospi!J!ll - Nodular fasciitis New York CLong Island Jewish Medical Cooter\ • lnflammatory myofibroblastic tumor New York CNassau Univcrsitv Medical Center) - Plasmacytic ma.1itis with ossification New York (Stony Brook University Hospital. Residents) - Neurofibroma New York !SUNY Downstate Residents\ - Neurofibroma with osseous metaplasialhamarroma New York (Westchester Medical Center) - .lnflammatory pseudotumor North Carolina (Pisgah Associates of Pathology) - lnllammatory pscudotumor/intlammarory myoflbroblastic tumor Oklahoma. Oklahoma Citv - Malignaot peripheral nerve sheath twnor Oklahoma. Tulsa - Inflammatory pseudtumor vs. malignant lymphoma vs. plasma cell jlranuloma Pennsylvania (AIIeghenv General HOSI>ital) - Malignant n:iton tumor Pennsvlvaoia <Conep>augh Meroori!il Medical Center\ - Malignant peripheral nerve sheath tumor Peonsylvanja IDrexel Uniyersjty College ofMedjcjnel - Inflammatory myofibroblastic tumor with ossification!fasciitis ossificans Pennsvlvnnja (Mt. Nittany Me<lical Center) - Myxoid neurofibroma :Pennsvfvania CPennsvlvania Hospital Residents> - Metaphtiiic carcinoma with osseous differentiation Puerto Rico (University of Puerto Rico) - Inflammatory pscudotumor Texas <Georgetown Heallheare System\ - Malignant peripheral nerve sheath tumor with ossificarion Texas. Houston - Myocpithcliwna Texas. Lubbock - Plexifonn neorofibroma with bone metaplasia Texa.• fProPalb Associates) - Neurofibromatous stromal change (1 ); Neurofibromarous change of stroma {I) Texa.c;; San Antonio .. MFR vs. malignant IMT vs. sarcomatoid carcinoma Texa.• !Scott & White Memorial Hospital) - Neurofibroma Texa,.(Wilford Hall Medical Center) - Sarcomatoid carcinoma vs. carcinos.~rcoma Wns1Jjn&lon <Lower Columbia Pal!!ologists, PS) - Sclerosing lymphocytic lobulus(? 4iabctic) (1); Myxoid neurofi~roma with marked

inflammatory foreign body and fibrosis. Mild FCDfpla.'ma cells (I); Malignant peripheral nerve sheath tumor (l); Schwanoma (neurilcmmoma)'(t);Plasma ·cells mastitis(!); Myxoid neurofibroma (I)

\Vest Virginia I Greenbrier Valley Medical Center\ - Neurofibromatosis with osseous me~1plasia

CITR, Scptcmbc' 2005 "Minutes" (Subscription A) 5

We>1 Virginia IWeq.eJ Coum:y HospjtaJ) - Inllamed nourufibroma Wisconsin CM!l!libfield C!iojcl - Myolibrob!sstoma, myxoid variant Austrn!ia <Nortb Queensland Pathologv Grounl - Plasma cell ,_itis/inOammatory pscudatumor Ausl18!ialRoyal Prince Alfred Hosoilall - Inflammatory pscudorumor AI!Sl!jllja ISumyan Njcol1lides Patho!ogv) - Plasma cell granuloma Brazil fMinB.S Gerais School of Medicine) - Inflammatory myofibroblostic tumor "ith bone metaplasia Brazil SIQ Paulo - Benign peripbeta! nerve sheath tumor (2)

Gcnnany lUKE. Kcmjnstitut fur Pathologiel - Neurofibroma Jamaica !The IJnlyersitv of the West Indies> - Melaplastic carcinoma Japan (Kyoto Unixersity Hospital) - ln\'olvcmcnt ofncurofibromruosis NethcriWJds. Amstclycen - Neurofibroma and metaplastic bone fonnotlon and plasmacytic cell infillrnlion Qatar /Hamad Medjcal Coroorutionl - Plasma cell granuloma (inOammmory myoflbroblastic tumor)

Case l- Diagnt'"l~:

Inflammatory myofibroblastic rumor/pscudotumor, breast T-04000, M -76820

Case 2 - References: Fisher, C. Myofibroblastic Malig!W)Cies. Adv Anal Patho/2004; 11(4):190-201. Egden B. ElectrOn Microscopy in the Study ofMyofibroblastic l..esions. S.min Diagn Ptnho/2003; 20(1 ):1l-24. Coffin CM. Watterson J, Priest JR. et aL Ex!Japulmonary lnOammalory Myofibroblastic Tumor (Inflammatory Plieudowmor)-A

Clioicopalbologie and lmmunohislocbclnical SIUdy of84 Cases. Am J Surg Pathol 1995; 19(8):859-372. Hussong JW, Brown M. Perldns SL, et al. Comparison of DNA Ploidy, Histologic and lmmunohistocbcrnical Findinss with Clinical

Outcome in lnfllltnmatory Myoblastic Tumors. ModPatho/1999: 12(3):279-286. Zardawi 1M. Clark 0 and Williamsz G. lnOammatory Myofibroblostlc Tumor of the Breast. A Case Report. Acta Cyto/2003;

47(6):1077-1081.

Case No. 3, Acc:CllSion No. 30000 September 2005

Alameda CA!amcsla County Medical Center\ - Microg!andular odcnosis Wld Intraductal hyperplasia without aiYPi• Baldwin Pad< <Kaj:s;r Pc!!!U!f!entel - Complex sclerosing IC!Iion (3) f!CS!lg !St. ARJlcs MC!!iel Center) - Florid byperpiiiSia Fontana (Kaip l'ennanen!e) - Florid ductal hyperplasia, inlr.lduclal papilloma and adenosis vs. OCJS and myocpilheliosis Glendale - lntnduetal papilloma Hal'Wl!!l!/Fn;QJ()f)t - lntnlduclal papillomatosis Lorna Linda !lAma Uncia fa!ho!ogy Residents) - Sclerosing adcnosis with intraduclal papilloma Long Beach 0 .akcwooa Regional Medical Center) - lntraduclal papillomatosis next to lumpectOmy healing site (7) Monterey !Communi'Y Uosoj!@l ofMonterov Peninsula) - Florid duct hyperplasia Mountain Vjcw (lll Qamino Hospital\ - Microglandular adenosls Oakland CKaisu l'ermanentel - FCC with florid hyperplasia and adenosis (4) Ornnge COnwse Coun!v Medical Group) - Benign papillomns Riverside (Knjst.r Pcrmancntel .. Myoepithelial carcinoma San Djcso fNa)'l!l Medical Center) - Fibrocysticchanges with per!phcrul lnl18ductal papilloma ( ! ); l.ntraductul pupl!lomatosis ( I)

Sarua Barbaro ICotwcc Hosnital) - Proliferntive fibrocystic changes Santa Rosa (Santa Rosa Memorial t losojtall - Papilloma ( I); lntraduclal papilloma (2) Ventura - lntraduclal papilloma Woodland Hills - Malignant myoepithelioma (pending immunohistochcrni$11')') Arizona. Pbocpix .. Melaplastic carcinoma Arkansas !1/AMSJ - lntraduetal papilloma and inOammatory myofibroblastic rumor, b<eaSI Colora!lc ffiysrgreenl - San:omatoid carcinoma

Floric!a mapJiS! Hospj!al) - lntnlduclal papilloma {4); Well-<liffl'cr'C1lliated papillary carcinoma with cyst formation (I ) Florida ITai!Aha.<.<ecl - Atypical duclal hyperplasia. secretory DC IS Florid!! CW)Q!er Hayen) - Pllj)il!omatosis

6 CITR, Septemb« 200S "Minutes" (SubS<tiptioo A)

Illinois lfajryjew Ridges llw itall • lnlnldueul papiUoma with hyperplasia. ? fibromatosis-like metaplastic carcinoma (I) DC IS, micropapillluy aod solid (I)

llliools !!Ayola Univositv of Chicago! • lkni8J1 protifenltive changes, fibrocystic change, florid duetal hyperplasia of the usual type, multiple intrnductal papillomas, adenoois, sclerosing adcnosis, columnor cell change, apocrine metaplasia

