Male 61 years

Bladder. H/O Haematuria. Papillary tumour but very angry looking bladder mucosa and bladder neck.

Macro: Multiple pieces of firm pale tissue up to 15 mm.

Immunohistochemistry:
N/A.

Female 82 years

Left kidney. History of recurrent pyelonephritis Lots of necrotic looking tissue at operation site.

Macro: Nephrectomy specimen 15 x 11 x 8cm. Separate fragments of fat, blood clot, and necrotic material. Cut surface of kidney shows solid multinodular appearance with associated pus. Focal extension into perinephric fat. No calculi.

Immunohistochemistry:
Special stain - Von Kossa stain.

Female 69 years

Radical Nephrectomy.

Macro: Tumour seen adjacent to medulla, 35mm maximum diameter with yellow cut surface. No other gross abnormality. All sections showed a similar microscopic appearance and immunochemistry.

Immunohistochemistry:
Strongly CK7, Carbonic Anhydrase IX and high molecular weight cytokeratin positive CD10 and AMACR negative throughout.

Male 42 years

TURBT. Known pelvic lymphoma. Previous diffuse large B cell lymphoma-germinal centre subtype in external iliac lymph node.

Macro: Bladder chippings weighing 7 gms.

Immunohistochemistry:
CD20, BCL6 positive; CD10, CD30, BCL2 negative.

Male 59 years

Left nephrectomy. Left renal tumour 12cm on CT scan.

Macro: A kidney and surrounding fat, in total measuring 205 x 135 x 110mm. The kidney measures 135 x 95 x 90mm. Occupying almost the entire kidney is a large homogenous (? necrotic) tumour which measures 110 x 88 x approximately 85mm. The cut surface of the tumour is tan brown.

Immunohistochemistry:
CK7+ (diffuse and strong), CD117-, E-cadherin+, RCC-, CD10-.

Male 34 years

Radical orchidectomy. The specimen was a radical orchidectomy from a 34 year old man who presented with a hard lump in the testis.

Macro: The testis measured 50x30x25mm and there was a pale coloured tumour in the lower pole is 15mm in diameter.

Immunohistochemistry:
None.

Female 70 years

Left nephrectomy. Left renal abscess causing psoas abscess. Also spinal osteomyelitis.

Macro: A kidney measuring 11.4 x 8 x 5.2cm and weighing 235g. Slicing reveals fibrosis, calcification and a yellow cavity associated with the upper pole calyx, which involves the perinephric fat.

Immunohistochemistry:
N/A.

Male 60 years

Right Nephrectomy. Right nephrectomy for complex cyst in lower pole. No solid/expansile nodules seen, just thinned walled cysts.

Macro: Nephrectomy measuring 153 mm pole to pole x 83 mm x 64 mm. In the lower pole was a collapsed mulitloculated cystic structure up to 92mm which showed smooth inner lining with no assocaited mass lesions.

Immunohistochemistry:
None.

Male 83 years

Scrotal skin. Extensive skin rash on scrotum.

Macro: Ellipse of skin measuring 77 x 30 x 5mm.

Immunohistochemistry:
EMA, CK7, CEA positive. PAS positive. S100, CK20, Melan A negative.

Female 71 years

Bladder tumour, TURBT. 1st bladder tumour, resection.

Macro: Multiple irregular fragments of necrotic and grey white tissue measuring upto 100mm in aggregate.

Immunohistochemistry:
None.

Female 58 years

Nephrectomy. Tumour.

Macro: Kidney containing a tan coloured well circumscribed tumour measuring 97mm in maximium dimension. The tumour contains a central paler area.

Immunohistochemistry:
None performed.

Female 68 years

Nephrectomy. Renal mass.

Macro: 110mm well circumscribed partly necrotic tumour upper pole of kidney.

Immunohistochemistry:
CK7+, Racemase +, P63 negative.

Male 74 years

TRUS Bx. PSA 7.94, TRUS volume 70cc. DRE => BPH.

Macro: Two cores measuring 18 and 20mm.

