—  SPECIALTY CONFERENCE HANDOUT  — Genitourinary Pathology Wednesday, March 2, 2011, 7:30 PM CC 103 A/B Clinical histories are printed below. Click on the case numbers for text and references of each case. Click on each slide thumbnail image for an enlarged view The Case That Taught Me The Most In Urologic Pathology Moderator: JOHN CHEVILLE Mayo Clinic Rochester, MN Disclosure: In accordance with ACCME guidelines regarding disclosure, the USCAP policy requires that faculty members who have a significant financial or other relationship with a commercial company, entity, or service (which will be discussed in this Symposium) must disclose this to attendees. The Academy also requires that speakers disclose any products that are not labeled for the use under discussion. The speakers listed below have indicated they have nothing to disclose. Panelists: Peter Humphrey, Washington University, St. Louis, MO Satish Tickoo, Memorial Sloan Kettering Cancer Center, New York, NY Samson Fine, Memorial Sloan Kettering Cancer Center, New York, NY Jun Zhang, Mayo Clinic, Rochester, MN Clinical Histories and Still Images are displayed below. Click on slide thumbnail images for an enlarged view. If you have any difficulties viewing these slides, email or call George Clay at +1.724.449.1137. Case 1 - Click here for Text and References Submitted by: Peter A. Humphrey - Clinical Summary: The patient is an asymptomatic 55 year old man with an elevated serum prostate specific antigen of 6.5 ng/ml. He underwent ultrasound-guided prostate needle biopsy. Pertinent Laboratory Data: Elevated PSA (7 ng/mL) Case 1 - Figure 1 Single small detached fragment with crowded glands Case 1 - Figure 2 Crowded small gland process Case 1 - Figure 3 Small acini with focal nuclear hyperchromasia Case 2 - Click here for Text and References Submitted by: Satish K. Tickoo - Clinical Summary: A 67 year old male presented with left flank pain and microscopic hematuria. CT scan performed revealed a left UVJ calculus with mild hydronephrosis, along with a 2.5 cm enhancing mass in the lower pole of the left kidney. After the placement of left ureteral stent, subsequent MR revealed no hydronephrosis, but persistent complex cystic mass in the kidney. A partial nephrectomy was performed, and the photomicrographs are from the resected 2.5 cm, cystic and solid mass. Case 2 - Figure 1 Cystic areas in the tumor with papillary proliferations. Case 2 - Figure 2 Prominent papillary architecture. Note the clear cell cytology of the tumor. Case 2 - Figure 3 A solid area in the tumor showing closely packed tubular architecture. In addition to the clear cell cytology, the arrangement of nuclei away from basement membrane is prominantly present. Case 2 - Figure 4 A higher magnification image showing the characteristic linear arrangement of nuclei. Case 2 - Figure 5 This image illustrates the spectrum of morphologic features in this clear cell papillary RCC: tubular/acinar pattern with characteristically arranged nuclei, microcysts, solid sheet-like area composed of numerous mico- or "collapsed" acini, and smooth muscle metaplasia of the capsule with extension into the tumor. Case 2 - Figure 6 Diffuse positivity for CK7. Case 2 - Figure 7 Diffuse membranous positivity for CA-IX. Case 3 - Click here for Text and References Submitted by: Samson W. Fine - Clinical Summary: 51 year old male with a history of a 3 cm, organ-confined clear cell renal cell carcinoma in 1998. Pertinent Laboratory Data: Over a four year period the patient's PSA rose from 1.71 to 3.28 prompting a systematic prostate needle biopsy. Case 3 - Slide 1 Click to view with ImageScope Click to view with a Web-Based Viewer Case 4 - Click here for Text and References Submitted by: Jun Zhang - Clinical Summary: 71-year-old male with dysuria, recently underwent cystoscopy on 9-28-10 and had a transurethral resection of a small bladder tumor. Past medical history significant for metastatic prostate cancer to bone and status post prostatectomy, radiation and hormonal therapy. Pertinent Laboratory Data: Bladder calculi Case 4 - Figure 1 Case 4 - Figure 2 Case 4 - Figure 3 Case 4 - Figure 4 Case 4 - Figure 5 Case 4 - Figure 6 Case 4 - Figure 7 S100 Case 4 - Figure 8 Bone biopsy Case 4 - Figure 9 Bone biopsy - PSA Case 4 - Figure 10 Case 4 - Figure 11 Case 4 - Figure 12 Case 4 - Figure 13 Case 4 - Figure 14 Case 4 - Figure 15 Case 4 - Figure 16 Case 4 - Figure 17 Case 4 - Figure 18 Case 4 - Figure 19 Handouts for all Specialty Conferences will be accessible via the "Educational Materials" section on the homepage the morning after each respective conference. Printed copies of the handout will not be available at the meeting.