Cases of the Week 2022

Middle-aged male with large renal mass, undergoes nephrectomy. Representative H&E sections of the renal mass shown here along with a single paired immunohistochemical assay. : -2022-40/October 17

2022-40/October 17

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A female in her 60s with an incidentally found kidney tumor. Partial nephrectomy was performed. :- 2022-39/October 10

2022-39/October 10

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A woman in her early 70s was incidentally found to have a 4.5 cm right upper pole renal mass on imaging (Figure 1A). She underwent a right partial nephrectomy. :- 2022-38/October 03

2022-38/October 03

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A 7-week-old previously healthy male was found to have a right inguinal hernia and small bilateral hydroceles. During surgery for hernia repair, a 1.5 cm red, jelly-like mass was identified on the ventral aspect of the spermatic cord. The mass was moderately firm and was scattered with punctate yellow deposits, suggestive of calcifications. The mass was dissected from the cord and sent for histopathologic evaluation. :- 2022-37/September 26

2022-37/September 26

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A man in his 30s presents with a left testicular 2.3 cm cystic mass with marked heterogeneity, concerning for a malignant neoplasm. The patient had a left testicular surgery performed in childhood with unclear indication. Serological studies include: LDH 140, AFP 5.3, and beta-HCG < 3. :- 2022-36/September 19

2022-36/September 19

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A 52-year-old male patient presented with repeated gross hematuria and left-sided abdominal pain. Imaging studies revealed a 2.9 x 1.8 cm polypoid mass, within the calyces of the upper pole of the left kidney. :- 2022-35/September 12

2022-35/September 12

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A 69-year-old male with macroscopic hematuria and low back pain was admitted to the Department of Urology. Two years earlier, the inferior lobe of his left lung was removed because of pulmonary adenocarcinoma. After that, the patient received chemo- and radiotherapy and was tumor-free. A contrast-enhanced abdominal CT was recently performed that revealed a 13-cm-large tumor in the left kidney. A radical nephrectomy was performed. :- 2022-34/September 05

2022-34/September 05

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A 75-year-old man with a right renal lesion measuring 3.2 cm in greatest dimension. A partial nephrectomy is performed. :- 2022-33/August 29

2022-33/August 29

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A male patient in his 70s presented with macroscopic haematuria and underwent transurethral resection of a bladder tumour. He had a history of hypercholesterolaemia and metastatic prostatic carcinoma on androgen deprivation therapy. :- 2022-32/August 15

2022-32/August 15

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A woman in her 80s underwent nephrectomy along resection of multiple retroperitoneal nodules. One small nodule (1.5 cm) showed a firm and fascicular cut surface (see figures 4 and 5). :- 2022-31/August 08

2022-31/August 08

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Bilateral orchiectomy was performed in an elderly male with prostatic adenocarcinoma with bone metastasis. (First 3 images are from the left testis, whereas the last 2 images are from the right testis). :- 2022-30/August 01

2022-30/August 01

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A young male in his 20s with a known cancer syndrome presented with bilateral epididymal masses :- 2022-29/July 25

2022-29/July 25

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A man in his 60s with a history of diabetes and benign prostatic hyperplasia presented with 6 weeks of fatigue and 3 days of suprapubic tenderness. Ultrasound demonstrated moderate hydronephrosis of the right kidney and urinary retention. He returned 1 week later with lethargy, hyperglycemia (blood glucose 850), and continued dysuria. Urine and blood culture were positive for Escherichia coli. On imaging, extensive gas was noted in and around the kidneys bilaterally. The patient developed septic shock, and bilateral radical nephrectomy was performed. :- 2022-28/July 18

2022-28/July 18

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Male in his 70s presents without prior malignancy history presents with symptoms of benign prostatic hyperplasia, transurethral resection is performed :- 2022-27/July 11

