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Cases of the Week 2023
Previous Cases of the Week 2022
Previous Cases of the Week 2021
Previous Cases of the Week 2020
Previous Cases of the Week 2019

Current Case of the Week 2024

2025 – 2/Feb 24
A 52-year-old female had a clinical history of E. coli infections, leading to renal and retroperitoneal abscesses formation with spinal extension. She underwent a left radical nephrectomy. A circumscribed tan-red nodule (2.2 cm in greatest dimension) was seen grossly within the necrotic renal parenchyma.
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2025 – 1/Jan 20
Case History: A 58-year-old female patient presented with right renal mass. Gross examination of the partial nephrectomy specimen revealed a 2.0 cm red-brown hemorrhagic and cystic mass.
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Middle-aged male with large renal mass, undergoes nephrectomy. Representative H&E sections of the renal mass shown here along with a single paired immunohistochemical assay. : -2022-40/October 17

2022-40/October 17

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A female in her 60s with an incidentally found kidney tumor. Partial nephrectomy was performed. :- 2022-39/October 10

2022-39/October 10

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A woman in her early 70s was incidentally found to have a 4.5 cm right upper pole renal mass on imaging (Figure 1A). She underwent a right partial nephrectomy. :- 2022-38/October 03

2022-38/October 03

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A 7-week-old previously healthy male was found to have a right inguinal hernia and small bilateral hydroceles. During surgery for hernia repair, a 1.5 cm red, jelly-like mass was identified on the ventral aspect of the spermatic cord. The mass was moderately firm and was scattered with punctate yellow deposits, suggestive of calcifications. The mass was dissected from the cord and sent for histopathologic evaluation. :- 2022-37/September 26

2022-37/September 26

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A man in his 30s presents with a left testicular 2.3 cm cystic mass with marked heterogeneity, concerning for a malignant neoplasm. The patient had a left testicular surgery performed in childhood with unclear indication. Serological studies include: LDH 140, AFP 5.3, and beta-HCG < 3. :- 2022-36/September 19

2022-36/September 19

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A 52-year-old male patient presented with repeated gross hematuria and left-sided abdominal pain. Imaging studies revealed a 2.9 x 1.8 cm polypoid mass, within the calyces of the upper pole of the left kidney. :- 2022-35/September 12

2022-35/September 12

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A 69-year-old male with macroscopic hematuria and low back pain was admitted to the Department of Urology. Two years earlier, the inferior lobe of his left lung was removed because of pulmonary adenocarcinoma. After that, the patient received chemo- and radiotherapy and was tumor-free. A contrast-enhanced abdominal CT was recently performed that revealed a 13-cm-large tumor in the left kidney. A radical nephrectomy was performed. :- 2022-34/September 05

2022-34/September 05

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A 75-year-old man with a right renal lesion measuring 3.2 cm in greatest dimension. A partial nephrectomy is performed. :- 2022-33/August 29

2022-33/August 29

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A male patient in his 70s presented with macroscopic haematuria and underwent transurethral resection of a bladder tumour. He had a history of hypercholesterolaemia and metastatic prostatic carcinoma on androgen deprivation therapy. :- 2022-32/August 15

2022-32/August 15

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A woman in her 80s underwent nephrectomy along resection of multiple retroperitoneal nodules. One small nodule (1.5 cm) showed a firm and fascicular cut surface (see figures 4 and 5). :- 2022-31/August 08

2022-31/August 08

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Bilateral orchiectomy was performed in an elderly male with prostatic adenocarcinoma with bone metastasis. (First 3 images are from the left testis, whereas the last 2 images are from the right testis). :- 2022-30/August 01

2022-30/August 01

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A young male in his 20s with a known cancer syndrome presented with bilateral epididymal masses :- 2022-29/July 25

2022-29/July 25

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A man in his 60s with a history of diabetes and benign prostatic hyperplasia presented with 6 weeks of fatigue and 3 days of suprapubic tenderness. Ultrasound demonstrated moderate hydronephrosis of the right kidney and urinary retention. He returned 1 week later with lethargy, hyperglycemia (blood glucose 850), and continued dysuria. Urine and blood culture were positive for Escherichia coli. On imaging, extensive gas was noted in and around the kidneys bilaterally. The patient developed septic shock, and bilateral radical nephrectomy was performed. :- 2022-28/July 18

2022-28/July 18

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Male in his 70s presents without prior malignancy history presents with symptoms of benign prostatic hyperplasia, transurethral resection is performed :- 2022-27/July 11

2022-27/July 11

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A woman in her early 60s underwent a radical nephrectomy due to a 9.0cm tumor with multi-cystic central component and solid nodular appearance at periphery at imaging studies. Thoracic imaging showed multiple small cysts in the lung suggestive of lymphangioleiomyomatosis. The gross picture shows the 9.0 cm with both multicystic appearance in central kidney and solid configuration in upper lobe. Venous invasion in renal sinus (upper third). The lower lobe shows smaller white nodules –the largest measuring 2 cm. Further sectioning showed multiple white spots within renal parenchyma. Some of them are illustrated in figure 2. Figures 3 to 5 illustrate the large tumor. :- 2022-26/July 04

2022-26/July 04

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A woman in her late 50s underwent wide resection of vulva and inguinal skin due to massive verruciform lesion. She had crusted / keratotic plaques with appearance of follicular keratosis in the back, neck, face, and extremities for 27years. :- 2022-25/June 27

2022-25/June 27

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Middle-aged man with no prior history of malignancy presents with hematuria. Cystoscopy showed blue light positive bladder lesion, biopsied :- 2022-24/June 20

