Presented by Dr. Ashley Cimino-Mathews and prepared by Dr. Katherine Fomchenko
This case is a young adult male with a testis mass.
You have already completed the quiz before. Hence you can not start it again.
Quiz is loading...
You must sign in or sign up to start the quiz.
You have to finish following quiz, to start this quiz:
Results
Time has elapsed
Categories
Testis0%
1
Answered
Review
Question 1 of 1
1. Question
This case is a young adult male with a testis mass.
Correct
Answer: A. Seminoma
Histology: The lesion is composed of nests of loosely cohesive cells with round to cuboidal nuclei, coarse chromatin, conspicuous nucleoli, and background chronic inflammation. The lesion is unencapsulated but relatively well circumscribed.
Discussion: Seminomas are the most common malignant germ cell tumor of the testis and most frequently occur in young adult males, but they do have a bimodal age distribution. The neoplastic cells are often accompanied by a lymphoplasmacytic infiltrate, as well as non-necrotizing granulomas. By immunohistochemistry, the neoplastic seminoma cells label for OCT 3/4, and are negative for hematolymphoid markers and cytokeratins. Like seminoma, diffuse large B cell lymphoma cells are also loosely cohesive, but they are negative for OCT 3/4 and instead label for CD45 (pan-lymphoid) and CD20 (B-cell lineage). Embryonal carcinoma, another type of malignant germ cell tumor, is histologically high-grade and labels for cytokeratins and CD30. Finally, spermatocytic tumors (formerly, spermatocytic seminomas) are composed of three different cell types (small, intermediate, and giant cells) and have a benign clinical course.
Williamson SR, Delahunt B, Magi-Galluzzi C, Algaba F, Egevad L, Ulbright TM, Tickoo SK, Srigley JR, Epstein JI, Berney DM; Members of the ISUP Testicular Tumour Panel. The World Health Organization 2016 classification of testicular germ cell tumours: a review and update from the International Society of Urological Pathology Testis Consultation Panel. Histopathology. 2017 Feb;70(3):335-346. doi: 10.1111/his.13102. Epub 2016 Dec 14. PMID: 27747907.
Moch H, Cubilla AL, Humphrey PA, Reuter VE, Ulbright TM. The 2016 WHO Classification of Tumours of the Urinary System and Male Genital Organs-Part A: Renal, Penile, and Testicular Tumours. Eur Urol. 2016 Jul;70(1):93-105. doi: 10.1016/j.eururo.2016.02.029. Epub 2016 Feb 28. PMID: 26935559.
Incorrect
Answer: A. Seminoma
Histology: The lesion is composed of nests of loosely cohesive cells with round to cuboidal nuclei, coarse chromatin, conspicuous nucleoli, and background chronic inflammation. The lesion is unencapsulated but relatively well circumscribed.
Discussion: Seminomas are the most common malignant germ cell tumor of the testis and most frequently occur in young adult males, but they do have a bimodal age distribution. The neoplastic cells are often accompanied by a lymphoplasmacytic infiltrate, as well as non-necrotizing granulomas. By immunohistochemistry, the neoplastic seminoma cells label for OCT 3/4, and are negative for hematolymphoid markers and cytokeratins. Like seminoma, diffuse large B cell lymphoma cells are also loosely cohesive, but they are negative for OCT 3/4 and instead label for CD45 (pan-lymphoid) and CD20 (B-cell lineage). Embryonal carcinoma, another type of malignant germ cell tumor, is histologically high-grade and labels for cytokeratins and CD30. Finally, spermatocytic tumors (formerly, spermatocytic seminomas) are composed of three different cell types (small, intermediate, and giant cells) and have a benign clinical course.
Williamson SR, Delahunt B, Magi-Galluzzi C, Algaba F, Egevad L, Ulbright TM, Tickoo SK, Srigley JR, Epstein JI, Berney DM; Members of the ISUP Testicular Tumour Panel. The World Health Organization 2016 classification of testicular germ cell tumours: a review and update from the International Society of Urological Pathology Testis Consultation Panel. Histopathology. 2017 Feb;70(3):335-346. doi: 10.1111/his.13102. Epub 2016 Dec 14. PMID: 27747907.
Moch H, Cubilla AL, Humphrey PA, Reuter VE, Ulbright TM. The 2016 WHO Classification of Tumours of the Urinary System and Male Genital Organs-Part A: Renal, Penile, and Testicular Tumours. Eur Urol. 2016 Jul;70(1):93-105. doi: 10.1016/j.eururo.2016.02.029. Epub 2016 Feb 28. PMID: 26935559.
Presented by Dr. Ashley Cimino-Mathews and prepared by Dr. Katherine Fomchenko
This case is a middle-aged female with a breast mass.
You have already completed the quiz before. Hence you can not start it again.
Quiz is loading...
You must sign in or sign up to start the quiz.
You have to finish following quiz, to start this quiz:
Results
Time has elapsed
Categories
breast0%
1
Answered
Review
Question 1 of 1
1. Question
This case is a middle-aged female with a breast mass.
Correct
Answer: D. Angiosarcoma
Histology: The lesion is an infiltrative neoplasm composed of a vascular proliferation with anastomosing vessels, blood lakes, nuclear atypia and endothelial mitotic activity. Vascular spaces infiltrate irregularly through fat and around and through breast terminal duct lobular units.
Discussion: Angiosarcoma is a malignant vascular neoplasm. There are broadly to types of angiosarcoma in the breast: primary angiosarcoma and secondary (post-radiation) sarcoma. Primary angiosarcomas of the breast typically present as breast masses in pre-menopausal females, and the lesions are generally centered in the breast parenchyma. Secondary, or post-radiation, angiosarcomas of the breast typically present as skin changes in post-menopausal females approximately 7-10 years after breast radiation, and the lesions are generally centered in the dermis. Primary and secondary angiosarcomas of the breast may be widely infiltrative, and although the mainstay of treatment is complete surgical resection with widely clear margins, they frequently recur and cause significant morbidity and mortality.
The differential diagnosis of angiosarcoma includes benign vascular proliferations and other spindle cell lesions of the breast such as metaplastic carcinoma. Unlike atypical vascular lesions and hemangiomas, angiosarcomas display nuclear atypia, endothelial cell multilayering, mitotic activity, and infiltrative growth. Immunohistochemical stains can be used to classify spindle cell lesions of the breast. Angiosarcomas will label for markers used for endothelial differentiation, such as CD34, CD31, and ERG. Unlike breast carcinomas, angiosarcomas are typically negative for cytokeratins.
