WIOR Slim!IAl\ COLLi!.CTION

SE? II

l.lAbaoJ;. Asroci ation of ~tholo.;illt•,

Dr. 1.. P . St=t

,

• r':") ... C ~ li."'l a tiel" 'Jf !:1:. t~ ! • . ~ .. !'1.! ",.. " •' a~ 1 J l"'' ... )"- 0 •

" . ~

.b il n l' _ .. ~') nrn s.J.c '~ nl c ' '~ .i. L. ol>: t:>Q ~ the cst.o.' ( ~~. 11'[! ' ,~ ' (1 l. . .. ) "" . "' ,.

nun o:~ .. liE! t' J H<·••C., t '• CCJ:C1 " pol::'t :.'!lj:-li. _. un

I lDli' lt0111' v(Hlrr'}.h ! ll to f.V(l l 1. -~ 1:" .• t;J . •:( 1 J.. ..

'"' '"Or.C.Jl1.1 za llS ::1'13 i;;t~:o;.w "1 r oc.·ll;.r-~.

~rr: t- op.!.!Llun L· • o oa.rl) r n~ c qf -n •r "=6 l:f!.J"£1 not :.t'"J!).~ot'JC. .. !h!D 121 tlU~ :lf rJ""' ~~1

br I'C 13- _esiGU>3 •t t:.r. F 'Ovb, tto!•l rr :>ita.:.. r-···F~ v. ll tt .ll!or_ty vlt;:;; th< Ql"'U'Ill'lO o t'l'Cshl~ 1i 'i!"..', roco t!:l. at.g•nod c-~.;:;: rl"O':" "i~ .... o cult\U".e "r- ~(' a.r.~

.!r:.ntlc:r. of p e '"=-- m:rl r -rlt!Gt.O "' fl.!x:..-'!1!1. I ~ i!_ ~~ .ml. rtl!.ir; l;c r:>ru>.:> e. poe-ti~e C 1~0< . r e>:;:"C:.:'" ':' ;; f C r rQCOGJ11 .... 9 QJH:l'~ Jt"OU.IJ• Of" Ce., . f: ''1Ch P • .'l'U ':: 'tiz.- 4

... ot:~ so u.e.h "1-unl- s:.n 'tit I he• cc:.IaOt 00 · .. l.2..1:1e-vtu cr c.:.. :rn o~!l~l.'l·lc-ss d~f.:r 11 o L"' ft&""r I _, rl:l~ r-

: rot..t~ a :~p1cto·· of .~!!!ioi.L·:-r. .. ut a.r;i " :1.ij to c.,.court"! ('lxp)oJ D t. on of t:a chest on '-"!.1:. • a vir 6""'00 1~. .- 1 ~ i: • -

_n t on iu n ... 'lt..~!:\>'A, ! r _ 1 1 he L J t h:ftl e ~o :!lee~ t...'--0!:. ~ tl'' n i· .... ~ .... xa"Jine:tion r.n.r ""I' e-t \w l'ctyu'(lod ~t ir ).O:l~l· ·

' ···~

:

.. tut, l ,\. ~"¥! :.l.Orr :.. } t

Perwnn lra:L!.. o:t!" ~ OS: 0'"., • ~ .1~~

t· .~ or t: ._ .... ~-::i,

.~::o-• l x-• .,,

b ·-! ._._

CASE 1

References cont:lnued:

Sat~brook, 00\'lar, "F . J.

1· or.dnll, H. H.

Dia::;noatic Val11o of ErJ:"o11s.ted Cella .from Oatlcerous Tie aue o

J.A.U.A. 1~1:372:1946

Ca.rconoroa of Lun(;: Value of Sputwr. ir. Dincnosia Brit. J. S1u-g. ;o:l9~:194.?

De::lonstrat1on of Neoplastic Ce11~ :.n the Sputum !lctc.. i!atbol. Gl'ld l:icrob1ol. Scs::O!nav. 20 :485:1943

cor·-l"l't (Dr. C&sey ) Thia 1a " con t rol ~mear for the PsPanicoleou nethod. It <~11.3 tal<en .from n bronchus i=eCI1Ately ll.f'ter death . The !l" tiont died with 1n1'erot1on of the heart. 'l'he bronol\1 ant: the lllllfls were exom1ned carefully e.na are ava1lablo for e:tsuinat i on by the group. A rew tHlu.rur.ous but no oaro1POl'lf\ cells "'arc noted in tb<> exiJ!!ination or a large number o! 8m8ere.

'

Aln. Ascn. ~nth . • April 1q47 • i.r. ~ . P. '3tout

~·~r:\""5 ... ~.!,.'JC.:.AL'L~c:·4!<:t'IJS PAPrU.IF .rtlS Or' SCALP

Cn~c 2 (81!0) P~ Z6l~l

l!1nro~coo1c exrun1na1;1on ~howa a cor.mlex pap1llory crrowth made up or lnrce nodul ar thickeni.n::;s the 001'(10 of rn1ich are CO!!tpOSGd lal'(lOly Of tll/'XOid tiS!lUG l'SBE<-!!)­l 1n!; me«mohyme, n!Any bl ood vosnels and some ad\llt collaclln-

ous t.boue. 'l.'lmre have been new nr.d old lla:lorrhage" ami ootr.c phe.ooo~teJ her.osideriu 1n pz•eeent. The nod>>los ar-e covorod on their supor .{'ici al sur!.'oceo with ep1der:>ia. i:he sides of the nodules, however, are covered ~1th p :eudo­att•~otU'1od columnnr <!pithelllln containinG 1'19!!'/ isolated l;O'blet Colli' ::'illed ::>rcba'bl;\' \'litlllll'lCin. At the tor:o ends of t.ho baae of the tumor it joins tho akin or !:he 3calp s; d here arc n few s ... et glP.nds, hairs on:! :~ebcceous £;lpnda. :IC!'< of thea' ncca~sory &kin sl:ruet'!ros oro row'd in ':he tl.u.-..ol'~

COl.' :rT: Tlrl.s is ur:dou'btedl.y o compound con 1lax naeVI> o ot the type called naevus tlyrll>,&o~odenomatotua pspillefB!'\Jc , rhe peeudo• at ratified op1thel1um with goblet oells represents r>robo'bly (I nae•Joid dsvelop:uont from OJObrycnl C .S\'"OQt eland~ 1'he e1>i thol1a l membrane produced look 3 or.ore l i ke the con­jur.otivn in t he r so1on of the eorunclo but it has c;enerolly be on aooribed to G "'''ea t tSlnnd op1thol1nl ~rig:tn 1•!",en 1 t ocoure n"ny fron', t.h9 r ec.;l on of the oonj unct;1 va. 'rhl a ;>e.rti­culnr example ie unusual beco••se ell of t.he 1:umor projact,. Qt>o\·o the ou::ofEtCe of the soslp "nd tltero '11'6 no s•'ast ;;land> rorood 'beneat h th" ooverin{; lr.yer . :t':l8 ocelp is one of ;::r.e favored ple.oes for t.>tese hsiona to dovolop And tlll>y a."'6 afton mult1pl3. Tho:1 a1'0 no!: mali ;annt.

Cans • o. ll1atolo01e der HAutkt'a.~..khoitan, Berlin, .r. 51Jrl.non­l928, vru.. n , <>P• 282··284.