Illinois (Naval tlospjtai-Great Lakes) • Fibrocystic disease Illinois !Oak. Brook) • Florid papillomatosis ~Indiana (Knkqmo Pathologist Health s~ . Myoepithelial carcinoma Indiana (St Joseph HosnitaJ\ .. Metaplastic cnrcinoma Louisiana O.oujsinna State !Jniversitv Heal!h Service Centu) • Intraductal papilloma Louisiana !Orleans Panish Coroners Office) • inlnldueul papillary adcnosis Maryland CN!!!ional Naya! Me!lical Ccoterl • Radial scar Marylaru! /Nonh"'CSI Hospjlal Ctnteil • lnlnlduCIJIJ papillomas with atypical hyperplasia M!!.<l!!clruts!!S ll!t!!!s!!ire Me!lical Ccntq) • Metaplastic c:=inoma Mjchjoao (Kalamozool · Rilliial scar Mjebi!!lln !Oakwood RoSpilal} · Benign Phyllodes twnor Miehigrut IS!. Joseph Mcrev Hosojltlll · Proliferative fibrocystic changes New Yorls O.on• I< land Jewish Medical Center) • Florid proliferative fibrocystie changes ""th papillomatosis New York fi'!pssau Univusitv Medjeol Ccmer> • Atypical intraductal papillomruosis New York CStony Brook University Hosnjtal Resjdcntsl - Synovial sarcoma New Yot!c (SUNX DOM!state Resident<) • Papillary inlnlduCIJIJ hyperplasio with atypia New Yor!t IW<S!chcstcr Medical Cen\t!) • Benign proliferative breasl disease Nor!h CaroHna (pjsllllh Associates of Pa!ho!ogyl • Complex sclerosing lesion with focal al}l'ia (?ADM vs. lobular extension) Oklahoma. Oklohoma Ci!V • Fibrosarcoma Oklahoma, Thlsa • Protifenltivc librocy>tie change Ptnnsylvaoja !Allegheny General Hosnj!nl) • Sclerosing papilloma with fibromatosis Ptnnsylyanja IConcmau!!h Memorial Me!ljcal Center} • Fat necrosis with inlnlductal papilloma PennsylyoniaCOrcxcl University College ofMcdjcinel - Sarcomatoid cnrcinomn of the breast ~ylyanja !Mt. Nittany Modjcal Center\ • Mieroglandular adcno5is penn:wlvnnja <Pennsylvania Hospjlal ResjdcJJtsl · Malignant myoepitheliOitll'l Pueoo Rjco lUnivcrsitv of Puerto RiCQl · Nodular sclerosing adenosis Texa< 10comcto"'11 Hcalthcsre SVS!em) • Lipid rich or histiocytic carcinoma TeX&.\ HOU~10o - Apocrine carcinoma Texas. Lubbock • Papillomatosis Texas IProPA!h M;gciatesl • Benign intnldU<tll papillomatosis (2)

Tcx!!S. San Antonjo • Micropapillary OCIS, papillomatosis and fibrocystic changes Texas l§s;ou & Wbile Memorial Hosni!!!ll • Fibrocystic changes with florid non-atypical ductal hyperplasia Tox011 !Wilford Hall Medical Center) • Benign papilloma, librocystic changes and florid usual ductal hyperplasia Washjngton ILow<."l' Columbja Pat!Joloojsts. PSl · Atypical intraductal hyperplo.sia. florid plus other benign chonges (I); FLD with

intraductal hyperplasia,? atypical, sclerosing ndcnosis ( I); Proliferative 6brocystic change with llorid hyperplasia, focal atypical ductal hyperplasia, adcno•is, papilloma, hypcrsecretory change ( I); Tubular ndenosis and sclerosing adenosls, also fibrocystic chan&cs with iittradueul hyperplasia without atypia(!); DCIS/papillary type, focal area suspicious for invnsive (would do actin!PAS) (I); Fibrocystic disease, papillomatoois (I)

West Vjrgioja (Greenbrier Va)Jey Medical Ccntq) · M;cropapi!!ary ductal carcinoma in-situ Wes! Vircinjo /Ws!zcl C9untv flospiW) • Fibrocystic disease with atypical dueul hyperplasia WISCO!)sjn !Marshfield Clinic) · J'ibrocyslie changcsoflxcast Au.5!!ll!ia CNorth Ou<rnsland P;!tholoey Group) • Fibrocystie change with intraduet papillomlliOSis and columnar cell hyperplasia AuSl!!lljA IB!W3,1 Prince Alfred Hospjtall • Mc'lllplastic carcinoma AuSt!llliA !Sul!ivWJ Nicolaides Pathology) • Florid fibrocystic change Bmt.!l IMjnas Gerais School ofModicinel • Myoepithelial carcinoma Brazil. Sao Paulo • Florid epithelial hyperplasia wiUl fibrocystic changes (2) Germany lUKE. Kcminstitut fur P!!lholocicl • Lobular cancerization Jamaica lThc Unj\'crsity ofthe West fndie() . Squamous carcinoma with clear cell features /!l!!j!!l CKvO!o Uni,·crsitv HOS!!jral) - lntradueul papilloma Ne!huJand.<. A!nstclvccn • Myofibroblastoma Oatnr 111omac! Mc!lical Co!J!Orationl · Fibrocystic changes ofbTCaSt with atypical dueul epithelial hyperpwia

CTTR, September 200l "Minutes" (Subscription A) 7

Cue J ~ Diagnosis: Florid ductal hyperplasia and focal micropapillary DCIS, brca.~l

T ..Q4000, M· 72420

Case 3 - References: Newman LA. Locon:gional Ccmrol of Breast Cancer. Surgical Technique Does Matter. AnnSurg Onco/2003; 11(1):11-13. Diezl.K and Sneigc N. Esuogcn Rec:ep<or Analysis for Breast Cancer. Curren! Issues and Keys 10 lncmlsing Testing Accuracy. Adv

A nat Parlro/ 2005; 12(1):10-19. Sauer T, Lomo J, Gam:d 0, et al. Cytologic Features of Ductal Carcinoma In-Silu in Fine-Needle Aspiralcn of1he Breast Mirror lhe

HistopalllOiogic Growth Pauem Heterogeneily and Ornding. C<mcer 2005: 105(1 ):21-27, Kuroda H, Salwnoto G, Ohnisl K. el Ri. Clinical wtd l'nlhologlc l'eaaures of lnva.<lve Micropapillary Carcinoma. Breast Cancer 2004;

11 (2):169-174. Kuroda H. Sakamo1o G, Obnisi K, er al. Overexpn:ssion ofHer2ineu, Estrogen and Progesterone Recoptors in Invasive Micropapillary

Carcinoma of !be Breast Brtmt Cancer2004; 11(3):301-306.

Case No. 4, Accession No. 28092 Septcm her 2005

Al;un<da /Alameda County Medical Cencerl • Squamous cell carcinoma. meiUS141ic Baldwin Pllrl< !Kaiser Pennoncntel - Carcinoma (basosquamous), lung primary ( I): MetaStatic ad<t10$quatnOUS carcinoma (I);

Me18S181ic squamous can:inorna lo lymph node (I); f«soo IS!. A!!DCS Medical Center) - Poorly differtntlated do<W carcinoma fontana (Kaiser Pcrmancntcl · Metastatic metaplastic carcinoma Glendu!e - Mc1USI4Lic squwnous cell carcinoma tlayward/Frcmont - Serosal ductnl breast carcinom•~ metastatic to lymph node l.omn Unda CLoma Linda Palholog:y Residents) - Medullary carcinoma !.ono Beach flakewond Re&ionu! Medical Center) • Metaplastic carcinoma with squamous features (7) Monterey (Communjty Hospital of Monterey Pc;njnsutol .. Adenocarcinoma Mountain View lEl Camjoo Hospital> . Squamous cell carcinoma Oolslood (J{ajser Permanentcl - MdaSWie mc:Uiplastic caseinoma (4)

Oran•• I0!1!JJge County Medical Group) - Mclasltuie carcinoma (mcwplaslic) Rjycrside (Kajsq Pemn\Jlentc> - Metastatic metaplastic carcinoma S:m pjeso (Naval Mcdjcn! Center) - Poorly diO'erentiated infiltrating duciUI carcinoma wilh areas of metaplastic change (I); Poorly

d!tfercoliatcd carcinoma (2); Mewplastlc carcinoma (1) Sama Barbara !Cottage Hospjt!lll - Metaplastic ClllCinoma. metastatic SanJ8 Rosa !Santa ROllll Memorial Hosoi!aD - Mewuuic =cinoma (2); Mctasta~ie squamous tell ClllCinoma (I) Ymll!m - Squamous ceU ean:inoma Wpodland Hills • Melllplastic carcinoma Arir.pna. Phoenix - Mel4plastlc carcinoma, metasllllic from breast Arkgnsa< (IJAMSl - MetapiRSLic carcinoma, meliL>1atic to lymph node Colorado (Evergreen> ~ Metaplastic carcinoma Florjda ffiantjS{tfospilall - Metaplastic carcinoma (4); Mixed ducravsquamous carcinoma (I) florida Cfall8hasseel - Me~aplaslic carcinoma florida (Wmter Haven) - Meraplaslie carcinoma

llljnojs !fairview Ridges HosniJall - Adcnosquamous can:inoma (I); Consistent ,.;th poorly differentiated infillt8ting duct carcinoma (I)

!l!jnois (Loyola UniversitY of Chicago) • Lymph node wilh residual metastatic carcinoma with status post chemotherapy/radiotherapy related changes. Clinical history suggeslivc of inflammatory carcinoma

Illinois <Nayal HoSpilal ..QrMt b!!lresl - MelllSlalic poorly diO'crentiarcd carcinoma I!Unojs /Oak Brook) • Carcinoma, apocrine

lndjllna IKakomo PatholoajSJ l!ealth SYStem) - Mel4st8tic mc:tap13stic carcinoma Indiana ISL Joseph Hosnila!) - Metastatic carcinoma

8 CTTR. S.plcmbcr 2005 "Minutes" (Subscription A)

touisjana <Louisiana State Univcrsitv Health Service Center) - Metaplastic carcinoma Louisiana !Orleans Parrish Coroners Office\ - MelaStatic intraductal carcinoma Maryland <National Naval Medical Center\ • Metaplastjc c-arcin.oma Maryland <Northwest Hospital Center\ • Squamous cell carcinoma Ma.«achusctts (Berkshire Medical Center) • Mecaswic mucoepidermoid carcinoma (I); Metaslalic metaplastic carci.noma (I} MichigAn {Kalamazoo) .. Metastatic metaplastic carcinoma Michigan <Oakwood Ho:mital> .. Invasive carcinoma, with squamou.~"features Michigan !St Joseph Mercy Hospital\ • Mc1ilstatic carcinoma New York !Long Island Jewish Medical Center\ · .Poorly dillerentiated metastatic mammary carcinoma ~cw York(Ji!assou Unjve!lijty Medicai.Center\ • Poorly differentiated squamous cell carcinoma New YorlcfSJony Brook Universitv Hospital Residents\ - Meroplasticcarcinoma NcwYork !SUNY Downs!ate Resi!lent<\ • Metaplastic carcinoma New York (Westchester Medical Center\ • MelliSUitic metaplastic duct carcinoma North Carolina !Pisgah Associates of Pathology\ • Metaplastic carcinoma Oklahoma. Oklahoma City - Metaplastic carcinoma Oklahoma. Tulsa . Invasive metapla<tic carcinoma with ·squamous features Pennsvlvania (Aileg!Jeny Geneml Hospital\ • Metaplastic carcinoma Pennsvlvania !Concmaug!J Memorial Medica! Center\ • Metastatic medullary carcinoma l)ennsylvania £Drexel Universjty Cot1ege of Medicine) .. Metastatic mammary carcinoma, ductaJ t)'pe

