CALIFORNIA TIJMOR TISSUE REGISTRY WMA LINDA UNIVERSITY PROTOCOL FOR MONTHLY STUDY SLIDES FEBRUARY 1994 FEMALE GENITAL TRACT ...

CALIFORNIA TIJMOR TISSUE REGISTRY WMA LINDA UNIVERSITY PROTOCOL FOR MONTHLY STUDY SLIDES FEBRUARY 1994 FEMALE GENITAL TRACT...

CONTRIBUTION: Jobo SICOOIIdgc, M.D. CASE NO. 1 - FEBRUARY 1994 Sylmar,CA TISSUE FROM: Left adaeu ACCESSION #127320 CLINICAL ABSTRACT: ~: This 20 year old female presented with shortness of breath, hyperbilirubinemia and elevated tmnsamjnases She also had severe anemia with a hematocrit of IS and severe abdominopelvic pain with a tender abdominopelvic mass. Physical Examination: Head CT revealed a left frontal lobe hemorrhagic lesion. CXR indicated bilateral infiltmtes and a large pleural effusion. Abdominal pelvic ultrasound indicated hemoperitoneum. SURGERY: 03/10/93 Exploratory laparo10my with left salpingo-oophorct;tomy, omental biopsy, and left extcmar iliac node sampling. 3400 oc of dark old blood were removed. GROSS PATHOLOGY: The left adnexal mass was necrotic and hemorrhagic and was approximately 12-15 em in maximum diameter with a smooth external surface.

CO:rrrRIBUTOR: K. Greg Petenon, M.D. CASE NO. 2- FEBRUARY 1994 Siou:< Falls, S.D. TISSUE FROM: Right ovary ACCESSlON II 26883 CLINICAL ABSTRACT: Histon : This 16 year old female had a long-standing history of metrorrhagia and had been on Provera for cycle control with minimal effectiveness. A pelvic uhrasound I 112 years earlier had suggested a 4 em solid mass of the right adnexa and her physician elected to observe ibis. A follow-up ultrasound 3 montbsjater showed bilateral solid adnexal masses. The right side was read as 3 x 2.5 em and the left 2.5 x 2.5 em. She was again observed. She continued to have problems with metrorrhagia and her menstrual cycles became every 10 to 21 days and lasted 7 to I 0 days. They produced extreme eramps, to a point where she missed school. She was otherwise healthy and had no bowel or bladder complaints.. Physical Examination: A 6 em firm. solid pemc mass of the right adnexa was 2+ tender. Her left adnexa felt negative. Ultrasound confirmed a solid mass with very slight cystic component in the right ovary measuring approximately 6 em. SURQERY: 10/15/90 Right ovarian cystectomy and left ovarian wedge resection. GROSS PATHOLOGY: The right ovarian mass consisted of a single, ovoid, tan-pink soft tissue mass which measured 5.5 x 5.0 x 3.4 em. The external surface was smooth and glistening except for the apparent margin of resection. The cut surface was dense, tan-yellow and nodular. A 1. 7 em area of cystic degeneration was present in the center of the mass. The left ovarian wedge consisted of unremarkable ovarian stroma.

CONTRIBUTOR: Neil Korostotr, M.D. CASE NO. 3- FEBRUARY 1994 Bdlflower, CA TISSUE FROM: Pel\ic tumor mass ACCESSION II 26032 CL!N!CAL ABSTRACT:!iis2n:: This 23 year old. gravida 3 para 2 female presented with a 16-18 week me pelvic mass which during the COUJSC of a month increased to a 18-24 week size. There was a history of amenorrhea for the prior three months. Before that ber menses were normal. Pb1"Sical Examination; Patient was a normal-appearing female with a mildly increased amount of facial hair DOled under the chin. No other evidence of virilization. SUl\GERY: June 1987 Exploratory laparotomy. Multiple tumor excrescences were present on a 25 em pelvic mass with adhesions to parietal periloocum. small and large intestines. appendix. pelvic side wall and dome of the urinary bladder. No adenopathy was found. GROss PATHOLOGY: Recei\'ed was a 20 x 25 em multilobulated. partially cystic tumor mass with tumor nodules of 6 to 10 em. The cut surface of the tumor was pale-tan with multiple areas of hemorrhagic necrosis. The opposite ovary was uninvolved grossly and microscopically.

CONTRIBUTOR: K. GregPetenoo, M.D. CASE NO. 4- FEBRUARY 1994 Sioux Fall,5.D. TISSUE FROM: Uterus ACCESSION# 26832 CLINICAL ABSTRACT: Historv: This 42 year old, white, gravida VI, para IV, spontaneous abortion 11 female had sudden onset of I()WI:T abdominal pain, mostly on the right side but present on the left side.as well. She was nauseated with the pain but had not vomited Urination and bowel movements had been normal. Stools were not black tany and did not show fresli blood. She had regular menses "'ithout pain, and no irregular bleeding or spotting in between periods. A pregnancy test was negative. Phvsical Examination: Her abdomen was obese and minimally tender. She had a midline, slightly tender mass in the suprapubic area on the right side, grapefruit size. CT scan of her abdomen showed an inegularly calcified 8.4 x 8.4 x 4 Cit) mass invoh'ing the" superior aspect of the uterus. There '"as also a right adnexal mass, suggestive or an ovarian cyst. SURGERY: July 1990 Total abdominal hysterectomy, right salpiilgo-oophorectomy. GROSS PATHOLOGY: Submitted was a 14 x 7.5 x 6 em distoned uterine fundus with attached right ovary and fallopian tube. (The cervical portion of the uterus was submitted detached.) The serosa was smooth and glistening. A 10 x 7.0 x 7.5 em smooth swfaced mass protruded from the rightlateral aspcct of the specimen, well demarcated from the adjacent tissue. Its cut surface was fum, white, and whorled medially, while laterally jt was gelatinous tan-yellow and focally bemonbagic. The endometrial cavity was lined by shaggy, Pink, focally hemorrhagic endometrium up to 0.5 em thick. The myomciriwn was pink-tan and finn. The right ovary had a 3.5 em hemorrhagic corpus luteum cyst.