Esposito E, Avino F, di Giacomo R, Donzelli I, Marone U, Melucci MT, Rinaldo C, Ruffolo F, Saponara R, Siani C, Tortoriello R, Botti G, Rinaldo M, Fucito A. Angiosarcoma of the breast, the unknown-a review of the current literature. Transl Cancer Res. 2019 Oct;8(Suppl 5):S510-S517. doi: 10.21037/tcr.2019.07.38. PMID: 35117129; PMCID: PMC8798946.
Incorrect
Answer: D. Angiosarcoma
Histology: The lesion is an infiltrative neoplasm composed of a vascular proliferation with anastomosing vessels, blood lakes, nuclear atypia and endothelial mitotic activity. Vascular spaces infiltrate irregularly through fat and around and through breast terminal duct lobular units.
Discussion: Angiosarcoma is a malignant vascular neoplasm. There are broadly to types of angiosarcoma in the breast: primary angiosarcoma and secondary (post-radiation) sarcoma. Primary angiosarcomas of the breast typically present as breast masses in pre-menopausal females, and the lesions are generally centered in the breast parenchyma. Secondary, or post-radiation, angiosarcomas of the breast typically present as skin changes in post-menopausal females approximately 7-10 years after breast radiation, and the lesions are generally centered in the dermis. Primary and secondary angiosarcomas of the breast may be widely infiltrative, and although the mainstay of treatment is complete surgical resection with widely clear margins, they frequently recur and cause significant morbidity and mortality.
The differential diagnosis of angiosarcoma includes benign vascular proliferations and other spindle cell lesions of the breast such as metaplastic carcinoma. Unlike atypical vascular lesions and hemangiomas, angiosarcomas display nuclear atypia, endothelial cell multilayering, mitotic activity, and infiltrative growth. Immunohistochemical stains can be used to classify spindle cell lesions of the breast. Angiosarcomas will label for markers used for endothelial differentiation, such as CD34, CD31, and ERG. Unlike breast carcinomas, angiosarcomas are typically negative for cytokeratins.
Esposito E, Avino F, di Giacomo R, Donzelli I, Marone U, Melucci MT, Rinaldo C, Ruffolo F, Saponara R, Siani C, Tortoriello R, Botti G, Rinaldo M, Fucito A. Angiosarcoma of the breast, the unknown-a review of the current literature. Transl Cancer Res. 2019 Oct;8(Suppl 5):S510-S517. doi: 10.21037/tcr.2019.07.38. PMID: 35117129; PMCID: PMC8798946.
Presented by Dr. Ashley Cimino-Mathews and prepared by Dr. Katherine Fomchenko
This case is an elderly female with a parotid mass. There is no known history of malignancy, and a previous biopsy was benign.
You have already completed the quiz before. Hence you can not start it again.
Quiz is loading...
You must sign in or sign up to start the quiz.
You have to finish following quiz, to start this quiz:
Results
Time has elapsed
Categories
Parotid0%
1
Answered
Review
Question 1 of 1
1. Question
This case is an elderly female with a parotid mass. There is no known history of malignancy, and a previous biopsy was benign.
Correct
Answer: A. Traumatic Neuroma
Histology: The lesion consists of a disorganized proliferation of peripheral nerve bundles with intervening scar tissue. The nerve fibers form irregular clusters with intervening fibrous scar. The lesion is relatively well-circumscribed but not encapsulated, with surrounding skeletal muscle.
Discussion: Traumatic neuromas are non-neoplastic lesions that develop in the setting of previous trauma to an area, usually in the form of a prior biopsy or procedure at the site of the lesion. The lesion contains both axonal cells and Schwann cells. In contrast, a Schwannoma is a benign peripheral nerve sheath tumor composed entirely of Schwann cells, is encapsulated, has hyalinization of blood vessels, and has hypocellular (Antoni A) and hypercellular (Antoni B) areas. Neurofibromas are a benign peripheral nerve sheath tumor composed of all components of the nerve sheath, with spindled cells, hyalinized stroma, and mast cells.
Zabaglo M, Dreyer MA. Neuroma. 2022 Jan 9. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–. PMID: 31751028.
Alotaiby FM, Fitzpatrick S, Upadhyaya J, Islam MN, Cohen D, Bhattacharyya I. Demographic, Clinical and Histopathological Features of Oral Neural Neoplasms: A Retrospective Study. Head Neck Pathol. 2019 Jun;13(2):208-214. doi: 10.1007/s12105-018-0943-1. Epub 2018 Jun 21. PMID: 29931661; PMCID: PMC6513954.
Incorrect
Answer: A. Traumatic Neuroma
Histology: The lesion consists of a disorganized proliferation of peripheral nerve bundles with intervening scar tissue. The nerve fibers form irregular clusters with intervening fibrous scar. The lesion is relatively well-circumscribed but not encapsulated, with surrounding skeletal muscle.
Discussion: Traumatic neuromas are non-neoplastic lesions that develop in the setting of previous trauma to an area, usually in the form of a prior biopsy or procedure at the site of the lesion. The lesion contains both axonal cells and Schwann cells. In contrast, a Schwannoma is a benign peripheral nerve sheath tumor composed entirely of Schwann cells, is encapsulated, has hyalinization of blood vessels, and has hypocellular (Antoni A) and hypercellular (Antoni B) areas. Neurofibromas are a benign peripheral nerve sheath tumor composed of all components of the nerve sheath, with spindled cells, hyalinized stroma, and mast cells.
Zabaglo M, Dreyer MA. Neuroma. 2022 Jan 9. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–. PMID: 31751028.
Alotaiby FM, Fitzpatrick S, Upadhyaya J, Islam MN, Cohen D, Bhattacharyya I. Demographic, Clinical and Histopathological Features of Oral Neural Neoplasms: A Retrospective Study. Head Neck Pathol. 2019 Jun;13(2):208-214. doi: 10.1007/s12105-018-0943-1. Epub 2018 Jun 21. PMID: 29931661; PMCID: PMC6513954.
Presented by Dr. Andres Matoso and prepared by Dr. Katherine Fomchenko.
This case is an adult female with a renal mass.
You have already completed the quiz before. Hence you can not start it again.
Quiz is loading...
You must sign in or sign up to start the quiz.
You have to finish following quiz, to start this quiz:
Results
Time has elapsed
Categories
Kidney0%
1
Answered
Review
Question 1 of 1
1. Question
This case is an adult female with a renal mass.
