—  SPECIALTY CONFERENCE HANDOUT  — Genitourinary Pathology Thursday, March 25, 7:30 PM Salon 3 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 Controversial Issues in Urologic Pathology Moderator: JOHN CHEVILLE Mayo Clinic Rochester, MN Disclosure: In accordance with ACCME guidelines regarding disclosure, the USCAP policy requires that faculty members who have a significant financial or other relationship with a commercial company, entity, or service (which will be discussed in this Symposium) must disclose this to attendees. The Academy also requires that speakers disclose any products that are not labeled for the use under discussion. The speakers listed below have indicated they have nothing to disclose. Panelists: THOMAS J. SEBO, Mayo Clinic, Rochester, MN DONNA E. HANSEL, The Cleveland Clinic, Cleveland, OH JOHN N. EBLE, Indiana University School of Medicine, Indianapolis, IN MAHUL B. AMIN, Cedars Sinai Medical Center, Los Angeles, CA Clinical Histories and Still Images are displayed below. Click on slide thumbnail images for an enlarged view. If you have any difficulties viewing these slides, email or call George Clay at +1.724.449.1137. Case 1 - Click here for Text and References Submitted by: Mahul B. Amin - Cedars Sinai Medical Center, Los Angeles, CA Clinical Summary: 67 year old male with a history of gross hematuria, acute prostatitis and benign prostatic hypertrophy. Cystoscopy revealed a small, polypoid growth with a broad base emanating from the left side of the verumontanum in the prostatic urethra. A biopsy was performed. Pertinent Laboratory Data: Elevated PSA (7 ng/mL) Case 1 - Figure 1 Low power view of lesion in prostatic urethra demonstrating a papillary and glandular architecture. Case 1 - Figure 2 Low power view of lesion in prostatic urethra demonstrating a papillary and glandular architecture. Case 1 - Figure 3 Low power view of lesion in prostatic urethra demonstrating a papillary and glandular architecture. Case 1 - Figure 4 Higher power demonstrating that the lesional cells are tall columnar to cuboidal. Case 1 - Figure 5 Higher power demonstrating that the lesional cells are tall columnar to cuboidal. Case 1 - Figure 6 Higher power demonstrating that the lesional cells are tall columnar to cuboidal. Prominent nucleoli are present. Case 1 - Figure 7 Higher power demonstrating that the lesional cells are tall columnar to cuboidal. Prominent nucleoli are present. Case 1 - Figure 8 The lesion in the prostatic urethra is positive for PSA. Case 1 - Figure 9 Triple cocktail immunohistochemistry - p63, high molecular weight cytokeratin and racemase Case 1 - Figure 10 Case 2 - Click here for Text and References Submitted by: Donna E. Hansel - The Cleveland Clinic, Cleveland, OH Clinical Summary: A 72 year old man is referred to our urologist for nocturia and urinary urgency. His past medical history is significant for BPH, which has been treated with Flomax. The patient is a retired machinist and has a 30 pack year history of smoking cigarettes. He has not experienced gross hematuria or dysuria. The patient's current PSA is 1.62. Urinalysis was performed and was normal. Urine cytology did not reveal any abnormalities. Cystoscopy was performed and showed a normal urethra, trilobar hypertrophy of the prostate and a reddened, raised patch on the posterior wall of the bladder. A biopsy was performed. Case 2 - Figure 1 Case 2 - Figure 2 H&E Case 2 - Figure 3 H&E Case 2 - Figure 4 H&E Case 2 - Figure 5 Ki67 Case 2 - Figure 6 Case 3 - Click here for Text and References Submitted by: John N. Eble - Indiana University School of Medicine, Indianapolis, IN Clinical Summary: A 14-year-old girl complained of abdominal pain. Computerized tomography showed a 40 x 20 mm solid mass in the lower pole of her left kidney. Case 3 - Figure 1 Pre-operative needle biopsy of the mass shows nests of neoplastic cells with abundant eosinophilic cytoplasm. Some of the cells contain deposits of pigment. Case 3 - Figure 2 Higher magnification shows the nuclei to be regular and round. The pigment is borwn or black and ranges from a fine dust to small granules. Case 3 - Figure 3 The resection specimen gave a more panoramic view, showing the neoplastic cells to grow in large nests surrounded by a delicate vasculature. Case 3 - Figure 4 Immunohistochemistry with antibody to TFE3 shows a positive reaction in the nuclei of the neoplastic cells. Case 3 - Figure 5 Immunohistochemistry with antibody HMB45 shows a positive reaction in the cytoplasm of the neoplastic cells. Case 4 - Click here for Text and References Submitted by: Thomas J. Sebo - Mayo Clinic, Rochester, MN Case 4A - Clinical Summary: 75 YOM With Hematuria – Voided Urine Cytology; History of Prostate Cancer Case 4a - Figure 1 Case 4a - Figure 2 Case 4a - Figure 3 Case 4B - Clinical Summary: 60 YOM – Voided Urine Cytology; History of Renal Insufficiency Case 4b - Slide 1 Click to view with ImageScope Click to view with a Web-Based Viewer Case 4b - Figure 1 Case 4b - Figure 2 Case 4b - Figure 3 Case 4b - Figure 4 Case 4C - Clinical Summary: Right (Figures 1-3) and Left (Figures 4-6) Ureteral Brushing Cytologies 68 YOM; Hematuria with Current Cystoscopic Evidence of Bladder Mass and History of BCG-Treated Case 4c - Figure 1 Case 4c - Figure 2 Case 4c - Figure 3 Case 4c - Figure 4 Case 4c - Figure 5 Case 4c - Figure 6 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.