CONTRIBUTOR: Samuel Southwick, M.D. CASE NO. 5 FEBRUARY 1994 LaMesa,CA TIS,SUE FROM: Uterus, tubes and ovaries ACCESSION # 27300 CLINICAL ABSTRACT: Historr: This 30 year old blade female, gravida 1. para I, bad a long history of abnormal vaginal bleeding wbicli was apparently related to an anovulatory cycle and endometriosis. Three D&C's over a six year span failed to reveal any abnormal endometrium. A laparoscopy showed endometriosis. Her sytnploms worsened and another Japaroscopy with hysteroscopy revealed endometrial implants in the pelvic area as weu as hyperemia of the pelvic peritoneum and broad ligament. Six months of monthly shots of Depo-Lupron resulted in mild resolution of the symptoms but she developed post menopausal symptoms characterized by bot flashes and vaginal dryness. When treaunent was stopped, symptoms of dysmenorrhea. pelvic pain, abdominal cramping and severe Vl!ginal bleeding recurred within 2-3 months. Patient did not want to continue hormonal therapy and wanted a definite treatment, hysterectomy and bilateral salpingd-oophorectomy. SPRGERY: 04/12/93 Laparoscopic vaginal hysterectomy with bilateral salpingo-oopborectomy. GROSS PATHOLOGY: The uterus with attached bilateral adnexa weighed 152 grams. The uterus was 9 x 7.5 x 4 em. lis serosa was hyperemic, focally ecchymotic, moist and glistening. The hemorrhagic endometrilim was 0.2 em thick, the myometrium V.'as 1.5 em thick and hemorrhagic. The right ovary measured 4.5 x 2.0 x 1.0 em and the left ovary measured 2.5 x 2.5 x I.0. Both contained hemorrhagic corpora lutea and multiple hemorrhagic thin-walled cysts val)'ing in size from 0.2 to 0.4 em in greatest diameter (right) and 0,3 to 0.7 em (left). The rightfallopian tube was 5 em long and varied in diameter from 0.2 to 0.5 em. The left fallopian tube was 5.5 x 0.7 x 0.7 em. Both were hyperemic.

CONTRIBUTOR: William J. WeiUI, M.D. CASE NO. 6 -FEBRUARY 1994 Jack!on,MS TISSUE FROM: Left ovary ACCESSION # 27388 CLINICAL ABSTRACT: History: This 86 year old nulliparous female presented with a pelvic abdominal mass which was confirmed by cr scan and ultjasouod.and estimated at 7 x 10 em. She bad few symptoms except mildly decreased appetite and weigbtloss of 10 to 15 pounds. She had hac;! a right radical mastectomy 3 years previously for infiltrating ductal carcinoma with 2 positive nodes. Physical E?g!!!lination: Abdominal exam revealed a ballottable mass effect in the abdomen that could be freely moved and seemed to represent two masses. one more to the right and one deeper on the left The pelvic examination suggested that these masses were adnexal, although pedunculated uterine libroids were also considered. Tliey had a solid consistency. SURGERY: 9/16/93 Exploratory laparotomy with left salpingo-oopborectomy, then completion hysterectomy with right salpingo-oopborectomy; node biopsies and partial omentectomy; appendectomy. There Was no evidence of peritoneal seeding. GROSS PATHOLOGY: The left adnexal mass was 15 x I 2 em and weighed. with tube, 5 79 grams. The tube was stretched over the sutface of the.mass and appeared otherwise unreltl31kablc. The cut sutface showed a dense fibrotic tumor, constituting about 800/o of the mass, which varied from white to brown. About 20% of the mass bad foci, up to 2 em in diameter, which were red, hemorrhagic and soft, in conuast with the rest of the tumor. Several of these areas extended to the scro~ swface of the ovary.

CONTRIBUTOR; Betll)' D. Slouer, M.D. CASE NO. 7 FEBRUARY 199.t PuadeDa, CA TISSUE FROM: Uterw ACCESSION # 27364 CUNICAL ABSTRACT: J:!imn:: This 44 year old female had a history of uterine fibroids. She presented with complaints ofvaginal bleeding and pelvic pain for the post several months. and a notable increase in abdominal girth accompanied by pelvic pressure for the last two months. Past Medical Hist9o:: Two cesarean sections. No illnesses. Pbysical Examjpation: The patient was a well developed. well nourished female in mild distress witlt signifu;ant abdominal pain. The abdomen bad a 16 em. tender, cystic mass above tbe pubic symphysis. There was no rebound tenderness and no fluid was noled in the peritoneal cavity. Pelvic exam n:vealed the mass to be adherent to the cervix but the examiner was unable to tell whether it was utcrioe or adnexal. Laboratory tests show severe anemia with hemoglobin of 6.5 gm. Pap smear was Class I. MarlceJs for HCG, AFP and CA-125 were all negative. Ultrasound m'e31ed a 14.0 x 10.0 x 10.0 em multilobulaled. cystic mass. SURGERY: 07128193 Abdominal hysterectomy, bilateral salpiogo-oopboreclomy. GROSS PATHOLOGY: The uterus with bilateral tubes and ovaries weighed 1488 grams. The uterioe fllngjs was markedly enlarged, globular and measured 18.5 X 17.5 X 12.5 c;m, The surfaces \\'ere pinlc-tan. smooth and glistening. Within tbe anterior myomeuium was a 12.5 em diameter lobulated cystic mass. It had multiple lhid-wa11cd locu1es containing atj. nt!ant clear watery yellow fluid. Delineating tbe loculcs were trllbccula of firm glistening white whorled tissue. Aqjacent to this mass was an o-.'oid. well circumscribed nodule measuring 4.5 x 4.0 x 3.5 em, composed light tan whorled pareochyma without evidcoce of softening. hemorrbage or necrosis. There were less discrete nodules of similar appearing tissue present within tlle myomeuium at tbe periphery of!be loculated mass which measured up to 2.5 em in diameter. In the posterior wall of the uterus were two more well-demarcated spheroidal nodules (0.9 and I.S em) of tight tan whorled pareochyma without evidcoce of central softening. hemorrhage or occrosis.

CONTRIBUTOR: BI1Ke P. Swinyer, M.D. TISSUE FROM: Ovary Bakenfidd ~CA CASE NO. 8- FEBRUARY J994 ACCESSION # 2S576 CLINICAL ABSTRACT: History: This 37 year old Caucasian, female, grnvida IlL para II, spontaneous abortion f, presented with complaints of beadacbe, depression associated with the onset of menses, and of not feeling well in general. She.had had a normal menses six days prior to ber appointment With her doctor. Phvsical Examination: Pelvic exam revealed bilatenil ovarian masses. Laparosoopy revealed bilateral ovarian lllmors with smooth surfaces. SVRGERY: 10115/85 Vaginal hysterectomy, bilateral salpingo-oopborectomy GROSS PATHOLOGY: Tbe 5.0 x 3.7 x2.7 em left ovary was relatively finn and had a smooth surface without excrescences. In the center of the ovary was a 2.0 em diameter cystic area filled with ooagulaled blood. Tbe surrounding ovary was fll1l1 and pale tan-yellow. The previously bivalved right ovary was triangularshaped and measured 7.8 x 4.5 x 3. 7 em, Tbe center contained a 4.0 em diameter cystic region, partially filled with coagulated blood. The surrounding stroma was abundant and pale tan-yellow. Ex!emally the ovary showed a focal area of tan friable tissue corresponding to an apparently infarcted area adjacent to the internal cyst.