Correct
Answer: C. Renal carcinoid tumor
Histology: The lesion is a generally well-defined nodule within the kidney with focal areas of infiltrative growth at the edge of the nodule. The monotonous neoplastic cells have a nested and trabecular growth pattern and nuclei with finely speckled “salt and pepper” chromatin typical of neuroendocrine neoplasms.
Discussion: Neuroendocrine neoplasms of the kidney are rare tumor that can behave more aggressively than carcinoid tumors originating from other sites, with a high rate of recurrence at the site of resection and metastasis to other sites. In one case study of this entity, 24% of patients with this tumor had a horseshoe kidney. Immunostains for neuroendocrine markers such as synaptophysin and chromogranin A will be positive. Case reports of the tumor show that many express somatostatin receptors, raising the possibility of using somatostatin analogues as an adjuvant treatment.
Hansel DE, Epstein JI, Berbescu E, Fine SW, Young RH, Cheville JC.. Renal carcinoid tumor: a clinicopathologic study of 21 cases. Am J Surg Pathol. 2007 Oct;31(10):1539-44
Histology: The lesion is a generally well-defined nodule within the kidney with focal areas of infiltrative growth at the edge of the nodule. The monotonous neoplastic cells have a nested and trabecular growth pattern and nuclei with finely speckled “salt and pepper” chromatin typical of neuroendocrine neoplasms.
Discussion: Neuroendocrine neoplasms of the kidney are rare tumor that can behave more aggressively than carcinoid tumors originating from other sites, with a high rate of recurrence at the site of resection and metastasis to other sites. In one case study of this entity, 24% of patients with this tumor had a horseshoe kidney. Immunostains for neuroendocrine markers such as synaptophysin and chromogranin A will be positive. Case reports of the tumor show that many express somatostatin receptors, raising the possibility of using somatostatin analogues as an adjuvant treatment.
Hansel DE, Epstein JI, Berbescu E, Fine SW, Young RH, Cheville JC.. Renal carcinoid tumor: a clinicopathologic study of 21 cases. Am J Surg Pathol. 2007 Oct;31(10):1539-44
Presented by Dr. Andres Matoso and prepared by Dr. Katherine Fomchenko.
This case is a middle-aged female with a bladder mass.
You have already completed the quiz before. Hence you can not start it again.
Quiz is loading...
You must sign in or sign up to start the quiz.
You have to finish following quiz, to start this quiz:
Results
Time has elapsed
Categories
Bladder0%
1
Answered
Review
Question 1 of 1
1. Question
This case is a middle-aged female with a bladder mass.
Correct
Answer: B. Squamous Cell Carcinoma
Histology: The lesion is composed of an invasive neoplasm composed of sheets and nests of cells with pleomorphic nuclei invading into the detrusor muscle. Nuclei have prominent, sometimes multiple nucleoli with focal nuclear molding and a high nuclear to cytoplasmic ratio. There is also prominent lymphovascular invasion and focal necrosis. Of note, there are areas of benign urothelium overlying the invasive carcinoma.
Discussion: This lesion is a metastatic HPV-related squamous cell carcinoma from the cervix involving the bladder. Most primary squamous cell carcinomas of the bladder occur in the context of squamous metaplasia from a process causing chronic irritation, such as schistosomiasis. Primary squamous cell carcinoma is rare and more difficult to treat than urothelial carcinoma, as it is typically resistant to chemotherapy. Urothelial carcinoma can exhibit squamous features, which may be associated with a more aggressive and treatment resistant course. The basaloid appearance of the tumor, along with its location undermining benign urothelium, are suggestive of a carcinoma from another site that is involving the bladder as a metastasis or direct extension. In women, HPV-related basaloid squamous cell carcinoma is most commonly an extension from the gynecologic tract.
Dotson A, May A, Davaro F, Raza SJ, Siddiqui S, Hamilton Z. Squamous cell carcinoma of the bladder: poor response to neoadjuvant chemotherapy. Int J Clin Oncol. 2019 Jun;24(6):706-711. doi: 10.1007/s10147-019-01409-x. Epub 2019 Feb 1. PMID: 30707342.
Clark PE. Urothelial carcinoma with squamous differentiation: response to chemotherapy and radiation. Urol Oncol. 2015 Oct;33(10):434-6. doi: 10.1016/j.urolonc.2015.06.019. Epub 2015 Aug 14. PMID: 26278365.
Incorrect
Answer: B. Squamous Cell Carcinoma
Histology: The lesion is composed of an invasive neoplasm composed of sheets and nests of cells with pleomorphic nuclei invading into the detrusor muscle. Nuclei have prominent, sometimes multiple nucleoli with focal nuclear molding and a high nuclear to cytoplasmic ratio. There is also prominent lymphovascular invasion and focal necrosis. Of note, there are areas of benign urothelium overlying the invasive carcinoma.
Discussion: This lesion is a metastatic HPV-related squamous cell carcinoma from the cervix involving the bladder. Most primary squamous cell carcinomas of the bladder occur in the context of squamous metaplasia from a process causing chronic irritation, such as schistosomiasis. Primary squamous cell carcinoma is rare and more difficult to treat than urothelial carcinoma, as it is typically resistant to chemotherapy. Urothelial carcinoma can exhibit squamous features, which may be associated with a more aggressive and treatment resistant course. The basaloid appearance of the tumor, along with its location undermining benign urothelium, are suggestive of a carcinoma from another site that is involving the bladder as a metastasis or direct extension. In women, HPV-related basaloid squamous cell carcinoma is most commonly an extension from the gynecologic tract.
Dotson A, May A, Davaro F, Raza SJ, Siddiqui S, Hamilton Z. Squamous cell carcinoma of the bladder: poor response to neoadjuvant chemotherapy. Int J Clin Oncol. 2019 Jun;24(6):706-711. doi: 10.1007/s10147-019-01409-x. Epub 2019 Feb 1. PMID: 30707342.
Clark PE. Urothelial carcinoma with squamous differentiation: response to chemotherapy and radiation. Urol Oncol. 2015 Oct;33(10):434-6. doi: 10.1016/j.urolonc.2015.06.019. Epub 2015 Aug 14. PMID: 26278365.
Presented by Dr. Andres Matoso and and prepared by Dr. Katherine Fomchenko
This case is an adult male with a urethral mass.
You have already completed the quiz before. Hence you can not start it again.
Quiz is loading...
You must sign in or sign up to start the quiz.
You have to finish following quiz, to start this quiz:
Results
Time has elapsed
Categories
Ureter/Bladder/Urethra0%
1
Answered
Review
Question 1 of 1
1. Question
This case is an adult male with a urethral mass.
