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* * ** * **** ***** ** **** * * *** ********CALIFORN!II.TUf40RTISSUE REGISTRYLOS ANGELES COUNTY - UNIVERSITY OF SOUTHERN CALIFORNIAPROTOCOLFORMONTHLY STUDY SLIDESOCTOBER 1981HAND AND FOOT TUMORS * * ** * ***** **** ******* *********

CONTRIBUTOR: H. V. O'Connell, M. 0.Bakersfield, CaliforniaTISSUE FROI1:OCTOBER 1981 - CASE 1ACCESSION NO. 18638Right footCLl.'!ICAL ABSTRACT:foot.History: A 37-year-old caucasian female had a mass in the rightAtumor had been removed from the same site previousl y.SURGERY: (June 24, 1970)A pearly white tumor was found below the first metatarsal in thearea of scar f rom previous surgery. Islands of tuw r were present inskin and surrounding tiss ue. All abnormal tissue was excised.GROSS PATHOLOGY :The main tumor mass was 5.5 x 4 x 4 em. and appeared to be coveredby an intact capsule except at one end where there was a rupture andsome granular tissue appearing in the defect. Several smaller piecesof tissue containing smal l tumor nodules were submitted.FOLLOW UP:A letter dated August 27, 1981 states that the patient exhibitedno evidence of recurrence at a recent office visit.

CONTRIBUTOR:J . N. Carberry, 1 .OCTOBER 1961 - CASE 2D.Los Angeles, Cal iforni aACCESSION NO. 22456TISSUE FROM : Right foo tCLINiCAL ABSTRACT :Hi story : A 39-year-old caucasian mal e noted a mass on the sol eof t he right foot for foll r years which recently i ncreased i n sized.He had difficul ty wearing a shoe and he stated that it felt as thoughhe were "wal king on eggs" . There was some pain radiating to t he knee .Radiograph: An x- ray s ho1 ed an extensive soft t issue mass i n theP.lantar area without bony invol vement.SURGERY : (November 1975)A large t umor n2ss involvi ng the plantar tendons and aponeuroticfa scia 1 as remcved.GROSS PATHOLOGY:A 9.5 x 5.5 x 4.5 em. tumor mass weighed 105 gm . and was fai rl y wel lcircumscribed and irregularly lobul ated on one margin. The cut surfacewas 1hite and gl i stening with some areas of cystic degenerati on. Thernass was firm, rubbery, and infil trated recogni zab1e ten \ i no us tissue.Tht·ee small er t issue pi eces with tumor 2, 3.5, and 7.5 em. in gre testdimension were also submitted.FOLLOW UP:Pati ent expired on November2 ,1977 .

CONTRIBUTOR: Gene Burke, M. D.Inglewood, CaliforniaTISSUE FROM: Left handOCTOBER 1981 - CASE 3ACCESSION NO. 15460CLINICAL ABSTRACT:History: A 65-year-old fem le stated that the large mass on herleft hand had been present only 4 weeks.SURGERY: {February 1967)The patient would not consent to hospitalization and allowed onlyan office procedure. About 50 of the mass could be removed.GROSS PATHOLOGY:A solid to somewhat friable grey-white rubbery mass from 3 to 1.5em. in thickness and with notable areas of yellow necrosis was submitted.FOLLOW UP:None available.

CONTRIBUTOR:Nick Petirs, M. D.Anaheim, CaliforniaTISSUE FROM: ightOCTOBER 1981 - CASE 4ACCESS ION tiO. 22390footCLINICAL ABSTRACT:History: A 63-year-old caucasian male had a walnut sized lesion onthe dorsum of right foot for years. However, the mass had m rkedly enlarged in the last six months.SURGERY:(October 6, 1976)The mass was excised and this surgery was foll owed in one week by abelow the knee amputation .GROSS PATHOLOGY:The specimen cons isted of an ovoid grey-pink tumor 9.0 x 7.5 x 5.0em., adherent to tendons and fascia. Cross sections showed bulging greytumor with focal calcifications and hemorrhage. The amputation specimenshowed a few residual tumor nodules up o 1 em. in diameter but no jointor bone involvement.FOLLOW UP:The pati ent received chemotherapy and radiotherapy. Bi lateral pulmonary and hepatic metastases later developed and the patient expired onHarch 21, 1979. No autopsy was performed.

CONTRIBUTOR:Raymond Peterson , M. D.Anahei m, Ca 1 iforn1aOCTOBER 1981 - CASE 5ACCESSION NO. 18320TISSUE FROM: Left handCLINICAL ABSTRACT:Hptory: A 40-year-old male had a tumor between the thumb andindex--lnger of the l eft hand. The mass had been enlarging for severalweeks.SURGERY : (August 5, 1969)The mass was excised.GROSS PATHOLOGY:The tumor mass weighed 42 gm. and had a glistening yellowish mucoidappearance.FOLLOW UP:Subsequent biops ies on November 20 , 1969 failed to reveal any additional tumor. No f urther follow-up i s avai l able.