2022-24/June 20

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Man in his 30s, non-smoker, initially presented with hematuria, dysuria, and constipation was diagnosed with urothelial carcinoma of bladder on transurethral resection of bladder tumor (TURBT) at an outside hospital. Upon transferring care, patient underwent a subsequent radiology work up which revealed a large vascular mass involving prostate and pushing against bladder base. He underwent systematic prostate needle biopsies. The TURBT from outside hospital was also obtained and reviewed. :- 2022-23/June 13

2022-23/June 13

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The patient is a female in her 60s who presents with an incidentally detected kidney mass. Computed tomography shows an enhancing exophytic, solid right kidney mass of the lower pole. The patient elects to undergo a laparoscopic partial nephrectomy of the mass. The specimen measures 3.0 x 2.0 x 1.2 cm and consists of a well-defined, partially cauterized, enucleated, and encapsulated lesion. The cut surface shows a well-defined, glistening, tan-red-brown, and rubbery to spongy mass with no obvious necrosis(Figure 1).The lesion abuts both the parenchymal margin and capsular surface, without discrete involvement of either. :- 2022-22/June 06

2022-22/June 06

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A woman in her 60s with end-stage renal disease (ESRD) receiving hemodialysis (HD) was evaluated for right lower quadrant pain. Computed tomography (CT) demonstrated a 3.9 cm complex renal cyst, enlarged from 2.1 cm on previous imaging. There was concern for malignancy and she subsequently underwent left radical nephrectomy. The specimen was bisected to reveal multiple masses in the upper and lower poles. These masses demonstrated variegated, orange-yellow to tan-red cut surfaces with well-delineated borders. The remaining parenchyma demonstrated multiple cysts measuring 4.5 cm in greatest dimension. (Microscopic images are from the largest mass, showing similar features with the other masses) :- 2022-21/May 30

2022-21/May 30

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A teenager noticed a nodule in the dorsal side of the penis two years before this presentation. The nodule was surveilled clinically. In this period, no skin lesions were noted. In the last months, the lesion rapidly grew causing ulceration in dorsal skin and invading corpora cavernosa and corpus spongiosum (as evaluated by imaging studies) :- 2022-20/May 23

2022-20/May 23

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Male in his 60s with 2.7cm renal mass, confined to kidney (pT1a). Partial nephrectomy is performed. :- 2022-19/May 16

2022-19/May 16

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A male patient in his 80s with a 1.5 cm polypoid and ulcerated lesion in scrotal skin. :- 2022-18/May 2

2022-18/May 2

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A man in his early 50s underwent atotal nephrectomy due to a 4.5cm solid tumor. :- 2022-17/April 25

2022-17/April 25

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A male in his 20s, presented with a rapidly enlarging painless right testicular mass. On scrotal ultrasound, there was a 6.8 cm well-circumscribed mass compressing the adjacent testicle. ALP was minimally elevated, while LDH and bHCG were within normal limits :- 2022-16/April 18

2022-16/April 18

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A male in his 60s with history of prostate cancer status post radiation treatment. Transurethral resection of the prostate is performed. :- 2022-15/April 11

2022-15/April 11

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A male in his 40s with the incidental finding of a right renal mass on CT angiography of the abdomen during cardiac surgery work up. He underwent right open partial nephrectomy which showed a 2.2 cm, well-circumscribed, solid, tan-white to yellow tumor. :- 2022-14/April 4

2022-14/April 4

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This is a prostatectomy specimen from a patient in his early 80s (GG5, pT3b; with 10% involvement of the gland). :- 2022-13/March 28

2022-13/March 28

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A male patient in his 70s underwent transurethral resection of the prostate. :- 2022-12/March 21

2022-12/March 21

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60-year-old-female was found to have an incidental left renal and adrenal mass on imaging :- 2022-11/March 14

2022-11/March 14

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A man in his early 40s underwent partial orchiectomy due to a 2.2 cm nodule. Serum tumor markers were within normal limits. :- 2022-10/March 7

2022-10/March 7

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A female in her 60s presented with a 2.4 cm solid and hypovascular left renal mass. She underwent diagnostic biopsy. :- 2022-09/February 28

2022-09/February 28

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Male in his 20s underwent left orchiectomy due to cystic tumor measuring 1.8 cm. Microscopic examination revealed epidermoid cyst. Additionally an incidental 2 mm nodule was found in the rete testis. :- 2022-08/February 22

2022-08/February 22

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During follow-up for urothelial carcinoma of the upper urinary tract, a man, aged 79 years, underwent a cystoscopy and incidentally discovered an exophytic blueish area on the bladder dome, covered by flat and smooth urothelium. The urologist performed an en-bloc resection of the lesion. :- 2022-07/February 14

2022-07/February 14

A 76-year-old man with an incidentally renal tumor in the lower pole of the right side of a horseshoe kidney was submitted to a partial nephrectomy. :- 2022-06/February 7

2022-06/February 7

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A man in his mid-50s presented with dysuria and gross hematuria. Imaging revealed a 14.9 x 10.0 cm mass essentially replacing prostate and seminal vesicles, and invading the urinary bladder. After biopsy confirmation of malignancy, a cystoprostatectomy was performed to completely remove the tumor. On pathologic gross examination, the tumor had a fleshy, tan-white cut surface with central necrosis. :- 2022-05/January 31

2022-05/January 31

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A patient in his early 60s underwent prostatectomy, which showed a Grade Group 2 (Gleason 3+4=7) tumor, stage pT3a. The following images show focal areas of the tumor. :- 2022-04/January 24