Correct
Answer: D. Condyloma
Histology: The lesion consists of an exophytic appearing squamous cell proliferation composed of papillary projections with fibrovascular cores. The squamous epithelium shows moderate nuclear atypia and koilocytic changes.
Discussion: Condyloma accuminata is an HPV-related sexually transmitted infection causing a wart-like lesion arising in the squamous mucosa of the genital area. The distal penile urethra, specifically the fossa navicularis, is lined by a non-keratinizing squamous epithelium, allowing the urethral meatus and distal urethra to be involved by these lesions. Lesions at this site are uncommon, and can be asymptomatic or cause symptoms of dysuria. HPV 6 and 11 commonly cause genital warts but do not commonly progress to HPV related neoplastic lesions like HPV 16 and 18. Immunostains for p16 will show diffuse, block like positivity. Unlike a carcinoma, the lesion is benign and will not have any features of invasion.
Vives Á, Vazquez A, Rajmil O, Cosentino M. Urethral condylomas in men: experience in 123 patients without previous treatment. Int J STD AIDS. 2016 Jan;27(1):39-43. doi: 10.1177/0956462415574627. Epub 2015 Feb 22. PMID: 25712107.
Holstein AF, Davidoff MS, Breucker H, Countouris N, Orlandini G. Different epithelia in the distal human male urethra. Cell Tissue Res. 1991 Apr;264(1):23-32. doi: 10.1007/BF00305719. PMID: 2054843.
Incorrect
Answer: D. Condyloma
Histology: The lesion consists of an exophytic appearing squamous cell proliferation composed of papillary projections with fibrovascular cores. The squamous epithelium shows moderate nuclear atypia and koilocytic changes.
Discussion: Condyloma accuminata is an HPV-related sexually transmitted infection causing a wart-like lesion arising in the squamous mucosa of the genital area. The distal penile urethra, specifically the fossa navicularis, is lined by a non-keratinizing squamous epithelium, allowing the urethral meatus and distal urethra to be involved by these lesions. Lesions at this site are uncommon, and can be asymptomatic or cause symptoms of dysuria. HPV 6 and 11 commonly cause genital warts but do not commonly progress to HPV related neoplastic lesions like HPV 16 and 18. Immunostains for p16 will show diffuse, block like positivity. Unlike a carcinoma, the lesion is benign and will not have any features of invasion.
Vives Á, Vazquez A, Rajmil O, Cosentino M. Urethral condylomas in men: experience in 123 patients without previous treatment. Int J STD AIDS. 2016 Jan;27(1):39-43. doi: 10.1177/0956462415574627. Epub 2015 Feb 22. PMID: 25712107.
Holstein AF, Davidoff MS, Breucker H, Countouris N, Orlandini G. Different epithelia in the distal human male urethra. Cell Tissue Res. 1991 Apr;264(1):23-32. doi: 10.1007/BF00305719. PMID: 2054843.
Presented by Dr. Pedram Argani and prepared by Dr. Katherine Fomchenko
This is an elderly male with a history of prostate cancer and an inguinal mass.
You have already completed the quiz before. Hence you can not start it again.
Quiz is loading...
You must sign in or sign up to start the quiz.
You have to finish following quiz, to start this quiz:
Results
Time has elapsed
Categories
Groin0%
1
Answered
Review
Question 1 of 1
1. Question
This is an elderly male with a history of prostate cancer and an inguinal mass.
Correct
Answer: C. Clear cell hidradenoma
Histologic Description: This is a somewhat cystic lesion with solid and papillary architectures. The neoplastic cells closely resemble urothelium in that they have a transitional type appearance and are associated with flatted cells at the top which resemble urothelial umbrella cells. The stroma is hyalinized, and there is essentially no mitotic activity. These features are typical of clear cell hidradenoma, an adnexal neoplasm.
Differential Diagnosis: Metastatic urothelial carcinoma would have a similar pattern but would demonstrate greater cytologic atypia and mitotic activity. This would be extremely unusual in the absence of a history of urothelial carcinoma. Given the patient’s history of prostatic adenocarcinoma, a metastases from that tumor is a significant concern; however, the absence of immunoreactivity for prostatic markers like NKX3.1, as well as diffuse immunoreactivity for GATA3, excluded that possibility. Invasive squamous cell carcinoma would demonstrate keratinization as well as greater cytologic atypia and mitotic activity.
Recently, clear cell hidradenomas have been shown to have the same gene fusion has been identified in mucoepidermoid carcinoma of salivary glands (CRTC1/3-MAML2).
Incorrect
Answer: C. Clear cell hidradenoma
Histologic Description: This is a somewhat cystic lesion with solid and papillary architectures. The neoplastic cells closely resemble urothelium in that they have a transitional type appearance and are associated with flatted cells at the top which resemble urothelial umbrella cells. The stroma is hyalinized, and there is essentially no mitotic activity. These features are typical of clear cell hidradenoma, an adnexal neoplasm.
Differential Diagnosis: Metastatic urothelial carcinoma would have a similar pattern but would demonstrate greater cytologic atypia and mitotic activity. This would be extremely unusual in the absence of a history of urothelial carcinoma. Given the patient’s history of prostatic adenocarcinoma, a metastases from that tumor is a significant concern; however, the absence of immunoreactivity for prostatic markers like NKX3.1, as well as diffuse immunoreactivity for GATA3, excluded that possibility. Invasive squamous cell carcinoma would demonstrate keratinization as well as greater cytologic atypia and mitotic activity.
Recently, clear cell hidradenomas have been shown to have the same gene fusion has been identified in mucoepidermoid carcinoma of salivary glands (CRTC1/3-MAML2).
Presented by Dr. Pedram Argani and prepared by Dr. Katherine Fomchenko
This is a middle-aged female with a renal tumor.
You have already completed the quiz before. Hence you can not start it again.
Quiz is loading...
You must sign in or sign up to start the quiz.
You have to finish following quiz, to start this quiz:
Results
Time has elapsed
Categories
Not categorized0%
1
Answered
Review
Question 1 of 1
1. Question
This is a middle-aged female with a renal tumor.
Correct
Answer: B. Xp11 translocation carcinoma
Histologic Description: This is a clear cell neoplasm with a solid/nested architecture. The stroma is somewhat hyalinized, and there are associated psammoma bodies. In many areas, there are prominent subnuclear vacuoles. The neoplasm is essentially non-immunoreactive for carbonic anhydrase 9 (CA-IX) and cytokeratin 7, but demonstrates strong nuclear immunoreactivity for TFE3. This supports the diagnosis of Xp11 translocation renal cell carcinoma.
