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Surgical Pathology Unknown Conference SPUC : 01/04/13

Surgical Pathology Unknown Conference SPUC : 01/04/13. CASE 1 75-year-old female with recent weight loss and 1.1 cm cystic renal mass in right kidney and 5.5 cm solid renal mass in left kidney. CASE 1B. CASE 1B – 10x. CASE 1B – 20x. CASE 1B – 40x. CASE 1B – 10x. CASE 1B – PAS - 40x.

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Surgical Pathology Unknown Conference SPUC : 01/04/13

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  1. Surgical Pathology Unknown Conference SPUC: 01/04/13

  2. CASE 1 75-year-old female with recent weight loss and 1.1 cm cystic renal mass in right kidney and 5.5 cm solid renal mass in left kidney.

  3. CASE 1B

  4. CASE 1B – 10x

  5. CASE 1B – 20x

  6. CASE 1B – 40x

  7. CASE 1B – 10x

  8. CASE 1B – PAS - 40x

  9. CASE 1B – PAS - 60x

  10. CASE 1B – panCK - 40x

  11. CASE 1B – CD68 - 40x

  12. CASE 1 – DIAGNOSIS MALAKOPLAKIA

  13. CASE 1 – DIAGNOSIS MALAKOPLAKIA: Malakoplakia is a rare chronic inflammatory condition which makes its presence known as a plaque or ulceration that usually affects the genitourinary tract. It may also be associated with other bodily organs. It was initially described in the early 1900s as soft yellowish plaques found on the mucosa of the urinary bladder. Microscopically it is characterized by the presence of foamy histiocytes with basophilic inclusions called Michaelis-Gutmann bodies: intracellular deposition of iron and calcium. It usually involves gram negative bacteria (>70% E. coli).

  14. CASE 1 – DIAGNOSIS MALAKOPLAKIA: Malakoplakia is believed to result from the inadequate killing of bacteria by macrophages or monocytes that exhibit defective phagolysosome activity. Partially digested bacteria accumulate in monocytes or macrophages and lead to the deposition of calcium and iron on residual bacterial glycolipid. The presence of the resulting basophilic inclusion structure, the Michaelis-Gutmann body, is considered pathognomonic for malakoplakia. Studies have suggested that a decreased intracellular cyclic guanosine monophosphate (cGMP) level may interfere with adequate microtubular function and lysosomal activity, leading to an incomplete elimination of bacteria from macrophages and monocytes.

  15. CASE 2 59-year-old male with renal mass of the left kidney with possible vein thrombosis.

  16. CASE 2

  17. CASE 2 – 20x

  18. CASE 2 – 20x

  19. CASE 2 – 40x

  20. CASE 2 – 40x

  21. CASE 2 – DIAGNOSIS • RENAL CELL CARCINOMA, CLEAR CELL TYPE, FUHRMAN NUCLEAR GRADE 4/ 4, (12.8 CM), WITH >80% SARCOMATOID DIFFERENTIATION • INVASIVE INTO PERIRENAL AND SINUSOIDAL ADIPOSE TISSUE (pT3b) • TUMOR THROMBUS WITH INVASION OF RENAL VEIN WALL • POSITIVE VEIN SURGICAL MARGIN

  22. CASE 3 80 year-old male with history of prostatic adenocarcinoma in 1998 and high grade invasive urinary bladder cancer in 2009. Now with enlarged (5 cm) left inguinal lymph node.

  23. CASE 3 – 20x

  24. CASE 3 – 40x

  25. CASE 3 – 40x

  26. CASE 3

  27. CASE 3 – CK7 - 40x

  28. CASE 3 – Ki67 - 40x

  29. CASE 3 – podoplanin - 40x

  30. CASE 3 – b-hCG 40x

  31. CASE 3 – b-hCG 40x

  32. CASE 3

  33. CASE 3

  34. CASE 3

  35. CASE 3 – DIAGNOSIS SEMINOMATOUS GERM CELL TUMOR Recent laboratory findings of elevated serum beta-HCG (63 mIU/mL) and normal level of serum alpha-FP are noted. The serologic findings together with the histological appearance and tumor marker profile of this tumor are most consistent with a seminomatous germ cell tumor. No evidence of urothelial, mesothelial or prostatic tumor is observed.

  36. CASE 4 46-year-old man with large retroperitoneal mass, ultimately found to be a germ cell tumor.  Had his right testicle removed.  He received chemotherapy.

  37. CASE 4 – 20x

  38. CASE 4 – CEA – 20x

  39. CASE 4 – CDx – 20x

  40. CASE 4 – Tumor markers CDX-2: Positive CK20: Positive CEA: Positive NSE: Positive CD56: Negative CD30: Negative

  41. CASE 4 – DIAGNOSIS CONSISTENT WITH METASTATIC COLONIC ADENOCARCINOMA

  42. CASE 5 88-year-old female with history of left renal mass and incidental cyst found by CT scan.

  43. CASE 5

  44. CASE 5

  45. CASE 5 – DIAGNOSIS • Renal cell carcinoma, clear cell type; Fuhrman nuclear grade 2/ 4, (6.9 cm) • Tumor thrombus is present in renal vein and grossly invading into its wall and the renal sinus (pT3a) • Surgical margins with no evidence of malignancy

  46. CASE 6 60-year-old male with history of metastatic squamous cell carcinoma. Now with bilateral renal masses (right, 14.8 cm; left, 0.9 cm)

  47. CASE 6

  48. CASE 6 – 10x

  49. CASE 6 – 40x

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