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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
Disclosure: The speakers have indicated they have nothing to disclose.
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for Text and References
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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Case 1 - Figure 1
Mixed epithelial and stromal tumor with a mixture of collagenous and smooth muscle stroma and cysts of variable size lined by cuboidal and columnar epithelium A few fat cells are present in the upper right.
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Case 1 - Figure 2
Mixed epithelial and stromal tumor with irregular branching lumen lined by cuboidal and hobnail epithelium.
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Case 1 - Figure 3
Mixed epithelial and stromal tumor with collagenous stroma and cysts lined by urothelium.
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Case 1 - Figure 4
Mixed epithelial and stromal tumor with collagenous stroma and a cyst with spatulate papillae with cellular cores protruding into it. Histiocytes are present in the lumen of the cyst and in one of the papillary cores (upper right).
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Case 1 - Figure 5
Mixed epithelial and stromal tumor with cyst with spatulate papillae protruding into it. The stroma is smooth muscle and contains clustered small cysts of variable size lined by cuboidal epithelium. In upper left quadrant is a blood vessel with mural sclerosis on its way to becoming a fibrous lump resembling a corpus albicans of the ovary.
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Case 1 - Figure 6
Mixed epithelial and stromal tumor with smooth muscle stroma and clusters of minute cysts line by low cuboidal epithelium.
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Case 1 - Figure 7
Mixed epithelial and stromal tumor with smooth muscle stroma and a few fat cells.
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Case 1 - Figure 8
Mixed epithelial and stromal tumor with smooth muscle stroma interspersed with collections of small cystic glandular structures containing brightly eosinophilic proteinaceous fluid and lined by cuboidal epithelial cells.
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Case 1 - Figure 9
Mixed epithelial and stromal tumor with cyst lined by ciliated columnar epithelium.
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Case 1 - Figure 10
Mixed epithelial and stromal tumor with rounded blunt papillae with cellular stromal cores and a covering of cuboidal and flattened cuboidal cells.
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Case 1 - Figure 11
Mixed epithelial and stromal tumor with cyst lined by urothelium and by columnar epithelium.
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for Text and References
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
This is a straightforward case from a clinical perspective. This H&E slide shows an adenocarcinoma of the prostate. The tumor has both typical invasive acinar and cribriform growth pattens.
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Case 2 - Figure 2
Immunohistochemistry confirms that the cribriform tumor represents intraductal tumor spread and not invasion.
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Case 2 - Figure 3
This is a straightforward case from a clinical perspective. This H&E slide shows an adenocarcinoma of the prostate. The tumor has both typical invasive acinar and cribriform growth pattens.
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Case 2 - Figure 4
Immunohistochemistry confirms that the cribriform tumor represents intraductal tumor spread and not invasion.
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Case 2 - Figure 5
This photomicrograph highlights prominent nucleoli and luminal secretions, both characteristics often found in prostate tumors and used as diagnostic features in prostate needle biopsies.
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Case 2 - Figure 6
Findings associated with more aggressive clinical course include Seminal vesicle invasion (slide 6) and extra-prostatic extension (slide 7).
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Case 2 - Figure 7
Findings associated with more aggressive clinical course include Seminal vesicle invasion (slide 6) and extra-prostatic extension (slide 7).
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Case 2 - Figure 8
FISH assay demonstrating ERG break apart on chromosome 21. Break apart of the ERG probes and loss of the green signal is characteristic of than TMPRSS2-ERG fusion prostate cancer. Gene fusion prostate cancers are believed to be more aggressive and have recently been found to be associated with a strong histologic phenotype including cribriform growth, blue-tinged mucin, and prominent nucleoli as seen in this case.
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Case 2 - Figure 9
FISH assay demonstrating ERG break apart on chromosome 21. Break apart of the ERG probes and loss of the green signal is characteristic of than TMPRSS2-ERG fusion prostate cancer. Gene fusion prostate cancers are believed to be more aggressive and have recently been found to be associated with a strong histologic phenotype including cribriform growth, blue-tinged mucin, and prominent nucleoli as seen in this case.
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for Text and References
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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Case 3 - Figure 1
The appearance of the swollen scrotum with the testicular tumor protruding trough the skin.
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Case 3 - Figure 2
Low power view of the rather undifferentiated tumor
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Case 3 - Figure 3
Higher power with primitive tubular structures surrounded by undifferentiated tumor cells.
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Case 3 - Figure 4
Low power view with tubular structures and structures mimicking primitive glomeruli (right corner at the bottom). The insert shows the positive immunohistochemical reaction of the tumor cells with the CD 99 antibodies.
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Case 3 - Figure 5
Vascular invasion of the tumor masses.
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Case 3 - Figure 6
Another low power view of the tumor.
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Case 3 - Figure 7
Areas with spindled tumor cells resembling smooth muscle cells.
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Case 3 - Figure 8
The spindled cells stain positively with desmin antibodies.
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Case 3 - Figure 9
Low power view of tubular structures immunohistochemically stained with cytokeratin antibodies (CAM 5.2)
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for Text and References
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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for Text and References
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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