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Genitourinary Pathology
Sunday, February 27, 2005 - 7:30 PM
Rivercenter Salon Rooms B,F
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Moderator:
Mahul Amin
Emory University School of Medicine
Atlanta, GA
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Clinical histories are printed below.
Click on the case numbers for text and references of each case.
Click on each slide thumbnail image for an enlarged view
Submitted by:
Pedram Argani
Johns Hopkins University
Baltimore, MD
An 18-year-old male presents with hematuria and is found to have a 7-cm left renal mass.
Case 1 - Figure 1 - Note entrapped native elongated renal tubule within the neoplasm.
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Case 1 - Figure 2 - Low and intermediate power views of the tumor showing sheet like architecture and biphasic histology. The majority of the cells are epithelioid with either clear or eosinophilic cytoplasm. A second population of smaller cells is clustered around nodules of hyaline basement membrane material.
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Case 1 - Figure 3 - Low and intermediate power views of the tumor showing sheet like architecture and biphasic histology. The majority of the cells are epithelioid with either clear or eosinophilic cytoplasm. A second population of smaller cells is clustered around nodules of hyaline basement membrane material.
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Case 1 - Figure 4 - Cytological touch preparation highlights the smaller cell population, clustered around basement membrane material.
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Case 1 - Figure 5 - PAS-diastase stain highlights the nested pattern and hyaline nodules
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Case 1 - Figure 6 - Immunostain for type 4 collagen labels the hyaline nodules, supporting ultrastructural observations that these nodules represent duplicated basement membrane
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Submitted by:
Jae Y. Ro
Asan Medical Center
Ulsan University, Seoul, Korea
A 79-year-old man presented with gross hematuria of 1 month's duration. His past medical
history was remarkable for diabetes and hypertension for 10 years, but his family history was
unremarkable. Urinalysis demonstrated RBC 3+ with no protein or sugar. Other laboratory tests
were within normal limits except for slight elevation of PSA level (6.0 ng/ml) and fasting
glucose of 131 mg/dl. Chest x-ray was normal. Abdominal CT showed an intraluminal
protruding mass in the right anterior wall of the urinary bladder with wall thickening (Figure 1).
No enlarged lymph nodes were identified. On cystoscopy, two nodular masses (3 cm and 1.5 cm
in diameter) were found in the right antero-posterior wall of the bladder (Figure 2). Under the
clinical diagnosis of T1 invasive transitional carcinoma, transurethral resection of the bladder
tumor (TURBT) was performed. Microscopically, the tumor (Figures 3, 4 and 5) and mucosa
adjacent to invasive tumor (Figure 6) are illustrated. Figures 7 and 8 are CK7 and CK20 in
neoplastic cells, respectively. After TURBT, the patient received intravesical mitomycin C for 6
times. Follow-up urine cytology 3 months after the diagnosis demonstrated a few malignant
cells. The patient is alive with disease.
Submitted by:
Elsa F. Velazquez
New York University School of Medicine
New York, NY
A 49-year-old man was seen for a large, ulcerated and hemorrhagic penile mass. The lesion, which
affected the glans, coronal sulcus and foreskin, was rapidly growing for the past year.
Case 3 - Figure 1 - Gross features of a large, ulcerated and hemorrhagic penile mass that affects the glans, coronal sulcus and foreskin and deeply invades the corpora cavernosa.
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Case 3 - Figure 2 - Low-power view of the neoplasm showing the ulcerated surface and interanastomosing channels lined by neoplastic cells.
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Case 3 - Figure 3 - Microscopic views illustrating the interanastomosing channels lined by tumor cells dissecting through the stroma. The neoplastic cells vary from flat to hobnail to polygonal with hyperchromatic and pleomorphic nuclei. There are fibrovascular tufts lined by neoplastic cells. Some of the spaces contain detached neoplastic cells and erythrocytes. Occasional intracytoplasmic vacuoles are seen. Cords of more cohesive undifferentiated epithelioid cells are focally present.
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Case 3 - Figure 4 - Microscopic views illustrating the interanastomosing channels lined by tumor cells dissecting through the stroma. The neoplastic cells vary from flat to hobnail to polygonal with hyperchromatic and pleomorphic nuclei. There are fibrovascular tufts lined by neoplastic cells. Some of the spaces contain detached neoplastic cells and erythrocytes. Occasional intracytoplasmic vacuoles are seen. Cords of more cohesive undifferentiated epithelioid cells are focally present.
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Case 3 - Figure 5 - Microscopic views illustrating the interanastomosing channels lined by tumor cells dissecting through the stroma. The neoplastic cells vary from flat to hobnail to polygonal with hyperchromatic and pleomorphic nuclei. There are fibrovascular tufts lined by neoplastic cells. Some of the spaces contain detached neoplastic cells and erythrocytes. Occasional intracytoplasmic vacuoles are seen. Cords of more cohesive undifferentiated epithelioid cells are focally present.
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Submitted by:
Thomas M. Ulbright
Indiana University
Indianapolis, IN
A 27-year-old man presented with a 3-week history of an enlarging right testicular mass. An
orchiectomy was performed. On gross examination, there was a 5.5 cm, fleshy, well-circumscribed tumor
that bulged above the adjacent parenchyma. A separate 0.6 cm nodule was also noted.
Case 4 - Figure 1 - The tumor forms anastomosing islands with diffuse microcystic change.
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Case 4 - Figure 2 - Intermediate magnification shows smaller islands of tumor with microcystic change in a prominently hyalinized stroma.
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Case 4 - Figure 3 - The microcysts are mostly round and regular and appear empty.
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Case 4 - Figure 4 - A high magnification shows the cytological features of the tumor cells.
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Submitted by:
Stacey E. Mills
University of Virginia Medical Center
Charlottesville, VA
A 40-year-old man presented for elective sterilization and was found on physical examination to have a
previously undetected rock hard right testicular mass. Ultrasound demonstrated a 3 cm.
heterogeneous, partially calcified solid mass in his right testicle. A right orchiectomy was performed
with prosthesis insertion.
Case 5 - Figure 1 - Much of the lesion consists of calcified and ossified islands in a hypocellular, sclerotic stroma.
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Case 5 - Figure 2 - Strands and cords of uniform eosinophilic cells, a minor component of the tumor in terms of surface area, are the characteristic feature of this neoplasm.
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Case 5 - Figure 3 - At higher magnification, the eosinophilic cells have uniform nuclei with prominent nucleoli. Occasional cells have cytoplasmic vacuoles.
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