Ala. 'o~~. Pat~., ~~ril 1047~ ~r. A. ~. r-t~ t Gi1~'"1JLOSI, c· .LL '!'"1'')~ CF ~u·' ov:,~y llo SLI'ti"

C~St.: 2 (L-1044)

;;icrosco:>i<: exa"1ination shown a cellular eplt.hel1d tumor in which. the cells in some areas i;eod l;o be nr.rn.'l.l)ed in follicles or rosettes often containing a dr?plat of alb>:u:~1noue IllQ t erinl in tho lumen •i11le tl:roughout r.tucl;l of t he neoplasm the cello are packed together in un­difterentiated :nasses. Thora 18 a supnortino; frn!'l&r.or k of vnacul.nr fibrous t1ssno .rhich awears as aoptn paasing be• tvJ~aen the tum<ll' cell masses.

cor: .HT: This 1s the relatively f a:!!l.l1ar picture of the foliiO'>:iler forr.:s of gl'annloea coll tumor . !Ao:.i.'l.t;l:; it bad produced eCJ!Ie estrogenic hormone. The quastion of fir,;t icportanco concerns ~~e relative mal1~'l.CY or t~e ~or. It 1a sooerelly ssreod that the 171ll\Ulosa cell t=or is "'a21g­nl!llt eomotl!nee but the frequency ia variously estb<lted at from 10% to 55~. Probably the actual t1suro stMds oonawt.ere botween t he oxtrm:.<1a but it is bel'd to oeti!Ulta becanse, as Jooos ond ToLlllde hAve shewn, metnetaeee and recurrences mn7 not manifest themselves for a period as long ns 19 yanrs nftor the ro!'IOVDl of the pr1rnt\ry e;ro11tb. Those tumors are best treated by surgical r w ovnl becDuse, although in in­op<>rabl<l oaoae good li'alliati ve roeult s may be obt ained by radiothersr>'Y, the t wnol'o sl way oventunlly t•ecnr, usually with fntel results. Although t he preoon t tumor onl-y shows a oodarat o degree of follicular differentiation with most of it undifferent l.atedJ t )lis is nTJoarently no reliable .,;uide ':o its de(lree of oalignene-y. This section sho11S only tho eer-oalled • m.re• i'on:t or gren\1109£. o&ll t=or uithout arr:I adrlixture of theca cell eler~onta. Traut end "arc!catt1 have called attention to ~he f act ~~at those two t,~or forns sre closely nll1ad, since they hs.vo a co::r.~on cellular origin am that both :.Jl! be romed 1n the so.oo tunOI'. Tl>0!9 tll!!!OI'II •.flioh are predm1nately or ••holly :;ra~ uloea cell oeopla~• ore apt to be !:'ora oi'ten ::~alignent than the O'>re theca cell tlll!lora.

Ala. J\am. rath., •-.'>rll l'l47 • t>t-. 11. r. Stout

~.:.....i (L-1044) P:::S 26120 cort.1m.:od:

ill; ck, F. u.

Jc.noo, 0 E.S. and T<JL1nde, P.. •::.

~ .. tout~ A.P .

Traut, ll .F. and !"are>-otti, .\ .A.

Ovarian Tumora J. Jim. l.7ed . !lo1. 212 :7:;8: 1946

The Curability or Granulosa 0611 Ttw•orG Arn. :r. Obet<l t, ~ Qoyn. 50:691:1945

-rut:or Seminar Theca Cell Tumor or th& Ovary '"i th ':aseulinizBtion in a Precr,ant r:r.mum

Texne State J . ~ed . 41:564:1946

A Co~sideratian or eo-called "Or~osa• snd "Theca• Cell 't'tnor or t.he Ovary Surg. Oyn. e Obstet. 70 :6:;2:1940

'

Hn. Assn. Path., 1\prtl 1947, Dr . A. ? • Stout;

llicrorco:>ic Cl<ll':'ination of the th;ymus s~l'>Wa 'IJl>at Jfla7 be de scribed as hyperplasia of tho rettculu:!! a1 <! l:11"?hocvtic olE!:le!'lta or the glnnd ri.th n=l tt!)POill-in<:; lla.ssell t., corpuscles nnd no dei'l nl. te evidence or tho forma~ tion of ljet'lll11lal cantors . The muscle. sections t:hovT no ev:l.­dcmco of lymphorr'-1Q{!es and moot of the muGcle i'ibot•s are in a aood state or preservation.

co:.1J,J:r': It soema poasihlo to call ~his lesion a turtor Of tho th;'1"ll1Uft rather than bypl.lrpll\sin or persiatOtlOO Of hllO thomus becauo~.> lt wna n acp!U'IIto nodule VI!Jich l'las unr,erellt to a\~roundinb structures, kt the Presb;terion Ho~pital ~'rlnu the past 25 ~ear.a tr.ero ftave boon 69 casea or myas-t l enia t:ll'av1a. or the eo lo hnd pathological oxa:11nations, 9 at autopsy at\d 7 by operation. Of tho 16 casos 9 showed tunor, :; ~erpasl.n or persistent thymus IUld 4 :ltlO'Ifod no almornnlity ot the thymus . &Joo t or the so tu:nors ttere il,'<."J)er­plsetic nodules w"'cb dii'f'ered Uttle 1f any !'rom clif'fu!le ga!'lorslized hyperplno1a, \:hen one etr1vea to find de!'ir.ite hiQtOlogicol proof of true .nt'lO)ll(lst!C activity SS Oj)TJOSOd tO simple hyporplasis., the dti'f1C1llt1ee are round to be fo:rm1L1~ able be~nae 1n n os t instances, it 1s only infiltrative growth or r:etsstasis tbat per:-.i.ts one to bG s11re. Occasion~ ally a tumor d. 11 have r;roups of oizarre rct1onllll:l calls or 'I! ll ahov chatl(>es of li/Tiphosarcoma, leukOJJia or l!odgktn' e d!soaae, or may oven ~ penr like a carcinom9 (\'lilaon ond Prl. tci1a.rdl ..,Hh ';he cells arronned :In annotooos1nl,l cords. l3ecsu5e cl' the llllo:!!alous eppelll'ance ar.d tha doubt about the exnct nature of the celle in theac ohymic t=ore, 1~ ae<na w1seet to oont!nue the uao of the t~~ thymcoa for oost thymic tmnon llnless they are of ocrne dot'1ntte typo like lJ=phosarooma or Hoauk1n's d1oeasc, unt!l further investiga· tio~ defines their truG notre. f.hother tho canngos noted 1r. the th~c :In aoi!!O cases ot myasthenia gravis are cauee 0!' et·tect is aa yet ur:deter.niMd. !t aOe:4s established, however, tl1nt certain co.sos nro benefitted by removal o.f tha thymus •

(Soe Pgge 2 for rererences)

Ala. Aocn. Path., A~il ~947, Dr. ~. P. Stout

Case 4 (P-8251) Pt.:S 26127

Re:t:oronces :

o7urray , ll. A. and l'cDon.'lld , J. R.

Sloan, H. c. Jr.

•ueon, F . II. end Pritchard, J. D,

Tumors of the Thymus in lfye sil.'lenia Gravis ~. J . C~in, Patb. 15:87:1945

Tbe TJrsmus in L!Outren1a Gravis Surgery 1;:1~:194;

'

Ala. As~n. Pntn., ~,r1l l~l7. Dr. A. r . Stout

R/ll:IATIOU Gll~I'!Jl'.CC"A 0!> -:?OL Sl'-IJLA'II:!O l"''Br'l£f,~C:):·~ •

CASt: 5 ( 57641 PZ.S 26ll8

l'!crosoopic exat~1nat1on or tho tuo slides reputed to have been made frOIII the tunor 1n the ri<;ht ;:;reat toe ehoea a leeion com;>ooed of mRI1}' llll'ge bizarre calls which are uautllly L"'''egularl y e l ongated or 9p1ndle•ehaPa:i but oooaeionally ere rounded or polrsonal. These usually bsVtl ~~all nucl eol i end cl earl y defined chromatin but show vo~ few tn1toees. The cells seem to be aooompaniod by nUDorous collagen and reticul in t'1bare. The oell cytoplowc is gener ally swollen an1doph111c and atructuroleaa, altbo•.l!lll ocos-e 1onally I think I can detect 1ntrn•oellulor fiber&. llo intracellular pi ;;ment can be detected. The surfACa of tha (!ro"l'lth 1e uloemted, :Ln one section the dooper ..xtension or the growth i e displayed. Here it 1o much more definite~"~ 1'1brous end the thi ckened cella arc rarelr seen. ili:re the growth 1ntordi:;it,tes mth the subcntoncoue me! aponm~rotic t1asue. It ie sccew~t r~iacent or the chnn~e£ found 1n Dupuytrtm' a contracture. -