CONTRIBUTOR: Douglas Kaba, M.D. CASE NO. 9-FEBRUARY 199 Sylmar, CA TISSUE PROM: Right ud Left Ovary ACCESSION 1117383 CLINICAL ABSJ'MCT: Hlll2n:: This 39 year old female presented with a three month history of urinary frequency, constipation and pelvic pressure. She reponed a 60 pound weight loss but stated she had been dieting. Eleven years previously she bad a toial abdominal hysterectomy for microinvasive cervical carcinoma. Pbvsical Examination: The abdomen was obese. Bimanual exam revealed a fum, tender, somewhat fixed 20 em abdominal pelvic mass. The mass was more on the right but crossed the midline. There were no RCtal masses and stool was negative for occult blood. Ultrasound revealed an 8 em complex pelvic mass. Barium enema was negative. Upper GJ was negative. SURGERY: (07112/93) Exploratory laparotomy with bilateral salping~borectomy and tumor debulking. GROSS PATHOLOGY: Both ovaries were enlarged and grossly involved by tumor. The right OVlll)' was a 7.0 x S.O x 3.0 em mass of gray-tan to red-brown tissue encasing a 6.0 x 1.0 em ovary. The left ovary consisted of a 10.0 x 3.0 x 3.0 em inegularly shaped portion of gray-tan tissue. It contained a cyst with a 3.0 em diameter white tan nodule in the lumen. Also submitted was a 20.0 x 9.0 x S.O em nodular omental mass and an appendix with serosal tumor involvement.

CONTRIBUTOR: Guillermo Acero, M.D. CASE NO. 10- FEBRUARY 1994 Saata Paula, CA TISSUE FROM: Left ovary ACCESSION II 27328 CLINICAL ABSTRACT: HiStory: This 78 year old female bad a three week history of dysfunctional bowel symptoms, especially urgency for bowel movements with inability to pass stool. The little stool passed bad no blood Sbe bad a good appetite, no weight loss, and no prior bowel problems. Family history was negative fur colon cancer. Plr.'Sical EJC!lmination: The patient was a uim, healthy appearing, well-developed. well nourished female in no acute distress. Pbysical euminarion was non-colliilllutory. A barium enema demonstrated maoo::d narrowing in tbe mid sigmoid colon, consistent with a colon carcinoma. SURGERY: 05/14193 Exploratory laparotomy. A hulky pelvic tumor involved tbe sigmoid colon. terminal ileum. uterus, left ovary, omentwn. and left ureter. Tumor debulldng included partial resection of sigmoid colon. small bowel. tout abdominal hysterectomy with bilateral salping~rtetomy, omenlcciomy, and pal1ialleft ureteral rescclion. GROSS PATHOLOGY: Multiple specimens included a block resection of uterus, both ovaries, segment of colon, and portion of omentwn. The left ovary was enmeshed in an 8.2 em diameter tumor mass which was composed of necrotic, lobulated, yellow-gray tissue. The 25 em long segment of colon bad numerous serosal adbeslons and oodules of tumor involving tbe muscular wall and elciending into tbe mesentery. The mucc6al surface appeared uninvoh'ed. Tbe uterus bad an endometrial polyp but was otherwise unremarkable. The 1.3 em diameter right 0\'ary was free of rumor. Resections of ureter and ileum also showed gross rumor im olvemcnl

CONTRIBUTOR: Gerrit D'AblaiDg, M.D. CASE NO. 11 - FEBRUARY 1994 Lol Aaaeles, CA TISSUE FROM: Right ovary ACCESSION Nl7381 CLINICAL ABSIRACT: History: This 19 year old Hispanic female, Gl, Pl (four months post-partum), presenled with CIOmplaints of increasing abdominal ginh. She also reponed a 20 pound weight loss and a three month history of a neck mass, interpreted as a large goiter. Physical Examination: Ultrasound showed a 30 week size complex right adnexal mass. Past History: The patient's mother died of endometrial cajcinoma five years previously. SURGERY: (06/01/93) Right oophorectomy and staging prooedurc. GRQSS PATBOWGY: The prinwy specimen consisted of multiple fragments of a large mass forming a 30 em aggregate. The mass was predominately solid with a pale yellow, somewhat lobulated surface. Some areas were variegated showing solid and mucoid areas as well as multiple blood filled spaces and multiple cystic structures rangiqg from a few millimeters to several centimeters in greatest diameter. Some of the cystic structures contained green. gelatinous material.

CONTRIBUTOR: William Walker, M.D. CASE NO. 1l - FEBRUARY 1994 IUaler ArB, MS TISSUE FROM: Right ov1ry ACCESSION 1127424 CLINICAL A8STRACT: Hii12o:: This 6 year old black female presented for evaluation after ber mother noted enlarged breasts a few months previously, as well as acne on the face and back, pubic hair, axillary hair, body odor, and labial enlargement Tbe molher saw no discharge from the breasts or from the vaginal area. Tbe patient bad no headaches, vomiting, visual changes, seizures, paralysis, fever, abdominal enlargemenl, constipation or dysuria. Tbe mother takes birth control pills but says tbe child never bad oonlaet with this medication. Past Hi5tory: Patient bas asthma. The mother is an insulin-dependent diabetic which oomplicated the pregnancy. She also contracted a urinary tract infection during the pregnancy and was treated with antibiotics. Tbe child was delivered vaginally at 28 weeks gesiation and weighed I pound, I 0 ounces. After delivery, tbe child was in the NICU where she received a transfusion and antibiotics. She also had apnea difficulties for three months. Phvsica1 Examination: Her general appearanoe was of an alerl, awake, happy and playful child. The breast exam revealed a Tanner Stage m without galactorrhea. A s to 6 firm, non-tender, nodular mass was felt distal to tbe umbilicus in tbe pelvic region. The child had oomedones over the mid forehead, nose and back. The genitalia were normal female with pubic hair, Tanner Slage m, moist vaginal mucosa, and hooded clitoris visible. A stimulation estradiol of 57.4 was suggestive of follicular phase pubertal estradiol level. Ultrasound oftbe pelvis revealed a 9.6 x 5.7 x 6.6 em :nidline pelvic mass. MRl showed no evidence of hepatic metastases or lymphadenopathy. SQJlGERY: (09/30193) Right salpingo-oophorectomy. GROSS PATHOLOGY: The 268 gram, IO.S x 7.8 x 6.0 em right ovary was totally replaced by a sol\, tan-yellow, vaguely nodular neoplasm with rare foci of necrosis. The ovarian capsule showed underlying nodular excrescences but the capsule appeared intact No cystic change was noted.

