2017 Annual Meeting

Evening Specialty Conference
Genitourinary Pathology

Difficult Diagnosis in Genitourinary Pathology

March 5 2017, 7:30pm to 9:30pm

Moderator:
Cristina Magi-Galluzzi, MD, PhD
Panelists:
Priya Rao, MD - Sean Williamson, MD - Maria Picken, MD - Rajal Shah, MD

Pre-Meeting Materials

Case 1

Faculty:
Priya Rao, MD

Clinical History:

28 year old female presented with multiple renal masses. A 3.5 cm heterogenously enhancing mass was identified in the upper pole. There were also additional lesions within the kidney that were suggestive of lipid-poor angiomyolipoma by MRI.

Pertinent Laboratory Data:

Diffuse sclerotic lesions within the pelvis and lumbar spine as well as a family history of renal tumors

Morphological Findings (click to enlarge):

Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Figure 6 CK7 2X
Figure 7 CK20 4x
Figure 8 CD117 4x
Figure 9 PAX 8 2x

Case 2

Faculty:
Sean Williamson, MD

Clinical History:

A 34 year-old man presented with multifocal lymphadenopathy including retroperitoneal adenopathy. He underwent excisional biopsy of a supraclavicular lymph node, followed by orchiectomy and resection of retroperitoneal and liver masses.

Morphological Findings (click to enlarge):

Figure 1 Excisional supraclavicular lymph node biopsy
Figure 2 Excisional supraclavicular lymph node biopsy
Figure 3 Orchiectomy specimen
Figure 4 Orchiectomy specimen
Figure 5 Orchiectomy specimen
Figure 6 Orchiectomy specimen
Figure 7 Retroperitoneal mass
Figure 8 Retroperitoneal mass
Figure 9 Liver masses
Figure 10Liver masses

Case 3

Faculty:
Maria Picken, MD

Clinical History:

A 27 years old, air conditioning technician, presented with intermittent gross painless hematuria. He presented to the ED where a CT A/P wo contrast demonstrated a low density 4 cm right renal mass with extension into the IVC. Bone scan was negative for osseous metastases. He subsequently underwent a right radical nephrectomy, including partial adrenalectomy, inferior vena caval tumor thrombectomy (infrahepatic) and extended retroperitoneal lymphadenectomy. PMH: herniated disk (L-S spine) with radiculopathy. SH: current smoker, 6 pack year smoking history, occasional EtOH, single, no children. Family history negative for genitourinary malignancies.

Morphological Findings (click to enlarge):

Figure 1 Axial CT
Figure 2 H&E - 60x
Figure 3 H&E - 60x
Figure 4 H&E - 60x
Figure 5 H&E - 125x
Figure 6 H&E - 250x

Case 4

Faculty:
Rajal Shah, MD

Clinical History:

A 58 year old African American man presented with an elevated and rising serum PSA for 2 years. His baseline PSA was 4.5 ng/ml. He had past history of having undergone a prostate biopsy with the diagnosis of HGPIN. His latest PSA measurement was 8.5 ng/ml, which was confirmed by a repeat examination. The patient underwent repeat biopsy. The pathology represented in submitted images is from the repeat sextant biopsy and involved two biopsy sites.

Morphological Findings (click to enlarge):

Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Figure 6
Figure 7PIN4-ERG
Figure 8PIN4-ERG

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