2022-04/January 24

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A male patient in his 40s with 19 cm multiloculated cystic mass in his right kidney. :- 2022-03/January 17

2022-03/January 17

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A man in his 30’s presented with 3 days of abdominal pain, nausea, and vomiting. CT imaging revealed a 14 cm ill-defined right retroperitoneal mass, a 2 cm left pulmonary nodule, and a 10 cm right testicular mass. Serum alpha-fetoprotein (AFP) was elevated, and beta-HCG and LDH were normal. He underwent biopsy of the retroperitoneal mass. :- 2022-02/January 10

2022-02/January 10

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A woman in her mid-60s with history of uterovaginal prolapse, status post hysterectomy, was incidentally noted to have a patent urachus at the bladder dome on cystourethroscopy. A CT scan showed a partially distended urinary bladder with a small vesicourachal diverticulum and focal calcifications at its apex. Partial cystectomy with excision of the entire urachus was performed. Gross examination showed a 3.2 cm cystic nodule with calcified cut surface. Images from the partial cystectomy are shown below. :- 2022-01/January 3

2022-01/January 3

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A man in his mid-40s presented with a right testis mass. Serum LDH was 243 U/L (normal: 100-235 U/L). β-HCG and α-FP were in the normal range. A right radical orchiectomy was performed.

2021-52/December 27

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A man in his early 50s underwent a partial nephrectomy due to a 0.8cm solid tumor.

2021-51/December 20

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A woman in her 60s with a history of COPD, GERD and arthritis presented with a one week history of right flank pain. Work-up revealed an obstructed right kidney with a staghorn calculus and a cystic renal mass. Urine cultures grew E. coli and P. mirabilis

2021-50/December 13

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A man in his 80s reported hematuria during preoperative period before prostatectomy due to prostate cancer. A 1.9 cm exophytic tumor was detected in bladder dome at cystoscopy. A multidisciplinary team opted for radical prostatectomy and partial cystectomy. The radical prostatectomy specimen showed a prostatic acinar adenocarcinoma Gleason score 4+3=7 (Grade Group 3 with cribriform morphology), pT3a. Images from the partial cystectomy are shown below.

2021-49/December 6

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A man in his late 60s with a history of prostate cancer, status post radiation therapy, had a TURP performed.

2021-48/November 29

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Female in her late 50s with past medical history of cervical cancer s/p radical surgery and chemoradiation, bilateral hydronephrosis (s/p PCN placement) comes with flank pain. Imaging reveals a 3.0cm solid enhancing right renal mass, suspicious for renal cell carcinoma. Needle biopsy is performed.

2021-47/November 22

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A man in his 40s with 5.3cm testicular mass grossly extending into hilar soft tissue. Section of central mass shown.

2021-46/November 15

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A man in his 60s presented with lower urinary tract symptoms. After imaging studies and multiple transurethral resections of the prostate, he ultimately underwent robot-assisted radical prostatectomy.

2021-45/November 8

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A man in his 40s with end stage renal disease, status post living donor kidney transplant for IgA nephropathy in his 20s, underwent a radical nephrectomy for an incidentally discovered, contrast-enhancing, solid, interpolar mass of his native left kidney.

2021-44/November 1

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A man in his early 30s sought urologic care due to a solitary warty lesion in his scrotum. There were no similar skin lesions elsewhere.

2021-43/October 25

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A man in his 40s with a left peri epididymal mass which had been stable in size for several years, underwent excision, showing a 4 x 3 cm ovoid mass (Figure 1) not appearing to be involving the testicle.

2021-42/October 18

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A man in his late 20s presented with a left testicular mass found on self-examination. Orchiectomy was performed.

2021-41/October 11

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A 61 year old male developed a scrotal mass which on gross examination revealed a 2.8 x 2.1 x 1.5 cm soft, multilocular cystic mass with white-yellow semi-translucent gelatinous contents

2021-40/October 4

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A man in his late 80s presented with urinary retention and a PSA of 2.2 ng/mL. He underwent a TURP. On cystoscopy, he was noted to have abnormal tissue at the base of the prostate that had a papillary appearance.

2021-39/ September 27

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A woman in her early 30s presented with pelvic pain, and a 2.0 cm kidney mass was incidentally found.

2021-38/ September 20

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A female patient in her 50s presented with a 3.9 cm renal mass and underwent partial nephrectomy. On gross examination, a well circumscribed un-encapsulated solid mass with a tan brown cut surface is noted.

2021-37/ September 13

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A female patient in her 50s presented with haematuria. Transurethral resection of bladder tumour was performed.

2021-36/ September 6

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A man in his 80s sought medical attention due to balanopreputial adhesions. He underwent phimosis surgery 13 years before and had a long history of recurrent balanoposthitis. At surgery, adhesions were removed, and there was no intraoperative impression of carcinoma. Images refer to foreskin biopsy. The patient had no history of diabetes mellitus or penicillamine intake.

2021-35/ August 30

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A man in his mid-30s presented with a 17 cm left kidney mass and underwent radical nephrectomy. Imaging had shown a solid heterogeneous mass with calcifications.

2021-34/ August 23

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A man in his mid-60s with a history of end-stage renal disease requiring hemodialysis for 5 years was found to have a 1.9cm left upper pole renal mass during pre-transplant evaluation. He underwent radical nephrectomy.

2021-33/ August 16

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A middle aged man underwent partial cystectomy and excision of urachal cyst. Gross evaluation identified a 2cm unilocular cystic lesion with abundant intraluminal mucin.

