cows-2021 – GUPS : Genitourinary Pathology Society

Previous Cases of the week 2021

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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