Differential Diagnosis: Many areas of the neoplasm overlaps with clear cell carcinoma. One difference is that the stroma of clear cell RCC is typically more cellular and hypervascular than the hyalinized stroma of an Xp11 translocation RCC. The absence of CA-IX labeling and strong TFE3 labeling excludes clear cell RCC. TCEB1 mutated renal cell carcinomas also have extensive clear cells, and can overlap in areas with clear cell RCC. However, TCEB1-mutated RCCs typically have prominent smooth muscle stroma and branching arborizing papillary architecture. Clear cell papillary renal cell carcinoma atypically demonstrates subnuclear vacuoles, and may have a prominent tubular architecture. However, clear cell papillary RCC labels for both cytokeratin 7 and carbonic anhydrase 9, but not for TFE3.
This case illustrated the ability of Xp11 translocation RCC to demonstrate subnuclear vacuoles that mimic those of clear cell papillary RCC.
Incorrect
Answer: B. Xp11 translocation carcinoma
Histologic Description: This is a clear cell neoplasm with a solid/nested architecture. The stroma is somewhat hyalinized, and there are associated psammoma bodies. In many areas, there are prominent subnuclear vacuoles. The neoplasm is essentially non-immunoreactive for carbonic anhydrase 9 (CA-IX) and cytokeratin 7, but demonstrates strong nuclear immunoreactivity for TFE3. This supports the diagnosis of Xp11 translocation renal cell carcinoma.
Differential Diagnosis: Many areas of the neoplasm overlaps with clear cell carcinoma. One difference is that the stroma of clear cell RCC is typically more cellular and hypervascular than the hyalinized stroma of an Xp11 translocation RCC. The absence of CA-IX labeling and strong TFE3 labeling excludes clear cell RCC. TCEB1 mutated renal cell carcinomas also have extensive clear cells, and can overlap in areas with clear cell RCC. However, TCEB1-mutated RCCs typically have prominent smooth muscle stroma and branching arborizing papillary architecture. Clear cell papillary renal cell carcinoma atypically demonstrates subnuclear vacuoles, and may have a prominent tubular architecture. However, clear cell papillary RCC labels for both cytokeratin 7 and carbonic anhydrase 9, but not for TFE3.
This case illustrated the ability of Xp11 translocation RCC to demonstrate subnuclear vacuoles that mimic those of clear cell papillary RCC.
Presented by Dr. Pedram Argani and prepared by Dr. Katherine Fomchenko
This is a middle-aged female with a breast mass.
You have already completed the quiz before. Hence you can not start it again.
Quiz is loading...
You must sign in or sign up to start the quiz.
You have to finish following quiz, to start this quiz:
Results
Time has elapsed
Categories
breast0%
1
Answered
Review
Question 1 of 1
1. Question
This is a middle-aged female with a breast mass.
Correct
Answer: C. Malignant phyllodes tumor
Histologic Description: The vast majority of this neoplasm consists of a nondescript high grade pleomorphic spindle cell sarcoma. The neoplastic cells demonstrate high mitotic activity including atypical mitoses, and extensive necrosis. Focally, after multiple additional sections were taken, a lower grade phyllodes tumor component with liposarcomatous differentiation was identified. This latter area was key to the diagnosis of malignant phyllodes tumor in this case, as the high grade spindle cell areas demonstrated no specific immunostaining.
Differential Diagnosis: Metaplastic carcinoma would be expected to either demonstrate immunoreactivity for epithelial markers and or a carcinomatous component. A primary mammary sarcoma is a diagnosis of exclusion, since phyllodes tumors with stromal overgrowth overlap with primary mammary sarcomas. Fibromatosis would lack the pleomorphism, mitotic activity and necrosis of the current case.
This case highlights the utility of additional tissue sampling in characterizing high grade pleomorphic neoplasms. Multiple rounds of immunostains on a high grade anaplastic component are less useful than well taken additional sections.
Incorrect
Answer: C. Malignant phyllodes tumor
Histologic Description: The vast majority of this neoplasm consists of a nondescript high grade pleomorphic spindle cell sarcoma. The neoplastic cells demonstrate high mitotic activity including atypical mitoses, and extensive necrosis. Focally, after multiple additional sections were taken, a lower grade phyllodes tumor component with liposarcomatous differentiation was identified. This latter area was key to the diagnosis of malignant phyllodes tumor in this case, as the high grade spindle cell areas demonstrated no specific immunostaining.
Differential Diagnosis: Metaplastic carcinoma would be expected to either demonstrate immunoreactivity for epithelial markers and or a carcinomatous component. A primary mammary sarcoma is a diagnosis of exclusion, since phyllodes tumors with stromal overgrowth overlap with primary mammary sarcomas. Fibromatosis would lack the pleomorphism, mitotic activity and necrosis of the current case.
This case highlights the utility of additional tissue sampling in characterizing high grade pleomorphic neoplasms. Multiple rounds of immunostains on a high grade anaplastic component are less useful than well taken additional sections.
Presented by Dr. Pedram Argani and prepared by Dr. Katherine Fomchenko
This is a middle-aged female with a renal mass.
You have already completed the quiz before. Hence you can not start it again.
Quiz is loading...
You must sign in or sign up to start the quiz.
You have to finish following quiz, to start this quiz:
Results
Time has elapsed
Categories
Kidney0%
1
Answered
Review
Question 1 of 1
1. Question
This is a middle-aged female with a renal mass. WT1 and ALK immunostains are included.
WT1:
ALK:
Correct
Answer: C. ALK rearranged renal cell carcinoma
Histologic Description: This is an extremely unusual and illustrative case. Morphologically, most of the lesion looks like metanephric adenoma in that it is composed of small tubules formed by blue cells with minimal cytoplasm arranged in a hyalinized stroma, given a “fingerprint” like appearance. This morphology merges with areas with more overt papillary architecture, more open chromatin, and large areas of necrosis with neutrophilic infiltrate, some of which could be due to a prior biopsy. By immunohistochemistry, the lesion demonstrates patchy nuclear labeling for WT1, but also demonstrates patchy immunoreactivity for ALK protein. The neoplasm demonstrates an ALK gene rearrangement.