Pennsvlvania !Mt Nittany Medical Center! • Meta;'tatic metaplastic carcinoma Pennsvlvania <Pennsylvania Hospital Residents> -lntlamm~tory carcinoma Puerto Rico fUniversitV of Puerto Rjco> - Metaplastic carcinoma/metastatic squamous carcinoma Texas CGeornetown Hcaltbcare System) - Memp'lastic carc-inoma with cllondroid differentiation Texa.c;; Houston .. Metastatic carcinoma Texac;.. Lubbock .. Metastatic metaplastic carcinoma Texas <Pro Path Associates\ • Metastatic breast carcinoma (I); lnOammatory adenocarcinoma of breast-lymph node met. (I) Texas. San Aol!lnio • Metaplastic (sarcomatoid) carcinoma Texa< (Scott& White Memorial Ho,yital\ • Metaplastic carcinoma Texas !WilforQ Hall Medical Center\ • f>.:!ctastatic adenosquumous carcinoma Washington (L9wer Columbia Pa!hologists. PS\ • Poorly differentiated carcinoma, metastatic (I); lnfillrating ductal carcinoma with

squamous mctaplasiaand necrosis metastatic, metaplastic carcinoma (I); Lymph node "ith poorly differentiated mctasrotic carcinoma with squamous differentiation (I); MetaStatic carcinoma. favor breast origin. metaplastic carcinoma with focal squamous differentiation (I); Metastatic mammary carcinoma ductal type, poOrly differentiated (I); Meta:,1atic ndenosquamous carcinoma (I)

West Virginia (Greenbrier Valley Medical Center) - Metastalic ductal cell carcinoma West Virginia (Wetzel Cowlty Hospital\ - Metastatic poorly difierentiated carcinoma with squamous differentiation and necrosis Wisconsin (Marshfield Clinic) .. Metastatic mammary carc.inoma with cartilage metaplasia Austm!ja CNorth Queensland Pathology Group\ • Metastatic in11anunalory carcinoma Austmlia <Royal Prince Alfred Hospital\ • Metaplastic carcinoma Australia !Sullivan NicoiDides PQ!hologv\ • Mctaplastic·breast carcinoma (mainly squamous) Bmzil (Minas Gemis School ofMe4icine\ • Metaplastic carcinoma heterologous, osseous type Brazil. Sao Paulo • Melaplastic carcinoma (Z) Germany (UKE, Keminstilllt fur Pathologic\ - Metastasis (adenosquamous carcinoma) Jamaica <The Universitv of the West Indies\ - Invasive ductal carcinoma, poorly differentiated, n1etastatic Japan !Kyoto Univ=itv Hosnital\ - Squamous cell carcinoma (metaplastic carcinoma) Netherlands, Amstclvc<:n - Metastatic infiltrating ductal adenocarcinoma, matrix producing and squamous ditfer~.'l1tiation Oilar <Hamad Medical Comomtion\ - Metastatic poorly difli;renliatCd carcinoma most. probably of marnmary origin

Case 4 - Dlagnosi~: Metaplastic carcinoma metastatic to ax.iUary node(s), breasr

T-04000, M-80106

Case 4 • References: World Health Organization. Histologic Typing of Breast Tumors. Tumori 1982; 68: I 81·198.

CTIR, Sqncmber 2005 "Minules" (Subscription A) 9

Leibl S, Gosg-Kammcrcr M, Andrea Sommcrsacher MT, ct al. Melllpl•stic Breast Cnrcinomas. Arc They ofMyuepithelial Differentiation? Immunohistochemical Prolilc of SlliCOmatoid Subtype Using Novel Myoepithelial Markers. Am J Surg PaJhol 2005; 29(3):347-353.

Kurian KM and A)..,'lafussi 11. Saroomatoid/Metaplastic Carcinoma of the Breast. A Clinicopathological Study of 12 Cases. Histop<Jtlto/2002; 40(1):5841.

Gobbi H, Simpson JF, et al. MetBplastic Brc.,'t Tumors with a Dominant fibromatosis-Like Phenotype Have a High Risk ofLocnl Recurrence. Cancer 1999; 85(10):2170-2182.

Fisher Bl. Perera FE. Cooke AL, ct ai Long-Term Follow-Up of Axillary Node-Positive Breast Cancer Patients Receiving Adjuvant Systemic Therapy Alone. Pan.em.s ofRccurreoce. lnJ J Rnditu Oneol Bioi Plrys 1991; 38(3):541-550.

Case No. 5, Accession No. 29467

Alameda CAiamcda Countv Medical Cemer) • Fibroadenoma Baldwin Pads (Kaiser Pennancnte) • Phyllodcs, low gmdo (3) Fresno CSt Agnes Medical Center) • Phyllodes tumor, benign fontana CKojsq Pennauentel • Fibroadenoma Glenc!aJe - Fibroadeoo1118 Hayward!fn;mom · Phyllodes rumor, low gmde Lorna Linda fLoma Linda Pg!hology Residents) • Phyllodes tumor Lons Beach !Lakewood Rcsional Medjgl! Center) • Phyllodcs twnor. benign (7) Monterey CCommuoitv Hosnl!al or Montgey Penjnsulal • Phyllodes tumor MOUIItlUn view lEI Camino HOS!!itall • Benign Phyllodes twnor Oakland CKajsq Permaoeotel • Phyllodes tumor, benign (4) Orange COraoge County Medical Group) • Benign Phyllodes twnor Riverside (Kaiser Pcrmanentel • Pbyllodcs tumor San Diego tNayal Medical Cegt«l • Fibroadenoma (2) San!a llarbaA ICotJage HQ8!jl!!l) · Fibroadenoma Santa RosaiS!IIJ!aRosa Mworial HOSpital) · PhyUodes vs. fibroadenoma(!): Fibroadenoma (2) V en IUra • Phyllodes tumor \Voodlnod Hj!!s • Fibroadenoma Arizona. Phoenix • Phyllodes tumor Arkansas !J!AMS) · Filxoadenoma Colorado !Evergreen) • Benign Phyllodes tumc>r Flodd!! fBantin Hospl!all • fibroadenoma with myxoid stroma (2); Fibroadenoma (3) florida CTallnhass:el · Phyllodcs tumc!r Florida CWjnter Haven) • Jlcnig~~ Pbyllodes tumor

September 2005

lllinojs IFajryiew Ridges tlomitall · Fibroadenoma with pseudoaogioll181oid stromal h)']>CfJ>lasia;{l ): Phyllodes rumor ( I) !llinojs !Loyola Uoj\'ersjtv p(Chicago) • Benign Phyllodcs rumor Illinois INaval liospitai ..(Jrem Lakes) • Benign Phyllodes tumor Illinois (Oak Brook) - Pbyllodcs tumor. bcnig~~ Indiana (Kakpmo Pa!holg•ist f!ea]tll System> • Pbyllodes rumor Indiana 1St. IQSph Hosnj!a!l • PbYIIodes tumor Louisiana f!.ouisiana SJAI!l Uni\'crsirv HealJh Service Center) • Phyllodcs tumor, benign Louisiana IOrlcMs PBJlish Coroners Office) • Fibroadenoma Marvland INalional Naval Medical Center) • Phyllodcs tumor, benign Marvland INorthwcst Hospjtal Center) • Bcnig~~ Phyllodes tumor Ma.'!!!3cl(uscti' <Berkshire Medical CenJ&rl • Phyllodes 1Umor, benign Michil!l!J! (JC.alamazoo) • Giant fibroadenoma Michil!l!J! (Oakwood Hosnjtall • Fibroadenoma Michionn ISJ Joseph Mercy Hospital) • Phyllodes tumor New York Q.one Island Jewjsb Medical CenJ&rl • Benign PhyUodes tumor New Yods INassau Univcrsjtv Medica! Center) • Phyllodcs rumor. benign New Y9ds ISJonv Brook VniV<I'llitv Hosnjta] Residcnts) • Fibroadenoma PhyUodcs New York CS!lNY DownsnJC Residents) • fibroadenoma with ductal hyperplasia New York CW.stchester Ms.'!!ical Center! • Fibroadenoma North Cnro!lnn (Pjsgah As$0Ciate.< ofPuthology) · Phyllodes tumor, fuvor benign Oklahoma. Oklahoma City • Fibroadenoma Oklahoma. Tulsa • Fibroadenoma Pcnnsvlvaola (Alleghegy General Hospi!all • Benig~~ Phyllodes Pennsvlvanln CConemauoh Memorial Medjeq! Center) • l' hyllodcs Pcnnsylygnjn Cprexel Unjyersity College of Medicine) - Jlhyllo<les tumor

10 CT11(. Sepccmbc:r 2005 "'Minutes" (Subscription A)

PeruJ.<vlvanja(ML Nii1Bny Medical Centq) • Low grade Pbyllodos tumor Pcnn<ylvonia (pennsvtvania Hospjtal Re5jdcnJS) · Fibroadenoma with focal Pbyllode5 Puqto Rico CUnjvmitv of Puerto Rico\ • Fibroadenoma Ten• CGco!l!s!OWQ H@thcare System) • Fibroadenoma Pbyllodcs Texas, Houston • Fibroadenoma vs. benigJl cystosarcoma Phyllodes with lobular CLS Texas. Lybbock • Phyllodes tumor, borderline Texas CPmPath M:;ocjntesl • Benign Phyllodes tumor (giant fibroadenoma) Texas Snn Antonio · Phyllodes tumor, low grade Tex!lS CSeoll & White Memorial Hospitall • Low gr.Wc PhyUodes tumor Texas <Wjlford Hoi! Medical Center) • Benign l'hyl!odcs tumor (4); Fibroadenoma (I); Fibroadenoma wi~liDH (I) Wnshinston fLower Columbia Pathologists. PSI • Fibroadenoma (2); Fibroadenomallotracanilicular type with focal duct hyperp1B$ial?

