Case 1 - Click here for Text and References
Submitted by: Michelle S. Hirsch
Clinical Summary:
A 45 year old female with a history of ulcerative colitis presents with vague abdominal pain three years status post total colectomy. An x-ray was performed and reveals a 3.5- cm left upper pole solid renal mass. An ultrasound 3 years prior read both kidneys as 'normal'. Subsequent CT- scan demonstrates that the mass is enhancing and homogenous, suspicious for renal cell carcinoma. Serum creatinine is normal and the patient denies hematuria. A partial nephrectomy is performed. Frozen section evaluation for margin and diagnosis is read as "oncocytic neoplasm, favor oncocytoma; tumor is present within 0.1 cm of the parenchymal resection margin."
A relatively well-circumscribed white/tan mass was identified at partial nephrectomy.
A low power image demonstrates an oncocytic neoplasm with a predominate tubular architecture, some of which are tightly compact
Nuclei are round with some containing small prominent nucleoli.
Only rare mitotic figures are identified, and necrosis is not present.
Foamy histiocytes are present.
Compact tubules appear to take on a spindle cell morphology.
The spindle cell architecture is better appreciated at low power.
Cytologically, the spindle cells lack atypia.
Increased mitotic activity and necrosis/apoptosis are not identified in the foci of spindled cells
A CK7 immunostain is diffusely positive.
An AMACR immunostain is diffusely positive.
A CD10 immunostain is only focally positive, with an apical staining pattern in the less compact tubular cells.
An HMB45 immunostain is negative.
Conventional karyotype demonstrates multiple chromosomal loss, consistent with MTSCC.
Case 2 - Click here for Text and References
Submitted by: David John Grignon
Clinical Summary:
This 20 year old pregnant (27weeks) woman presented with an episode of gross hematuria. An MRI was read as showing "a left lateral wall mass with full thickness invasion and concern for an extra-cystic component." At cystoscopy a 3 to 4 cm polypoid mass was seen and transurethral resection of the lesion was performed.
Case 3 - Click here for Text and References
Submitted by: Kiril Trpkov
Clinical Summary:
A 56-year-old male was found to have a mass in the right lobe of prostate on ultrasound examination. Prostate needle biopsy was performed.
Pertinent Laboratory Data:
PSA was 1.13 ng/ml, gland volume was 40.08 cc and PSA density was 0.02.
Cores showed spindled cell proliferation without any normal prostatic tissue.
Spindled cells demonstrated fascicular growth.
High-power view of Fig 2 showed uniform and bland spindled cells with indistinct cell borders and without prominent nucleoli.
Fascicular growth was less prominent in some areas.
Spindled cells bordered focal hyalinised areas.
Higher magnification of Fig 5.
Rare mitotic figures were present.
CD34 was diffusely and strongly positive. CD34
CD117/c-kit was diffusely and strongly positive.
Ki67 was positive only in rare cells (less than 2%).
Case 4 - Click here for Text and References
Submitted by: Daniel M. Berney
Clinical Summary:
A 35 year old man complained of right testicular pain and examination was suspicious for a lump. An ultrasound showed an intratesticular 1cm mass. Germ cell tumour markers were within normal ranges. Orchidectomy was performed.