co:-·m-r: It is obvious that ~ nre f'eced 1u1r9 'a'i t.'t a lii "ion oxoeoo<.,gly aH'f'icnl t to interpret . 1'h9 "t"tGnant thnt tho 1:\wor of the gr"<>st too WM blook ond tung11ting col:oe ona think or oalignent molanOClll. I believe thst !'rob­ably oan be excluded. ·The {!t'Owth io definitely i'ibroua.

~~~;b:0 .. ~~1~h~~!ei~~ !i~~t~et!~~~~o:!~~ ~0~lW ~>'~~= the c;rowth l oses nos t or 1 te larGe cello e.nll rese.lbles fibroma or sear tissue. TI1e lesion 1e relatively avescu~ wl1.1oh I believe excludes considerati on or Kaposi's dis<Hlse. 'i.'he lliotory also necessitates the o me1derntion of t:IUlti,plo neurofibroma•. I think this also 1a very unlikely. Th'.>ra 1s nothing abo"Jt this section ~~:hic:h our;geste to me s al.::!ple naurofibrama nor a !:!alignent Schwannio.n t=or developed from it. Tbe bizarre, l erge oells &l<.aye de:n~n d aorotinJ 1n order to detel.'l:11ne m ethero or not tney aro either ll!)oblnr;t o or ::ryoblaeta. einoe these &-."'8 we "'oaodermal tunor 1'ort1c regu­l aryl char"eterlzea by the r~otion of blz~e ~ant ~alls ~1le I do not reel that it 1s poae1ole canplotely to exoluda e.ither ot tnesg, the lar!;O Qlllount of intercellular conr.sct1"e tissue and the failure to find eny deUnito ooni'in:~atoi'l ovidenco convince ne thnt both ol theso d1acnosos are ox­tr~,oly tmprob~ble. Since the growth is fibrous. it !s nec­essary to consider wb3thar or not 1b mey be $&ligr.ent fibro­sarcoma wit h the fo=ation or biz~rro oelle. Hero tie havo a ~~nl ponsibility,· But this is a leeton which evidently bognn in the skin.

Ala, A9tm. l'ltt.'>,, Aprll 1947 • Dr. ! • " . ~tout

Cu" 5 ( 5764J P::S 26ll8

I hAVe recentl~ reviewed all of tho fibrooaro~a of t~ Okin of .,b:l.ob ;;here are sections 1n the labor a tory of surB!ca.l PAtholol!:( of CollMbia University. not ono of tilel:l leaked lil<o thh nnd 1noidentall? not one meta;ett>sized, ~BY ;;>roved t~e1r nnliannnoy only by infiltrative growth.

There ie one very :rl.6ft1f'1oM t fact 1.n the history o£ this oaee to wh1ob so fnr no rCJf'eretlce has been mr>de . 'l'ho originAl le sioos woro treotod both w1 til t'P-di\1J!l 11nd X-rny nithout ralief, Eere I think i e tho clue to the nature of tho present leeion. In a n=bor of inntnnoeR we heve ob~arved t itn•llsarcCI!l&-~ilw gr-:mth a ooot~rr1ng in the skin or oucoue oe.>:~brana at the site or 1njudicioue rnd1at101'1 treat­.ont. I ll&ve bam tacptad 1n tbc peet to call sU3h _;ro:;the f'1~rosarcooae or rhabdomyosarcomas boooueo of their lnrgo bi%Dl'l'6 colle. But £eVer have euch JD o1ona dono !'lora than rom A looal !!IOllnd of tissue and I hove CO!!lll to bal1eve that it 1d noth1nz "'ore thall n b1~erre t'ocUation renotlo::t in the f1l:lrou a ar soar tissue. It is._or course, not 1:-:r>os&iblo tar a ::18l.i8nant a nreO!:IS to de7eloped ln radiated scar t1sS"~c but thon tbo ssrc~ haa the chnraotoriat•o• or a truly "lrul(lllant •. 1broa(U'cooa ~ does not form n lot- of swollan. peculiar look1118 cells such aa t:e !!!OCl 1n tb:l. s oasa. I =¥ bo in orror but I will bazerd the (;Uoae that this P~>ticmt will 'bo ou~oed b;" the p!,'ooecluro which bas been oorriod out •

• Stout. A, P. =~or ~om1n9r• case II

Texas :>tate J. l'od. 40:366:1944

r

C~RCD'OI'Jl. rl'VCl!.'ry,G BROJ'a!US

1 lCl'OSCOJ)iC Oltl$'11nat1on of' tl\C sr.\SIU' e1-=a dt!"ln1tc ovide•ce of' cancer. In tbo ttoot;1on e>m.".t!.nod by "-' there 1: one "''~11 elm!!P ccr'>oSOd or al:>out ;o cells "' ~c.a ore lllrl!e, • G~t of them 1rr'l .,,11>-rly rounded v1 o;h lio!>Gl'­oh:ocs.tic nu.:lo1, ant" 1n OM olftoc +..,ere is a •hO!'l of :l!lt• tcnocl o 11~ reerlllin<!; a oocrl. "tl.Cfl<''oro there nr~ Be'1a~ ler~o c1~o of long, Elender, n'1ndle- r~e ~orter ORt-n"noed ~ell<~ -!th tMolet r'>t ·!1 ttr" not !JT-lere'>r=nt:.e. vo-:y ocooaio:•r·ll-y mcm~; t.'oos.,, l'<l"gc.:: bizn>:'re cellr can be do ;octo~. A r.·odrr~te n=t ot n:uous 1- !'rB8ont or" a fE!'I1 nozrll.l fle", OeeqiiCl'lted epithellJ;l. cella.

co·· • l'T: rhe presence or t:19 lnr~;e bif:e.rl:'o call~ in oiur•,;;;--;;s_ th tl"e apparent for>:~nt1on ar a poarl justifioa ·.;!;a r.ia_,'l:oeh or mnlic;nont epit.hallol tUJ,or, probnbly elLh(lr n({'•nmnue ooll e-,i thslioma or ooroir!amn ..,1th toOUfll!IO'l& ::;etA­p'..ae1a. 'the hi11to~;r of thin oneo 111 lnoomploto, ain¢e it <'.oils no~ 1~ive ••s the X- ro.., f1r . .,1nt;n of lun;;o or caatro­intoshlnRl tl'aot.. !t is no~ poselhlo to be oe!'trin l:horaforo who tiler thi~ is n p~•innry or 1:10taetntlo tn~or or tie luu~· l'iJGro R"O oorto1n 1rul1catiouo, hQIVover, Which au;;geet that ~~o tl!l110r 111 pr1m~ 1n tM loft up;JIIl' lobo. Pnrr.l-:;eis of t.he loft voonl aord lt ver;; r~•·nl. oo.nood by wnttUJ~Beos be• ca•1so t'uly rar~l) involV<l ':;?".e ·pol: or ~ho lun;; . It 11! con­oGivnble but l~robo.blo t'·at tMs 15 a ~l:'i.mru':1 t>•dlA..,tiruU. oarol.r.cr.o 'It th exto=ion up.,o.rd ~o involve tl " rae• r! <>-'l!: lc.~~nl nerve cd mtil :::etn11~.ns1s to the lu.'\3 a:>tGno1ng lnto a bronch-1s. (Dr. Stout)

OOI""Iml'l A biopll': was onae of tbio p~t1ont at th.; tina tho bronchi "11 <JOOars wora tol:m. It ell01l7ed brnnoh!l:;enic oaro!ua::10 &O deeoribad by '!Jr. stout. I>aoh or the broncb1ol lll!IIHire l'llldo by the PQPeniOolaou net'1od bo.s cnroinooa cella, ooe t l'dllh cltl!lps no deeoribed by Dr. ntout. (Dr. C&.eo;')

t.la. A arm. P~~otll., April 1q47, "Or. A, P, Stout

U.IO:'YO!'~rco"A ( ?) O"" O"T.C'W.'

Case 7 (71..44> p:-,s 26~20

'"icroacopic ~inotion shown o tumor CQI!l• nosed of bnnds of long s9indle-shoped onlln eccomorun!ed by oolle.gen an., reticulin J."ibore ,-.hj oh ero n1nuously intorlstled. '!'he nuclei ere blurt-ended and al:ow oooaelcmal tt:itose~. Rarely tho nuole1 nra aligned in ~hort pelisode fonoat1on. n1o oytoolomn is rather scanty, oo1doph111c, nnd contstne lona1bud.l.nolly dis posed fibrilo. 'l'l't&ro aro eevarnl nreas or hooorrhngo Pnd others of rlagcmerntion 1Ti th disaooeei'&nOO oi' colla.

