Case 1

submitted by:
Robert H. Young
Massachusetts General Hospital
Boston, Massachusetts

Clinical Summary:

A 40-year-old man presented with gross hematuria and at cystoscopy was found to have a bulky bladder tumor. This was transected transurethrally.

Case 1 - Figure A - Low power view showing epithelioid neoplasm with predominantly diffuse growth and involvement of muscle bundles.

Case 1 - Figure B - High power view showing nested pattern of tumor cells with abundant cytoplasm. Blood vessels are conspicuous.

Case 1 - Figure C - Tumor cell necrosis.

Case 2

submitted by:
Victor E. Reuter
Memorial Sloan-Kettering Cancer Center
New York, New York

Clinical Summary:

This 47 year-old male with vague abdominal symptoms was found to have a 3.0 cm mass within the left kidney by abdominal CT scan. At the time of nephrectomy, it became clear that the kidney contained multiple lesions ranging in size from 0.1cm to 3.0 cm.

Case 2 - Figure 1 - Oncocytosis: Multiple cortical tumor nodules.

Case 2 - Figure 2 - Oncocytosis: Oncocytic tumor cells infiltrating among renal tubules.

Case 2 - Figure 3 - Oncocytosis: Minute oncocytic nodules. Could any of these structures represent "in situ" disease?

Case 2 - Figure 4 - Oncocytosis: Hybrid tumor. Several oncocytic microcysts are present near a solid nest of tumor cells with nuclear features reminiscent of chromophobe RCC.

Case 3

submitted by:
Isabel A. Sesterhenn
Armed Forces Institute of Pathology
Washington, DC

Clinical Summary:

This 58-year-old gentleman presented with a right testicular mass and bilateral hydroceles. A right orchiectomy was performed.

Case 3 - Figure 1 - Carcinoma of the rete. The tumor involves the rete testis and shows papillary, solid and tubular areas. H&E x 32.

Case 3 - Figure 2A - Transition from normal rete epithelium to tumor can be seen. H&E x 160

Case 3 - Figure 2B - Transition from normal rete epithelium to tumor can be seen. H&E x 160

Case 3 - Figure 3 - The infiltrating component consists of anaplastic cells with amphophilic cytoplasm and tubule formation. H&E x 160.

Case 3 - Figure 4A - Infiltrating tumor with focal tubule formation. H&E x 80.

Case 3 - Figure 4B - The keratin highlights the tubular morphology of the tumor. Anti-keratin x 80.

Case 3 - Figure 5 - Peripherally the tumor infiltrates the interstitium of the testis. H&E x 160.

Case 4

submitted by:
Jonathan Epstein
Johns Hopkins Hospital
Baltimore, Maryland

Clinical Summary:

A 70 year-old man with a history of adenocarcinoma of the prostate Gleason score 7 was treated with neoadjuvant hormone therapy and external beam radiotherapy. Two years following radiation the patient presented with gross hematuria. At cystoscopy, an erythematous lesion was identified and biopsied.

Case 4 - Figure 1 - Low magnification image showing proliferation of urothelial nests into lamina propria.

Case 4 - Figure 2 - Intermediate magnification demonstrating nests of urothelium extending into the lamina propria. Note associated recent hemorrhage and overlying normal urothelium.

Case 4 - Figure 3 - Nests of urothelium associated with dilated congested vessels and fibrin deposition.

Case 4 - Figure 4 - Nests of urothelium associated with recent hemorrhage. Note moderate nuclear pleomorphism and occaisional prominent nucleoli.

Case 5

submitted by:
Juan Rosai
Istituto Nazionale Tumori
Milano, Italy

Clinical Summary:

60-year-old female with a left renal mass discovered in June 2000, during the course of a post-laparoscopic cholecystectomy sonographic control. The CT scan confirmed the presence of a 4 cm mass in the left kidney. A left radical nephrectomy with para-aortic lymphadenectomy was carried out in October 2000. Gross examination revealed a 3.8x3.5x2.8 cm well-circumscribed solid brown mass in the renal cortex. The renal capsule, pelvis, renal vessels, adrenal gland and lymph nodes were free of tumor.

In a follow-up control carried out in February 2002, a mediastinal mass was detected in the chest x-ray, resulting in compression and anterior displacement of the trachea. The thyroid gland was not involved. This mass was biopsied.

The sections submitted are from the renal tumor removed in 2000.

Case 5 - Figure 1 - Kidney, low power.

Case 5 - Figure 2 - Kidney, high power.

Case 5 - Figure 3 - Mediastinum, low power.

Case 5 - Figure 4 - Mediastinum, high power.