Atypia ( I); Fibroadenoma, pericanalicular type (I); Juvenile fibroadenoma with focal sclerosing adenosis (I); Bcnil!Jl eystosarcoma PhyUodes rumor ( 1)

We51 Vjmjnja CG!mlbrier Valley Medical Centql • Pbyl!odcs tumor Weg Vj!J!inia (Wctttl Countv Hosni!l!!) • Fibroadenoma with epithelial hyperplasia Wiscoqsjn !Marshfield Clinic\ • Phyllodes tumor, benign Australia <North Oueepsland Pathology Group\ • Benign Phyl!odes tumor Austmlia CRoy!!l Prince A!f@l Hospital\ • Fibroadenoma witb focal epithelial hyp•-rplasia Ay~tmlin CSy!!iyao Nicolaides P8Jholocyl · Low gmdc Phylfodes tumor Brazil (Minas GCCllis Scbool of Medicine\ • Benign Phyllodes tumor, fibroadenoma Phy!!odes BrnzjL Sao Paulo • Fibroadenoma (2) Germany CUKE, Kcminstilul fur l'alholoejg) • Phyllodes tumor Jamaica Ol!e University of the West Indies> • l'hyllodcs tumor, low malignant potential J8pM CK)'O\O Uniycrsit'' Hospjtall • Phyllodcs tumor, benign Netherlands, Am>1elvccn • Benign Phyllodes tumor Oatar O!&mad Medj<:a! Corporation) • Bcnilll' Pbyllodes tumor

Case 5 • 1Yta&n0$is: Phyllodes tumor, breast

T-04000, M-90213

Case 5 • References: Tse OM, Mu TK. Pang LM, et al. Fine Needle Aspimtion Cytologic Features of Mammary Phyllodes Tumors. Acta Cyto/2002:

46(S):8SS-863. Kodama T, Kameyama K, Mukai M, et nl. ln\'liSi\'c Lobular Carcinoma Arisin& in Phyllodes Tumor of the BreasL Virchows Arch 2003;

442(6):614-616. Cristofanilli M, Gonzalet.-Angulo A. Sneige N, ct al. Jnvasi>-e Lobular Carcinoma Classic Type. Response to Primary Chemolhcrapy

and Survival Outcomes. J Clin Oncoi100S; 23(1):41-48. Sauer G, Oeisslcr H. Swnz K, Helms G, et al. Ultrasound-Guided Largo-Core Noodle Biopsies of Breast ~ions. Analysis of%2

Cases to Determine the Number of Samples for Rc~ablc Tumour Classincatlon. Br J Cancer 200S; 92(2):231 -235. Doyle OJ, Relihan N, Redmond HP. et al. Mei3S1atic Manifestations of Invasive Lobular Breast Carcinoma. Clin Radio/1005;

60(2):27 I ·274.

Case No. 6, Accessio11 No. 2.9078 September 2005

Alameda IAII!J!<da Coontv Medical Ceoterl • Tubular adenoma Baldwjg Pads CKaiserPermanentcl • Fibroadenoma, cellular ( l); DuttaJ adenoma ( I); Fibroadenoma (I} Fresno CSL A@pes Medical Center) • Adenoma Fontana CKajser Pem1anentel · Fibroadenoma Glendale • Adenosis tumor H.avwnrdlfmmont • f ibroadenoma Lo!11J1 Linda !Lorna Linda PiUJtotogy Rcs!dcnls) · 1..ac.1uting adenoma !.one Beach CL8kowogd Regional Medical Center) • Fibroadenoma (7) Monterey <Community Hospital of Monterey Jlenjosulal .. Adenomyocpithcliomn Moun!Ajn view lEI Camino Hospi!Ail · AdCllomyoepi1hclioma OO!ansl /Kaj:;q Pcnnancntcl • Fibroadenoma (4} Oran2e COmo•• County Medical Group) • Fibroadenoma

C!J1\, September 2005 "Minutes" (Subscription 1\) II

Riverside !Kaj:;q Pgmanentel · Tubular adcnomaffibroadenoma SM Diego <Naval Medical Center) - Fibroadenoma (9); Adenomyocpithelioma (8) Sll.!lta Barbara ICot!ru!e 1-!ospilllll - Benign fibroadenoma variMI Santa Rosa (Santa Rosa Memorial Hosp!Jn!l- Adenomyocpithclioma {2) Fibroadeno1na (I)

Ventura - Fibroadenoma Woodland Hills - Juvenile fibroadenoma (fibroadenoma with ductal hyperplasia) Arizona Phoenjx . Fibroadenoma Arkansas CUAMSl - Phyllodes rumor, benign Colon!do fEverl!!'!:enl - '1'ub1dar adcnonla florida <llaptist HospjJall - Hamartoma (I); Juvenile Obroadenoma(l); Fibroadenoma vs. Phyllodes twnor, benign (1): Tubular

adenoma (I); Fibroadenoma ( I) Florida ITallahassm) - Fibroadenoma wriant florida (Winter Hayen) - Tubular adenoma !lljnuis <Fairview Rjdaes Hosoitall - Fibroadenoma (2)

ll!jnoisllovolal!njycrsity ofChicasol - Fibroadenolllll, pcricanalicular lypc Illinois (Naval Hospjtni-Grcat Lakes) - Fibroadenoma Illinois (Oak Brook) - Tubular adenoma !ndianafKakomo Patbologist Health SVSJcml - Fibroadenoma ? with lactational change Indiana 1St. Joseph Hosnilall - Fibroadenoma l&uisiaoa floujsiana State Universjtv Heafth Service Ceptql .. Fibroadenoma Louisiana !Orleans P(lllish Coroners Office) - Fibroadenoma Maryland <Nationul Nnvnl Medical Center) - Nodular adenosis MW')!IMd fNorthwC!!l Hospj)al Center) - Adenomyocpithelioma M•szhUSd.ts lBqksbire Medical CcntW - Fibroadenoma Micbii!8D <Kalamazoo) - Tubular adenoma Michi211n 10a1cwood Ho:milall - FibroadCilolllll, "itb Jibroc:yl>1ic change Michj!l!l!l 1St Joseoh Mercy Hospilllll - Fibroadenoma New Y9£k <Long lslllQd Jewish Medical Center) - Adcnosis tumor New York <Nassau !Jniyersity Medical Cemerl - Fibroadenoma New York I Stony Brook Univasity Hospi!al Resident•> - Myxoid hamartoma New York I SUNY Do"nSJatc ltcsidentsl - Complex fibroadenoma New Yorlc IWeS(ehester Medical Center) - Adenofibroma Nonh Carolina CPjssW1 A>.'<OCiates of l'ruholoCYl - Tubulllt ndcnomllitubulllt fibroadenoma Oklahoma. Oklal!OIDII City - Fibroadenoma Oklahoma, Tulsa - Tubular ad011oma, variMt fibroadenoma PsnnsyiVMia (Allegheny General Hospital! - Adeoomyocpithelioma Pcnnsvlvania IConCDl!!!Joh Meroorial Medical Center! - Fibroadenoma Pennsvlvaoja<Drs;xc! University College o(Mcdjcjncl - Adcnomyoepithc!ioma,tubulartypc Pcnnsylvanja CMt. Njunny Medical Center> · rtibroadcooma Pcnnsy!vanja CPennsvlvania Hospital Rcsjdents) . Du'-1 hamartoma Pueao Rico <University of Puerto Ricol - Fibroadenoma with tubular adenoma Tex8$ IGeorectown tl<al!hcan: System) - Complex fibroadenoma Tcl!t!S. Houston - Rule out carcinoma in lobular fibroadenoma Texas lubboc!s - Fibroadenoma fullS IProPath Msoclatesl - Fibroadenoma (2) Texas. San Antonjo • Fibroadeoorou Texas ISoott & Wbitc Memorial Hospital\ • Fibroadenoma Texas (Wilford Hall Medica! Center! - Fibroadenoma Washineton CJ,owqColumbia PatholoaiAA PSI - Fibroadenoma (I); Fibroadenomafmtrncanalicular I)'J)C with focal duct hyperplasia.?

atypical ( I); Fibroadenolllll, pcricana!ieular cypc (1); Juvenile fibroadenoma with focal sclc:rosing adenosis (I}; Adenomyocpithelioma (I); Adenoma (I)