C:l: t.;'l't "ithout i'1ber stoine it is vocy dL"i"icult to dec!ae uhethor or not the intracellular fibrils erG E70f1br1le. It secme to ""' th.oit the ~· ee;nosia n1uat 11o 1n this case be­t>,een le1<llllyos&.reO!:iS anc fibrosat"OIZ'Ilo I Qto ~O!:!Gtrhat ir.cl!.nod

to a etacnoaia of lei~~oaaro~n bocouse or ~b& blunt-ended nuclei oi th ocoas1ona1 paliano1nu, the tone:' one~ of tho tuoor to n·•dergo cystic degeneration nnd the oco&s1onal eernonstrr • t1on of an lntraoollular fiber. v. 1 tltout: l!if!orentiaJ. sta::ne, however • the findings ere at>ffioi en tly vacua l;o ll'.ake po un­\'11111ng to mel«> en unqU&11fied diar;noaie. I e:n perl1ap11 saJe• vrl· at 1nfluoncod by the f's.ct end omen tal rm<' re tropnr1 tonel'll f"1broonrcompa ere r~uoh lees ooounon th.nn ~mooth nmscle tu.mot•a. In the 1'6Corcio of the 'lurgicsl l'nthol06Y J,nbOl'otocy of Columbia nntvoro i ty there ore 12 ooao~ of l e1omyosnrcomR of retropn>'1 tonenl >.1 ssuos, one or the •1osnnto~ encl r:ono of T.ho anonta=. 1here aro only 3 rPtroporltonool, a me~ente~o and no OMental f1bros~COI!l$s. The s Jtu~t1 on ot thee~ t:uruors and t.M f"aot that they 1nftltratc "~al·o 1 t e:o:eecd1ns1-y llifi'i enlt to eradl.o~tt., tl e en.til"' ::r=tb, oaDeoiolly in th: rotro­pcr1tonf:'lal zone so th-o!t- e-ure3 nro rnre,. evon o:-t:-cn 1-:he TI:nnra do not retl!stes1ze, 'lllrcoey is the only oc~ ~1bl -:t !ol'l!l of' trea~ent, e1noe ~he ~ora ere VG!'1 rod1o-re~1~tnnt.

t;oldon, T. and Stout , A. P.

Stout, A.P.

Smooth ··u9cle Tumors of the Oastroi~teatinal Trnct a.~ Rotroporitoneal Tissues sure;., <l1n· one Ob~tet. 73:704-11941

Tumor !lentiniU', Oasa 15 Loiomy~•aroomc or Retroperitoneal 'l'190U88 'l'o:o:oa State J, r.!ed. 41:564:1946

Ala. Aesn. Path., April 1~47, ~. A. P. S~~ut I.:LTA!'l'~T!C .. ,f.I'J~'-1' "!'11!'01. ( ~··~.t 4l!O'l!C ''"L-"O:'A?) ::U I:r.G

r .... T:! Ir(rll;' r, ~s -om:

CASTi 8

l!ioroscopic exa..,1no.t1un ehofle frocnents of a nuoh enlnrged lymph node. Cona1deroble oort1ons of i t al'o l'eplnoed by a tumor composed of lnrao nlQsses and slender oorda of rounded and polygonal cello 1Y!. th ah!ll'PlY defined ooll membranes enclosins a i'Bintly no1clopll1lio, veey granu­lar cytoplasm. The nucl ei nr'e contl'ally plaooCl, rn>ve clear• ly defined n1arkings with smell nucleoli and show e.n n"!erego of one mitoels in every 111gb powel' t'iel<l . bre are narr"'" but d1at1nct spaces betv:een the cella Ol'ld no lntercelluliU' br1<le;oe travsrne them. Rarely, lergel' mult;ir.ucl.,ate cells are pl'oeent. The cells shcm no ;>1pnt ol' ot:.,r d!fferenti­at1nc; fcab•res.

co·-···•'?: Since t!>is ie 0 'llllli(lnOrlt Metaeta.e1dng 1:llnor W\ t1l veey few dirforentia t.tng feAtures, it l o only '>OSf'!blo to 81>oculftte pbout its or1-;1n and nroturo. tts <'1strlbuti"" in tbo node excludes the nol!tdbl1l1 ty of retiCl'tlum c ell anl'Oontll s ince this t-.mor g~erAlly ntreote an entire node diffusely nnn not in oords· of oells. Th1e seems to na to be tho only type of sorooQe l)Oee1bll' to consider. If thla 1B correct, then the rumor 1'1t•tated deeply 1n tho l.a g cannot be primacy but muat be "'ot&otot1c eG is the otu1e or !:he 11l@l1nal lympb nodo . Tho tlll'lor moot spt to metaottts:l>'a i n tll1s !'neh1on fl'Om an ooou.lt oouros i s !;btl me.lisnent melanoll!ll. In the lnbol'ntory of SUl'g1Gel. l'othology we now hnvo recOl'ds of more thon tv}(mty cases of motaot11t1o t'llllignant :'ielanot>•n in U'hicl:l the pl'imaey neoplaiSt:l wao nevel' d1ecovel'ed in spite or painetnkin(S !!ee.rch. This 1e t~tore tl'tle of tho !'!al.i.:'<lBn~ J:lOlanorna than of any otho.- vorle t1 of molie;nant neoplaSOl. Tbe fact tl'"'t no pi{;ment can 'be round of course cloos not 1nval1de.to the clia::nos1s.

\.ebetor, J. P., Stev<nson, T. \. , and Stout, ~. P. Tba SUl'llical '<'reab>lent of !'elignont lleli1Xl01111lll of the Skin , Surg . Cl1n. north 11:rlerl co 24t3l9 (April) 1944.

llotet Silvel' stains for nelanin •1ere repentedly nsgntive. tu1d i'n t s tains waN stro ogly po~1 t1 ve on the primary tumt'll' of fue log f)l'\d on the aucoessiva metnstneoa in tho inguinal rag1ons . Control melnnin and fat stains v~l'e poa1t1ve.

Ala. Assn . Path. , l<llril 1947 • Dr. A.. r. Stout

P.&n!Xl'-'YOSAPC:Y.. A { SA"C'l!.A 301'PYOIM.- l o~ ~r.; "FT.lAiiY l3f.ADJ:~;R

CASE 9 (6973) (7813) Pf~ 26121 and 26125

tl1crosco~ic ext>n1nat1 on of t.he biopsy tnlwn at autopsy shows t h e t rue natura of tile neorJlao'" muclt be t tor than the vary w.cll frfl01l(ll'lt of t1 ssue renoved onto mortem. Usaontially this is a 6rowth compoaod of a~sllste. rounded am short spindle•sliCJ?ed colla aet in n loose ncyxoid stroma, all of "h1oh h held to~;ether by a vast.u l aY' fra.'l!e• ttork. Snporfiois.lly t.hh reare:blos tho low po,..er '91cture ot a l1poaarcorna but in hir,hor oowera it ia poas1bl e to note basic Clfferencel! . A nmber of tho cello contnin a st1•ollj;ly aoidophilic ~terlel wl>.ioh 1a rel atively omorphous . A few ot tbe tiny el<lll8tlt&d stnlll Me! 11l'>1nt5le- rhr.PGd col la sl!o!r dof1n1te orcas striations. The aaall l:'ounC!ed cells are acnettnea vacuolated and tho so.. arm ear to be of tt"Jo VPr1et1aol 11hen the v~tcuolee are irregul!lrly d1 S!)Osed end of varying sizes, l:he cells are probably rhe.bdol!lyoblooh eontPining gly0060nJ dum the vae·•ol es aro Rll tiny and \1ll1form, the colb are prol:>ably !Jhs.gpcytos tilleCI dth lipoid, :J:bgss featuree are beet shown t'lith llo.saon' a trichrome stain .

