Genitourinary Pathology
Thursday, February 16, 2006 - 7:30 PM
Centennial II
Moderator:
Peter A. Humphrey Washington University School of Medicine Barnes-Jewish Hospital St. Louis, MO
Disclosure: The speakers have indicated they have nothing to disclose.
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
Case 1
Submitted by: David J. Grignon Wayne State University Detroit, MI
Clinical Summary:
A 74 year old woman is found to have a 3 cm complex cystic mass involving the right kidney. A partial nephrectomy is performed. Grossly the lesion measures 2.8 x 1.8 x 1.8 cm and bulges from the cortical surface. It is multicystic with thin septae and no solid areas. The cysts contain translucent pale yellow fluid.
Case 1 - Figure 1 - Low power photomicrograph illustrating multiloculated cystic mass with thin fibrous septae and adjacent renal parenchyma.
Case 1 - Figure 2 - Additional low power photomicrograph illustrating multiloculated cystic mass with thin fibrous septae and adjacent renal parenchyma.
Case 1 - Figure 3 - Center of mass illustrating the thin nature of the septae.
Case 1 - Figure 4 - Tumor edge illustrating a fibrous capsule and the hypocellular, fibrotic appearance of the septae.
Case 1 - Figure 5 - The thin fibrous septae are covered by a predominantly single layer of cuboidal cells with clear cytoplasm. Note the absence of cells within the septae.
Case 1 - Figure 6 - High power photomicrograph illustrating the clear cells. Note the small, uniform hyperchromatic nuclei.
Case 1 - Figure 7 - Photomicrograph highlighting the fibrous septae and clear cells.
Case 1 - Figure 8 - In this septae there are nests of clear cells within the fibrous stroma some of which are forming tubules. Note again the low grade nuclei.
Case 1 - Figure 9 - High power photomicrograph highlighting the clear cells with low grade nuclei in the stroma.
Case 2
Submitted by: Esther Oliva Massachusetts General Hospital/Harvard Medical School Boston, MA
Clinical Summary:
A 70-year-old man underwent a transurethral resection for urinary retention secondary to bladder outflow obstruction. Relevant prior clinical history includes invasive esophageal carcinoma diagnosed and treated in 1995 and an incidental prostatic adenocarcinoma Gleason score 6/10 (present in 3 of more than 100 chips) in a background of florid benign prostatic hyperplasia diagnosed in a transurethral resection done for urinary retention in 2003.
Case 2 - Figure 1 - Round to elongated tubules are present in between muscle fibers.
Case 2 - Figure 2 - Small and irregularly defined tubules are composed of cells with eosinophilic or vacuolated cytoplasm and rounded to elongated nuclei with slightly prominent nucleoli.
Case 2 - Figure 3 - Florid and complex papillae are lined by cells with slightly clear cytoplasm and some of them contain prominent intracytoplasmic basophilic secretions.
Case 2 - Figure 4 - Tiny tubules with prominent luminal basophilic secretion closely simulate signet ring cells.
Case 2 - Figure 5 - Small tubules are admixed with slightly dilated tubules in an edematous and inflamed background.
Case 2 - Figure 6 - Dilated tubules with irregular outlines are lined by flat eosinophilic cells that focally have a slight hobnail appearance.
Case 2 - Figure 7 - Cystically dilated tubules contain eosinophilic secretion and are juxtaposed to elongated thin tubules.
Case 3
Submitted by: John R. Srigley McMaster University/Credit Valley Hospital Mississauga, ON, Canada
Clinical Summary:
A 53 year old male presented with non- painful left scrotal enlargement of several months duration. Clinical and ultrasound examinations revealed a hydrocele without any obvious mass lesion and a left hydrocelectomy was performed
Case 3 - Figure 1 - low power photomicrograph of hydrocele specimen showing fibrosis and chronic information. Note proliferation of surface mesothelium and tubular glands uniformly distributed in a linear fashion within connective tissue.
Case 3 - Figure 2 - mesothelial proliferation involving inner surface of hydrocele sac with tubular elements extending into underlying connective tissue.
Case 3 - Figure 3 - proliferating mesothelial tubules involve wall of hydrocele sac.
Case 3 - Figure 4 - surface mesothelial proliferation with multi-layering and papillae.