qoo STUDY GROUP CASES FOR FEBRUARY 1994 FEMALE GENITAL TRACT SUGGESTED READING Hart W, Clement.P. Addenda-95th Semi-Annual Seminar- "Tumors of the Female Genital Tract." California Tumor Tissue Registry. December 1993

CASE NO. 1, ACCESSION NO. 17320 FEBRUARY 1994 LOS ANQELES Choriocarcinoma (6). SAN BEENARQINO <INLAND> Choriocarcinoma (6). LAMESA Choriocarcinoma (6). I.:QNG BEACH - Choriocarcinoma (6). MARYI:.AND Choriocarcinoma (12). SAN DIEGO- Choriocarcinoma (14). SAN!' A BARBARA Choriocarcinoma (I): santa ROSA- Choriocarcinoma (3). NEW JERSEY Choriocarcinoma (3). ~- Choriocarcinoma (2). ALAMEDA Cowry Choriocarcinoma (7). SACRAMENTO Choriocarcinoma (17). OKINAWA Choriocarcinoma. FOLLOW-Uf: A craniotomy was perfonned which showed choriocarcinoma. Despite chemotherapy, the patient Clij)ired. DIAGNOSIS: METASTATIC CHORIOCARCINOMA, BRAIN (T87000/M91003) REFERENCES: Vance RP, Geisinger KR. Pure Nongestational Choriocarcinoma of the 0v8JY. Report of a Case. Cancer 1985; 2231 2235. Jacobs AJ, Newland JR. Green OK. Pure Choriocarcinoma of the Ov8JY. Obstet Gynecol Surv 1982; 37; 603-609. Kurman Robert J. ed. Blaustein's Pathology of the Female Genital Tract (Third Edition). Choriocarcinoma pp 68~86.

Cuel 1., February 1994.. REFERENCES (Continued): Hillard A, Allen R, Beale G. Metastatic Choriocarcinoma Correlation ofmri, CT and Angiography. Southern Medical Journal Nov 1993; 86(11): 1299-1301.

CASE NO. 2, ACCESSION NO. 26883 FEBRUARY 1~4 LOS AHGfl fs Sclerosing stromal tumor (6). SAN BERNARDINO CINLANDl Sclerosing stromal tumor (6). LA MESA. Hyalinized and leutienized fibrothecoma (5); vs sclerosing stromal tumor (1). LONG BEACH Thealma (6). MARYLAND Sclerosing srromal tumor (12). SAN P!fGO Sclerosing stromal tumor (14). SANIA BMBARA Thealma (I). SANTA ROSA Stromal tumor of ovary (sclerosing) (3). NEW JERSEY Sclerosing stromal tumor (2); Luteinized fibrothecoma ( 1). ~ Sclerosing stromal tumor (2). ALAMEDA COUNT Luteiniud thecoma (3); Sclerosing stroma tumor (4). SACRAMENTO Sclerosing stromal tumor ( 17). OKINAWA Sclerosing stromal tumor. FOLLOW-UP: Patient's physician indicated that she was doing fine. DIAGNOSIS; SCLEROSING STROMAL TUMOR (T87000/M85901) REFERENCES: Cbalvardji.an A, Scully RE. Sclerosing Stromal Tumors of the Ovary 1973; 31: 664-670. Gee DC, Russell P. Sclerosing stromal Tumors of the Ovary. Histopathology 1979; 3: 367-376. Sab KH, Steele HD. Sclerosing Stromal Tumor of the Ovary. A Case Report and Further Observations. Diagn Gynecol Obstctl981; 3(2): 155 159. Damajanov I, Drobnjak P, Grlzelj V, Longbino N. Sclerosing Stromal Tumor of the Ovary: A Hormonal and Ultrastructural Analysis. Obstet Gynecol 1975; 45(6): 675-679.

CASE NO. 3, ACCESSION NO. Ui032 FEBRUARY 1994 LOS ANGELES Andtoblastoma (6 ). SAN BERN ARPINO CINLANP> Sex cord rumor, NOS (6). LA MESA- Senoli-leydig cell rumor (5); vs granulosa cell tumor (I). LONG BEACH Granulosa cell tumor (2); Sex cord stromal tumor (4). MARYLAND Senoli-Leydig cell rumor (12). SAN DIEGO Senoli-ccll rumor (14). SANTA BARBARA No ~gnosis (I). SANIA ROSA Sertoli-Leydig vs hilus cell tumor (I); Germ cell stromal sex cord rumor (1). NEW JERSEY Granulosa cell rumor (I); Sertoli-Leydig cell rumor {I); Poor quality kodachrome (1). ~ - Senoli-Leydig cell tumor (2), ALAMEPA COUNTY Endometrial stromal sarcoma (2); Gonadal Stromal tumor (can't tell from photo) (3). SACRAMENTO Dysgerminoma (17?. OKINAWA Sertoli cell tumor. FOLLQW t!p Patient bad n:currence of tumor I year and 9 months after diagnosis and was treated with resection and chemothetapy. Second recurreoce was one year later. She again was treated with resection and chemotherapy. Patient expired thn:e years after being diagnosed. CONSULTATION AFIP (Martin Lefkowitz, MD.) Diagnosis: Anhenoblastoma (Senoli Leydig cell rumor). DIAGNOSIS; SERTOLJ-LEYDIG CELL TUMOR, OVARY (T87000/M86310) BEFERENGES: Barkan A. cassoda F, Loriaux DL, Marshall JC. Pregnancy in a Patient with Vtrilizing Arrhenoblastoma. Am J Obste and Gyn 1984; 149: 909-9 10.

Cue 113, February 1994 REfERENCES (Continued): Serov SF, Scully RE, Sobin LH. Histological Typing of Ovarian Tumours (International Histological Classification oftwnows No.9.) World Health Organ, Geneva 1973; 17-54. Young RH, Scully RE. Senoli-Leydig Cell Tumors. A Clinicopathologic Analysis of207 Cases. Amer J Surg Pathol 1985; 9: 543 569. Stegner HE, Lisboa BP. Steroid Metabolism in Androblastorna (Sertoli-Leydig Cell Tumor.) A Histopathological and Biochemical Study. Inl J Gynec:ol Patholl984; 2: 410-425. Young RH, Scully RE. Ovarian Senoli Cell Twnors. A Report of 10 Cases. I.nt J Gynecol Patholl984; 2: 349-363. Young RH, Scully RE. Ovarian Sertoli Leydig Cell Twnon with a Retiform Pattern. A Problem in Histopathologic Diagnosis. A Report of25 Cases. Am J Surg Patholl983; 7: 755-771.