co:.:1ll!Tt This 1 s a bizarre tumor and ono r•ot ordinarily 1'ound !i1 adults. It consists essont1elly of undifferentiated meaomoh:rmnl cells, some of nhich have dittercntiated autf1o1ent­ly eo thnt they cen be recognized oa rhabdoruyoblast s. Oqo 1s ~;rently aided by uasscn's trlobrollto etaln which enebl.ed :ue to finCI cross atriatione in a few cella , thus ass->ring tho d1acnoe1a . The stronal y ao1doph111o materi~ present in oan:y cells which is ata ined far deeper and r.~ore spectsou­lar red b:y the Ge~d fU.c!lsin 1n ·raaaon1 a trlahro:!la stain than by eosin 1e something of a puz;t.le for 1 ts nature is not reoognieed by na. If it us oOI!lpoud of the chondl'ioscc;es of the rbabdomyoblasts, it should G :ow a .-,ore &tin1U. •truoture. 'lhlse t=ors are fou'ld oapecioll"S' !n the uro­<;on1tal trnct and this is tho AOre co!Zion h1stolo(;1Cal type. Varlante !'lay eh~m nure mp<XV~toue meeanoh:yme without di:f'f'er­enti ot1 on or tbe tumors ra:y be llllxo"• showina areas of eoubryonal bone, eel't110lle, fat and other mesenchymal tumor or P>eeonehymOllla. The majorl ty behave in the f'ashl ;m o1: this ):ll'tlsent growthJ that 1 s, tl'>ey show s tubborn, infil­trat ive grorrth U5llally but not al\"flYS Vlithout nH!Itast&sis vmen t~1e l:>lndder is t,ba e1te o:r orl ::;in,

Ala. Aaen. Path,, Ayril 1g~7. Dr. ~. P. Stout

Pnce 2.

Jboy nre rad1orea1stant avA hevo defeated the ••est radical aure1oal nttem))ts to cure thent. Thore were onl y ~omo 26 oases ot rllnbdomyosarcoma of the bladder on r ocor d 1n 1945 (Pavich, Stout $l'ld Rav1 ch) •

Pavich, A., stout, A. P, end l'avich, R. A.

Stout . A .. 'P.

lllllnarm, ll, • Gro asmrm A • llild Clavin, J .rr.

:·all.gnant ~·ar:ular c~ 1"1o­bleat~ Involv!n~ t~ Urinar:y Bladder Ann. ~=I!· 12lr 36111-945

llhnbdomyoearcona of the Skeletal f."uscl!!o Ann. SurjJ. 12;:4!4711946

RhobdornyOa6rCO!ll& of ~.he Ble4dor Ann. Surg. 109:624sl939

'

•

Ala. Aenn. Path., Aprl.~ ~947, Vr. ft. P, Stout

i'!IT,J\'l'f.:RhL PrOTil> Silti.h~ ITIS (JUD1JLICZ 1S SY1!!l!'O::E) 1!0 SLJI:£

CASl' 10 (P-86~6) P&s 26117

llicro scoplo exar.d.na t1on s hot-Ja several t:tny t'rac;-'lente of pRrOt 1d a all vary giand, 1'08 t of these J!C'\OW no changes eave for t:h$ pl'eaenoe of eome tat between the ao1n1 . 'r'P:o fl'egmen1;s on one ellde ehow definite pathologi­cal obangea. In one thel'e bes been o 11\!lrked dogenerat1ve chance rueoo1ated nth the formation of m•ny tl'>.read-11lt9 brnnoood hemotoJcyUn- otair.ed structures r.!'ll.ob bs'l!e no dsf1ni t.e pattem. 'l'hill seems to have ooourrod 1n t.he 'Parotid tissue tt1 thout 1nfl!l11!11Bt1on. The otho;r nroo h oom'Ooned la:zoee1.y of l,..ohooytea Cll'ld 1o n ot def1n1toly 1n porotia tissue, Anothe11" ali de short a 11 pol't1on oi' a duet •:h1oh baa a thickened wsll due to the preeenoo of l!lelly lymphooytoo e nd again tho threon­llke brnnohed henatOJcyUil• stsinod etruoturea,

co:~ ·:J:'l'r Slnce non111a alb1o~IUI wae cultured frot1 the aooroticna in the parotid C>.1ct , it 1s natul'Bl to stuey the b1opay for ov1denees of 1t in the pa1'ot1d t;lond. '!'hel'O is no evidGllco recognued by me of ei thor hyphae Ol' s">oros 1n the t iei!Uss l'l!!::oveo. The basoph111c threo.de sre evidences or dogonol'ation and are ~oet comnonly to~">d in lymnho1d atruoturea Ol' in los1on~t 1nf1ltnted 'b:r lymphocytes. Bi­lateral onlarg«llent of one ar l'lore !laira of st>llva:ry k\ltlllde or the ,lec:r1mnl e~e t"lhen it iP not ooueed b1/ mumps, 18 often sr>ol<on of as !~1lrul1oz 1 e syndl'ome. It is scnel'aUy caused by involvEII!Ient or the atrootoll lllnn<la by lympllo­e~l'coroa. leukemia. Hodgkin's <l1eeaes or by chronic eiolallen­i tie. Tho sielndenitis ie uouPlly non•speo1f1c nnd ~ften aesoo1ated "1 th 11!8rkea l~hooytio 1n1'11tret1an or tho glnnde. It r>.ay 18st fcl' years ..-1th recun1ns pel'1 ods or exaoerbst1an Yhen the s.,...lling inoreaeee and 1e pa1mul. while 1n tho intorven1r.g period e the eTel11ng climini!!hee and the 'lain Vlltli!!hes. The acmto oxeoerbat1on~ otm often be al ·ortened 81\C! the ?AiD Nl18V8d by ,.,.,~11 (!oeee Of l'ad!o­thOl'&py canttou&:r em j•-eic!ausly a<"11n1etered. Tbh oaae aoo::~a to bel ong to thia group.

Ash• J .E. nnd Spitz. S• Patholomr of Tropioel Disae.l!8s. An .Atlee. ! . • B. Seundere Co., Pb11e.. end L~on, 19~5 0 p~. 150 and 16;.

Ala. Assn. Path., Apl'il 1qL7t Dr. ~. P. Stout

P 4PTLY ~1""1>l'r~ 1. Tim P.F.'?"OI'F.f'J 'l''l'"EU. LIPO!lA<>C'1 .. A

CA:;T; 11 (II-39) P"cS 26U6

!:icroseopic examina t1 on sh~e a t\1ll!or cOl:>­posed ot stellAte and irregularly shaped cells of var):ing eir.ee o.ot in a genel"''.lS myxoid stroma. 1'he cells occasion­ally ore Vtlcuolatad ..nd a Scharlooh R etain shows that r.ta motorial in the vacuoles 1a lipoid. Tho colla I!Ild atr0101r. are Sl.\PPOrted by a rich network of O(loillaries t"l t h a ~1te ronulor orrcngement. Tbis l'!Ol'Pholo~ i o Minteinsd in all of the oeotiona.

cor-1.1!'rt This ease is entirely oharaetor1at1c of the partly differentiated lipoaarcoaa dovelopin3 in one of its favor1 to si tua tion11 1n the retroper1 tone Ill. re:;1on. In the

soft parts, the llposarco:.a 11tnnds next to fibrosarcoua EO tho second r.oat co=on =llt:;nent tul'lor derived fro::> ee&e!:­c~ tiaeuea. It !e r:ore =onl-:; round 1n the later :,rears of lito, el thollgh it ha&-.beeo noted 1n children: it occurs with equal. frequency in tho two sexes and it may be found 8ll}'\'Alero e.lthough its fa'.loro" o!tee ara the ratro­per1tonoo.l rea 1on, espec1alJ.y o.r<)Ulld the kidney nnd in the tllll)l l'ald h.tp area e. The tucor often r oaobes :Jpootac•llar proportions and co.ses wei~ng 60 pounds and uore bo.ve been rooordod, nll;hon:#l t he record V1&1!¥>t for any tumor is clcdl!l<ld b) nelnmator for a retropert tonoal l1pOillll which 1 e • aid to hava .,o1cbor.'l 275 poundiJ . 'l'hero "ra t~ prino1 pal ve'!'ietbe of lipoeeroCI!la; those Tlhicb 1m1tote the upponrnnee end ~oid conoiatenoy of ordinary embryonol ad!~ooe t1esua 6Dd those oharacterued "B1>ao1a1ly by rounded l1pobluts wl1:1cb ollgzost the o!'l!lracterietiee of brOl'ltl fot and the hibernating !!londs. Occasionolly a poorly d1fforo.nt1ated llposarcor..t: will be a "'ixture of the tv,u vnrtetiea an(l nny or ~.r.= =l' bnve toro•a rese•,bling fibro sarcoMa.