Wost VirVnja COn;cnbricr Valley McdiAAI Center) - fibroadenoma West Viroinja IWct>cl County Hospital! - Tubular adenoma

t2 CTTR. Septemb« 2005 "Minutes" (Subscription A)

\Visconsjn (Marshfield Clinic) • Juvenile fibroadenoma AUS!I'A!i• <North Ouecnsland Pa!!Jology Group) - Tubular adenoma Aymo!iafRoyal Prince Al!h;d Hosoitllll - Myoid MmMioma A\Lffmlia fSulliv!l!! Nicolaides l'athologyl - Myoid hwnartoma Brazil !Minas Gerais School ofMc!licinc) - Juvenile (cellular) fibroadenoma Brazil. Sw .Paulo - Juvenile fibroadenoma (2) Germany lUKE. Kcminsti!U! fur PadtoJogie) - Fibroadenoma Jamaica !The Oniyersity of the Wnt Indies\ - Tubular adenoma, complex fibroadenoma 1!"0 (Kyoto University l-lospjtall • Fibroadenoma Netherlands. AmSJelveen - Bn:ost in breast (h:mwtoma) Oatar fHII!!lad Medica! ComoraUonl - fibroadenoma

Case 6 - Diagnosis: Fibroadenoma, breast

T-{)4000, M-90100

Case 6 - References: Rix DB. Tredwell SJ and Forward AD. Cystosarcoma Phylloides (Cellular lntraeanalicular Fibroadenoma). Clinical-Pathological

Relationships. CanJ Surg 1971; 14(1):31-37. Smith C. Jr., Parsons RJ and Bogart WM. Giant lntnu:analicular Fibroadenoma. A Report of Five Cases. Ca/i[Med 1951; 75(2):101-

104. Ng WK. Fine-Needle Aspimtioo Cytology of Fibroadenoma with Multinucleated Stromal Giant Cells. A Review of Cases in a Six-Year

Period. Acto Cyro/2002; 46(3):535-539. Davis C Jr and Patel Y. Surgical Problems in the Management of Giant Fibroadenoma of the BreasL Am J Ob>tet Gyneco/ 1985;

IS2(8): 1010-101 S. Shimim 1', Ebihara Y, Scrilawa H, et aL Histopadtolosical Study of Stromal Smoo!JJ Muscle Cells in Fibroecknoma of the Breast.

Pothollntl996; 46(6):442-449. StW$ 0 , Bonk U, Wunschura S. et al. A Fibroadenoma with a t(4;12)(q27;qiS) AR'ectlng the HMGI-C Gene, A Member of the ~ligh

Mobility Group Protein Gene Family. Breast Cancer Ru Treat 1996; 38(3):299-303.

Case No. 7, Accession No. 30238

Alameda !Alameda CouniV Medical Center\ - Adenomyoepithelioma Haldwjn Pork <Kaiser Pennaneotel - Tubular adenomo (3) Fresno 1St. Agnes Medical Ceoterl - Lactating adenoma Fon!Ma (Kaiser Pcnnaneg!e\ - Adenoma Glendale - Adcnomyoepi!!Jclioma li!IY»"an11Fn:mont • Tubular adenoma ( I); I vote tubula. adenoma with adenomyocpitbeliomatous fcatu~ (I) !.oma Linda (Lorna Linda Pathology Residents\ - Adenomyoepi!!Jelioma Lono Beach fi.akewood Rcgjopa! Medjelll Center\ - Tubular adenomyoepi!!Jelioma (7)

Monterey CCommunirv Hoscital of Monterey ·reninsu!V · Micropapillruy ca.rcinoma Mountain Vjew lEI Cwnjno Hosojtall - Tubulat adenoma Oakland /Kaiser Pennanente) - Adcnomyoepithelioma (4} Orange !Ornoge Coumx Mcdjca! Group\ - Adenomyocpithclioma Rivcajdc CKaiser Pennanentel - Tubular adenoma San pjceo {Naval Me!lical Center\ - Adcnomyoepithelioma (I 0); Tubular adenoma (7)

Sanm Barbara fCouagc HosoiJA!l - Tubular adenoma Slll!ta Rosa I Santa Rosa Memorial tlospita!l - Tubular adenoma (2): Microglandular adcnosis ( I) Y£nlliDI • Tubular adenoma Wpodlnnd Hills - Tubularndcnoma Ariwnll. Phoenix - Adcnomyoep!U•elioma AtkMS!!S Cl!AMS\ - Tubular adenoma. breast Colora!lo !E\'ergreenl - Adcnomyoepitbetioma florida fBBptjst Hosoill!ll - Tubular adenoma (4); Fibroadenoma (I)

C1TR. September 2005 •Minute>" (Subscriptioo A)

September 2005

13

Florida !Tal!nha<.«:el - Tubul.ar adenoma Florida <Winter Haven> - Adenoma lllinojs (fairyiew Rjd&CS Hosnillll) - Adenomyocpithelioma (2) llljnojs O,oyo!a Unjyqsily ofChic:agol ~ Adcnosis twnorhubular adenoma lllioojs CNpyal Hospjta)-<Jmst Lakesl · Lactating adenoma 111inois (Oak B!l!Ok) - Adenomyoepitheliomo Indiana fKoknmo Pathologist Health Svstem) · Lactating adenoma Indiana !St. Js!SCPh Homitall - Tubular adenoma of breast Louis-iana CLouisjana Sl41C llnjversity Health Service Center) - Tubular adenoma louisiana !OrlCM,< PaaJsh Coroners Office! - Tubular adenoma Maryland INJ!Ijnoa! Nayal Medjca! Center\ - Myoepithelioma Maryland !Nonhwe§! t!ospjtnl Center> - Adenosis tumor Ma.sachusgt(S !Bedsshjre Medical Centetl - Tubular adcnomu Michigan !Kalami!lMI - Adenomyoepilhelioma MichisWI (Qak;wood Uospital) - Tubular adenoma Michigan CSt Jost_pb Mercy AosoitaD · Tubular adenoma NeW York (long Is!und Jcy,ish Medical Center) - Tubular adenoma New York, <Nom" University Medical Center) . Tubular adenoma N£w York !Stony Brook Uniymity Hospital Residents) - Tubular adenoma New York ISVNY Do"DS!Ble Resic!ent<l - 1\lbular adenoma New York !*-<!Chester Me4ic:a! Center> - Tubular adenoma Nortb Carolina CPjssah AssociatesofPatbolocyl - Adenomyocpilbc!ioma Oklahoma. OklAhoma City - Adcnomyoepithelial adenoma OI!Jahoma. TulSA - Adcnomyoepithelioma PennsylyMjA tA!lcgheny General Hm:nitall - Tubular adcnomu PennsylywJja <Conemaugh Memorja! Medical Center} ~ Tubular adenoma l'ennsylyao!n (Drexel llgjyersity ~ollc:ge of Mt<licincl - Tubular adenoma Pcnnsvlvani• (Mt. Njuruw Medical Center) - Tubular adcoomn Pennsylvania C!>ennsylvanin Hospital Rc:sidcnlo;l ·Tubular adenomn Puerto Rjco CUnjyersjwofPueno Rico> • Lactating adenorun TC1111S !Geo!lletown Hc:aJthcare System) - Tubular adenoma Texas Houston .. Adenoma Texas. Lubboc!c - Tubular adenoma Texa.< CProPJ!!b AS""ti8!<8) - Tubular adenoma (2) Tree. Sao Antoojo • Tubular adenoma Tens CScou £ White Memorial Hosnitall - Tubular adenoma Texa:; !Wilford Hall M¢ical Ceoter) - Tubular adenoma \Vashinaton O.Owq Columbia Patho!oajSJS. PSl - Tubular adenoma (3); Adeoomyoc:pithc!iomo (I); Juvenile papillomlllosis (1);

Lac:tating adenoma (I) West Virginjg CGreenbrier ynlley Medical Center) · Juvenile adenomn W.,1 Vimin!a !Wetz,el Countv Hospital) - Tubular adeoomu Wisconsin CMml!blicld Clinic) - Adcnomyocpithelioma A~1mlia <Noah Queensland Pathology Group) - Microgla.nduhU' ndenosis~ lactating nodule Aus\I!!Ihl ffioynl Prince Alfred Hospital) - Adeoomyoc:pithe!ioma, adcnosis typelwbu!ar adenoma Austmlia(Su!ljyllll Nicolaides Pathology} - TUbular adenoma Brazjl !Min!L' Gcrnjs School of Medicine) - Invasive aprocrinc carcinoma. high grade Brazil Soo Pay!o - Tubular adenoma (2} Germany N KI?. Keroin.<titut fur Patbolo•ie) - Nodular adenosls Jpqica Cibe UojymjN ofJhe West Jndicsl · AdcoomyOC!)ithelioma. brtaSt Japan CKyP!o Unjymjrv HQS!!illll) - Tubular adenoma Netherlands. Arnstelvem - Tubular adenoma Oa!ar !Hamad Me4ical Corporation) - Tubular adenoma

14 CTIR, September 200S "Minutes• (SubS<ripdoo A)

Case 7 - Diagnosis: Adenomyoepithelioma, breast

T-04000,~-81400

Case 7 - References: Loose JH, Patchefsk-y AS, Hollander JJ, ct a!. Adenomyoepithelioma of the Breast. A Spectrum of Biologic Behavior. Am J Surg

.Patho/ 1992; 16(9):868·876. Zliang C. Quddus ll<fR and Sung Cl. Atypical Adenomyoepithotiomu of the Breast. Diagnostic Problems and Practical Approaches in

Core Needle Biopsy. Breast J2004; 10(2):154-155. Chllllg A. Bassett Land Bose S. Adcnomyoepithelioma oflhe Breast. A Cytologic Dilemma. RepOrt of a Case and Review of the

Literature. Diagn Cytopalho/2002; 26(3):191-196. Reis-Pilho JS, Fulford LG, Crebassa B, et al. Collagenous Spbcrulosis in an AdenomyoepiUlelioma of the Brea<t. J C/in Patho/2004;

57(1):33~. Howlett DC, Ma.<On CH, Biswas S, et al. Adcnomyoepilhelioma of the llreasL Spectrum ofDiscase with As.wciated Imaging and

l'athology. AJR Am J Rocntgeno/2003; I 3()(,3):799-303. Ng WK. Adenomyoeilllelioma of the BrcasL A Review oflbree Cases wiUt:Reappraisal oflhe Fine Needle Aspiration Biopsy Findings.