CASE NO. 4, ACCESSiON NO. 26832 FEBRUARY 1994 LOS ANGEI:.ES -Uterine tumor resembling ovarian sex cord tumor (6). SAN BERNARDINO CINLAND>: -Epithelioid (atypical) leiomyoma (6). LA,ME$A- Endoriletrial stromal sarcoma- low grade (5); Cellular leiomyoma (I). WNG BEACH- Stromal sarcoma (4), Leiomyoma (2). MARYLAND -Stromal nodule (12). SANDIEGO- Low grade endometrial stromal sarcoma (13); CeUular leiomyoma ( I). SANTA BARBARA Sertoli-leydig tumor (I). SANTA ROSA -Low grade endometrial stromal sarcoma (I); Stromal nodularvs low grade stromal sarwma (2). NEW JERSEY- Endometrial stromal nodule (I); Endometrial stromal nodule, of uncertain biological potential (I);? Malignant smooth muscle tumor (I). JAPAN - Endometrial stromal nodule (2). ALAMEDA COUNT - Stump tumor (IJ; Stromal sarcoma, low grade (2); Endometrial stromal nodule (I); Leiomyoma (2), SAfi:RAMENTO -Benign stromal tumor (17). OKINAWA - Uterine 'stromal tumor resembling ovarian sex cord tumor. FOLLOW-UP: Sbe saw ber physician in May of 1993 and at that time she bad developed hypertension. The left ovary was normal and no recurrent masses were found on examination. No ultrasound was peiformed at that time. DIAGNOSIS; UTERINE TUMOR RESEMBLING SEX CORD TUMOR (T8lOOOIM85901) REFERENCES: Clement P, Scully R. Uterine Tumors Resembling Ovarian Sex-Cord Tumors. A Clinicopathologic Analysis of Fourteen Cases. Am J Clio Pathol 1976; 66: S12-S2S. Fisher E, Paulson J, Gregorio R Myofibroblastic Nature of the Uterine Plexiform Tumor. Arch Palhol Lab Med 1978; 102: 477-480.

Cue 114, February 1994.. REFERENCES (Continued): Menez-Aionzo C, Battifora H. Plexifonn Tumors of the Uterus: Ultrastructural Study. Cancer 1979; 44: ll07-lll4. Franquemont DW, Frierson HF Jr, Mills SE: A lmmuno Histochemical Study of Normal Endometrial Stroma and Endometrial Stromal Neoplasms. Evidence for Smooth Muscle Differentiation. Am J Surg Patholl991; 861-870. Kaminski PS, Tavassoli FA: Plexifonn Tumorlet: A Clinical and Pathological Study of IS Cases with Ultrastructural Observations. Int J Oynecol Patho11984; 3: 124-134. MOll M, Hom T. An Unusual Uterine Tumor Resembling Sex-Cord Tumor of the Ovary with Papillomatous Features. Immunohistochemical and Electron Microscopic Observations. Acta Obstet Gyne:ool Scand 1992; 71(7): SS0-554.

CASE NO. S, ACCESSION NO. 17300 FEBRUARY 1994 LOS ANGELES Diffuse hemangiomatosis, abel-pelvic (6). SAN BERNARQINO ONLAND) - Angiomatous lesion (not ovacy) ( 4 ); Polycystic ovacy disease (Stein Leventhal syndrome) (2). Note: Two study sets had the ovarian tissue and the others did not LA MESA Hemangioma (2); Angiomatosis (4). LONG BEACH - Multilocular peritoneal inclusion cyst (3); "Lymphangiography effect" (3). MARYLAND- Polycystic ovary(6); Stromal hypeijllasia (2); Nonnal ovajy (4). SAN:DIEGO - Hyperthecosis (stromal hyperplasia) (10); Nonnal ovacy (3). SANTA BARBARA -No significant pathologic abnonnality ( 1 ). SANIA ROSA- Ovarian stromal hyperplasia (1); Benign ovarian tissue with multiple follicular cysts and oorpora altiicans (1); Stromal hyperplasia (1). NEW JERSEY- Stein Leventhal (2); Stromal hyperplasia with hyperthecosis (1). JAPAN Multiple follicular cysts (2). ALAMEDA COUNTY Nonnal ovacy (S); Stromal hyperplasia (2). SAGRAMENTO - Polycystic ovacy disease ( 17). OKINAWA Steroid cell tumor. DIAGNOSISi DIFFUSE HEMANGIOMATOSIS, ABDOMINAL PELVIC AREA (TY4100/M76310ffY4400/M76310) REf'EBENGES: Rao VK, WWeiss SW: Angiomatosis of Soft Tissue: An Analysis of the Histologic Features and Clinical OuiCOme in S1 Cases. Am J Surg Patholl992; 16(8): 764-771. White CW, Sondheimer HM:, Crouch EC. Wilson H. et at. Treatment of PulmoDaJy liemangiomatosis with Recombinant interferon Alfa 2a. N Engl J Med 1989; 320(18): 1197 1200. White CW, Wolf SJ, Korones DN, Sondheimer HM:. et al. Treatment of Childhood Angiomatous Diseases with Recombinant interferon Alfa-2a. J Pediatr 1991; 118(1): S9-&. Billington DC. Angiogenesis and Its Inhibition: Potential New Therapies in Oncology and Non Neoplastic Disease. Drug Des Discov 1991; 8(1): 3-35. Takamatsu H, Akiyama H. Noguchi H. Tabara H. ct at. Endorectal Pull-Through Operation for DilJuse Cavernous Hemangiomatosis of the Sigmoid Colon, Rectum and Anus. Eur J Pediatr Surg 1992, 2(4): 245-247, Rush C, Langleben D, Schlesinger RD, Stem J. et at. bun~ Scintigraphy in PulmoDaJy CapillaJy ~mangiomatosis. A Rare Disorder Causing PrimaJy PulmoDaJy Hypertension. Clin Nucl Med 1991; 16(12): 913-917.

Cue 115, Febnaary 1994 REFERENCES {Continued): Confino E, Fnllerg J, Giglia R. Gleicber N. Sonographlc Imaging of lnlr8uterine Adhesion. Obst Gynecoll9SS; 6S: S96 S99.

