Radiology and Path all in One

1. Radiology and Path all in One

2. Angiomyolipoma

3. Angiomyolipoma

4. Angiomyolipoma

5. Tuberculosis-Kidney

6. Tuberculosis- Other sites Testis+Epididymis

7. Tuberculosis- Radiology

8. Schistosomiasis

9. ITGCN Comments:Seminiferous tubules with intratubular germ cell neoplasia showing large cells with clear cytoplasm, enlarged vesicular nuclei, and prominent nucleoli. There is no spermatogenesis. The tubular basement membrane is thickened; this was an atrophic undescended testis.   return to Intratubular Germ Cell Neoplasia Comments:Immunoreactivity for Placental-like Alkaline Phosphatase (PLAP) with cytoplasmic membrane staining and some cytoplasmic staining is a quite sensitive and specific test for ITGCN. Generally less than 1% of non-neoplastic spermatocytes show staining with PLAP.   return to Intratubular Germ Cell Neoplasia

10. Seminoma Comments:The cut surface shows a cream-colored, soft, fleshy, multinodular tumor bulging from the surrounding testicular parenchyma. Note a satellite nodule on the lower left.   return to Seminoma Comments:Diffuse sheets of tumor cells with clear cytoplasm separated by fibrous trabeculae containing lymphocytes.   return to Seminoma

11. Mixed Germ Cell Tumour Comments:Mixed germ cell tumors have a variegated gross appearance due to admixture of different germ cell tumor elements. This tumor was composed of embryonal carcinoma and mature teratoma. The pearly white areas seen grossly corresponded to hyaline cartilage.   return to Mixed Germ Cell Tumor Comments:This is a left orchiectomy specimen from a 30 year old male who presented with a 6 month history of painless enlargement of left testicle. Testicular ultrasound revealed a solid mass with increased vascularity suspicious for a neoplasm. It was a mixed germ cell tumor consisting of embryonal carcinoma and yolk sac tumor components.   return to Mixed Germ Cell Tumor

12. Epididymis-Adenomatoid tumour Comments:Adenomatoid tumor is the most common tumor of the epididymis and spermatic cord. It may be asymptomatic or present as a painless scrotal mass in the region of the head of epididymis or the lower pole of the epididymis (as seen here). The cut surface is firm, white-gray and homogenous Comments:The tumor is composed of cuboidal or flattened epithelioid cells arranged in round, oval, or slit-like tubules, cords, and nests in a fibrous stroma. The borders may be infiltrative

13. Klinefelter’s Syndrome Comments:This testicular biopsy is from an adult male with history of normal semen volume and severe oligospermia. He had small firm testes and body habitus suggestive of Klinefelter’s syndrome. The biopsy shows small hyalinized seminiferous tubules and pseudo-adenomatous clusters of leydig cells

14. Prostate - Normal Comments:In this benign gland, the luminal contour shows tufts and papillary infoldings. The tall secretory epithelial cells have pale clear cytoplasm and uniform round or oval nuclei. Prominent nucleoli are not seen. Many basal cells can be identified Comments:Basal cells are present in a continuous layer in most benign glands. The antibodies to high molecular weight cytokeratin 34bE12 stain basal cells but not secretory or stromal cells in the prostate. Besides cancer, the basal cell layer may be disrupted in atrophy, inflammation, atypical adenomatous hyperplasia (adenosis), and high-grade PIN.

15. Prostate - HGPIN Comments:High-grade PIN consists of intermediate to large size preexisting glands with proliferative changes resulting in hyperchromatic appearance. Note the small foci of cancer adjacent to PIN on the upper left and lower right.  Comments:The benign glands on upper right have continuous basal cell layer; high-grade PIN glands in the middle have fragmented basal cell layer; malignant glands on the left completely lack basal cell layer

16. Prostate – Ca Prostate GLEASON PATTERN 3 Comments:Gleason grade 3 is the most commonly seen pattern. Even at low magnification, one can easily appreciate the variation in size, shape, and spacing of glands. Many small glands have occluded or abortive lumens. There is no evidence of glandular fusion.  GLEASON PATTERN 2 Comments:The focus of cancer is not circumscribed. The glands are round to oval and uniformly placed. There are no sharply-angulated or distorted glands

17. Prostate – Ca Prostate GLEASON PATTERN 4 Comments:This biopsy is completely replaced by Gleason grade 4 adenocarcinoma. The glands are fused and there is no intervening stroma. Glandular fusion is a hallmark of Gleason grade 4.  GLEASON PATTERN 5 Comments:Tumor cells are arranged in solid sheets with no attempts at gland formation in this example of Gleason grade 5  