Acta Cyto/2002; 46(2):317-324.

Case No. 8, Accession No. 29661 September 2005

Alameda I Alameda County Medical Center! - Apocrinecarcinoma, inVIlSive Baldwin Park !Kaiser Perrnanente) - Grade 3 ductal carcinoma with ex,tensive lymphatic/vascular i•wasion (I); Infiltrating poorly

differentiated ductal carcinoma and high grade DCIS ( I); Grade 3, infiltratingduc1al carcinoma (I); Fresno (St. A&Jles Medical Center) • Poorly differentiated invasive ductal carcinoma FOntana CKaiser Permanentel • Invasive ductal carcinoma and comedo DCIS with aprcx:rine features Glendale • Infiltrating ductal carcinoma Hayward/fremont • Ductal carcinoma (apocrine features) Lorna Linda Odoma Linda Pathology Residents) · (nvasive ductal carcinoma Long Beach (Lakewood Regional Medical Center) · Infiltrating ductal carcinoma (7)

Monterey (Communitv RosprtaJ of Monterey Pcn"insulal · Invasive ductal carcinoma, comedo DCIS Mountain View CEI Camino Hospital). • lrifiltrating ductal carcinoma, ~de 3

Oakllind (Kaiser Pennanentcl • High grade infiltratingductal carcinoma (4)

Oranse COmoge County Medical C1!'0up1 · Invasive mammary carcinoma, 'NOS Riverside (Kaiser Pennanentel - Infiltrating ductaJ carcinoma, Grade 3 San Djeoo !Naval Me!ljcal Cen1er> • Poorly differentiated infiltrating ductal carcinoma with apocrine features San(a Barbs!ll !Cottage HOSililll!l • Infiltrating ductal carcinoma, high grade Santa Rosa !San!A ROlla Memorial Hosoitall- Infiltrating ductal cacci.noma (2); Invasive ductal carcinoma ( 1)

Ventura . lnliltiating ductal carcinoma Woodland Hills - Ductru carcinoma, poorly difr<'re!ltiated Arizona. Phoenix - Squamous cell carcinoma Arl<ansas CUAMS\ · MammlU)' duct cell carcinoma,NST Colorado !Evergreen) • Infiltrating ductal carcinoma Florida <Bantist Ho>pital\ • Higb.gra(le invasive apocrine carcinoma (2); Infiltrating duct adenocarcinoma, poorly differentialcd (3) Florida !Tallahassee\ ·Pleomorphic lobular carcinoiJU!. duc1al ctm:inoma, get c-cadberin Florida C\Vintcr Raven) · fnvasivc ductal carcinoma Illinois !Fairview Ridges Hosnilal\ • Infiltrating ductal carcinoma with apocrine differentiation (I); Infiltrating duct carcinoma, Grade

III, DC IS, Grade 3 ( I) Q Illinois !Loyola University ofChicaoo\ · Infiltrating duc!AI carcinoma, grade 3/DCIS solid type, nuclear grade 3, with necrosis and

microcalcificatioo Illinois !Naval Hospital -<;reat Lakes) - Infiltrating ductal carcinoma, gTdde Ill, \vith apocrine features

Illinois I Oak Brook\ • Carcinoma Indiana (l<akomo Pathologist Health System\ • Ductal carcinoma J.wli.ooa ISLJoseph Hosnitall • Apocrine carcinoma of breast Loujsiana <l&u1siana State Uni.versity Health Service C..enter) - Jn:filtradng ductal carcinoma with foci ofDClS

CITR, September 2005 "Minutes" (Subscription A) IS

Louisiana COd CAns Parrish Coroners Office) .. Lobular carcinoma Mlyyland <Na!jona! Naval Medical Center) • Infiltrating ducwJ carcinoma M!IO'!and !Nort!JwCSI HospitAl Cenwrl · Higll grade invasive duelal carcinoma Meye~USC!!i l!lqk.<hire Me!liClll Cenlcrl • Invasive duoul can:inoma Michigan CKa!amazool .. Jnvash•c ductal careinoma Michigan (Qnkwood Hospjtoll .. Invasive duc.tnl carcinoma Michigan (St Joscnh Mercy Hospital) - 0u._1al carciooma New Yor!c Qpng l<laru! Jewish Medjea! Center> • Invasive poorly dilfd'CfltiOled dudal c:arcinODil\? apoc;rine fc:alures New Yonc INAAWJ Univmity Modical Ccntcrl - Poody dilferentialed ductal carcinoma with vascular invasion New York (Stony Brook Unjyersity Hospital Residents> · lnvash•e ductal carcinoma with apocrine features and DCIS New Yonc I SUNY ))ownstaN Resjdentsl - Infiltrating ductal c:&<:inom3 with apocrine features, higllpe New York <Westchester Medical Center) • Invasive duct carcinoDil\ Nonh Carolina IPist&h Assgc:jiJeS of1'81hg!pgyl - lnfil!l'llling duelal carcinoma and hi&h grade DCIS (? aproerine features) Oklahoma. Oklnhoma Citv • lnfillratiog du(.1al carcinoma with focal DC IS Oklahoma. Tulsq • Infiltrating carcinoma probllbly duciJI.I pending e-cadberin result PenMy!vania (Allegheny Genm!l Hospital) - Invasive ductal carcinoma, NOS Pennsylvania !Copemaugh Memorial Medical Center) • Invasive dudal can:inoma, poorly differentiated Pepnsylvanin tprexel Univertjly College of Medicine) • Infiltrating mwnmary carcinoma, ductal Jype, nuclear grade rn Pcnnsvlvania CMt. Nittany Medical Center> • Invasive apocrine carcioomo Pcnn.wivania CPennsvlvanjn Hospital Bgjdt."Ots) .. lnfiltrutiog locular can:inoma, alveolar variant Puqto Rico CUnivers:i'Y of Puqto Ric.ol - Aprocrine c:areinoma Ipxas ffieorsctown Healthcarc System) - Aprocrine carC'inoma Is;xa5, Houston • Infiltrating ductal carcinoma Iexa.';, Lubbock • lnftltro!ing ducwJ carcinoma Tc;xas IPmPo!h Associalcsl • lntraduoul (oomedo) and infiltrating duelal carcinoma (I); lovasive ~ish grade adenocarcinoma with

comedo oompooeat (I) Texas. San Amonio . Invasive ductal carcinoma Texas <Scott & While Memorial Hospital> • Invasive duct carcinoma Texas (Wilford Hall Medical Center) • Invasive Q)lllllmary carcinoma. "ith lobular Ccatums Washin!!!on 11.9""' Columbia Pa!holoojsls. J>S) • lnllluating duct can:inoma. poorly dilferentiated wilh areas (<S%) ofDCIS, ~iah

grade with comedo necrosis (I); Infiltrating ductal carcinoma {I); Poorly dilfercntill!od in.filll'ating mammary curcinoma. ductal type {I); Malignant adcnomyoepithelioma wilh epithelial and myoepithelial carcinoma ( I) Mammary infil!ratiog careinoma, ductAl type ( I); Duct cell carcinoma ( l)

West Vinlinia CGn:enbriu Valley Modica! Center) • Infiltrating lobular carcinoma West Virginia (Wetzel Couotv Hosnita!l • Pleomorphic lobular carcinoma Wjscoosin CMarshfic.ld Clinic) .. lnfilcrating mammary cnrdnoma Australia (North Oucenslapd Pathology Group) • Pleomorphic lobular carcinoma (I); High grade ductal NST adcnocarclnoma ( l) AuStrnlia !Royal Prince Alfred Hosnitall • Infiltrating hish pe ductal carcinoma {NOS) AUSiralia <Sullivan Njeolaidcs PathoJogyl • Grade 3, invasive dudal carcinoma {NOS) Brazil CMjnM Gerais School of Medjcinel • Adenomyocpilhelioma BrazJ!. Sao Paulo • Mixed duetal and lobulor carcinoma (2) Germany lUKE. Keminstitut fur Palholo&icl • Invasive ductal carcinomn.pe IIJ Jamaica (The Uojversitv of the West Indies) • Invasive lobular carcinoma. pleomorphic, ""- invasive doc!Al can:inoma Japan CKyoto Universitv HQ$l)jtsll · Invasive lobular carcinoma. pleomorphic Ns:!herlands. Amstelveen • lnfiltmfing ductal carcinoma, pe Ill Ontar (Hamad Medical C.omorntionl • Hiah g111de intillnttlng duct carcinoma, NOS

Case 8 • DlagnO<Is: Infiltrating high grade ductal carcinoma, breast

T-04000, M-85003

Case 8 - References: BoMca M. Wallis T, Rossmann M. et al. Hi$19pa!hologie Analysis of 1\Jypical Lc.<ions in Image-Guided Core.B=st Biopsies. Mod

Patho/ 2003; 16(2):154-160.