001. NO. 6, ACCESSION NO. 17388 FEBRUARY 1994 LOS ANGELES- Brenner tumor with transitional cell CA (high grade) (4); X-file: Malignant Brenner tumor, RIO metastatic CA (2). SAN BERNARDINO (!NLANQ\ - Benign Brenner tumor and mcwtatic carcinoma (6). LA MESA- Brenner tumor with UDdiffereruiatcd carcinoma (3); Malignant Brenner tumor (3). LQNG BEACH - Malignant Brenner tumor (6). MARYLAND - Malignant Brenner tumor (II); Brenner tumor and poorly differentiated malignant neoplasm (I). SAN DI!!GO - Brenner tumor with malignant poorly differentiated neoplasm ( 14). SANTA BARBARA - High grade malignant neoplasm metastatic to Brenner (1). SANTA ROSA- Brenner tumor with malignant component vs collision tumor (I); Collision tumor vs Brenner tumor and undifferentiated carcinoma (I); Two entities: so<a.lled "collision tumor mewtatic c:ajtinoma to breast (I). NEW.JERSEY- High grade (I transitional cell) cazcinoma (I); Malignant Brenner tumor (2). ~-Benign and malignant Brenner tumors (2). ALAMEDA COUNT)' - Brenner tumor with malignant change (3); Brenner tumor with mewwis (3). SACMMENIO -Malignant Brenner tumor (9); Brenner and mewtatic tumor (8). OKINAWA -Malignant Brenner tumor. FOLLOW-UP: Patient had abdominal wall mewt.asis and was resected two weeks after oophorectomy. Currently is on chemotherapy with no additional evidence of disease. DIAGNOSIS: MALIGNANT BRENNER TUMOR, OVARY (T87000/M90003) R FERENCES; Austin RM, Norris HJ. Malignant Brenner Tumor and Transitional Cell Carcinoma of the Ovary. A Comparision. lnt Nail J Obstet Gynccol, 6: 29-39. Santini D, Gelli MC, Mazzaleni G, Ricci M, eta!: Brenner Tumor of the Ovary: A Correlative Histologic Histochemical and Ultrastructural Investigation. Human Pathol, 1989; 20: 787-795.

Cue 116, February 1994., REFERENCES (Continued): Rybak BJ, Ober WB, Bernacki EG. Malignant Brenner Tumor of the Ovary, Diagnostic Gynecology and Obstetrics 1981; 3: 61-74. Seldenrijk CA, Willig AP, Baak JPA. Malignant Brellller Tumor: A Histologic, Morphometrical, lmmwtohlstochemical and t.ntrastruaural Study. Cam:er 1986; 58: 754-760. Woodruff JD, Dietrich D, Genadly R, Parmley lli. Proliferative and Malignant Brenner Tumors. Review of 47 Cases. Am J ofobstet and Gyne 1981; 141: 118-125. Roth LM, Gersell DJ, illbright TM. Ovarian Brenner Tumors and Transitional Cell Carcinoma: Recent Developments. Int J Gynecol Pathol1993; 12(2): 128-33. Hampton HL, Huflinan HT, Meeks GR. Extraovarian Brenner Tumor. Obstet Gynecoll993; 79 5(Pt2): 844-846. Hoffman M, Ru11'olo EH, Harris W. Giant Brenner Tumor. case Repon. J FlaMed Assoc 1989; 76(9): 772-773.

. CASE NO. 7, ACCESSION NO. 27364 FEBRUARY 1994 LOS ANGELES - Cellular cystic leiomyoma (.S); X~File: c;ysts/lymphangiomatosis (1). Cellular leiomyoma with SAtfBERNARDINO <INLAND) - Cellular leiomyoma (6). LA MESA- Cellular leiomyoma (5); Low-grade sarcoma, NOS (I). l.ong BEACH- Leiomyosarcoma (4); Mitotically active leiomyoma (2). MARYLAND -Cellular leiomyoma (12). SAN DIEGO- Cellular leiomyoma with cysts (9); Lymphagioleiomyoma (.S). SANTA BARBARA- Leiomyoma (I). SANTA ROSA - Cellular leiomyoma (3). NEW JERSEY - Cellular leiomyoma (3). JAPAN- Smooth musele tumor of uncertain malignant potential (2). AI.AMEDA county 'Leiomyoma or cellular leiomyoma (7). SACRAMENTO- Cellular leiomyoma (17). OKINAWA -Cellular leiomyoma DIAGNOSIS; CELLULAR CYSTIC LEIOMYOMA, UTERUS (T82000/M8892J) REFERENCES: Prasad KR, Arona C, Saheb DA. Primary Leiomyoma of Ovary. Indian J Med Csi 1993; 47(2): 39-41. Macri CI, Vasilev SA. Bilateral Giant Primary Ovarian Leiomyomas. A Case Report. J Reprod Med 1993; 38(6): 480-482. Ozisik Yv, Meloni AM. Powell M, S.urti U. et al. Chromosome 7 Biclonality in Uterine Leiomyoma. Cancer Genet Cytogenet 1993; 67(1): 59-64. Brandon DD, Bethea CL, Strawn EY, Novy MJ,J3urry KA. et al. Progesterone Receptor., Messenger Ribonucleic Acid and Protein are Overexpressed in Human Uterine Leiomyomas. Am J Obstet (jynecol 1993; 169(1): 78-85. Okizuka H. Sugimura K. Takemori M, Obayashi C. et al. MR Detection of Degenerating Uterine Leiomyomas. J Comput Assist Tomogr 1993; 17(5): 760 766.

CASE NO. 8, ACCESSION NO. 15576 FEBRUARY 1994 LOS ANGELES Krukenberg tumor, bilateral (6). SAN BERNARQINO (INLAND)- Krukenberg tumor (6). LA MESA - Krukenberg tumor (met adenocarcinoma) (6). LONG BEACH Krukenberg twnor (6). MARnAND Krukenberg tumor (12). SAN DIEGO- Melastatic c:areinoma (Krukenberg tumor) (14). SANTA BARBARA Krukenberg tumor (I). SANTA ROSA- Krukenberg tumor (I); Metaslatic carcinoma (Krukcnberg) (I); Mucin producing adenocarcinoma, metastatic (I). NEW JERSEY Metastatic signet ring cell c:areinoma (3). lapan Krukenberg tumor (2). ALAMEDA COUNT - Krukenberg tumor (7). SACBAMENIO - Krukenberg tumor (17). OKINAWA Krukenberg tumor. DIAGNOSIS; KRUKENBERG TUMOR (T870001M84906) REfERENCES: Holtz F, Halt WR. Krukcnberg1\unors of the Ovary. A Clinieopa!hologic Analysis of27 Cases. Cancer 1982; SO: 2438-2447. Bullon A, Arseneau J, Prat J, Young RH, Scully RE. Tubular Krukenberg Tumor: A Problem in lfutopa!hologic Diagnosis. Am J Surg Pa!hol l981; 5: 225-232. Pilotti S, Silcle F, De Palo G. Krukcnberg Tumor. Letter to Editor. Am 1 Surg Pa!hol 1982; 6 486-488. Ramzy I, Delaney M. Signet -Ring Cell Stromal Tumor of Ovary Cytologic Appearances of Fine Needle Aspiration Biop5y. Acta Cytoll977; 21(1); 14-17. Petru E, Pickel H, Heydarfadai M. et al. Nongenital Cancers Metastatic to the Ovary. Gynceol Oncoll992; 44: 83-86.