2021-32/August 9

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A 60-year-old man experiencing voiding difficulties due to prostate gland enlargement, unresponsive to medical treatment, underwent a transurethral resection of the prostate to alleviate his symptoms. Endoscopic evaluation of the prostatic urethra was unremarkable. The patient had no known history of carcinoma.

2021-31/ August 2

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A female patient in her mid-60s presents with an incidental 1.7 cm left kidney mass on CT. A robotic-assisted partial nephrectomy shows a well-circumscribed not encapsulated tan solid nodule with small cystic foci, confined to the kidney (stage pT1a)

2021-30/July 26

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A man in his 40s presented with scrotal swelling for six months duration. USG revealed a 4 x 3 cm sized solid testicular mass. Serum germ cell markers were negative.

2021-29/ July 19

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3-day-old male born at 40 weeks via vaginal delivery with a testicular mass on ultrasound. The plasma level of beta-HCG is 9.4 mIU/mL, AFP is 100,377 ng/mL (ref 13,688-83,124 ng/mL) and LDH is 405 IU/L (ref 90-225 IU/L).

2021-28/July 12

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A woman in her 50s presents with a right flank / lower abdominal discomfort. Her past medical history is not significant. Ultrasound reveals a 9 cm right renal mass

2021-27/ July 6

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A male in his 60s presented with a scrotal mass of 4 years duration but with increased growth in the last several months. MRI demonstrated a 13 cm well circumscribed mass with a dark T2 signal and T1 iso-intensity.

2021-26/ June 28

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Partial nephrectomy in a 51-year-old female, with a circumscribed solid grey white tumor.

2021-25/ June 21

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A teenage female with hematuria and a 3.7 cm bladder mass on computerized tomography underwent transurethral resection.

2021-24/ June 14

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A woman in her early 50s presented with a kidney mass, which had been incidentally identified during radiological exams performed for other clinical issues.

2021-23/ June 7

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A man in his 70s presented with right flank pain. Computed Tomography (CT) Abdomen and Pelvis showed a large right renal mass with direct invasion of the right hepatic lobe and a likely tumor thrombus in the right renal vein. He underwent right radical nephrectomy with regional lymphadenectomy.

2021-22 / May 31

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Male patient in his 80s with prostate biopsy, PSA 0.9 ng/ml. Transurethral resection of the prostate was performed twice in the last two years due to benign prostatic hypertrophy with urinary obstruction.

2021-21 / May 24

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A man in his 20s with a left testicular mass underwent radical orchiectomy. Serum AFP: 3.2 ng/mL, βHCG: 6059 mUI/mL, LDH: 353 U/L

2021-20 / May 17

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A man in his early 70s underwent prostate needle biopsy due to elevated serum PSA (3.4ng/ml) and a PI-RADS 4 lesion in the right apex. Images are from the targeted biopsy.

2021-19 / May 10

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A man in his late 40s presented with lower abdominal pain and distension. A computed tomographic scan revealed a 7 x 7 cm solid and fairly circumscribed mass in the upper pole of the left kidney. A radical nephrectomy was performed and the specimen was submitted for pathologic evaluation.

2021-18 / May 3

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A male in his late teens, had an incidentally discovered 3 cm painless solid scrotal mass. At surgery the mass appeared to be well demarcated and adherent to the external surface of the right testis, i.e., the testis was not involved. He underwent testis-sparing “lumpectomy”.

2021-17 / April 26

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A patient in his 60s underwent prostate needle biopsy due to elevated serum PSA (12 ng/ml) and a PI-RADS 4 lesion at left apex.

2021-16 / April 19

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A man in his 40s presented with right testicular pain. He underwent right orchiectomy, which showed a 1.1 cm tumor centered in the mediastinum testis.

2021-15 / April 12

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A man in his late 50s with a history of unclassified renal cell carcinoma status post left nephrectomy, adrenocortical adenoma, and angiomyolipoma, was found to have a 1.3 cm round soft tissue mass near the right diaphragmatic crus. A core biopsy of the mass was obtained for evaluation.

2021-14 / April 5

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A male patient in his 80s underwent circumcision for phimosis.

2021-13 / March 29

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A woman in her late 50s with hypertension had an incidentally discovered 1.7 cm right renal mass. She underwent a right partial nephrectomy. Presented are the histological findings.

2021-12 / March 22

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A woman in her early 60s with an incidental neoplasm found in her kidney biopsy, which had been performed for medical kidney disease.

2021-11 / March

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A woman in her 80s presented with gross hematuria. She was found to have a large palpable and non-mobile abdominal mass. Cystoscopy revealed a 5.5 cm hemorrhagic tumor in the right bladder dome. A transurethral biopsy was performed and based on the histologic diagnosis; the patient subsequently underwent radical cystectomy.

2021-10 / March 8

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A woman in her mid-40s with a kidney tumor underwent radical nephrectomy

2021-09 / March 1

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A man in his early 40s presented with an enlarged right testis.

2021-08 / February 22

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A man in his 60s presented with a history of voiding symptoms. Digital rectal examination revealed enlargement of the prostate and his prostate specific antigen level was 4.31 ng/ml. Transurethral resection of the patient’s prostate was performed.

2021-07 / February 15

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A man in his mid-60s presented with lower abdominal pain and hematuria. Cystoscopy revealed ulceration of the entire urinary bladder mucosa along with a thickened bladder wall. A transurethral resection of the bladder tumor was performed and submitted for histopathological examination.

