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Genitourinary Tissue Pathology
Tuesday, March 4, 2008 , 7:30 PM
Convention Center 205/207
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Moderator:
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PETER A. HUMPHREY
Washington University School of Medicine
St. Louis, MO
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Disclosure:
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The speakers have indicated they have nothing to disclose.
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Clinical histories are displayed below.
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for Text and References
Submitted by: Hema Samaratunga -
Sullivan Nicolaides Pathology, Brisbane, Australia
A 52-year- old female presented with a two week history of right flank pain and gross hematuria. An ultrasound scan revealed a 5.5 cm mixed solid and cystic tumor in the lower pole of the right kidney. This was thought to be a renal cell carcinoma. There was no clinical or radiological evidence of metastatic cancer. A radical nephrectomy was performed. Involving the lower part of the kidney, there were several masses of tumor, the largest of which was partly cavitated. The tumor involved predominantly the medulla, with some involvement of the cortex and extension into the renal sinus and renal vein. The cut surface of the tumor was fleshy and white with haemorrhage and necrosis.
Case 1 - Slide 1
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Case 1 - Figure 1
Low power photomicrograph illustrating broad sheets of tumor infiltrating renal parenchyma. The tumor has delicate thin walled blood vessels.
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Case 1 - Figure 2
The tumor has a cystic component with many of the cysts containing serofibrinous fluid or blood.
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Case 1 - Figure 3
Highly cellular tumor infiltrates renal sinus fat.
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Case 1 - Figure 7
Focal necrosis is evident.
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Case 1 - Figure 8
Tumor cells are relatively monotonous with round to ovoid nuclei and a high nuclear to cytoplasmic ratio. Nuclei are vesicular with small or inconspicuous nucleoli. Mitotic figures are frequent.
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Case 1 - Figure 9
In some areas, tumor cells display, a small amount of pale cytoplasm.
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for Text and References
Submitted by: Ferran Algaba - Fundacion Puigvert , Barcelona, Spain
The clinical history is a 57 year old man with perineal pain and painful DRE. The PSA was 3.67 ng/L.
The specimen is a core needle biopsy.
Case 2 - Slide 1
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for Text and References
Submitted by: Dengfeng Cao - Washington University School of Medicine, St. Louis, MO
This is a 53-year old woman with a history of hysterectomy and bilateral salpingo-oophorectomies. She also had a history of nephrectomy for renal cell carcinoma. A recent follow-up CT scan showed a 4 cm mass in the posterior wall of the bladder. She underwent cystourethroscopy and transurethral resection of the mass. The specimen consisted of multiple fragments and the following pictures were taken from 3 representative fragments.
Case 3 - Slide 1
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Case 3 - Figure 1
Low power view shows variable-sized glands infiltrating within the muscularis propria of the bladder.
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Case 3 - Figure 2
At high power view of figure 1, one gland in the center is lined by mucinous epithelium.
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Case 3 - Figure 3
Other small glands in figure 1 are tubular in shape and are lined by cuboidal to columnar nonmucinous cells. Although some nuclei have prominent nucleoli, no cytologic atypia is seen. Some glands also show nuclear stratification.
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Case 3 - Figure 4
Low power view of several glands within the muscularis propria in a different fragment: small tubular glands and two cystically dilated ones.
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Case 3 - Figure 5
The two cystically dilated glands in figure 4 are lined by one single layer of cuboidal cells with mucinous cytoplasm and bland nuclei. The tubular glands are lined by nonmucinous columnar cells (with some cautery effect).
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Case 3 - Figure 6
Another fragment contains multiple tubular glands and few cystically dilated glands that are infiltrating the muscularis propria of the bladder.
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Case 3 - Figure 7
Medium power view of the glands and their surrounding stroma of figure 6.
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Case 3 - Figure 8
Some glands in figures 6 contain subnuclear cytoplasmic vacuoles. The lining cells are stratified cuboidal to columnar cells. The surrounding stroma consists of spindled to epithelioid cells. There is some collagen within the stroma.
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Case 3 - Figure 9
The glands and their surrounding stromal cells seen in figures 6-8 are diffusely and strongly positive for estrogen receptor (ER). The smooth muscle cells of the muscularis propria of the bladder (left and right upper corners) are negative for ER.
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Case 3 - Figure 10
The glands and their surrounding stromal cells seen in figures 6-8 are diffusely and strongly positive for progesterone receptor (PR). The smooth muscle cells of the muscularis propria of the bladder (left and right upper corners) are negative for PR.
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Case 3 - Figure 11
The stroma cells surrounding the glands seen in figures 6-8 are diffusely positive for CD10. The smooth muscle cells of the muscularis propria of the bladder (left and right upper corners) are negative for CD10.
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for Text and References
Submitted by: Victor E. Reuter - Memorial Sloan-Kettering Cancer Center, New York, New York
Unilateral testicular tumor in a 15 month-old child.
Case 4 - Slide 1
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Case 4 - Figure 1
Gross appearance of the 2.0 cm enucleated testicular mass.
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Case 4 - Figure 2
Low magnification view of the lesion.
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Case 4 - Figure 3
Two views of the mesenchymal component of the lesion. The image on the left contains primitive-appearing stromal cells and the image on the left appears more fibrous.
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for Text and References
Submitted by: Omar Hameed - University of Alabama School of Medicine, Birmingham, Alabama
A 62-year old gentleman with intermittent urinary retention, previously managed medically, presents to his urologist with hematuria and increasing retention. Upon performing a transurethral resection of the prostate, the urologist noted “globs of mucus” in the prostate.
Case 5 - Slide 1
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Case 5 - Figure 1
Primary enteric-type adenocarcinoma of the urethra appearing as a polypoid glandular proliferation. Notice the benign-appearing orderly and villous glandular pattern near the top.
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Case 5 - Figure 2
The tumor is composed of a complex glandular proliferation in which abundant dirty necrosis is evident. The appearances are clearly identical to what is seen in invasive colonic adenocarcinoma.
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Case 5 - Figure 3
Enteric-type adenocarcinoma displaying stratified columnar cells with elongated nuclei. Abundant mitotic activity is present.
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Case 5 - Figure 4
A high power magnification shows a malignant gland with dirty necrosis.
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Case 5 - Figure 5
Other areas of the tumor showed a prominent cribriform architecture also reminiscent of colonic adenocarcinoma.
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Case 5 - Figure 6
In this figure, adenocarcinomatous epithelium is seen within and distorting a von Brunn nest. This could represent adenocarcinoma in-situ, or more likely, extension of adenocarcinoma into von Brunn nests in the manner usually seen with urothelial carcinomas.
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Case 5 - Figure 7
The tumor was diffusely positive for CDX2. The tumor was also positive for villin (not shown) and displayed a nuclear staining pattern for beta-catenin (not shown).
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Case 5 - Figure 8
The tumor was also positive for cytokeratin 20 but negative for cytokeratin 7 (not shown).
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