2022-27/July 11

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A woman in her early 60s underwent a radical nephrectomy due to a 9.0cm tumor with multi-cystic central component and solid nodular appearance at periphery at imaging studies. Thoracic imaging showed multiple small cysts in the lung suggestive of lymphangioleiomyomatosis. The gross picture shows the 9.0 cm with both multicystic appearance in central kidney and solid configuration in upper lobe. Venous invasion in renal sinus (upper third). The lower lobe shows smaller white nodules –the largest measuring 2 cm. Further sectioning showed multiple white spots within renal parenchyma. Some of them are illustrated in figure 2. Figures 3 to 5 illustrate the large tumor. :- 2022-26/July 04

2022-26/July 04

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A woman in her late 50s underwent wide resection of vulva and inguinal skin due to massive verruciform lesion. She had crusted / keratotic plaques with appearance of follicular keratosis in the back, neck, face, and extremities for 27years. :- 2022-25/June 27

2022-25/June 27

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Middle-aged man with no prior history of malignancy presents with hematuria. Cystoscopy showed blue light positive bladder lesion, biopsied :- 2022-24/June 20

2022-24/June 20

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Man in his 30s, non-smoker, initially presented with hematuria, dysuria, and constipation was diagnosed with urothelial carcinoma of bladder on transurethral resection of bladder tumor (TURBT) at an outside hospital. Upon transferring care, patient underwent a subsequent radiology work up which revealed a large vascular mass involving prostate and pushing against bladder base. He underwent systematic prostate needle biopsies. The TURBT from outside hospital was also obtained and reviewed. :- 2022-23/June 13

2022-23/June 13

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The patient is a female in her 60s who presents with an incidentally detected kidney mass. Computed tomography shows an enhancing exophytic, solid right kidney mass of the lower pole. The patient elects to undergo a laparoscopic partial nephrectomy of the mass. The specimen measures 3.0 x 2.0 x 1.2 cm and consists of a well-defined, partially cauterized, enucleated, and encapsulated lesion. The cut surface shows a well-defined, glistening, tan-red-brown, and rubbery to spongy mass with no obvious necrosis(Figure 1).The lesion abuts both the parenchymal margin and capsular surface, without discrete involvement of either. :- 2022-22/June 06

2022-22/June 06

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A woman in her 60s with end-stage renal disease (ESRD) receiving hemodialysis (HD) was evaluated for right lower quadrant pain. Computed tomography (CT) demonstrated a 3.9 cm complex renal cyst, enlarged from 2.1 cm on previous imaging. There was concern for malignancy and she subsequently underwent left radical nephrectomy. The specimen was bisected to reveal multiple masses in the upper and lower poles. These masses demonstrated variegated, orange-yellow to tan-red cut surfaces with well-delineated borders. The remaining parenchyma demonstrated multiple cysts measuring 4.5 cm in greatest dimension. (Microscopic images are from the largest mass, showing similar features with the other masses) :- 2022-21/May 30

2022-21/May 30

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A teenager noticed a nodule in the dorsal side of the penis two years before this presentation. The nodule was surveilled clinically. In this period, no skin lesions were noted. In the last months, the lesion rapidly grew causing ulceration in dorsal skin and invading corpora cavernosa and corpus spongiosum (as evaluated by imaging studies) :- 2022-20/May 23

2022-20/May 23

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Male in his 60s with 2.7cm renal mass, confined to kidney (pT1a). Partial nephrectomy is performed. :- 2022-19/May 16

2022-19/May 16

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A male patient in his 80s with a 1.5 cm polypoid and ulcerated lesion in scrotal skin. :- 2022-18/May 2

2022-18/May 2

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A man in his early 50s underwent atotal nephrectomy due to a 4.5cm solid tumor. :- 2022-17/April 25

2022-17/April 25

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A male in his 20s, presented with a rapidly enlarging painless right testicular mass. On scrotal ultrasound, there was a 6.8 cm well-circumscribed mass compressing the adjacent testicle. ALP was minimally elevated, while LDH and bHCG were within normal limits :- 2022-16/April 18