18. Bladder – Von Brunn’s Nests Comments:Florid hyperplasia of von Brunn nests may mimic nested variant of urothelial carcinoma. In von Brunn nest hyperplasia, the nests are large with regular spacing as seen here. In properly oriented biopsies, the nests can be seen extending to the same horizontal level at the base of the proliferation Comments:Brunn’s Nests: Brunn’s nests consist of well-circumscribed clusters of urothelial cells that may or may not be attached to the overlying urothelium. Sometimes they are located deep within lamina propria

19. Bladder – CIS Comments:There is full thickness replacement of normal urothelium by highly atypical cells. However, full thickness change is not necessary for the diagnosis of urothelial CIS, unlike in some other locations Comments:Occasionally the cells may be small with high N:C ratios. The nuclei are irregular, enlarged and hyperchromatic

20. Bladder – TCC Comments:This radical cysectomy specimen shows multifocal papillary tumors with delicate fronds. Microscopically, it was grade 2 papillary urothelial carcinoma (WHO Classification, 1973) with muscularis propria invasion Comments:Another radical cystectomy specimen showing multifocal papillary urothelial carcinoma

21. Bladder – TCC Comments:This high-grade tumor shows little or no resemblance to urothelial cells. The exact histogenesis of high-grade urothelial tumors may be difficult to ascertain in metastatic sites. Clinical information may be of tremendous value in such cases Comments:As compared to Grade 1 tumors, this example of Grade 2 tumor shows slightly more architectural and cytologic disorganization while retaining features such as nuclear polarity. Umbrella cells can still be seen

22. Bladder – TCC

23. Bladder – Adenocarcinoma Comments:This gross photograph illustrates mucinous adenocarcinoma of the urinary bladder. The tumor has a glistening surface

24. Penis CONDYLOMATA ACCUMINATA Comments:This circumcision specimen shows a warty cauliflower-like lesion with papillary or polypoid fronds in a foreskin Comments:A low power scan of the glass slide shows warty cauliflower-like lesion with numerous papillary or polypoid fronds. The usual location for genital condylomas is corona of glans penis or penile meatus

25. Penis  Psoriasis involving the entire penis and scrotum. 

26. Penis – Lichen Planus Figure 13-11 Various presentations of lichen planus on the male genitalia. A and B, Individual and grouped purple papules on the penile shaft; some oriented in a linear pattern. C, White reticular pattern sometimes seen in lichen planus. D, Annular (ringlike) arrangement with a shiny surface.  (A from Korting GW: Practical Dermatology of the Genital Region. Philadelphia, WB Saunders, 1981, p 29; B to D from du Vivier A: Atlas of Clinical Dermatology. London, Churchill Livingstone, 2002, p 100.) The natural history of LP is benign, and the spontaneous resolution of cutaneous lesions has been observed in up to two thirds of cases after 1 year (Shiohara and Kano, 2003), although the oral form may persist significantly longer (Mignogna et al, 2000). Although bothersome pruritus is common with LP, asymptomatic lesions on the genitalia do not require treatment. The primary modality of treatment for symptomatic cutaneous LP is topical corticosteroids, with the caveats mentioned previously about their use on genital skin. For severe cases, systemic corticosteroids (15 to 20 mg/day; 2- to 6-week course [Boyd and Neldner, 1991]) have been shown to shorten the time course to clearance of LP lesions from 29 weeks to 18 weeks (Cribier et al, 1998). Other systemic therapies for severe LP include cyclosporine, griseofulvin, metronidazole, and acitretin (Ho et al, 1990; Boyd and Neldner, 1991; Cribier et al, 1998; Buyuk and Kavala, 2000), although randomized trials demonstrating efficacy are generally lacking.

27. Penis – BXO Figure 13-12A to C, Lichen sclerosis et atrophicus (balanitis xerotica obliterans) of the penis. Note the erythematous and white plaques involving the penile shaft, preputial skin, and glans Despite the similarities in name, LS shares little in common with LP and LN other than pruritus and a predilection for the genital region. Another critical distinction is that LS has been associated with squamous cell carcinoma of the penis, particularly those variants not associated with human papillomavirus, and may represent a premalignant condition (Velazquez and Cubilla, 2003). LS has specific histologic features, including basal cell vacuolation, epidermal atrophy, dermal edema, collagen homogenization and focal perivascular infiltrate of the papillary dermis, and plugging of the ostia of follicular and eccrine structures (Margolis, 2002). Biopsy is worthwhile both to confirm the diagnosis and exclude malignant change (Powell and Wojnarowska, 1999). From a management standpoint, long-term follow-up of patients with LS is important owing to the association with squamous cell carcinoma. The application of potent topical corticosteroids (e.g., clobetasol propionate 0.05%) for long courses (3 months) is well established as a treatment for LS in women and may both improve symptoms and reverse the disease process (Dalziel et al, 1991). This regimen is contrary to the usual policy of avoiding long courses of corticosteroid application to genital skin. The efficacy of similar approaches has not been confirmed in adult men, although benefits have been demonstrated in the pediatric age group (Kiss et al, 2001).