'l'his present tu."!or 1a pn &X8J!1Ple or the more comon ~id varie ey of llpostl.l'COIIIA. In s n. te or s~~rnl reourronoos 1 t baa r'>&1nta1nod <:OmO d ecree of dirfo1'6-'ltiation. oltlloueh it cannot be cl>lled o nll differentiated llpo­aarcom tor these are oompoaed of an 1ntoro1n&].ing of aeult and Oll:!bryannl rat calls and bovo of ten boao clllle d llpo~ ayxomne. Such ttL'!lors do not notnetne1r.o 'lS lone a s they on1nto.1n their good differantistioo, but they displq stubborn infiltrative IJ!'Owth oo tlult 1 t 1s difficult to c•.u.•o t.hem ut>less very wide oxc1.s1ono o.re Clone. !I bout forcy r,e r cent of ~te poorly differentiated l1poearoor.~aa I!Wtast!I.Bi~e

•

Page 2

CA~B 11 (U-~9) P~~ 26116

-ond those whion do not often event>Htlly 1<111 the- pet1mt b' continued spreading inf1ltrat1 vo growth i nvolving eventually Vi tal etruct-ure. ~.bon thleo tumors are found 1n the rotroparitoneel tissues, it 1o dOlbtful 11' t~>ta:r ara ever ourod n!le ther or not they motaetao1zo, because th>1r 1nsid1oua mot11od ?f oooult 1nfiltrnt1ve srowth -Akea it imj)osAible to ratnove t.ll or the tumor wt thout eacrU'ioing vital st.ruotures, pnd just oa in th1e oaee roourronoe is the rulo. Those tu-:tors, 'lhon tllsy aro ns ~~t~oll as 4 cn.. or lees 1n dianeter, ""'""¥ ba treated auocos&!'ull-y by l:'.ass1'1e doaoo or radiation , but t."!e larnor tutlore have never been ourod by irradiation.

Dol&l".ator, J . t

Stout, A.P,I

Rtout , A.P.t

Stout, ll. P.r

l'eJ'11!11oth 't'uot"r Clevoll'.nd l'e<l . Gaz. h ;l: l 8S9

Li posat•coma - 'l'hB r· nl1anent T\rar of Lipoblnnts Ann, Surg. 119:06tl844

~or r,BM1nar, Li~oearcoma Texa" stat<~ J, rod. 40r;66tl94h

sarcomlla or tha Soft Parts

'

!Cisoour1 State J . t:ed. ( 1n preea) 1947

A1a. Anrm. Path., APr11 19~7, 1)r. ~. P. Stout.

~icroooonio examination of tho loGton frcnm tlle baok show~ Q tumor made up of &J!tt•e:nel y heovily oig­:-let>oed cells of varying sizes snd "'"'!lee <Jhich extend from t!te paoilloe do=ward into but not throu=b• the cori= tu <A on eaoh elde they are apreaci tl'1nly 1n the onbpap!l:.ary 1ayer for a !:'.rudn:um tl1stpnce of 12 em. fr= tho oontral =~a of thickcnin(l. I:nn-y of tho colls appear o o isolated units while the reot oro in loose oo:rcJs of from one tiO throe cells in r.idth. l't>.ny cells aro e l ongatod , !n t..ha r.~ain tlllllor zone thoro is a s·urrouncHne f:!.brosi" e.nd "" aston1ahin!ll¥ intenoe plaS!"'.a cell infiltration. The ·Jpi• cle~:cl!lie 1s intact and not invaded. The nodule tr= ti:le axilla eh01ts no l~hoid tissue. Instead, it 1e conpost;il of eront masses of rounded cells l'cith centrally ol~csd nuclo1 nn<l USlle.lly lllrge nucleoli w1ich shot/ nltttoot no nitoeel! Md have arrululnr cyto}:>laam. rtds mny not &Gtuoll;: be as vory granular me it eppeers booeuse thoro npnaar to be sioilnr gr:mnlaa :mtside the call bodies and 'l:ha '<''tole syatet:l !MY be =tefnctue.l, l'o ni3"ent is found. ..1tocea average one in every hiGh cower field.

co::->::T;T: This caso ofi'er>t some d1fficalt1oe 1n 1nter-prstntion both or t bo primary losion and tho motnetse1e. The pr1m~ry lesion haG th~ PrrPnoO~ent Of ~ ~1CMOntOd r-ole 1n wl'liob the cells e.ro all verr ·~<!ovily nigmc:.nted. It ie not in ny estination n true blue nsovus or me!tonoh:roal. !:'Ole bacGuse there are mole coll2 in th11 onp!ll'.!rY ln:;er. "De' true blu~ rAevtts haa no ~ole oello nt e.ll of t he ev1t~elisl type. It looks essentially liHII a f1braca r.lth p scnt".G~ ~ of hrnnohed elonge.tod celLs enme~ltocl !:l!IO!lg t ho fibroblast• Pi~tont calls arc never found in tho papillary lnyor rmd l'lone o£ them hoe tho rour.decl :ron1 of' 11ole cells, In this pre~ent pi@Tlented tumor it iG c1!'l'ioult to eoo the nllclei bccaueo they e.ro obscured b~ the ;li(;c:cnt. 1'ho fo~< that can be seen ~elll!1 to hsve lnrge nucleoli. .._.,_.. tact that t'1i a tunor undorr.ent spontaneous ulca:cont1on an/1 tho very clde extent o!' tho 1>1<)!1ont colla around l:he t=or which must bn.vo given it e. hal o that ?robably inoroascd at tho time o:r ulcergtion era very atron<) pre,ml!1Pt1ve ev:l:cl<\ncos of r;n.lig• nsncy. !loavily pi~?Ponted r~oloa or t.hia type are ••ore canner 1n children then 1n adults. If tho~ pers1~t 1nto &dult

t.la. A a !ln. Pnth., Aurll 1947, Dr. r •• P . st.,ut

P.,.;e 2

CAS£ l2 ( ll-46-1.425, ll-47-108) Pl<.S 26124 81lti 26126

lll'e they IMY demonstrate ~::allgn81lOy but thay rarely do ao before ~bor~.

The a~illa_~ nooulo is alnoot earto~nly a metnatoeia in "1'1 te of the fact of tho vory different mo1'!>holo~_;1col appeera.>1ce of ~~la cells. Tl~io chau~e from ono fol'lll of tU!!Ior oel1 to enother is 11 a•>oo1o1 f ent1lrt! of tho nolar.ot1o .1ali~t t:IL"lora. The proe;noa1e in this 'OQOO 1a oxceedir-81Y IJre.va. ra have rnroly aeen any oaso 111 th provod ,.,etaatases recover , although <'eath r.a:r riot OOC'>r llnt.il yoP.rs later.

'l'u!!lor S=1nar, Cases 12 m>d 24. ::alig­l"...e.nt !.~131ano~'18.. Texa :~ f. tate J. l'ed. 40t366tl944

rontgomery, u. "''d F.ahlo,., J. r.: .

• 1'he Blue llevua (Jadueobn•Tiecha) Its Dist1nct.1on fro·• Ordinary "'oles and t'elie;nont ~~ole.nomu ~. J . Cnnoer 36r527•1959

'

Alo.. Arm. Path. • Ap.riJ.. 19h~ • Dr. • P. S~ou-';

SYJ··-""'"'."A ar.rr.·=· \.1.£. '·"" :.r .. ~v.;. ;

CA~~ 1§ ( Cnl'o) P.:.:S 2611-5