Differential Diagnosis: Metanephric adenoma fits the morphology of much of this case, though the more open chromatin in the slightly more papillary areas would be unusual. Metanephric adenoma-Wilms tumor composite is a consideration given the necrosis; however, there are no areas that diagnostic of epithelial Wilms tumor such as areas of tubule formation with columnar nuclei with mitotic activity. Metanephric adenomas do not typically form composite tumors with papillary renal cell carcinomas since they arise by different genetic pathways (BRAF mutation in metanephric adenoma, trisomy chromosome 7/17 in low grade papillary carcinoma) unless they are both associated with metanephric stromal tumor. There is no evidence of metanephric stromal tumor in this case. This case demonstrates the wide spectrum which may be seen in renal cell carcinoma associated with ALK rearrangement. Cases similar to this with rearrangement of ALK have been reported recently.
Reference:
International Journal of Surgical Pathology 2021; 29:808-814 (PMID: 33729862)
Modern Pathology 2020; 33:2563-2579 (PMID: 32467651).
Incorrect
Answer: C. ALK rearranged renal cell carcinoma
Histologic Description: This is an extremely unusual and illustrative case. Morphologically, most of the lesion looks like metanephric adenoma in that it is composed of small tubules formed by blue cells with minimal cytoplasm arranged in a hyalinized stroma, given a “fingerprint” like appearance. This morphology merges with areas with more overt papillary architecture, more open chromatin, and large areas of necrosis with neutrophilic infiltrate, some of which could be due to a prior biopsy. By immunohistochemistry, the lesion demonstrates patchy nuclear labeling for WT1, but also demonstrates patchy immunoreactivity for ALK protein. The neoplasm demonstrates an ALK gene rearrangement.
Differential Diagnosis: Metanephric adenoma fits the morphology of much of this case, though the more open chromatin in the slightly more papillary areas would be unusual. Metanephric adenoma-Wilms tumor composite is a consideration given the necrosis; however, there are no areas that diagnostic of epithelial Wilms tumor such as areas of tubule formation with columnar nuclei with mitotic activity. Metanephric adenomas do not typically form composite tumors with papillary renal cell carcinomas since they arise by different genetic pathways (BRAF mutation in metanephric adenoma, trisomy chromosome 7/17 in low grade papillary carcinoma) unless they are both associated with metanephric stromal tumor. There is no evidence of metanephric stromal tumor in this case. This case demonstrates the wide spectrum which may be seen in renal cell carcinoma associated with ALK rearrangement. Cases similar to this with rearrangement of ALK have been reported recently.
Reference:
International Journal of Surgical Pathology 2021; 29:808-814 (PMID: 33729862)
Modern Pathology 2020; 33:2563-2579 (PMID: 32467651).
Presented by Dr. Pedram Argani and prepared by Dr. Katherine Fomchenko
This is middle-aged female with a history of breast cancer and a 2 cm renal mass.
You have already completed the quiz before. Hence you can not start it again.
Quiz is loading...
You must sign in or sign up to start the quiz.
You have to finish following quiz, to start this quiz:
Results
Time has elapsed
Categories
Kidney0%
1
Answered
Review
Question 1 of 1
1. Question
This is a 50 year old female with a history of breast cancer and a 2 cm renal mass which was focally positive for actin and negative for estrogen receptor (ER), S100 and cytokeratin.
Correct
Answer: C. GLI1 rearranged neoplasm
Histologic Description: This is an unusual spindle cell lesion with a prominent myxoid stroma. The neoplastic cells are bland, and are separated from prominent vessels within the lesion by myxoid and variably hyalinized/fibrinous stroma. There are also large areas of hyalinization and calcification within the lesion which are paucicellular.
Differential Diagnosis: Metastatic breast carcinoma was a strong consideration given the history and the focal immunoreactivity for ER. However, this patient’s breast cancer was morphologically distinct from the current case, and was not spindled. Myoepithelioma was a significant consideration given the morphology and focal immunoreactivity for actin. However, the absence of cytokeratin immunoreactivity and absence of S100 protein labeling argue against that possibility. The morphology certainly raises the possibility of a schwannoma given the degenerative changes and spindle cell morphology. However, the absence of immunoreactivity for S100 excludes that possibility.
GLI1 rearranged neoplasms are particularly challenging diagnostically, in that they overlap significantly with lesions such as myoepithelioma, myoepithelial carcinoma, and ossifying fibromyxoid tumor. These neoplasms should be kept in mind when a tumor with this morphology does not fit entities such as myoepithelial neoplasm or ossifying fibromyxoid tumor by immunohistochemistry, and in such cases molecular studies are appropriate to establish a definitive diagnosis. This case demonstrated a GLI1-FOXO4 gene fusion by RNA-sequencing, and fits the spectrum of GLI1 rearranged neoplasms. Of note, GLI1 amplified neoplasms tend to have a more varied morphologic spectrum, perhaps due to amplification genes adjacent to GLI1.
Reference Am J Surg Pathol 2022; 46:667-687 (PMID: 34907995)
Incorrect
Answer: C. GLI1 rearranged neoplasm
Histologic Description: This is an unusual spindle cell lesion with a prominent myxoid stroma. The neoplastic cells are bland, and are separated from prominent vessels within the lesion by myxoid and variably hyalinized/fibrinous stroma. There are also large areas of hyalinization and calcification within the lesion which are paucicellular.
Differential Diagnosis: Metastatic breast carcinoma was a strong consideration given the history and the focal immunoreactivity for ER. However, this patient’s breast cancer was morphologically distinct from the current case, and was not spindled. Myoepithelioma was a significant consideration given the morphology and focal immunoreactivity for actin. However, the absence of cytokeratin immunoreactivity and absence of S100 protein labeling argue against that possibility. The morphology certainly raises the possibility of a schwannoma given the degenerative changes and spindle cell morphology. However, the absence of immunoreactivity for S100 excludes that possibility.
GLI1 rearranged neoplasms are particularly challenging diagnostically, in that they overlap significantly with lesions such as myoepithelioma, myoepithelial carcinoma, and ossifying fibromyxoid tumor. These neoplasms should be kept in mind when a tumor with this morphology does not fit entities such as myoepithelial neoplasm or ossifying fibromyxoid tumor by immunohistochemistry, and in such cases molecular studies are appropriate to establish a definitive diagnosis. This case demonstrated a GLI1-FOXO4 gene fusion by RNA-sequencing, and fits the spectrum of GLI1 rearranged neoplasms. Of note, GLI1 amplified neoplasms tend to have a more varied morphologic spectrum, perhaps due to amplification genes adjacent to GLI1.