CONTRiBUTOR:Wi lli m Snider, M. 0.West Covina, Ca liforniaOCTOBER 1981 - CASE 6ACCESSION NO. 18952TlSSUE FRml : Left handCLINICAL ABSTRACT:History: An 18-year-old female had pain and tenderness over theulnar aspect of the left hand for 3 or 4 months.Physical Examination: A 2 em. mass on the lateral aspect of theleft hand las tender to palpation.SURGERY:(October 9, 1970)The left f i fth finger andmet carpa lbone were resected.GROSS PATHOLOGY:The mid portion of the metacarpa 1 bone 1as expanded to 2.3 em di ameter and the cortical bone thinned to less than 0.1 em. thickness.The entire central portion of bone was replaced by a rubbery t an tumorwith mottled areas of red and yel low.FOlLOW UP:This pati ent was l ast seen 1973 and at that time had no evidence ofresi dual or recurrent dise se.,).f

CONTRIBUTOR: D. N. Halikis, M. D.Los Angeles, CaliforniaOCTOBER 1981 - CASE 7ACCESSION NO . 23025TISSUE FROM: Left handCLI NICAL ABSTRACT:History : A 60-year-old male noticed a slow growing non-tendermass on the l eft palm, 4 years duration.Physical examination reveal ed a soft, immobile mass, 3 x 1 em.,non-tender on the ulnar side of the polm. In addition, he had a1 i poma on hi s abdomina 1 Ia 11.SURGERY:(Juiy 24, 1978)An excisional bi opsy 1as performed. The tumor had displaced thefourth cleft neurovascul ar bundl e and it was apparently attached to thesheath surrounding the flexor tendons of t he 11ttl e finger . It was wellencapsulated.GROSS PATHOLOGY:'The specimen consisted of a 3 x 2 x 1. 5 em. lobulated, blue-gray,cystic, soft rubbery mass. Cut surfaces showed nodules of mucoid materialseparated by narrow bands of fibrous tissue.FOLLOW UP:The patient was last seen on November 11, 1980 at whi ch time thesurgical site was compl ete'ly healed without evi dence of recurrent tumor .

CONTRIBUTOR: Charles Osborn, M. D.Glendale, CaliforniaOCTOBER 1981 - CASE 8ACCESSION NO. 23399TISSUE FROM: Left PalmCLINICAL ABSTR!l.CT:History : An 18-year-old caucasi an female had a nodule in the leftpalm stated t o have been present for several years.SURGERY:(April 10, 1979)A nodule in the area of the carpal tunnel of the left palm was removed.GROSS PATHOLOGY:A yel low oblong shaped s.o x 3. 2 x 1. 2 em. nodul e was submitted. Athin filmy capsul e covered three- fourths of its surface. Sectioning revealed homogenous fatty tissue without hemorrhage, necrosis, or fibrosis.FOLLOW UP:Not il.vai lable .

CONTRIBUTOR:Roy L. Byrnes, M. D.South Laguna, Ca 1ifor.ni aTISSUE FROM:Right FootOCTOBER 1981 - {ASE 9ACCESSION NO. 23276CLINICAl ABSTRACT:History: A 70-year-old caucasian female had been ware of swellingover the dorsum of the .ri ght foot for at least 16 years. Within the lastyear or two t here had been some increase i n growth. Her internist feltthat the mass should be i nvestigated and referred her to an orthopaedicsurgeon.Physical Examination: A 2 em. mass was present beneath the ski n onthe do rsal lateral aspect of the right foot.Radiograph: An x-ray showed no bony involvement.SURGERY:(February 1979)The mass was not attached to skin, was not encapsulated, and infil trated down between the metatarsal bones . The surgeon felt t hat sometumor was left behind when the mass was excised.GROSS PATHOLOGY :Three grams of f i rm pul taceo us pieces of yellow-orange t issue weresubmitted.'·'FOLLOW UP:As of August 1981 no recurrenc.e of tissue growth, some dysthesiaand nerve i rri tation 4th &5th t oes .