lllo!'oscopie oxam1nQtS. on O'f tho uterus sl·=o tho nmtAl pregnancy hypertrophic ohnnees of the utar1ne mue.:11l111:ure. The luminal surface 1 o covorod by a thick blood clot uith much fibrin ~·''1oh reate upon ohorionio villi eoroo of ~h1cb 91'9 of rel~t1velv normal eppaarence, oltoopt for n cys•:ic enlarg~mnnt , but moot nre mt:tmount<ld b;v ··•an~ la11oro of b izarre •ynoytlnl trophoblastic cells r1th a !Jl"Bf\t 'lnrintl.on 1n tho ~onaar~noe of tho l'.cyperobr=• A.tlo nncle1. V'Llli nnd trophobls>o1:1e cells ha'le ~.nvaded the myO!'ltetrium !''>r r.pnroximately one holt of its th!.olme3a and somo of tht;m a'Jpear to lie ··•ithln endothel1sl-11ned spaooe.

l\' ton:u nne lined 1"1 th cyeta .

A section of one over~ ah~n one lerge corpus several thln-~sllcd ~y~te, aoce or rhleh era luteb calls .-·-11e_ othoro pppear "-O be follicular

co:·:·tr1't 'l'h_j_s case 1lluatratoe 0. nlll1!ber of inter6et!.ng pnono1enn. It is o~vious that the lesion must be either an invasive mole or ohorlonepltbelio:un. 3oth of tnese conditions llltl::i be "eaoc1ated "<"'i t h bil ateral oyet1o ovaries rrlth lutein e~·ota (Jooeph and Rabau~ Vnn Dongent Gordpn) cuo probably to hweroecl'etion of tm nntorioxo ?1tu1 t ary liko ho~tone. !:loth oonditl.ons ma:)' be associo.tod w1 th eovero 1ntraper1tbnelll. bomorrh11aes euch as occurred 1n thio onao (\.hitet Lazarus nnd Soh1J:rint Go rdon) . It baa oft on boon pointed out that the proliferating trophoblastic eelle of hydat1u1form m~lee can bo Jus t ae bizarre 1n n pear~oo nnd anpaar ju~t as t"Rlii!Dttnt as those 1n chorlonepithel10!llaa so that tile t;ro eondi t1one cannot be dlst1ngn1ahed by thia nethod ( Iwe:otr.<"). In tho oreaont case, the feet thBt the uterine wall has been panotrnted by an aetivoly :;ro•·lns ~:~olo b. ~hich th.; chorionic vn11 are prcaervod 1s otro~ ev1danc:e 01g~tr.st tho probnb1l1 ty that: the gro.,th bae boeorte a. trua c!lorionep1-thol1001ll. ~is fact has been «l!Phneized a num~er of t1r.:oa by pt>thors uno point .ont that 'llOat of tho 3o-eall<>d cured ol'>01"1on-op1 thell<F.as are in rea l1 tj' only !nvt> s1 ve "'ole e and thnt Whi l e invasive ~lea sre not e~tremely unc~on. t'('tte ohOl'1one,litbell01!1as1a very rnre (Curtis, 11rsenblatt nn<'l l'und) • In the present caoe tho ooourrenee of a trsn­e1ont J?l,nriey with effi'Blon "'flY "'l'lkO onG Stlspect t hG pooa1b1lity of ~leural ~:~etsstosls bnt t'lfl foct of its s•.lontAneous di snpp0aronM end fo~ luro to ret>ppeor a:r[l'~ee

Ala. t.e:ro. Patl:. , April 1947, Jr . A. P, «;tout

Page 2

p•,s 26115

-agAinat th1a. It is of oauroe, <l'>ita no8dblo that; soma troPhobla•~ic cells '"'~~'1 have lollged l;hore for n til:te but tho ~1fferonce bat~een simple trophoblastic oolls rund "nlisr>An t ohor1oneo1thaliOin& cel lo 1o t;)1ot t)'lo lntter per• niet on~ grow Whan they metastasize whlle the rorruer cis­appear . r~ ott~ots to d1at~oae ahor1onool thol1oma 1n uter<m C1lretl:inGs we h .. ve refused to moka tna dlafl!"osio U' o:~orloll1c villi ere atlll present vith bizarre trophoblastic ?roliter~t1ono ~en ~he curett~ge 1~ dono ~rtcr the rs-,oval af o •·ole. 4lysterectOJ:ll"' "l:•oat al<'II)"S our;,n n'.lcb cases . '!el'}' rarely chorl.onlo v1.lll ana c:1ortona?i tllslioom -.n..r Doorlat at tho 15e:1e tine. I have ee n ono ench cos'> t.>tout).

Chor1o-epi tbel1o"ln of •.bo uterus Surg. Gyn, and Obstot. 54rB61:1932

The l'reo~nant or UydQt1dirOl'l!l r·ol e and Chor1o-ep1thel1ome. 1•.1th ~ oonoideration of the F'elntlve Frequenall of l'..aoh Surg, Oyn. and Obatot. (Fob.) 242:192'

Grecnblati:, Ptmd , t::.F:.

R.B.Ino· i ry into the llt1 tvre or ao• oalled S-yn- · cytioroa Reoons1dernt1on or Chorionopi thel!ama goutb. !"ed, J. ~lrl40tl9~8

!"BJ\0111 , I. Y. !\t>>dies of Cell !!:>oloi 1n nlllcantn, Hydatid !:ole end Sync:it1<r~a "al1(l:1un ,

J"oocph, ~ • .ond llobau, E .

Latr.orua, J. ~. Scllitrin.; .•

Staut, 1\. . P.

Ztaohr. f . GebttrtGh. und O;malr. 9(>: <>3l rl927

C,~t1c !~ole. synoytiana i•nlignm:: and Luteu::l Cyet l' Arch. f . Gynak. l;4:46lrl928

Chorionic Villi Impl!Ults Ann. Surg. 115t9?irl942

'l'tlmor Seminar; Chor1ollop1 thol1cme of the Ute~s devel opine; from a flydet1f1fore r;ol.e Texas State J. I:.ed . 411561~:1946

( Seo pe.(le ; )

l'.l!l. Aean. Path., ~nr:tl 1947, rr . A. P. S~out

c~s· 13 (CUPo) P~Q 26115

nareronoae continued:

Van llongen, J. A.

fhito. =~. R.

Vesicular !:ole lledarl. ?1gae. v. Oenocsk. 2:1824:192k

Chor1roop1 thel101!1a ot tho TT:Ooru:>, with Perforation and Intra-abd~inel iiEl!lorrhage lllcb. StAte l'ed. Soc. J • 39:9491 194D

COI!Mantr (Dr. Curm1n<:;bam) 'l'b.ia p~tt1ent is ~live s.nci "Sll w1 thout opparent oetastasa s or roourranoes !!lore than ~o yeara attar hysterect~.

'

Ala. As~. rath. , April 1947, Dr. A. P. Stout

S~U/1: OUS Cf.LL F.l'I~7"T.IO::.Il 0!' TIIB ctP'-''IX ll'l'F.!':I A!':ISI;IG Fi\0!: Sc:'l1A:·o11S !1'.l'AI'IASIJ\ o:> ill• c;;rJICAL :·ncous 'H.A"llS

CAS'£ l4 ( 12~,426) ( SH 46-772) Pt<S 26129

r:icrosoopic eXIU!I:!nnt.1on eho"s a oe!:J!tent of the oarv u . At one end the muoouo (lltm~s are n=erous and aotJ.ve 'but n o neop1est1c cmll(;es oan be noted in t hem or in the m•l'1'ace mucous mel!lbrene , 1\a one progresses toward the internal oa, hCI\'19V9r, St>ddsnl y evidences Of ~qusmous '"10ta­plao1a ~menr both on the su.rface anO 1n the l11UCous glands, and this qnickl y changes to a equomoua oell enitheli01tl&. The opithelimatous chense, h01fever , ie not ~r>parently at first acc~~an1eo by invasive Gr~th for the sou~ous ttlmor cells re1'181n within the gl.tm<! onpt!lll3a, cUeter.ding ann Sa:!G­ti!lea ti111n:; the lun1en s. An edt'1 tional elc.,ent of 0111te d1fforent appearance a."lc unqueet1onah1e -.altsnenO}' soon is added to the .,1cture. Tlli& constat& of r.nll grpups of d!u'k1-ata1ned poll""orphous cella \rltb. aoi~o")h111c eytoplaE:Os mteh spring fr~ thO outer surface Of tbe ,,ataplaatiO B9ithel10• catoue oucous glands and iDvt>d& the ourrotm~ substanti~ propria of tho oe~LX as isolated units. These t unor cells to~. rosettes eomet1oes oDd occeeianally vacuoles of secretion are i'ound Tli thin tbEil:!, At the extreme inner and of the section both tho rlifi'erentiatee squiii!IOUO cella and the snall dark cello appear t o have ir•vadeo tho cer vical atroca, somatines eopll.rately and sornt;~ t11!les 11nlted toaather.

