cows-2019 – GUPS : Genitourinary Pathology Society

Previous Cases of the week 2019

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%.