2021-06 / February 8

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A female patient in her 80s with clinical suspicion of chronic cystitis and gross hematuria underwent cystoscopy showing multifocal erythema and erosions. There was no previous history of bladder surgery or instrumentation. At microscopy, the transurethral resection specimen showed several papillary lesions - the larger lesion measuring 2.6 mm.

2021-05 / February 1

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A male in his 50s with a history of multiple bilateral renal masses, the largest of which was a left sided 14.5 cm mass, and multiple pulmonary nodules. The patient underwent a left radical nephrectomy. Sections from the main tumor and background kidney are shown.

2021-04 / January 25

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A man in his 80s presented with gross hematuria for the past three months. He underwent transurethral resection of a bladder tumor.

2021-03 / January 18

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A man in his 50s presented with significant debilitating left flank pain and was found to have an asymmetrically-enlarged left kidney (16.5 cm) with a soft tissue mass involving the pararenal fascia and hilum concerning for malignancy.

2021-02 / January 11

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A man in his 50s presented with constipation and urinary frequency. CT scan identified a 20 cm abdominal mass. A biopsy of the mass was performed. He underwent orchiectomy two years back for a 11 cm right testicular mass.

2021-01 / January 4

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A male in his 80s presented with gross hematuria. On CT abdomen, there was a plaque-like thickening of the bladder wall measuring 7 x 6.5 x 2 cm with “fat stranding”. On cystoscopy, no distinct bladder mass was identified and a biopsy was performed.

2020-52 / December 28

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A previously healthy woman in her late 30s presented with a flank pain.A 9.5 cm left renal mass was seen on imaging.

2020-51 / December 21

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A man in his early 60s with a history of renal cell carcinoma metastatic to the lung presented with gastrointestinal bleeding. Endoscopy revealed multiple small polyps in the second and third segment of the duodenum, which were biopsied.

2020-50 / December 14

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Penile lesion in a man in his 40s

2020-49 / December 7

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Small incidental renal cortical cyst with small papillary proliferation in a male patient in his 70s operated on for high-grade ureteric urothelial carcinoma

2020-48 / November 30

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A man in his 50s presented with an elevated PSA of 27 ng/ml. A prostate biopsy was performed and all cores had prostatic cancer with 80% to 90% involvement of each core. Subsequent radical prostatectomy was performed and revealed the following findings.

2020-47 / November 23

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A woman in her early 50s presented with abdominal pain and was found to have an 8 cm left retroperitoneal mass on imaging. A resection including the mass and adjacent left kidney was performed.

2020-46 / November 16

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A man in his 60s presented with right sided abdominal pain. The CT scan of abdomen and pelvis with contrast showed an enhancing plaque-like thickening of the bladder wall. The patient underwent transurethral resection of bladder tumor and subsequent cystectomy, which revealed the lesion shown below.

2020-45 / November 9

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A man in his late 60s underwent a nephrectomy for a slowly growing renal mass. He had a prior diagnosis of oncocytoma on a core biopsy 7 years ago.

2020-44 / November 2

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A man in his early 50s underwent radical orchiectomy due to a 5.5 cm solid mass in the left testis and a partial orchiectomy for a 1.2 cm solid mass in the right testis.

2020-43 / October 26

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A man in his mid 60s had a prior history of prostatic adenocarcinoma (Gleason score 5+5=10, involving 12 cores). His PSA level initially declined to undetectable after introducing treatment with abiraterone + prednisone 1.5 years ago. He now presents with rising PSA level and has evidence of new bone metastases identifiable on CT imaging. A TURP was performed to relieve his urinary symptoms.

2020-42 / October 19

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Nephrectomy for a renal mass in female patient in her 50s. H&E and CD10 immunostains are shown.

2020-41 / October 12

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A woman in her 50s underwent a total nephrectomy for a 2.3 cm complex solid and cystic renal mass.

2020-40 / October 5

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A man in his late 30s presented with a 1.5 cm solid nodule at the head of the left epididymis.

2020-39 / September 28

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A man in his mid-50s underwent a 12-core prostate biopsy. Extensive glandular atrophy and basal cell hyperplasia were seen in all cores. In addition, the following focal lesion was identified

2020-38 / September 21

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A man in his mid-50s underwent a total nephrectomy due to a 7.5 cm solid tumor.Imaging suggested intratumoral calcifications.

2020-37 / September 14

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A male patient in his 70s underwent prostatectomy 3 months after 12-core prostate biopsy with the diagnosis of acinar adenocarcinoma Gleason 3+4 (Grade Group 2) in one biopsy site. The images are from the prostatectomy specimen.

2020-36 / September 7

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A 66-year old patient underwent 12-core prostate biopsy.

2020-35 / August 31

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A woman in her 20s presented with gross hematuria for over 3 months. MRI identified a 7.2 cm left renal mass. Metastatic disease was excluded based on imaging.

2020-34 / August 24

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A woman in her early 50s presented with multiple broad-based bladder mucosal lesions seen on cystoscopic examination.

2020-33 / August 17

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A woman in her mid 50s presented with persistent microscopic hematuria and declining renal function. She was found to have a non-functioning right kidney. The CT appearance was suggestive of upper ureteric urothelial carcinoma with no evidence of distant metastases. The patient underwent elective nephroureterectomy.

2020-32 / August 10

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A 55-year old male patient underwent a total nephrectomy due to a 7.5 cm solid tumor. Imaging suggested intratumoral calcifications.

2020-31 / August 3

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50-year-old male with a 10.8-cm right mid pole kidney mass and lymph nodes suspicious for metastasis.