CGE NO. 9, ACCESSION NO. 27383 FEBRUARY 1994 LOS ANGELES - Endomelrioid adcnosquamous carcinoma of ovary (6). SAN BERNARDINO (INLAND)- Endometrioid.adenocarcinoma (3); Poorly differentiated adenocarcinoma, NOS (I); Metastatic squamous cell carcinoma (2). LA MESA - Metastatic squamous carcinoma (4); High-grade endometrioid adenocarcinoma (2). LONG BEACH - Poorly differentiated carcinoma, NOS (6). MARYLAND -Papillary serous cystade.nocarcinoma (6); Endometrioid adenocarcinoma (I); Mixed epithelial malignant ovarian tumor (4); Metastatic carcinoma (1). SAN!)IEGO- Poorly differentiated papillary serous carcinoma (12); Squamous cell carcinoma (2). SANTA BARBARA- Papillary adenocarcinoma (I). SANTA ROSA - Malignant, consistent with endometrial carcinoma (I); Adenocarcinoma, endometrial vs serous vs metastatic (1); Poorly differentiated carcinoma, possible endometrial (1). NEW JER$EY- Poorly differentiated carcinoma, probably serous type (3). JAPAN- Serous cystadenocarcinoma, poorly differentiated (2). ALAMEDA COUNTX- High grade serous carcinoma (6); MMMT (I). SACRAMENTO - Bilateral papillary serous adenocarcinoma (I 0); Metastatic carcinoma (7). OKINAWA - Serous cystadenocarcinoma. FOLWW-UP: Che10otherapy in progress. DIAGNOSIS: ENDOMETRIOID ADENOSQUAMOUS CARCINOMA, OVARY Cf87000~83803) REFERENCES: Young RH, Gersell OJ, Roth LM, Scully RE. Ovarian Metastases from Cervical Carcinomas Other Than Pure Adenocarcinomas. A Report' ofl2 Cases. Cancer 1993; 71(2): 407-418. Rodriguez Moguel L, Huerta Bahena J, Zepeda Del Rio G, Lira Puerto V. Dennatomyositis and Adenosquamous Carcinoma of the Ovary. Report of a Case. Ginecol Obstet Mex 1992; 60: 296-298. sutton GP, Bundy BN, Delgado G, Sevin BU, et al. Ovarian Metastases in Stage IB Carcinoma oflhe CerYix: A Gynecologic Oncology Group Study. Am J Obstet Gynecoll992; 166(1Ptl): 50-53.

Cue 119, Feb111ary 1994.. REFERENCES (Continued): Brown IV, FU YS,.Berek JS. Ovarian Metastases are Rare in Stage I Adenocarcinoma of the Cervix. Obstet Gyilecoll990; 76(4): 623-626. Kornacki S, Chung HR, Khan MY,. Sarna JC. Adenosquamous Cell Carcinoma of the Ovary: Report of a Case with Postitive Peritoneal Fluid Cytology. Diagn Cytopatholl989; 5(1): 79-83,

CASE NO. 10, ACCESSION NO. 27328 FEBRUARY 1994 IPS ANQE! BS - Small cell CA, rule out transitional ceo CA (6). SAN BERNARDINO (INLAND) Undifferentiated carcinoma (4); Small cell carcinoma (I); Malignant Brenner tumor (I). LA MESA- Undifferentiated carcinoma (4); With neuroendocrine features (I); High-grade transitional ceji carcinoma (I). LONG BEACH-Poorly differentiated carcinoma, NOS (neuroendocrine?) (6). MARYLAND- Undifferentiated carciooma (9). Metastatic carcinoma (4). SAN DIEGO- Malignant poorly dift'erentiated cazcinorna (14). SANTA BARBARA- Small cell carcinoma of0v3jy (1). SANTA ROSA - Poorly differentiated malignant neoplasm lymphoma vs poorly differentiated epithelial ~lasm (I); Poorly differentiated non-hodgkins lymphoma, tlo poorly differentiated carcinoma (I); Carcinoma, transitional oell vs malignant Brenner's vs metastatic (I). NEW JER5EY- Undifferentiated carcinoma (I); Small cell carcinoma (2). JAPAN- Metastatic adenocarcinoma, bowel primary(!); Undi1rerentiated carcinoma (I). ALAMEDA COUNTY High grade carcinoma, 7 SCC from cervix (2); Poorly differentiated carcinoma, NOS(S). SACRAMENTO- Metastatic carcinoma (17). OKINAWA Transitional cell carcinoma. 10LLOW-yp: Patient took five cycles of c:ajbo-platinum and was on cytosin with an.excellent response. There was no evidence of residual disease on CAT scan. CA-12S is now 8 (WNL). Clinically she only had mild depression. DIAGNOSIS: SMALLCELLCARCmOMA,OVARY (T87000/M80413) REFERENCES: Silva EG, Tomos C, Bailey MA, Morris M. Undifferentiated Carcinoma of the Ovary. Arch Pathol Lab Med 1991; lis: 377-381.

Cue 1 10, Febn~ary 1994 REFERENCES (Continued): Eichhorn JR. Young RH, Scully RE. Prinwy Ovarian Small Cell Carcinoma of the Pulmonary Type. A Clinicopathologic Immunohlstologic and Flow Cytometric Analysis of II Cases. Am J Surg Pathol 1992; 16: 926 938. Kohn E, Liotta lance A. Invasion and Metastasis New Approaches to an Old Problem. Oncol 1993; 7(4): 47-52. Morikawa Y, Kawai M, Kano T. et al. Clinical Remission Criteria for Epithelial Carcinoma of the Ov81)'. Oyn Oncoll993; 48: 342 348. Chen KT, Schooley JL, Flom MS. Peritoneal Carcinomatosis After Prophylactic Oophorectomy in Familial Ovarian cancer Syndrome. Obstel 0ynecoll98S; 66: 935-945.