co:~li:Y!Tt This npuesro to be nn eJU~mpls of a !!".s.ll:;nent corvlca tUMor ~hich has arlaan on the bns1s of a preexls~inG aq1l00oue ttetapl a sla of tho ep1th&l1U!l1 or both cervicnl :;lands and the s-•l'1'ace. The t unor l e of constderabll interest te­cauae it seems to preserve t~o different Corns of dlfferen­t1at1~~ aince there are a~oua and zl~ndu1ar elc~enta in the t~or growth, s~etioes separately ond sometimes to~other. There are a nunber of lessons to be lenrned r~ this cess. Squanous ..,otAI)~osu in the cervix auat ~lt~sys be regerd&d 1!8 a .. ar\ous omd even <:Dinous cl>Pn<;a. !'ho nosF1"o1l1t; that en epithellome nay develop !rom it 1s a very real one ~ indeod, tl'OGO \'1110 deal With C9rv1Cel b1opa188 mow how otf'ficult !t l:laY be to <11atingu1s.~ be~een s1oplo eaunnous l:lOtnplae1a, 1ntr~coael e~1theliome nnd early 1nfiltrnt1ng e~thel1~.

Ala. ~san . Potb., April 1947, Dr. A. P. Stout

Pege2

(12;.426) (SH 46-772) pr,s 26129

Study or this tumor nlso emphasizes the fnot that oarvicnl eo1the11um oon give rise both the Bquamoue and glandular srowthe ond thn t the two may be cqmbined, as hae 11ppera.." tl7 occurred in this oese.

1'\md, 6 . n. and Auerbach, s. H.

TeL1nde, n.l". and Ge.J. v1n • a •

Suparf1c1al llon-tnvuive Intraepi~eluu ~ore of the Cervix ~. J. obstet. & o,n. 46t;;;tl943 Preinvasive CArcinoma of the Cervix 11ter1 -.r. r...r:.A. 1;1:96o :1946

'rbo r:infual ll1eto1oc;1ou Changss in B1ops1oe to Juotify n Di&~OG!S of Cervical Cnnoor lim. J. Obotot. & Qyn. 48:774:19~

'

Ala. htm. ot l'eth., AprU 194.7, Dr. •· P. !:.t<>ut

l~iGrosco,i<> exnminntion shows 11 1:tn!lor com?oeed ot very large, i rregularly rou~4ed cells ~d ooca~1011elly of smaller rounded cella. All or nhcee e.l'E)

oro\Vde>d tosether in l arge maseee eop!lrated by 1nconspiououe strnm'le ot VaiJQDl ar fibrouG tis!J\le . 'l'bs colla B.l'ld nuclei are often 1rrecularl y vacuolated. At wic:'le 1ntervnls groups of cell& are found contGin1tl{l small q11ontit1ee ot grmular bro,.n n1ament. r.OI!le or t.he coarser gron uleo are refrllct1le but t"Oet of the small er ones Pre nd:,

-czy,~-'1'Tr The history tmc:'l MOrPhOlO<lY or this CS!!'l leave 11ttle doubt about its nnture. It I!IU8t have started aa a '>iGOonted eole eno at sorae tina d~;veloped into a t:>al1.:;nsnt rol8J1Q:.Ia, This vsrlety c=oaed ot cells of gient eiu 13 a woll known, al though ~ather uuccmr1on var1ent of tld~; tu::or. n:e cases e owing 1t of 1!>11ch we have rocor6a l"DVB ge-..,rall;r boen ratl>..Gr slow 1n growth nne:'! MJtaetade j••st as ~ ~" OXIII!IPle but they have proved thoir r.tol1gnancy by the evert>t&l oppear~noe of metaata sl a anf. death just ea ro~~lorly as LOnt other vari&t1es.. l'he faot that the pa•1ent is e nc,;ro nee6 not invnlidate tho die<liloshl it 1e rolativ~ll1 leas CO!!!L~onl.7 found in the negro but there oro platty or recorded cesea to eubO~I'nt1nte t:h1e atetemsnt . In t:hh cnao the propriety of roa1onnl l~ph node dissection must be dieous~ec!, It is wol.l known that malignant ne l enoosa metastasize both thl'ou::;h tho bloo<l etro&-'!l nnd the lT-JPhat1os in moot ouee, and 1 t is tho blood-borne mete.ste~ea 11hioh eo ofton dofoet atta."f)ts to ' cnro. llevertheless not e.ll cases metaatao1me ilhl"lug_~ tho bloo~ etre~~ ann it 1s in an attempt to chock spread thrangh tho l',!l'1'9hntiou Rlona that re~onal node axoieion h u8'•all;; un•lertAken. 'lho re:nlt~ of :mch opartlt10Ds he.vo boa!l a:rtr~;me­ls ~1eepnointing. ~a cannot claim aoy cures rhero oetastaeee w&ro t~lron(ly Pl'&llent in the nodes l'lhe, they lfere r~oved e;;;­oept in one instPnco rt>cn the nrimAry t>.r~or ne 1n l:he dsl te i d ror;1on, rsotast~toe s wore l'O"'lOVed fi'Olll •Jte supraolav1cuU>r am nx.11.lnry re'"ione three years after oxoislon of the nrinll>ey growth, nn!l th<1 ;;irl was symptom. fr.,o nine yonrs after the second operation c··obster ot pl). nut tl!ie potiElnt was en a1r;ht yee.1• old girl and it ie well knovm tlu• t l!Uillgrumt melancmaa lire much less malignant bnforo r>llbcrty t"an after 1 t.

Ala. Asan. Path •• hpr11 1947, Dr. A. P . !tout

Page 2

CASF. 15 (SR 109, 937) f&S 261,0

In thie present case now under d1aouee1on, 11e m~>ld probably do en inguinal node o1osect1on whether or no t t.hero woo c11nionl evidenae of metaetaaj.s, in the hope t'·nt 1£ 1notutaeis has ooourred, 1 t is et1ll l'1:!nlted to th18 !!rOUP or nodee. but v1tlJ ~ho full reol1ZRt1on t hat t he hope 1e a forlorn one. Inc1dant~ly, it 11111 be or intere~t. to notG that 1n addition to the "'!1l1gnant melt~nO!"..as ar i sing befora ~hfl fl(lC or ..,Uberty s there (lN tTIO other V!lria t iee r l+ioh nre scnel"hat lees !:!lllif;nsnt than tha overf'ge. These aro f-.he subuncual. :::elana:>..es end the superficial spN~cing 1ntrndernol nclantt:l!la, so'"1etilnes orl1ed 'Al1<lJl.a.."lt f r ocltlee. In regard to trea~ent, ve prefer ~gory bocnuse rad1o­t!Jerapy 1s usually ineffectual. Rarely, 'elancr.1as prove ~••hat rod1oeane1t1ve •

. \'obetor, J.P • • Stevenson., T.r. end stout, ~.P.

T110 Surgical Troetment or ' T:oliSl'lant t~o1anO!!las or tho Cltin Sure. Cl1n. 1! .. Anmr. p. 319, April, 1944 '