2020-30 / July 27

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On follow up for a renal mass, a man in his early 60s presents with a fracture of his right arm. Imaging revealed a renal mass (5.5 x 1.7cm) in the lower pole, a destructive lesion involving humeral metaphysis, and small satellite nodules in liver.

2020-29 / July 20

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A woman in her early 30s presented with flank pain. Subsequent MRI confirmed a mixed solid and cystic renal mass (Bosniak IV) measuring 4 cm in greatest dimension, favored to be a cystic carcinoma. Gross and histological images from the partial nephrectomy specimen are shown below.

2020-28 / July 13

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A man in his late 80s underwent a transurethral resection of the bladder due to clinical diagnosis of bladder cancer.

2020-27 / July 6

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A 30 year-old male presented with long history of back pain and pain with ejaculation, which led to imaging studies that revealed left renal (3.5cm) and large retroperitoneal mass (6.5cm). He has a history of left undescended testicle as a child. Grossly, the kidney tumor exhibits solid and cystic cut surface on partial nephrectomy. Immunohistochemical stains show positive PAX8, GATA3 and AMACR expression in tumor cells, and negative immunoreactivity for CK7.

2020-26 / June 29

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A man in his mid 30s presented with a testicular mass. Areas represented by the photomicrograph encompassed several low magnification fields. A minor percentage of seminoma was present, while the majority of the lesion was teratoma. WT1 was expressed by lesional tissue shown.

2020-25 / June 22

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A 60-year old patient underwent a transurethral resection of the prostate due to clinical diagnosis of nodular hyperplasia.

2020-24 / June 15

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A 4 month-old boy with an unremarkable past medical history presented with a 9.0 cm renal mass. The patient was radiographically diagnosed and underwent 5 weeks of pre-surgical chemotherapy.

2020-23 / June 8

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A woman in her 60s with a well circumscribed mass in the renal cortex.

2020-22 / June 1

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A male in his 40s presented with left testicular swelling and pain. On ultrasound, a solid mass was identified in the left testis. Pre-operative AFP and HCG serum levels were not elevated. Serum LDH was mildly elevated preoperatively. The patient underwent a left radical orchiectomy for a presumed testicular tumor. Grossly, no discrete mass was noted in the specimen, but the cut surface of the testis was remarkable for hemorrhage. Given the discrepancy between the clinical impression and gross findings, the orchiectomy specimen was extensively sampled for microscopic examination and the main findings are shown in the accompanying photomicrographs.

2020-21 / May 25

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A 64 year-old-male presented with hematuria and a mass in the fossa navicularis of the anterior urethra. Past history was notable for Grade Group 5 (Gleason score 4+5=9) pT3b pN0 acinar adenocarcinoma of the prostate. His PSA had an interval increase to 0.569 ng/mL. PSA immunohistochemistry on the tumor showed scattered patchy expression.

2020-20 / May 18

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A 53 year old male with pT3b prostate cancer developed gross hematuria 20 months after receiving external beam radiation. A cystoscopy showed friable mucosa, which was thought to be suspicious for bladder cancer.

2020-19 / May 11

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The patient in his 40s presented with a complaint of a right testicular mass. Ultrasound revealed a 2.0 cm cystic mass. Serum tumor markers (HCG, AFP, LDH) were all normal. Positive immunohistochemical stains are shown. Additional stains performed (all negative) included CK5/6, calretinin, and OCT4.

2020-18 / May 4

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A 55-year-old man presented with paratesticular pain and swelling. A hydrocelectomy was performed.

2020-17 / April 27

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An man in his 80s with a history of painless hematuria has a small polypoid lesion within the proximal prostatic urethra.

2020-16/ April 20

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A 65 year old male was found to have a 2.6 cm partially renal mass. A robotic partial nephrectomy was performed. Special stains for microorganisms were negative.

2020-15/ April 13

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A middle-aged man with no prior medical history presents with hematuria. A TURBT was performed.

2020-14 / April 6

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A 29-year-old man presented with symptoms of lithiasis and was found to have a heavily calcified 1.9 cm renal mass, interpreted radiographically as a benign process. IHC was performed for CK7 (diffuse positive), and CA-IX (diffuse positive, picture shown) and CD10 (negative).

2020-13 / March 30

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55 year old male with a 0.5 cm bladder polypoid lesion.

2020-12 / March 23

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Accordion Title71 y/o male with an incidental 4.8 cm renal tumor treated with partial nephrectomy. The tumour is positive for PAX8, CK7 and KSP-Cadherin. CK20, Vimentin, CD10, AMACR and CA IX are negative. SDHB and Fumarate Hydratase are retained. The Ki-67/MIB1 index is low (≤5%).

2020-11 / March 16

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52 year old male presented with chronic left epididymal pain and discomfort. On physical examination, the posterior portion of left epididymis felt “nodular”. The patient had a vasectomy more than 20 years ago. Images are from the epididymectomy specimen.

2020-10 / March 9

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36 year old male with hematuria was found to have a renal mass, enlarged regional lymph nodes and metastatic lesions in the liver. A biopsy of the renal mass was performed.

2020-9 / March 2

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43 year old female with a 1.7cm renal cortical mass found incidentally on imaging.

2020-8 / February 24

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A 72-year old patient underwent a transurethral resection of the prostate due to clinical diagnosis of nodular hyperplasia. He had a previous transurethral resection of the prostate 18 months earlier. Micrographs show one or two areas of interest in the specimen, the largest area measuring 2.5 mm. The lesion was positive for PAX8 (photo), negative for PSA and Ki67 stained less than 5% of the cells.