Reference Am J Surg Pathol 2022; 46:667-687 (PMID: 34907995)
Presented by Dr. Pedram Argani and prepared by Dr. Katherine Fomchenko
This is an elderly female with a 4 cm renal mass.
You have already completed the quiz before. Hence you can not start it again.
Quiz is loading...
You must sign in or sign up to start the quiz.
You have to finish following quiz, to start this quiz:
Results
Time has elapsed
Categories
Not categorized0%
1
Answered
Review
Question 1 of 1
1. Question
This is an elderly female with a 4 cm renal mass.
Correct
Answer: C. Biphasic hyalinizing psammomatous renal cell carcinoma
Histologic Description: This is a lesion with a variety of unusual morphologic patterns. The lesion is both solid and papillary, and the papillae often have a branching “glomeruloid” pattern. The cytology is biphasic, with smaller epithelioid cells clustered around nodules of basement membrane material with larger epithelioid cells with more columnar shape at the edge. The stroma is generally fibrotic, and there are scattered psammoma bodies in the lesion. There is additionally a population of smaller primitive appearing spindled cells. These are the typical features of biphasic hyalinizing psammomatous renal cell carcinoma (BHP RCC), a recently described entity associated with mutations in the neurofibromatosis type 2 (NF2) gene.
Differential Diagnosis: Mucinous tubular spindle cell carcinoma (MTSC) may also be associated with NF2 mutations, may have non-mucinous areas with papillary growth, and is associated with spindling as in seen in the current case. However, MTSC does not have the biphasic morphology of the current lesion, lacks the distinctive glomeruloid architecture seen herein, and typically demonstrates fascicles of eosinophilic spindle cells which can mimic a smooth muscle tumor. TFEB rearranged renal cell carcinoma is suggested by the biphasic appearance and hyaline nodules, which are hallmark features of these tumors. However, BHP RCC does not demonstrate TFEB rearrangements, and does not label for melanocytic markers like Melan A and HMB45 as is characteristic of the TFEB rearranged renal cell carcinoma. Wilms tumor is a consideration given the primitive appearance of the smaller epithelioid cells and the spindled cells within the lesion. However, the more open chromatin of the larger cells in the lesion is not typical of Wilms, nor are the hyalinized nodules, fibrotic stroma, or advanced patient age.
Reference Am J Surg Pathol 2020; 44:901-916 (PMID: 32217839).
Incorrect
Answer: C. Biphasic hyalinizing psammomatous renal cell carcinoma
Histologic Description: This is a lesion with a variety of unusual morphologic patterns. The lesion is both solid and papillary, and the papillae often have a branching “glomeruloid” pattern. The cytology is biphasic, with smaller epithelioid cells clustered around nodules of basement membrane material with larger epithelioid cells with more columnar shape at the edge. The stroma is generally fibrotic, and there are scattered psammoma bodies in the lesion. There is additionally a population of smaller primitive appearing spindled cells. These are the typical features of biphasic hyalinizing psammomatous renal cell carcinoma (BHP RCC), a recently described entity associated with mutations in the neurofibromatosis type 2 (NF2) gene.
Differential Diagnosis: Mucinous tubular spindle cell carcinoma (MTSC) may also be associated with NF2 mutations, may have non-mucinous areas with papillary growth, and is associated with spindling as in seen in the current case. However, MTSC does not have the biphasic morphology of the current lesion, lacks the distinctive glomeruloid architecture seen herein, and typically demonstrates fascicles of eosinophilic spindle cells which can mimic a smooth muscle tumor. TFEB rearranged renal cell carcinoma is suggested by the biphasic appearance and hyaline nodules, which are hallmark features of these tumors. However, BHP RCC does not demonstrate TFEB rearrangements, and does not label for melanocytic markers like Melan A and HMB45 as is characteristic of the TFEB rearranged renal cell carcinoma. Wilms tumor is a consideration given the primitive appearance of the smaller epithelioid cells and the spindled cells within the lesion. However, the more open chromatin of the larger cells in the lesion is not typical of Wilms, nor are the hyalinized nodules, fibrotic stroma, or advanced patient age.
Reference Am J Surg Pathol 2020; 44:901-916 (PMID: 32217839).
Presented by Dr. Jonathan Epstein and prepared by Dr. Katherine Fomchenko
An adult female underwent a resection of a bladder mass.
You have already completed the quiz before. Hence you can not start it again.
Quiz is loading...
You must sign in or sign up to start the quiz.
You have to finish following quiz, to start this quiz:
Results
Time has elapsed
Categories
Not categorized0%
1
Answered
Review
Question 1 of 1
1. Question
An adult female underwent a resection of a bladder mass.
Correct
Correct Answer: A. Intestinal metaplasia with high grade dysplasia
Histological Description: The case consists of polypoid fragments composed of numerous glands with cytological atypia with enlarged, hyperchromatic nuclei, prominent nucleoli, increased mitoses and loss of polarity. Focally, some of the glands have residual goblet cells. The glands are relatively evenly distributed without individual infiltrating cells and without an associated desmoplastic stromal reaction.
Discussion: Assessment of glandular lesions of the bladder is entirely analogous to how one would assess a gastrointestinal (GI) glandular lesion. Intestinal metaplasia of the bladder is a benign glandular proliferation where the urothelial mucosa and proliferating glands of cystitis cystica/cystitis glandularis becomes lined by intestinal-type epithelium. This epithelium resembles normal colon crypts with cytologically bland, basally situated, small round nuclei, and diffuse goblet cells. The presence of focal residual goblet cells in this case is evidence that this lesion is primary in the bladder and arising from intestinal metaplasia, as opposed to from a villous adenoma or from another site. The current lesion also lacks a surface villiform architecture. Intestinal metaplasia may have abundant acellular extracellular mucin, and occasionally can involve the muscularis propria. Uncommonly, intestinal metaplasia may have dysplasia, and has the same morphology as adenomas in the GI tract. If the cytology is that of a tubular adenoma of the GI tract, it is considered moderate dysplasia in intestinal metaplasia. If glands show loss of polarity and greater cytological atypia, as seen in the current case, then it is considered intestinal metaplasia with high grade dysplasia, again analogous to diagnosing high grade dysplasia in an adenomatous polyp in the GI tract. Intestinal metaplasia without dysplasia has no increased risk of adenocarcinoma in the bladder, except for increased risk of adenocarcinoma in exstrophy patients. Although there are only limited studies, intestinal metaplasia with dysplasia is associated with concurrent adenocarcinoma of the bladder. If incompletely excised, patients who are diagnosed with glandular dysplasia require a repeat biopsy to completely remove the lesion and clinical follow-up.
