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Genitourinary Pathology
Wednesday, March 28, 2007, 7:30 PM
Convention Center 6 A/B
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Moderator:
PETER A. HUMPHREY
Washington University School of Medicine
St. Louis, MO
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Submitted by: John N. Eble - Indiana University School of Medicine, Indianapolis, IN
An incidentally-found 40 x 32 x 25 mm mass in the hilar region of the kidney of a 62-year-old woman was thought clinically to be a primary malignancy of the kidney.
Gross examination in the pathology laboratory found a rubbery well-circumscribed solid and cystic tumor which protruded into the renal pelvic cavity.
Case 1 - Slide 1
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Submitted by: Mark A. Rubin - Harvard Medical School, Boston, MA
P.J. is a 61 year old man, who during a recent routine medical check up was found to have Prostate Specific Antigen (PSA) level of 5.4 ng./ml. (up from 3.5 ng./ml. from the previous yearly visit). The patient was in excellent physical health. He underwent sextant prostate needle biopsies by a local urologist, which revealed adenocarcinoma of the prostate, Gleason grade 7 (4+3=7) involving 4 of 6 biopsies from both sides. Endorectal MRI did not detect any evidence of extraprostatic extension or seminal vesicle involvement. He underwent a nerve sparing retropubic radical prostatectomy.
Case 2 - Slide 1
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Case 2 - Figure 1
Low power photomicrograph demonstrating areas of cribriform tumor growth as well as more typical invasive acinar cancer.
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Case 2 - Figure 2
Low power photomicrograph demonstrating the presence of basal cells (34beaE12 and p63) in benign glands and the absence of basal cells in the cribriform areas of tumor proliferation. AMACR is expressed in both the cribriform tumor and the acinar cancer.
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Case 2 - Figure 3
Intermediate power photomicrograph demonstrating areas of cribriform tumor growth.
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Case 2 - Figure 4
Intermediate power photomicrograph demonstrating expression of p63 in the basal cells surround the cribriform growth.
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Case 2 - Figure 5
High power photomicrograph demonstrating an acinar tumor with luminal secretions and prominent nucleolei.
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Case 2 - Figure 6
High power photomicrograph taken from a section at the base of the seminal vesicle.
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Case 2 - Figure 7
High power photomicrograph taken from the right mid portion of the prostate gland.
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Case 2 - Figure 8
This high power photomicrograph is taken from one of the cribriform structures previously illustrated. This is a break apart assay for the ERG gene located on chromosome 21.
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Case 2 - Figure 9
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Submitted by: Gregor Mikuz - Medical University Innsbruck, Innsbruck, Austria
26-year old patient suffered a scrotal trauma playing soccer. 6 months later sudden onset of painful testicular swelling. The family physician diagnosed a posttraumatic epididimorchitis and prescribed a therapy with antibiotics. One week after beginning of the therapy the scrotum is still rapidly swelling and the scrotal skin becomes necrotic (see photography). The patient is referred to the urological clinic where a testicular tumor clinical stage II is diagnosed and a tumor orchidectomy with partial resection of the scrotum is carried out.
Case 3 - Slide 1
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Submitted by: Cristina Magi-Galluzzi - Cleveland Clinic, Cleveland, OH
A 63-year-old man presented with a complaint of two months duration of heartburn, regurgitation after eating, accompanied with nausea, vomiting, and easy satiety. He also reported a weight loss of 10 lb. over a short period of time, and lack of appetite. At about the same time he started having black stools, and reported feeling of dizziness. A duodenal mass was found on endoscopy. An abdominal CT showed a partially cystic mass in the right abdomen originating either in the kidney or in the adrenal gland.
Patient underwent angio-infarction and subsequent (5 months later) resection of a large right kidney mass. During the course of resection, it was discovered that the tumor had eroded into the duodenum with a pyeloduodenal fistula. Grossly most of the kidney was involved by a neoplastic process partially solid, cystic and extensively necrotic. The largest solid area of tumor (Figure 1-7) was located in the lower pole and measured 3.0 cm in diameter.
Case 4 - Slide 1
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Submitted by: Thomas M. Wheeler - Baylor College of Medicine, Houston, TX
This previously healthy 60 year old man presented with painless gross hematuria10 days prior to admission. Cystoscopic examination was performed and revealed a sessile tumor mass involving the dome and extending down the upper portion of the posterior wall. Biopsies were taken (figures 1-3) and the patient was sent to the recovery room in stable condition. Two weeks later following a negative metastatic work-up, the patient underwent radical cystoprostatectomy and retroperitoneal lymph node dissection. This showed extensive permeation of the tumor through the complete thickness of the bladder wall with extension into the perivesicle adipose tissue (figures 4-6). The prostate was not involved by tumor. Sixteen lymph nodes were examined histologically and none showed evidence of metastatic tumor. The patient had an uneventful recovery following surgery; however, within one year following surgery had developed widespread metastatic disease to bone, lungs and brain. The patient died of complications of metastatic disease within three years of initial diagnosis.
Case 5 - Slide 1
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During the meeting the slides and protocols will be available for study in the microscope
room in the Manchester Grand Hyatt (Betsy A-C) for participants who wish to review them prior to the
evening session.
Handouts for all Specialty Conferences will be accessible via the
"Educational Materials" section on the homepage the morning after each respective conference. Printed
copies of the handout will not be available at the meeting. However, we will provide a booklet at the
meeting which will have a page for each Specialty Conference, listing the names of speakers and space
for the important "take home messages".
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