Unknown Slide Case 2006

WISCONSIN SOCIETY OF PATHOLOGISTS
2006 ANNUAL MEETING

GENITOURINARY PATHOLOGY

Saturday, November 18, 2006

Richard J. Cote, M.D., FRCPath
Professor of Pathology and Urology
Director, Genitourinary Cancer Program
Co-Director, USC Biomedical Nanoscience Initiative
USC Keck School of Medicine/Norris Comprehensive Cancer Center
Los Angeles, California, 90033 USA

Case Histories

CASE 1:
Left adrenal gland showing 5 cm calcified lesion,
entirely excised

CASE 2:
2 cm lesion lower pole right kidney, well-circumscribed
by radiologic assessment

Partial nephrectomy with intraoperative margin
assessment obtained

CASE 3:
Papillary Tumor of the Bladder:
Comparison of Grading Systems

Histologic Features of Papillary Urothelial Neoplasms

CASE 4:
Micropapillary Transitional Cell Carcinoma

CASE 5:
Polypoid Cystitis

CASE 6:
Prostate carcinoma diagnosed by biopsy and treated
by radiation therapy

Patient now presents with rising PSA, presumed diagnosis
of recurrent prostate carcinoma

Radical prostatectomy performed

CASE 7:
Prostate Needle Biopsy:
Carcinoma versus Atrophy

CASE 8:
Prostate Glands in Seminal Vesicle

CASE 9:
Gleason Grading Scheme

CASE HISTORY 1

Left adrenal gland showing 5 cm calcified lesion,
entirely excised

ch1-2
Capsule, no lining

Calcification of capsule

Ossification

Hemangiomatous area

cyst
Cyst contents

DIAGNOSIS: Adrenal pseudocyst

Diagnosis: Adrenal pseudocyst
Relatively uncommon but well described

Usually discovered incidentally, occasionally with abdominal pain or mass, rarely with hemorrhagic shock
Radiologic studies often demonstrate calcified mass
- Characteristic “eggshell” calcifications
Usually large, median size 10 cm

Adrenal pseudocyst

Gross examination shows cystic lesion containing clear, brown, or bloody fluid
Often filled with necrotic material or thrombus

Microscopic examination:

Thick fibrous capsule that lacks an epithelial cell lining
Can show hemangiomatous areas
Cyst wall often calcified (“eggshell” appearance radiographically)
Cyst contents often show necrosis or thrombotic material
Important to rule-out necrosis due to neoplasm or infection

CASE HISTORY 2

2 cm lesion lower pole right kidney, well-circumscribed
by radiologic assessment

Partial nephrectomy with intraoperative margin
assessment obtained

Oncocytic lesion, positive margin

Oncocytoma

Two oncocytomas

Multiple incipient oncocytomas

Papillary adenoma

Oncocytoma/papillary adenoma

Oncytoma/papillary adenoma

CK7: papillary adenoma +, oncocytoma -

Angiomyolipoma

Angiomyolipoma, HMB45 +

Angiomyolipoma; HMB45 +

DIAGNOSIS: Multiple oncocytomas, papillary adenomas, and angiomyolipomas

Consistent with an early form of tuberous sclerosis
CK7 positive in papillary adenomas, negative to weak in oncocytomas
CK7 negativity indicate against diagnosis of chromophobe tumor for oncocystic lesion
Angiomyolipoma HMB-45 positive
Seen in consultation by Dr. John Eble “this constellation of findings have not been previously described”
No further surgery indicated

CASE HISTORY 3

Papillary Tumor of the Bladder: Comparison of Grading Systems

(Click for enlarged view)

Histologic Features of Papillary Urothelial Neoplasms

(Click for enlarged view)

Papilloma OS294

Papilloma

Papilary G1

Papillary G1

CASE HISTORY 4

Micropapillary Transitional Cell Carcinoma

Micropapillary S01-2086

Micropapillary

Micropapillary S1327

Micropapillary

Micropapillar

Micropapillary

Micropapillary Transitional Cell Carcinoma

Recently described variant
Bland histologic features
Invasive component has well formed papillary clusters with retraction artifact
Mimics vascular invasion
Micropapillary features can be seen in non-invasive component
Micropapillary features can be seen in metastases
Deceptively low-grade appearance
Relatively low nuclear cytoplasmic ratio
Nuclei show minimal to moderate pleomorphism
Tumor is highly aggressive
Can be seen in pure form or as component of urothelial carcinoma

CASE HISTORY 5

Polypoid Cystitis

Polypoid Cysytitis

Polypoid Cystitis

Variant of simple cystitis
Frequent complication of:
- Indwelling catheter
- Radiation Therapy
- Inflammatory insult
Can mimic papillary transitional cell carcinoma grossly and cystoscopically

CASE HISTORY 6

Prostate carcinoma diagnosed by biopsy and treated by radiation therapy
Patient now presents with rising PSA, presumed diagnosis of recurrent prostate carcinoma
Radical prostatectomy performed

Prostate s/p radiation Rx, rising PSA

Prostate s/p radiation Rx

PSA

K903

PSA

H&E of PSA + glands

Polypoid Cystitis

Variant of simple cystitis
Frequent complication of:
- Indwelling catheter
- Radiation Therapy
- Inflammatory insult
Can mimic papillary transitional cell carcinoma grossly and cystoscopically

CASE HISTORY 7

Prostate Needle Biopsy:
Carcinoma versus Atrophy

Cancer vs atrophy

2 cell layers

No nucleoli

K903 normal prostate

K903 negative

Diagnosis: Prostatic adenocarcinoma

K903 immunohistochemistry useful in distinguishing carcinoma from atrophy
Other Markers

CASE HISTORY 8

Prostate Glands in Seminal Vesicle

Prostate glands in SV, S01-3186

Prostate glands in SV

PSA

K903

Prostate glands in SV, S99-682

Prostate glands with myoepithelium

Prostate Glands in Seminal Vesicle

A rare but known occurrence (Salem, Gibbs, Highshaw, Reuter, Cote: Urology 1996; 48: 490-493)
Virtually always seen in radical prostatectomy specimens from treatment of prostate carcinoma
Need to distinguish from cancer involving the seminal vesicle