16 CTI'R, Sqltanbcr 2005 "Minuces" (Subscriptloll A)

Pass H, Vicini FA, Kestin LL, et al. Changes in Management Techniques and Patterns of Disease Recurrence Over Tunc in Patients with Breast-Carcinoma Treated with Breast:ConscrvingTherapy at a Single Institution. Cancer2004; 101(4):713-720,

Goldstein NS, Kestin Land Vicini F. Intraductal Carcinoma of the Breast. Pathologic Features Associated with Loeal Recurrence in Patients Treated with .Brcast-ConservingTherapy. tim J Surg Patho/2000; 24(8):1058·1067.

Krooqvist l'. Kuopio T, Jalava P, eta!. Morphomelrieal Malignancy Grading is a Valuable Prognostic Factor in lnvasi\'e Ductal Breast Cancer. DrJ Cancer 2002; 87(11):1275-1280.

Allelic Imbalance Aruilysis ofChromosome I6q Shows tharGrade I and Grade D1 Iavasivc Ductal Breast Cancers Follow DlJiercnt Genetic Pathways. J Patho/2002; 196(1):32-36.

Park SH, Kim Hand Song BJ. Down Regulation ofbc12 Expression in Invasive Ductal Carcinomas is .Both.Estrogen and Progesteroae­Receptor Dependent and Associated with Poor Prognostic Factors. Pathol Oneal Res 2002; 8(1):26-30.

Case No. 9, Accession No. 29138 September 2005

Alameda (Alameda County Medical Center) • Neuroendocrine carcinoma, invasive BaJdwjn PA!!c (Kaiser Permanentel • Carcinoma with features of neuroendocrine carcinoma, with Paget' s disease (3) ftesno CSt. Agnes Medical Center) - Poorly differentiated carcinoma WiUJ neuroendocrine features, rulc.out Jung primary Fontana CKaist.'f Pcrmancnte) .. . Breast carcinoma with neu.roendocrine-features Glendale .. Infiltrating carcinoma with neuroendocrin.e features Hayward/Fremont - Solid lobular carcinoma (2); Infiltrating duclal carcinoma (2) Lorna Linda lLama Linda Pathology Residents) - )'leuroendocrine carcinoma Long Beach (Lakewood Regional Medieal Centu) - Neuroendocrine carcinoma (7) Monterey (CommunitY HosnitaJ ofMonterev Pepinsu!al - Neuroendoc;rinc carcinoma, rule out Merkel ce.JI Mountain View CEI Camino Hospital> - Pqorty differentiated neuroendocrine carcinoma Oakland !Kaiser Permanenttfl • Metastatic neuroendocrine carcinoma (4) Orange <Orange Counrv Medical Grouo) - Neuroendoc·rinc: carcinoma Riverside (Kaiser Pennanentel - Neuroendocrine carcinoma San Diego !Naval Medical Center) - Neuroendocrine carcinoma ofb"""'1 (2) Sanla Barham (Conage Hospjta!l • Neuroendocrine carcinoma Santa Rosa (Santa Rosa Memorial Hosoitall • Infiltrating breast carcinoma with neuroendocrine features (3) Ventum - Infiltrating carcinoma with endocrine fuaturcs Woodland HU!s - Ducml carcinoma \Vith neuroendocrine differentiation -Arizona. Phoenix - Neuroendocrine carcinoma Arkaru;a< (I JAMS) - Large cell neuroendocrine carcinoma, breast Colorado <Evergreen> ~ Solid neuroendocrine carcinoma Florida IBaptjst Uospj!llll - Neuroendocrine carcinoma (2); Carcinoma with neuroendocrine features (I); Bigh grade ductal carcinoma

with neuroendocrine features ( I); Tn.filtrating ductal carcinoma with neuroendocrine differentiation (I) Florida !Tallahassee) • Invasive ductal carcinoma with ne.urocndoerine features Florida !Winter Haven) • Malignant carcinoid Jllinois !l'airvicw Ridges Hosnitall - Carcinoma with neuroendocrine differentiation Merkel cell-like (I); Carcinoid tumor (I) fllinois CLoyola lJniversirv ofChicagol - lofiftrnting carcinoma with neuroendocrine feat~ grade 2, tumor infiltrates into dermis, but

epidennis is free; DCIS-solid tjpc, nuclear grade tn, \Vith necrosis and ealcific81ion !Jiiilois CNaval Hospital -Great Lakcsl .. Neuroendocrine carcinoma llljoojs COal\ Brook) - Lobular invasive !ndjana IKakomo Pathologist Health Svstem) • Neuroendocrine carcinoma Indiana ISl Josenh "Hospital) • Carcinoid tumor of breast Louisiana (Louisiana State University Health Seryjce Center> - lnfiltrdting ductal carcinoma with neuroendocriuc features Louisiana £Orleans Parrish Coroner.:::. Office) - Invasive carcinoma with neuroendocrine differe-ntiation Marvland <National Naval Mecljcal Center) .. Invasive d~ctal carcinoma w'ith neuroendocrine differentiation Mazy land <Northwest Hospj!lll Cemerl - Lobular carcinoma Mas:;achuseus (Berkshire Medical Center) - Carcinoma with neuroendoorine features Michi!lM CK;!Jamawol - Snuill cell carcinoma Michjgan COak'V!·ood Hospita1) - Invasive carcinoma. favor ductal Micbjgan (St. Joseph Mercv Hospital) • Neuroendocrine carcinoma

CtTR, September 2005 "Minute'" (Sub,cription A) 17

New York (Long Island Jewjsb Medical Center) · Neuroendocrine carcinoma New York CNacesau l lnjyersity Medical Ce!l(crl · Neurotndocrine carcinoma Now Yor1< CS!Qny Brook Univernitv Rosoltal Residents) - Carcinoid New Yor1< SUNY DownSiatc Residents) - Infiltrating ducllll carcinoma with neuroendocrine diffcrcnriotion New Yori< !Wcsche>1or Modica! Center) - Invasive carcinoma with neuroendocrine features North Carol jon IJ>isgab Associates ofPaUJQiogy} - Neuroendocrine curcinoma Oklahoma. Oklahoma Ci!V - Small cell neuroendocrine carcinoma Oklahoma. TUlsa • lnfilrratiJI& carcinoma with ocuromdocrine fcotures Pennsylvania CAlieoheny GcnC!'!!l Rosoibl!) • Solid neuroendocrine carcinoma of the bre&.'l {WHO) mammary carcinoma with

neu.rocudocrinc features. Pennsylyania (Conemaugh Memoria) MedjcaJ Cent«) · Breast cancer with neuroendocrine features Pennsvlvania mrexel Univcrsinr College ofMedjcjpcl - lnfilll'Oiing mammary carcinoma, lobular type with neuroendocrine

differentiation Pennsvlvaniq CMt. Nittany Medical Ccntcrl - lnvasivc duct carcinoma with endocrine: features Pennsylvania CPcnnsvlvanjo Hospital Resjdents) -Carcinoid f'ucno Rico !Universitv of Pueno Rico) • Neuroendocrine carcinoma Texas !Georgetown Hea!thcwe Systeml - lnllammatory carcinoma Texas. Houston - Inliltratin,g lobular carcinoma Texa'ix Lubbock · Carcinoid tumor Texas fProPn!h Associates> - lnfilll'ating ductal adenocarcinoma with neuroendocrine fearures (2) Iexas. San Antonio - Mcraswic ncuroct1C1ocrin carcinoma vs. breast carcinoma with neuroendocrine differtutiolion Texas <Scou &. White Mcmorial liospjta!l - Small cell carcinoma Texas (Wilford Hall Mcdicnl Center) - Poorly diticrcntiated =inoma, with neuroendocrine feature.• Washin!!ton !Lower Columbln Pathologists. PSl - Infiltrating duct can:inoma with neuroendocrine d!O'erentialion (I); Merkel cell rumor

(I); Small cell carcinoma with lymphotic vessel inwsion. intraneuml and paineural invasion, favor metastatic ( I); Small cell carcinoma, ~mast primary ( I); Neuroendocrine carcinoma, poortydifTcrentiated (I); Malignant carcinoid rumor (I)

WGS~ Vuginia !Greenbrier valley MediCAl Center) - Malignant carcinoid tumor yirojnia (Wctz.cl County Hosnital> - Metnstatic neuroendocrine carcinoma Wjswnsin IM!l!l!bfield Clinic! - Neuroendocrine =!noma Australia !Noah Ouccos!and Pl!!bo!ogy Grounl - Neuroendocrine carcinoma AuS!!l!lia <Royal Prince Alfred Hospitall - lnfilll'ating high grade carcinoma 1\ith neuroendocrine differentiation Australia !SulliYJlJ! Nioolajdcs Pathology\ • Neuroendocrine carcinoma Brmi<Minas Qerajs School ofMe<licinel - Mammary carcinoma with endocrine features (neuroendocrine carcinoma), high grade ftrazil Sao Paulo - Neurocndocrinc carcinoma (2) Gqmany !liKE KcrninslitUI fur Patbologjel • Neuroendocrine carcinoma (Meri<el carcinoma) jamaica Cfbc University oflhc West Indies) • Paget's disease of !he nipple with underlying inflltmtlng ductal. carcinoma Jupan (Kyoto University llospjtall • Small cell carcinoma (neuroendocrine carcinoma) Netherlands. AmSielyeen • Poorly diflerontiotod infiltraling ducllll adenocarcinoma (ncurocndocrioc type) and angioinvasion Ol!!ar CHamac! Medical ColP9t1!1ionl - Neumcrulocrine carcinoma, probably of meta.stalic origin