28. Penis – Fixed Drug Eruption Figure 13-13A to C, Fixed drug eruptions involving the penis.               A fixed drug eruption occurs in response to oral medications, usually 1 to 2 weeks after the first exposure, and commonly involves the lips, face, hands, feet, and genitalia (Fig. 13-13). After subsequent reexposure to the drug, the reaction presents in the same location, usually within 24 hours (hence the term fixed). The most common medications causing this reaction are sulfonamides, nonsteroidal anti-inflammatory agents, barbiturates, tetracyclines, carbamazepine, phenolphthalein, salicylates, oral contraceptives, and salicylates ). When present on the penile shaft or glans, these lesions are usually solitary inflammatory plaques that may be erosive and painful (Margolis, 2002). On the genitalia, the differential diagnosis includes herpes simplex infection or an insect bite. Removing the offending agent usually results in resolution of the lesion, although a postinflammatory brown pigmentation may remain

29. Penis – STI’s Figure 13-20 Genital lesions associated with sexually transmitted diseases. A, Herpes simplex virus. B, Molluscum contagiosum. C, Syphilitic chancre. D, Granuloma inguinale. E, Chancroid. F, Lymphogranuloma venereum. G, Condylomata acuminata. 

30. Medullary Sponge Kidney

31. Kidney - XGP Comments:This gross photograph shows extensive destruction of renal parenchyma due to long-standing suppurative inflammation. The depressions seen in the lower half of the specimen were caused by a staghorn calculus which has been removed Comments:This 25 y/o female presented with a renal mass and underwent radical nephrectomy to rule out carcinoma. The specimen revealed xanthogranulomatous pyelonephritis with a large perinephric abscess. There is a 6.0 cm cavitary lesion in the center of the kidney lined by shaggy hemorrhagic surface. It communicates with the perinephric abscess on the central lateral aspect of the specimen

32. Kidney - Oncocytoma Well-circumscribed, mahogany brown, firm mass with a central scar Comments:The tumor cells have abundant eosinophilic cytoplasm and round uniform vesicular nuclei with punctate nucleoli. Close packing of cells nests has created a near-solid appearance

33. Kidney - RCC Comments:This partial nephrectomy specimen shows the typical yellow-orange gross appearance commonly seen in renal cell carcinoma. However, on gross features alone, its distinction from angiomyolipoma and xanthogranulomatous pyelonephritis may be impossible Comments:This large renal cell carcinoma shows cyst formation and foci of hemorrhage and necrosis

34. Kidney – Chromophobe RCC Comments:Grossly, chromophobe renal cell carcinoma is usually a well-circumscribed solitary mass in the kidney as seen in this case. The cut surface may be yellow, beige, or brown with close resemblance to oncocytoma. A central scar is seen in this specimen Gross: Large, well-encapsulated tumor that can breach the renal capsule and perinephric fat. 2.    Histo: CRC has distinct “vegetable” cells (central round nucleus with a halo and cytoplasm that’s condensed at the periphery) with distinct cell membranes. 3.    How: Tumors arise from the collecting duct intercalated cells. Associated with multiple chromosome losses and extreme hypodiploidy. 4.    Clinical: Excellent prognosis compared to the other two (CCC and PCC). Comments:Chromophobe renal cell carcinoma comprises about 5% of epithelial renal neoplasms. Microscopically, it is composed of variably-sized cells with abundant pale reticular or flocculent cytoplasm. The nuclei are moderately sized and hyperchromatic. Bi- and multinucleated cells are not uncommon. Chromophobe RCC appears to have a better 5-yr disease-specific and progression-free survival than conventional (clear cell) RCC or papillary RCC.

35. Kidney – Sarcomatoid RCC Comments:The yellow-white nodules had the typical morphology of conventional renal cell carcinoma, clear cell type. The solid, creamy-white, firm-appearing areas in between the nodules showed sarcomatoid change Comments:Approximately 5% of renal cell carcinoma cases show sarcomatoid change. The sarcomatoid areas generally show features of MFH, fibrosarcoma, or undifferentiated spindle cell sarcoma

36. Kidney – Sarcomatoid RCC Comments:The yellow-white nodules had the typical morphology of conventional renal cell carcinoma, clear cell type. The solid, creamy-white, firm-appearing areas in between the nodules showed sarcomatoid change Comments:Approximately 5% of renal cell carcinoma cases show sarcomatoid change. The sarcomatoid areas generally show features of MFH, fibrosarcoma, or undifferentiated spindle cell sarcoma