Case 3 - Figure 5 - high power micrograph showing proliferating mesothelium with tubular formation.
Case 3 - Figure 6 - inner surface of hydrocele sac showing a papillary proliferation of mesothelium.
Case 3 - Figure 7 - high power photomicrograph showing tubular mesothelial elements involving wall of hydrocele.
Case 3 - Figure 8 - high power photomicrograph showing mesothelial tubules within hydrocele sac. Note the relative architectural and cytologic uniformity.
Case 3 - Figure 9 - high power photomicrograph showing mesothelial cells with mild nuclear enlargement, pleomorphism and prominent nucleoli. Note the presence of a mitotic figure in the lower part of the field.
Case 3 - Figure 10 - cytokeratin 5/6 immunohistochemical preparation showing presence of mesothelial tubules relatively deep within the wall of the hydrocele sac.
Case 3 - Figure 11 - calretinin immunostain showing strong positivity in the mesothelial tubules.
Case 4
Submitted by: Rodolfo Montironi University of Ancona School of Medicine Torrette, Ancona, Italy
Clinical Summary:
September 1992. A 71-year-old Caucasian man presented with a 1-year history of increasing urinary obstructive symptoms. A diffuse enlargement of the prostate was documented by transrectal ultrasound and digital rectal examination. Supra-pubic (simple) prostatectomy was performed. The preoperative total serum PSA was 2.5 ng/ml. After the operation PSA decreased to below 1.0 ng/ml. The diagnosis was benign prostatic hyperplasia associated with diffuse BCH. The patient was clinically well until 1996 when he presented again with urinary obstructive symptoms. Transurethral resection of the prostate (TURP) was performed in June 1996, following which a temporary normal voiding was achieved. The pathology report included basaloid carcinoma of the prostate vs. transitional cell carcinoma. The reporting pathologist favored the latter diagnosis. In March 1997 the patient underwent a second TURP. A permanent normal voiding was achieved. The pathology report, which included the revision of the previous two histological examinations, was basaloid carcinoma with extension to the extraprostatic tissue. A local recurrence was documented in 2000. This was a progressively growing mass (20 cm across) originating from the prostate and compressing and obstructing the rectum. There were no urinary voiding problems. The patient was not given any therapy (i.e., chemotherapy or radiotherapy). A computed tomography scan performed in 2003 did not reveal secondary deposits in lymph node and distant parenchyma. The PSA remained below 1.0 ng/ml. He died because of heart failure in mid-2003. An autopsy was not done.
Case 4 - Figure 1 - Epithelial cell nests and islands arranged in basophilic nodules having expansible growth margins.
Case 4 - Figure 3 - Epithelial cell nests and islands. Single lumina are present.
Case 4 - Figure 4 - Solid epithelial cell nests and cords. The peripheral palisading pattern is evident. Small globules of dense eosinophilic material surrounded by basaloid cells are seen in some nests.
Case 4 - Figure 5 - Nest punctuated by cribriform spaces filled with tenuous basophilic mucinous secretion; squamous differentiation is seen in the lower left corner.
Case 5
Submitted by: Lawrence D. True University of Washington Medical Center Seattle, WA
Clinical Summary:
This 65 year old male presented with a bulky pelvic tumor. Nine years prior to admission a routine physical exam revealed an asymmetrically enlarged prostate. Prostate biopsies showed a "prostate adenocarcinoma, poorly differentiated." The tumor was treated with 6,800 Gy of radiation to the pelvis. The patient remained asymptomatic for 9 years, at which time he developed bladder outlet obstruction. A biopsy revealed tumor, which was treated by radical cystoprostatectomy. Based on evidence of residual tumor, additional radiation therapy, followed by en-bloc resection of residual tumor and rectum, was undertaken. The slides are from this latter specimen.
Case 5 - Figure 1 - The lesion cells have a predominantly spindle shape and haphazard growth pattern. Markedly atypical cells are present in this relatively hypercellular field.
Case 5 - Figure 2 - Spindle shaped lesion cells exhibit only moderate atypia and cellularity in this field.
Case 5 - Figure 3 - Lesion cells are admixed with an osteoid stroma in this field.
Case 5 - Figure 4 - Lesion cells form palisading aggregates of Verocay bodies in this field.