Case 9 . Diagnosis: Infiltrating lobular carcinoma with neuroendocrine feature, breast

T -04000, M-85202

Case 9 - References: Auger M and Huttner!. l'ine-Ncedle Aspiration Cytology of Pleomorphic Lobular Carcinoma oftbe Brea•L Comparison with the

Classic Type. Cancer !991; 81(1):29-32. Euscbi V, ~hacs F and Arl.operdi JO. Pleomorphic I..A>bular Carcinoma of the Breas~. An Aggressi\'C Tumor Showing Apnocrinc

Differentiation. Hum Patho/1992; 23(6):655-662. f'alacios J, SU11'io D, Garci•-Macias MC, ct a!. Frt((uent E-Oidh.erin Gene Inactivation By Loss of Heterozygosity in Pleomorphic

Lobular Carcinoma of !he Ureast. Mod Patho/2003; 16(7):674-678. Fu L, Tsuchiya S, MaJSUyru~~al andJshii K. Clinicopathologic features and Incidence oflnvasivc Lobular Carcinoma in Japanese

Wotncn. Pot,.of Int 1998; 48(5):348-354. Bassler R and Kmnsbein H. DisscmiDllled Lobular Carcinoma. A Predominantly Pleomorphic Lobular Ca.n:inoma of the Whole Breast.

Pathol Res Practl9$0; 166(4):456-470.

18 CITR, Scpcembcr 200S -Minutes" (Sub<criptjon A)

Ruibal A, Arias J, Del R.io MC. ct aL Study-of the Expression on the CD44v5 Adhesion Molecule in (nvasive Lobular Cateinomas of the Breasl. Association Bclwceo Negativity and Cellular S.Phase Froc~ion>7o/o. lnt J Bioi Markers 2000: IS(2):19S-196.

Case No. 10, Accession No. 30328

Alameda 1Aiam¢a County MedicuJ Center} - Angiosarcoma, high grade Baldwin Park (Kaiser PmnQll<nte\ • Angiosarcoma (3) Fresno !St. 6gng Medical Center\ - Angiosarcoma Fontana fK.aigr Pcnnnnente) .. Angiosarcoma Glendale • An&iosnrcoma Haywardlfrcmonl • Anglosarcoma Lorna Linda ILpmn Undq Puthology Residenw - Angiosarcoma Lono BeACh !! .nkowpnd Regional Medical CenJer} - Angiosarcoma (7) Monterey (Communjty liosnital of Monterey Peninsula> - An&iosarcoma Mountain Vjew ffil Camino Hospital) - Angiosarcoma OOiundCKai:ocr Pconancotcl - High gradeangiosarcoma(4) Oranoe !O!ll!!Ot Coyptv Medieal Groun\ • Angiosarcoma Rjverside ffi•in Pennanenlcl - Angiosareoma San Diego <Nava] Medical Centql - Angiosarcoma, grade Tl (I ); An&iosarcoma(l) Santa Bar!>arJ CCog.age Homitall • Angi058r00J118 Santa Rosa CSan11 Rosa Memorial Hospital\ - Angiosun:oma (3) ~ - Angiosarcoma Woodland Hms - Angiosarcoma Arizona. Phoenix .. Angiosarcoma Arlgu!sa•(lJAMSl • Angiosarcoma, breast Colorado CEyerareepl - Angiosarcoma Florida !Baptist Homj!all • Angiosarcoma (S) Florida !Tallaho.•:;ecl · Angiosarcoma Floridn (Winter Hayen) - Angiosarcoma Illinois (Fairview Rldg.es Hospitall • Angiosarcoma, high grodc ( I); Angiosarcoma (1) lllinois lLovoJo Uojyet§jtv of Chicago) .. Angiosarcoma, high grade !lljpois (Nayal Hospjtai-Oreat Lsl<esl - Angiosarcoma, intermcdiRte grade Illinois (Oak llrookl • Angiosarcoma , high grade Indiana (KIIkomo Pntboloojst Health System\ - Angiosarcoma (rnalignllDt hcmanginendotbelioma) Indiana (St Joseph liospilall - Angios8rcoma Louisjana £1.9\!iSIQlla S!i!te Uni,·ersity Health Senrjce Center> - Angiosarcoma Louisiana !Orleans Paaish Coroners Office} • Angiosan:oma Marvlarul (National Naval Mcs!ica! Center} • Angiosarcoma MaryiMd lNonbwest H01pital Center) - Angiosarcoma ll>'aeyhyseu.• C!lcrtsbin: MedicuJ Center) - Angiosarcoma Miebil!l!l! <Kaiiii!Jlll.ool - Angiosarcoma Micl!i•an IO;t!swoo<l liOI!Jlitall - Angiosarcoma Miebi!!ll!l 1St Jgseoh Mercy Hospital\ - Angiosarcoma New Yodc !Lops Island Jewjsh Medical Center) - Angiosarcoma New York (Nnssau Unjyqsity Medical Center> - Angiosarcoma New yorls <Stony Brook Univcrsitv HospitalResjdentsl - Anglosnt(oma New York CSVNY Qowpstute Rcsjdent<l - liigh grade angiosnrcoma New York (Westchester Medical Centerl • Angiosarcoma NoJlh Carolina IP!saah A;;sociates ofPatboloov\ - Angiosarcoma Oklahoma. Ok!aboma City • Angios:ucoma Oklahoma. TulSJI - Angiosarcoma Pennsylvania lAJJeghcny Oeneral Hosojta)l - _Angiosarcoma Pennsv!vanja !Conemaugh Memorial Medical Centorl - AngioWtOma Pennsylvania rorcxc! Uoj\'qsjty College ofMedieinel • Angiosarcoma. low grade Pennsylvania <ML NiliMY Mcdjeal CenJerl - Angiosarcoma Pennsylyapja!PepMvJynnja Hospital ResidentS) - Angiosarcoma Puerto Rico IUpi®i!Y of Puerto Rico) • Angiosarcoma Texas ffiwr!<IOWD HcaJ\hcare Svstpml - Angiosarcoma Texas. Houswp - Endothelial sarcoma (angiosarcoma) Texas. Lubb9sk • Angiosarcoma Texas !ProPa!b A'ISOCjatesl - High grade angiosarcoma (2)

CITR, September 200S "Minute$ (Subscriprion A)

September 2005

19

Texas, San Antonio - Angiosarcoma, high pe Texa.< !Seoq & White Memorial Howitall - Angiosarcoma Texas cwnrord Hall Medical Center! - Angiosarcoma Washinmon !!.ower Columbia Patholosists, PSI - Angiosarcoma, poorly diffcrentil!led (I); Angiosarcoma (4); Angiosarcoma, high

grade (I) West. Virojnja (Grt:CQbricr Valley MedjC!!l Center) - Angiosarcoma West yirpjnjn (Wetzel Countv Aosnit.u!l - AngioS3tCOrna Wjsconsjn (MR!Shfield Clinic) - AngiosatComa Austru!IB CNorth Queensland Pathology Orounl - Angiosarcoma Au!!tralia CRoynll>rinee Alfred Hospitpll - Angiosarcoma Australia CSuiHVM Njcolaidcs Patho1ogy) ~ Angiosarcoma Brazil CMiOA:! Gerais School of Medicine! - Primary llllgio:sarcoma ofbrtl!lll. high grade, Grade m Brazil. Sao Pav!o - Angiooarcoma (2) Gmpuw CUKE. Kcminstitut fur Pathologjcl - Angiosarcoma Jamaica Cl"he Univasity of !be West Indies) - AngiOSU'OOO:l8. intcnncdiatc pc Jap!!!J <Kyoto Univ=itv Hosoitall - Angi.-.coma (G-1) NetheriQndr,. AmsteJveeo - Angiosarcoma Oatar l!irunnd Medical Corporation) - Angiosarcoma

Case 10- Diagnosis: Angiosarcoma, breast

T-04000, M-91203

Case I 0 - References: West JG. Qureshi A, WestJE, et al. Risk or Angiosatwma FoUowing Breast Consef'latioo. A Clinical Akt1. Brerut J2005; 11(2}:115-

t23. Olapiron C. Adjenou V, Albion F. et al. Breast Angi.-.coma; Sonograpbic, Mammographic and MRJ Features. J Radio/ 2004;85( 12

PI 1):203S-2038. Haoasooo MM. Osborne MP and Dielubunza 8.1. Radiation-Induced Angiosarcoma after Mastectomy and 11tAM l'!np Breast

Rooon>'trUction. Ann PICl.>t Surg 200~; S4(2):211-214. Wynn GR. Bentley PG and Liebmann R. Mammary Parenchymal Angiosarcoma Aller Breast-Conserving Treatment for Invasive Hlgh­

Grude l)uctal Carcinoma. Breast .1 2004; !0(6):~S8·SS9. Kondis·Pafiti• A. l'syhogios J, Spanidou.Cnrvouni H, ct al. Clinicopathological Study of Vascular Tumors or the Brca.<t. A Series of

Ten Patients with a Long Follow-Up. Eur J Oynuecol Onco/2004; 2S(3):324-326. Burk A and Vinnani R. Tumors of tile ~lcurtlllld Great Vessels. Rosai J, Sobin LH eds. Atlas of Tumor Pathology, Vol 3d Ser Fascicle

16, Washington DC Armed Forces lmtiNJtc of Pmhology 1996; 231 .

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