CONTRIBUTOR: Howard Otto, M. D.Lauriun, MichiganOCTOBER 1981 - CASE 10ACCESSION NO. 23849TISSUE FROM : Left handCLINICAL ABSTRACT:History: A 22-year-old male presented with a many month history ofan enllarging tumor involving al i surfaces of the left middle finger. Noneurovascular deficits were associa·ted with the lesion.SURGERY:(Apri 1 11, 1980)The patient underwent surgical resection of the tumor.GROSS PATHOLOGY:An aggregate 4 x 5 em. mass of irregular gray to pal e yellow friabletissue pieces were submitted. On section they were noaular, pale yellowgray, mottled, and somewhat gritty.FOLLOW UP:There is questionable recurre nce of theoperative examination.tu rat the one year post-

CONTRIBUTOR: Raymond Lesons , M. D.Van Nuys, CaliforniaTISSUE FROM: FootOCTOBER 19B1 - CASE 11ACCESSION NO. 20614CLI NICAL ABSTRACT:A 64-year-old fema le and a la rge mass on the sole of the foot.SURGERY:(March 1974)The lesion was excised.GROSS PATHOLOGY:tSeveral portions of firm tissue were submitted , some of which werr.admixed wi th bone. The largest mass was 5. 5 x 4.8 x 2 em. and composedof adipose tissue with much lobular rubbery gray -white tissue admixed .A segment of tendinous appearing tissue was attached.FOLLOW UP :Not Avail able.t

CONTRIBUTOR:Harlon Fulmer, M. D.Fresno, CaliforniaTISSUE FROH:Right handOCTOBER 1981 - CASE1 ACCESSION NO . 22869CLINICAL ABSTRACT:Hi stor : A 25-year-ol d caucasian male no ted pain with movement ofand in 1973. Three years l ater a very smal1 mass noted. Fiveyears later the mass began inct·easi ng significantly in size causing pai nand inabi l ity to close the t humb to t he base of the fifth metacarpal.hi s ngntPhysical Examination:A 4 x 4 em. firm mi ldly tender fi xed mass was present over t he ulnaraspect of the right distal rpal- proximal metacarpal area .SURGERY :1 as(February 16 , 1978)A nonencapsuiated tumo r mass adherent to surroundi ng connective t issueexcised .GROSS PATHOLOGY:Several ovoid dark red granular fragments of cancell ous bone were submitted. Other submitted fragments of bone 1ere gray tan .FOLLOW UP :Nofo ll m -upwas avail able.

STUDY GROUP CASESl!OROCTOBER 19.81CASE NO. 1- ACC . NO. 18638LOS ANGELES: Tumoral-calcinosis ( B9, dystroph ic c.alcific.atio.n ) - 8;t ofus - 1; necrotizing chondro - 1BAKERSFIELD:Chondrosarcoma - 6CENTRAL VALLEY:INLAND:TUI!lerous calc i n0 1 - 4Tumo ral (dysccopbic calcinosis) - 11LONG BEACH :Tumoral calcinos is - 11M. TINEZ:OAKLAND:Benign s of t tis sue chondroma - 8Tumoral calcinosis - 9OHIO :Tumoral calcinosis - 2 ; calc.ifyiag chcndromato sis - 2; calcinosisRENO:Ca lci fying aponeurotic fibroma - 12; low grade chondrosarcoma - 1 SACRAMENTO:Tumoral calcinosis - 3REFERENCE:!l.arkess, J . \ . and Pet:ers, H. J . : Tumoral Cal cinosis; a report.of six cases. J . Bone J oint Surg . 49A: 721-73l, 1967.FILE DIAGNOSIS:Tumoral cal cinosis, r ight foot1713-554 5

CASE NO. 2 - ACC . NO. 22 456OCTOBER 1981LOS ANGELES: Superficial fib osarcoma- 1 ; leiomyosarcowA- 2;neurilemoma , n9 - 2; synovial sa rcoma monophasi c - 3; malignant f ibroushis tiocytoma - 1BAKERSFIELD :Synov1.al sarcoma - 6CENTRAL VALLEY:Synovial sarcoma (clear cell sar coma) - 3; fibrosarcoma - lSynovial sarcoma - 11IN :LONG BEACH:MARTINEZ:OAKIJL :Sarcoma, NOS - 6; malignant mesenchyma l nerve sheath tumor - 2Nerve sheath fibrosarcoma - 10; fibrosarcoma - 1 nophasicsynovial sarcoma - 9ORIO : Leiomyoblastoma (epithelioid leiomyoma) - 3 ; malignant fibrous tissuetumor - 1; tenosynovial sarcoma - 1RENO :Nerve sheath fibrosarcoma - 12; nerve shea th mesenchymoma -1SACRAMENTO:sarcoma - 1Synovial sarcoma - 1; hemangiopericytoma - 1 ; neurofibro-REFERENCE:Enzinger, Franz M. : Clear-cell Sarcoma of Tendons and Aponeuroses;analys is of 21 cases . Cancer 18:1163- 1174, 1965.FILE DIAGNOSI S:Synov ial sarcoma, right foot1713-9043