Incorrect
Correct Answer: A. Intestinal metaplasia with high grade dysplasia
Histological Description: The case consists of polypoid fragments composed of numerous glands with cytological atypia with enlarged, hyperchromatic nuclei, prominent nucleoli, increased mitoses and loss of polarity. Focally, some of the glands have residual goblet cells. The glands are relatively evenly distributed without individual infiltrating cells and without an associated desmoplastic stromal reaction.
Discussion: Assessment of glandular lesions of the bladder is entirely analogous to how one would assess a gastrointestinal (GI) glandular lesion. Intestinal metaplasia of the bladder is a benign glandular proliferation where the urothelial mucosa and proliferating glands of cystitis cystica/cystitis glandularis becomes lined by intestinal-type epithelium. This epithelium resembles normal colon crypts with cytologically bland, basally situated, small round nuclei, and diffuse goblet cells. The presence of focal residual goblet cells in this case is evidence that this lesion is primary in the bladder and arising from intestinal metaplasia, as opposed to from a villous adenoma or from another site. The current lesion also lacks a surface villiform architecture. Intestinal metaplasia may have abundant acellular extracellular mucin, and occasionally can involve the muscularis propria. Uncommonly, intestinal metaplasia may have dysplasia, and has the same morphology as adenomas in the GI tract. If the cytology is that of a tubular adenoma of the GI tract, it is considered moderate dysplasia in intestinal metaplasia. If glands show loss of polarity and greater cytological atypia, as seen in the current case, then it is considered intestinal metaplasia with high grade dysplasia, again analogous to diagnosing high grade dysplasia in an adenomatous polyp in the GI tract. Intestinal metaplasia without dysplasia has no increased risk of adenocarcinoma in the bladder, except for increased risk of adenocarcinoma in exstrophy patients. Although there are only limited studies, intestinal metaplasia with dysplasia is associated with concurrent adenocarcinoma of the bladder. If incompletely excised, patients who are diagnosed with glandular dysplasia require a repeat biopsy to completely remove the lesion and clinical follow-up.
Presented by Dr. Jonathan Epstein and prepared by Dr. Katherine Fomchenko
A middle-aged male underwent an orchiectomy for a testis mass.
You have already completed the quiz before. Hence you can not start it again.
Quiz is loading...
You must sign in or sign up to start the quiz.
You have to finish following quiz, to start this quiz:
Results
Time has elapsed
Categories
Testis0%
1
Answered
Review
Question 1 of 1
1. Question
A middle-aged male underwent an orchiectomy for a testis mass.
mass.
Correct
Correct Answer: D. Infarct with necrotizing granulomatous vasculitis
Histological Description: There is a well-demarcated area of testicular parenchymal infarct with residual outlines of necrotic seminiferous tubules. There is an associated polyarteritis nodosa-like (PAN-like) vasculitis with transmural necrotizing inflammation of small to medium-sized arteries. The affected vessels show either focal or circumferential involvement. The inflammatory component within the vasculitis is granulomatous.
Discussion: When presented with a case with necrosis in the testis, it is critical to assess the nature of the necrosis. Caseous necrosis consists of necrotic debris without visible structures native to the testis. In this setting, it is most likely infectious in origin, and the epididymis should also be affected, as that is the site of origin of the testicular infection. Cellular necrosis consists of ghosts of individual cells, where there is no suggestion of pre-existing seminiferous tubules. Often with necrotic seminoma, one can still see adequate cytology to make a definitive diagnosis. In these cases, sometimes OCT3/4 and CD117 may still label the tumor. The presence of germ cell neoplasia in-situ in the surrounding testis may also be helpful in establishing the diagnosis of necrotic germ cell tumor. Torsion is seen either in neonates or in teens/young adults and results in hemorrhagic necrosis of the entire testis. Localized infarcts of the testis taken out from presumed tumor are in the vast majority of times associated with vasculitis. At low power, the brightly eosinophilic fibrinoid necrosis in the vessel walls stand out. The vessels are medium-sized and often at the periphery of the testicle. Non-granulomatous vasculitis, seen in the vast majority of times, represent vasculitis isolated to the testis, although the patient should still be evaluated for systemic disease. Granulomatous vasculitis is much less common and has a higher likelihood of being associated with systemic vasculitis, such as Granulomatosis with Polyangiitis (GPA) or Churg Strauss syndrome.
Incorrect
Correct Answer: D. Infarct with necrotizing granulomatous vasculitis
Histological Description: There is a well-demarcated area of testicular parenchymal infarct with residual outlines of necrotic seminiferous tubules. There is an associated polyarteritis nodosa-like (PAN-like) vasculitis with transmural necrotizing inflammation of small to medium-sized arteries. The affected vessels show either focal or circumferential involvement. The inflammatory component within the vasculitis is granulomatous.
Discussion: When presented with a case with necrosis in the testis, it is critical to assess the nature of the necrosis. Caseous necrosis consists of necrotic debris without visible structures native to the testis. In this setting, it is most likely infectious in origin, and the epididymis should also be affected, as that is the site of origin of the testicular infection. Cellular necrosis consists of ghosts of individual cells, where there is no suggestion of pre-existing seminiferous tubules. Often with necrotic seminoma, one can still see adequate cytology to make a definitive diagnosis. In these cases, sometimes OCT3/4 and CD117 may still label the tumor. The presence of germ cell neoplasia in-situ in the surrounding testis may also be helpful in establishing the diagnosis of necrotic germ cell tumor. Torsion is seen either in neonates or in teens/young adults and results in hemorrhagic necrosis of the entire testis. Localized infarcts of the testis taken out from presumed tumor are in the vast majority of times associated with vasculitis. At low power, the brightly eosinophilic fibrinoid necrosis in the vessel walls stand out. The vessels are medium-sized and often at the periphery of the testicle. Non-granulomatous vasculitis, seen in the vast majority of times, represent vasculitis isolated to the testis, although the patient should still be evaluated for systemic disease. Granulomatous vasculitis is much less common and has a higher likelihood of being associated with systemic vasculitis, such as Granulomatosis with Polyangiitis (GPA) or Churg Strauss syndrome.
Please enter your email address to continue to the Johns Hopkins Surgical Pathology Case Conference website.
Why do we ask for your email? We’d like to send you periodic updates regarding Pathology educational materials released by our department. You’ll hear about new websites, iPad apps, PathCasts, and other educational materials.
Correct
mass. 