CASE NO. 11, ACCESSION NO. 17381 FEBRUARY 1994 LOS AN<jiD FS - Senoli-Leydig cdj tumor (sclerosing) with heterologous elements.. X-File: Immature tmtoma (6). SAN BERNARDINO ONLAND) -Teratoma with C3Jcinoid (6). LA MESA - Immature (malignant) teratoma (6). LONG BEACH - Granulosa cell tumor with multiloeular mucinous cysllldenoma (6). MARYLAND -Retiform Senoli cell tumor, intermediately differentiated, with heterologous (mucinous) elements (12). SAN DIEGO- Senoli-Leydla cell tumor with heterologous clements and focal retiform areas (14). SANTA BABBMA- Senoli-Leydig tumor (1). SANTA ROSA- Trabecular C3Jcinoma, r/o sex cord tumor (2); Carcinoid (I); NEW JERSEY- Androblastoma with hderologous elements (2); Stromal carcinoid (1). ~- Immature teratoma (2). ALAMEDA CO!JNTY - Immature teratoma with carcinoid (5); Immature teratoma with trabecular carcinoid (2). SACRAMENTO - Retiform Sertoli-Leydig with heterologous mucinous elements (9); Teratoma with carcinoid dl.tferentiation (7); Metastatic Papillary CA of thyroid ( I). QKJNAWA - Sertoli-Leydig cell tumor. follow-up: Patient bad two cycles of chemotherapy. Her last visit she showed no evidenoe of disease. DIAGNOSIS: OVARIAN BETEROLOGOUS SERTOLI-LEYDIG CELL TUMOR, OVARY (T87000/M863 I O/T87000/Ml6080) REfERENCES: Aguirre P, Scully RE, DeLellis RA. Ovarian Heterologous Sertoli-Leydig Cell Tumors with Gastrointestinal-Type Epithelium. Archives of Pathology and Laboratory Medicinel986; 110: 528-533. Prat J, Young RH. Scully RE. Ovarian Sertoli-Leydig Cell Tumors with Heterologous Elements II: Cartilage and Sketelal Muscle: A Clinicopathologic Analysis oftwelve Cases. Canoer 1932; 50: 2465-2475.

Cue Nll, F~bnaary 1994 REFERENCES (Continued): Young RH, Perez-Atayde AR, Scully RE. Ovarian Sertoli-LeydigCeU Tumor with Retiform and Heterologous Components. Report of a Case with Hepatocytis Differentiation and Elevated Serus Alpha Fetoprotein. Am 1 of Surg.Patholl984; 8: 709-718. Young RH, Scully RE: Ovarian Sertoli-Leydig Cell Tumors with a.r.etifonn Pattern. A Problem in Histopathologic Diagnosis. A Report of2~ Cases. Am J Surg Pathol 1983; 7: 755-771. Young RH, Prat J, Scully RE. Ovarian Sertoli-Leydig Cell Tumors and Heterologous Elements L Gastrointestinal Epithelium and Carcinoid. A Clinicopathologic Analysis of36 Cases. Cancer 1982; SO: 2448-2456..

CASE NO. 12, ACCESSION NO. 27424 FEBRUARY 1994 LOS ANGELES Juvenile granulosa cell tumor. X-file: Steroid tumor (6). SAN BEBNARPINO C!NLANP) Steroid cell tumor (lipid cell tumor), NOS (6). LA MESA Leutienized granulosa cell tumor (4); Juvenile granulosa cell tumor (I); Leydig cell tumor (I). LONG BEACH Leydig cell tumor (6). MARYLAND- Steroid cell tumor (8); Juvenile granulosa cell tumor (4). SAN DIEGO Luteinized juvenile granulosa cell tumor (12); Steroid cell tumor (2). SANTA BARBARA Lipid cell tumor (I). SANTA ROSA Hilus cell tumor r/o other tumors (I); Leydig celltumorvs lipid celltumorvs hepatoid virienlofyolk sac tumor{!); Hilus celltumorvs.a varient of yolk sac tumor (I). NEW JERSEY Luteinized granulosa cell tumor (I); Juvenile granulosa cell tumor (2). JAPAN Juvenile granulosa cell tumor (2). ALAMEDA COUNTY Gonadal stromal (Leydig cell) tumor, functional (4); Juvenile granulosa cell tumor (I); Adrenal rest tumor vs Leydig cell tumor (2). SACRAMENTO Juvenile granulosa cell tumor (14); Lipid cell tumor (3). OICINA W A - Jwenile granulosa cell tumor. l>iagnosjs: JUVENILE GRANULOSA CELL TUMOR, OVARY (1'87000/M86l01) REFERENCES: Co$ta M, DeRose P, Roth L, Brescia R. et al. Immunohistochemical Phenotype of Ovarian Granulosa Cell Tumors. Absence of Epithelial Membrane Antigen Has Diagnostic Value. Human Pathology 1994; 25: 60~. Biscotti CV and Hart WR. Juvenile Granulosa Cell Tumors of the Ovary. Arch Pathol Lab Med 1989, I 13: 40-46. Jacoby AF, Young RH, Colvin RB, Flotte TJ, Preffer F, Scully RE, Swymer CM and Bell DA: UNA Content in Juvenile Granulosa Cell Tumors of the Ovary: A Study of Early- and Advanced-Stage. Disease. Gynecol Oncol 1992; 46: 97-103. Roth LM, Nicholas TR and Ehrlich CE: Juvenile Granulosa Cell Tumor: A Clinicopathologic Study of'l:hree Cases with UltJ:astructural Observations. Cancer 1979; 44: 2194-2205. Schofield DE and Fletcher JA: Trisomy 12 in Pediatric Granulosa-Stromal Cell Tumors. Demonstration by a Modified Method of florescence in In-Situ Hybridization on Paraflin Embedded Material. AmJPathol 199.2; 141: 1265-1269.

Cue 11111, Febnaary 1994 REFERENCES (Continued): Swanson SA, Norris HJ,.Kelsteo MI.. and Wlu:eler JE: DNA Content of Juvenile Granulosa Tumors Delennined by Flow Cytomeuy. Int J Gynecol Pathol 1990; 9: 101-109. Tanaka Y, Sasaki Y, Nishihira H, lzawa T and Nishi T: Ovarian Juvenile Granulosa Cell Tumor Associated with Maffucci's Syndrome. Am J Clio Pathol 1992; 97: S23 S27. Young RH, Dudley AG and Scully RE: Granulosa Cell, Sertoli-Leydig Cell and Unclassified Sex Cord-Stromal Tumors Associated ~~>ith Pregnancy: A Clinicopathological AnaJysis of Thirty-Six Cases. Gyneool Oocol1984; 18: 181-20S. Young RH, Lawrence WD and Scully RE: Juvenile Granulosa Cell Tumor Anol.bcr Neoplasm Associated with Abnormal Chromosomes and Ambiguous GeniWia. A Report of Three Cases. Am J Surg Pathoi198S; 9(10): 737-743. Zaloudek C and Norris HJ: Granulosa Tumors of the Ovary in Children: A Clinical and Pathologic Study of32 Cases. Am J Surg Pathol 1982; 6: SI3-S22.