2020-7 / February 17

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A 58 year old man presented with a cystic 8.0 cm. mass in the testis.

2020-6 / February 10

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80 y/o male with hematuria and a bladder tumor. NKX3.1 and prostein immunostains are shown. Otherwise the tumor is positive for AR, PSMA and PSAP and is negative for GATA3, UroplakinII, CKHMW, p63, CK5/6.

2020-5 / February 3

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A 17-year-old patient with a paratesticular mass.

2020-4 / January 27

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A 39-year old male presented with a painful slowly enlarging left testicle with mass. A left radical orchiectomy was performed.

2020-3 / January 20

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A 31 year-old male was treated with chemotherapy for clinical retroperitoneal metastases a malignant germ cell tumor composed of 90% embryonal carcinoma, 9% yolk sac tumor (YST), and 1% teratoma. Post chemotherapy there was residual retroperitoneal tumor. A retroperitoneal lymph node dissection was performed.

2020-2 / January 13

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A 56 yo man presented with a complaint of hoarseness. Imaging studies revealed multiple nodules in his right lung and an 11 cm mass in his left kidney. Clinically, he was thought to have a kidney cancer with lung metastases. He underwent a radical nephrectomy. PAX8 (image 4) and TTF1 (image 5) immunostains are shown.

2020-1 / January 6

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A 46 y/o male with a testicular mass undergoes orchiectomy. On gross examination a well demarcated 1,5 cm tumor with spongy appearance confined to testis is seen.

2019-45 / December 30

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76 y/o M, presents with hematuria. On cystoscopy, bladder lesion found and biopsied.

2019-44 / December 24

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A 55 year old male had neurogenic bladder secondary to spinal cord injury and paraplegia. The patient performs self-catheterization for urination. He had history of repeated urinary tract infections with cultures showing Klebsiella and E. coli infections. He complained of bleeding during catheterization two months prior to the presentation. A cystoscopy showed diffuse erythema in the dome of the bladder and a nodule in the anterior wall of the bladder. A biopsy of the nodule was performed.

2019-43 / December 16

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A 55-year-old male with paratesticular mass with clinical suspicious of an epididymal tumor. Intra-operative frozen section was requested due to ultrasound finding of hypervascularity. A 3.8 cm tumor was received with grossly multilobular appearance. Cut surface showed multilobular lesion with fibrous septae and myxoid/edematous areas.

2019-42 / December 9

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A 36 year-old male underwent an orchiectomy for a 1.1 cm. testicular mass.

2019-41 / December 2

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10-year-old girl with 15 cm renal mass and multiple pulmonary metastases. She received neoadjuvant chemotherapy according to the SIOP Umbrella Protocol followed by radical nephrectomy. The immunophenotype was as follows: diffusely positive for vimentin, INI1, CD99, focally positive for cyclin D1, PAX2, S100, and negative for EMA, WT1, AE1/AE3, TLE1, ERG, FLI1, CD56, BCL2, PAX8, desmin. FISH analysis was carried out using EWSR1/FLI1 TriCheck Probe, which identified an EWSR1 rearrangement, but the FLI1 was intact.

2019-40 / November 25

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24-year-old male with congenital adrenal hyperplasia and bilateral testicular masses.

2019-39 / November 17

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A 45 year old female presented with abdominal pain during her menstrual cycle. Abdominal imaging showed a right ureteral mass and obstruction. The patient underwent right segmental ureterectomy.

2019-38 / November 10

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70 year old male with a bladder mass. CT with contrast showed a 2 cm left sided well-circumscribed bladder mass in the wall. Robotic partial cystectomy was performed. Pictures: 1-3 H&E’s, 4- CD34, 5- STAT6

2019-37 / November 3

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A 74 year-old female presented with a bladder mass obstructing the left ureteral orifice.

2019-36 / October 28

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72 y/o male with hematuria, bladder lesion found on cystoscopy.

2019-35 / October 21

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A 70 year old man underwent a TURB for a large hyperkeratotic lesion involving the entire bladder. The lesion could not be totally resected with only partial sampling performedA 70 year old man underwent a TURB for a large hyperkeratotic lesion involving the entire bladder. The lesion could not be totally resected with only partial sampling performed.

2019-34 / October 14

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An 82-year-old male with a prior history of rectal adenocarcinoma (treated surgically, followed by adjuvant chemo and radiation therapy) and upper tract urothelial disease (treated with a right sided nephroureterectomy) was recently diagnosed with penile cancer.

2019-33 / September 30

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69-year-old male with an elevated PSA and a cluster of somewhat dilated glands on prostate needle biopsy (images 1-3: low and high magnification images & PIN-4 IHC triple stain); images 4-5 depict a similar cluster in a prostatectomy specimen from a different patient.

2019-32 / September 23

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A 53-year-old woman presented with right upper quadrant fullness, increasing abdominal discomfort and a dull ache on her right flank over three months. Subsequently, she underwent excision of a large retroperitoneal peri-pancreatic solid and cystic mass, measuring 17cm in greatest linear dimension. This neoplasm did not appear to involve the adrenal gland. Histopathologic examination revealed a paraganglioma.