Immunohistochemistry:
Not performed.

Male 78 years

TRUS Bx. PSA 17.73. TRUS volume 45cc. DRE => T2c/T3.

Macro: Two cores measuring 18 and 20mm.

Immunohistochemistry:
Not performed.

Male 87 years

TRUS Bx. PSA 7.27. DRE => very enlarged, left lobe nodular and right lobe firm. Bx is from left apex.

Macro: Two cores measuring 17 and 18mm.

Immunohistochemistry:
Not performed.

Male 50 years

Radical prostatectomy. Patient noted to have a left sided prostate nodule on digital rectal examination in 2006. The serum PSA level was 4.1 ng/ml. A biopsy was performed that was benign. In July, 2014, the nodule was still present with a PSA of 3.6 ng/ml. and a 2nd biopsy showed Adenocarcinoma Gleason score 3+3=6 involving 20% of 1 core in the right apex. A third biopsy was performed on January, 2015 where in there was an atypical focus on the right apex but no tumour on the left. A multiparametric MRI was performed which showed a 3.2x2.2x3.2 cm lesion in the left peripheral zone with low signal T2, restricted water diffusion, and enhanced blood flow consistent with malignancy. There was a question of extra-prostatic extension. As a result of the patient's young age and palpable nodule along with cancer on a prior biopsy, a radical prostatectomy was performed.

Macro: None.

Immunohistochemistry:
None.

Male 76 years

Rectal biopsy. Presented with rectal symptoms and on MRI a circumferential mucosal thickening of the rectum was noted. The process extended to the seminal vesicles and the prostate was probably normal. A rectal biopsy was performed.

Macro: None.

Immunohistochemistry:
The tumour was pankeratin and CDX2 positive and negative for CK7 and CK20.

Female 48 years

During clinical work-up for hematuria, this patient was found to have in situ and invasive urothelial carcinoma of the bladder which required a radical cystectomy. Her past medical history was significant for paraplegia below T8 after a motor vehicle accident at the age of 23 years. Previously the patient had undergone a bladder- intestinal augmentation cystoplasty with Mitrofanoff appendicovesicostomy. She had been performing clean intermittent catheterization through the Mitrofanoff canal ever since, complicated by chronic urinary tract infections and development of small bladder capacity. A section from the cystectomy is submitted for your evaluation.

Male 24 years

This patient came to medical attention because of left testicular swelling. On physical examination he was found to have a large left supraclavicular mass and massive retroperitoneal lymphadenopathy. A right orchiectomy revealed a mixed germ cell tumor composed of embryonal carcinoma, teratoma and yolk sac tumor. His post-orchiectomy serum markers were: β-hCG within normal limits, and AFP of 5000 ng/mL (0-15). He received 4 cycles of bleomycin, etoposide and cisplatin (BEP). At the completion of his chemotherapy, AFP had declined to 41 ng/mL where it remained. He subsequently underwent a retroperitoneal lymph node dissection followed by resection of the residual left supraclavicular mass, both of which revealed teratoma and treatment-related changes. One year later he was found to have an enlarged left pelvic lymph node which increased in size from 1.5 cm to 3.1 cm over a two year period. Just prior to the resection of this pelvic mass, which also appeared to involve the psoas muscle, the serum markers were AFP of 2.6 ng/mL, HCG < 2 mIU/mL and LDH 120 u/L (60-200). A section from the left pelvic mass is submitted for your evaluation.

Male 77 years

Gentleman with a serum PSA of 12ng/ml. On biopsy, the local diagnosis was GS 4+4=8. Subsequent RPE showed only a minor component of a GS 3+3=6 tumour. What went wrong?



Specimen: Radical prostatectomy.

Macro: None.

Immunohistochemistry:
None.

Male 75 years

Gentleman with biopsy detected PCa. On RPE an unusual tumour component was seen. Is this a concomittant sarcoma?



Specimen: Radical prostatectomy.

Macro: None.

Immunohistochemistry:
None.