2022-16/April 18

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A male in his 60s with history of prostate cancer status post radiation treatment. Transurethral resection of the prostate is performed. :- 2022-15/April 11

2022-15/April 11

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A male in his 40s with the incidental finding of a right renal mass on CT angiography of the abdomen during cardiac surgery work up. He underwent right open partial nephrectomy which showed a 2.2 cm, well-circumscribed, solid, tan-white to yellow tumor. :- 2022-14/April 4

2022-14/April 4

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This is a prostatectomy specimen from a patient in his early 80s (GG5, pT3b; with 10% involvement of the gland). :- 2022-13/March 28

2022-13/March 28

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A male patient in his 70s underwent transurethral resection of the prostate. :- 2022-12/March 21

2022-12/March 21

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60-year-old-female was found to have an incidental left renal and adrenal mass on imaging :- 2022-11/March 14

2022-11/March 14

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A man in his early 40s underwent partial orchiectomy due to a 2.2 cm nodule. Serum tumor markers were within normal limits. :- 2022-10/March 7

2022-10/March 7

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A female in her 60s presented with a 2.4 cm solid and hypovascular left renal mass. She underwent diagnostic biopsy. :- 2022-09/February 28

2022-09/February 28

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Male in his 20s underwent left orchiectomy due to cystic tumor measuring 1.8 cm. Microscopic examination revealed epidermoid cyst. Additionally an incidental 2 mm nodule was found in the rete testis. :- 2022-08/February 22

2022-08/February 22

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During follow-up for urothelial carcinoma of the upper urinary tract, a man, aged 79 years, underwent a cystoscopy and incidentally discovered an exophytic blueish area on the bladder dome, covered by flat and smooth urothelium. The urologist performed an en-bloc resection of the lesion. :- 2022-07/February 14

2022-07/February 14

COW-2022-7

A 76-year-old man with an incidentally renal tumor in the lower pole of the right side of a horseshoe kidney was submitted to a partial nephrectomy. :- 2022-06/February 7

2022-06/February 7

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A man in his mid-50s presented with dysuria and gross hematuria. Imaging revealed a 14.9 x 10.0 cm mass essentially replacing prostate and seminal vesicles, and invading the urinary bladder. After biopsy confirmation of malignancy, a cystoprostatectomy was performed to completely remove the tumor. On pathologic gross examination, the tumor had a fleshy, tan-white cut surface with central necrosis. :- 2022-05/January 31

2022-05/January 31

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A patient in his early 60s underwent prostatectomy, which showed a Grade Group 2 (Gleason 3+4=7) tumor, stage pT3a. The following images show focal areas of the tumor. :- 2022-04/January 24

2022-04/January 24

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A male patient in his 40s with 19 cm multiloculated cystic mass in his right kidney. :- 2022-03/January 17

2022-03/January 17

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A man in his 30’s presented with 3 days of abdominal pain, nausea, and vomiting. CT imaging revealed a 14 cm ill-defined right retroperitoneal mass, a 2 cm left pulmonary nodule, and a 10 cm right testicular mass. Serum alpha-fetoprotein (AFP) was elevated, and beta-HCG and LDH were normal. He underwent biopsy of the retroperitoneal mass. :- 2022-02/January 10

2022-02/January 10

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A woman in her mid-60s with history of uterovaginal prolapse, status post hysterectomy, was incidentally noted to have a patent urachus at the bladder dome on cystourethroscopy. A CT scan showed a partially distended urinary bladder with a small vesicourachal diverticulum and focal calcifications at its apex. Partial cystectomy with excision of the entire urachus was performed. Gross examination showed a 3.2 cm cystic nodule with calcified cut surface. Images from the partial cystectomy are shown below. :- 2022-01/January 3

2022-01/January 3

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Interesting cases

Cases of the Week 2022