2019-31 / September 16

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A 78-year-old male underwent a transurethral resection of the prostate and representative images are shown. The immunophenotype is as follows: Positive: CK7 & focal, patchy expression of CK20, CKAE1/3 and CK-HMW Negative: NKX3.1, PSA, PSAP, P40, GATA3, synaptophysin and chromogranin Retained: PTEN

2019-30 / September 9

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A 4 year old boy presented with gross hematuria and a solitary bladder mass was identified on a renal/bladder ultrasound. Cystoscopic biopsy confirmed malignancy, and a partial cystectomy was performed. Representative H&E images and an immunostain for INI1 are shown. The tumor was also negative for pan-cytokeratin, EMA, S100, desmin, myogenin, myoD1, and CD34.

2019-29 / September 2

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Representative images of transurethral resections of bladder tumors taken from a 33-year-old male have been depicted.

2019-28 / August 26

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74 year old male presenting with gross hematuria and a bladder mass on cystoscopy.

2019-27 / August 19

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A 30 year old male who immigrated from Africa presents with gross hematuria. Cystoscopy and biopsy are performed.

2019-26 / August 12

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A 55-year-old female was found to have a 5.9 cm solid-cystic renal mass. Representative H&E images and an immunostain for Cathepsin K are shown.

2019-25 / August 5

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26-year-old male presents with a “fibrous plaque” of the penis associated with curvature. The patient undergoes surgery for presumed Peyronie’s disease at which time the surgeon excises the plaque material. The tumor is Keratin-positive. The immunostain shown is INI-1.

2019-24 / July 29

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A 33-year old male with a prior history of a desmoplastic medulloblastoma was found to have a 1 cm left testicular mass on follow up. Representative images of this lesion are shown. The immunophenotype is as follows: Positive: SF1, S100, CD68 and vimentin Negative: calretinin, inhibin, CK AE1/3, CD31, CD34, SMA, melan A, HMB45, CD163

2019-23 / July 22

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65-year-old gentleman presents with elevated PSA. Transrectal biopsies performed.

2019-22 / July 15

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25-year-old white male presents with large renal mass with pulmonary metastases. A nephrectomy was performed. SDH B immunostain is shown.

2019-21 / July 8

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35-year-old female presents with hematuria. She has a history of hypertension. Cystoscopy revealed a 3 cm bladder mass and transurethral resection was performed. The tumor is positive for GATA3 and synaptophysin.

2019-20 / July 1

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A 69 year old male presented with a 9.2 cm well circumscribed renal mass.

2019-19 / June 24

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A 58-year-old male presented with urinary obstruction and elevated PSA of 12 ng/ml. He underwent transurethral resection of the prostate (TURP).

2019-18 / June 17

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A 78 year old man presented with a mass in the left seminal vesicle. A cystoprostatectomy was performed.

2019-17 / June 10

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40 year old male with a 9.5 cm cystic and solid renal mass. All images are from the radical nephrectomy specimen.

2019-16 / June 3

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A 65 year old male with a bladder mass. Transurethral resection is performed.

2019-15 / May 27

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84-year-old male with a history of follicular lymphoma, melanoma, and a 3.6 cm kidney mass, present with inguinal lymphadenopathy. Images are from biopsy of left inguinal lymph node.

2019-14 / May 20

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54 yo male with a testicular mass. By immunohistochemistry, tumor cells are positive for cytokeratin AE1/AE3, desmin (perinuclear dot pattern) and WT1.

2019-13 / May 13

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A 70 year old man underwent a 12 part needle biopsy of the prostate due to elevated serum PSA levels. In one part, an atypical focus at the end of the needle biopsy was noted.

2019-12 / May 6

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A 57 year-old male underwent radical prostatectomy for Grade group 2 prostatic adenocarcinoma diagnosed on biopsy. Upon microscopic examination, a glandular lesion was identified in the left anterior prostate, in addition to a large tumor nodule of Grade group 2 cancer in the right posterior. The following images are representative of the left anterior lesion which showed strong and diffuse staining with PAX2 (shown) and racemase, and negativity for PSA and WT-1.

2019-11 / April 29

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A 67-year-old male with a 2.9 cm organ-confined renal mass.

2019-10 / April 22

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A 65 year old man presented with a 3 mm nodule in the bladder.

2019-9 / April 15

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A 35-year-old male presented with a 2-week history of discomfort and enlargement of the right testis. He was eventually treated with a right orchiectomy which revealed involvement by seminoma. Subsequently, he presented with early retroperitoneal relapse while on surveillance.

2019-8 / April 8

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40-year-old female with a 4.5 cm solid and cystic renal mass. Images are from the radical nephrectomy specimen.

2019-7 / April 1

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A 54 year old man presented with multiple bone metastases and a mass involving the bladder neck. A TUR of the bladder was performed. On outside stains, the tumor was negative for CD138, kappa and lambda light chains, CD56, CD45, CK7, HMWCK, AE1/3, desmin, and GATA3. Stains performed at our institution were positive for NKX3.1, P501S, PSA and negative for GATA3 and Uroplakin II. E-cadherin was lost in the tumor.

2019-6 / March 25

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The cut surface of the kidney reveals a diffusely cystic appearance in an adult (Case 1) and in a separate pediatric patient (Case 2), respectively.

2019-5 / March 18

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A 43-year-old male presented with a painless testicular mass. Representative histopathologic images and results of molecular testing are shown.

2019-4 / March 11

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A 25 year old man was found to have a 5.0 cm. paratesticular mass.

2019-3 / March 4

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A 79 year old male underwent a TURP due to obstruction. The tumor was stained at the outside institution and was diffusely positive for high molecular weight cytokeratin and negative for PSA, PSAP, GATA3, synaptophysin, with a ki67 of 90%.

2019-2 / February 25

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68 year old male with large bladder mass. Transurethral resection is performed.

2019-1 / February 18

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