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Slide Seminar
Differential diagnosis in uropathology

September 4th, 08.30-12.00 Auditorium I
Chairpersons: Marina Scarpelli (Italy) and Maurizio Colecchia (Italy)
Case 1
Presented by: Marina Scarpelli, Ancona, Italy

Male patient 76-year-old with very high PSA values (41 ng/ml). A large area, suspicious for carcinoma on D.R.E was found in the left prostate lobe and 2 biopsies were obtained from that area. A few months before a breast biopsy had been taken because of a palpable nodule in the left breast. CT scanning detected multiple osteoblastic bone metastasesThe slides refer to the prostate (Slide 1 H&E) and to the breast biopsy (Slide 2 H&E).
Slide 1Slide 2Slide 2- mammaglobin
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Case 2
Presented by: Maurizio Colecchia, MILAN, Italy

A previous healthy 39-year-old man presented with a testicular nodule. An ultrasound examination showed a mm.7 nodule in the right testis. No lymphnodal enlargement was found at ultrasonography of retroperitoneum. He underwent a surgical exploration of the right testis and the nodule was excised in proximity of the rete testis. An intraoperative examination was performed with the description of ”small cordonal proliferation and tubules in fibrous stroma without germ-cell features” and need for further studies was claimed for a definitive diagnosis. Immunohistochemical studies showed intense vimentin stain and focal inhibin positivity. All the other immunostainings (calretinin, keratins, cd 117, melan A, podoplanin) were negative. Intense beta catenin nuclear and cytoplasmic positivities occorred in tumoral cells. No other surgery was performed, the 2-years follow up is negative.
Slide 11 HE low magnification2 HE3 HE high magnification4 HE ssct and rete testisIHC beta cateninIHC beta catenin SSCT and normal
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Case 3
Presented by: Justine Varinot, Paris, France

Man 42 years, consults with macroscopic hematuria in our urology department. At cystoscopy a huge lesion in the anterior bladder wall is seen. A large resection is undertaken. The patient relapses 3 years later. At the latter resection, the same features can be observed.
Slide 1Img_066Img_067Img_069Img_075Img_082Img_084
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Case 4
Presented by: Simone Bertz, Erlangen, Germany

We present the case of a 85-year-old female with a history of cervical cancer which was treated with combined surgery and radiation therapy 18 years ago (1995). Postoperatively the patient developed a urethral fistula which was surgically treated with a vesico-cutaneostoma to the abdominal wall.

In the year 2009, 14 years after the primary surgery, a nephrogenic adenoma was diagnosed within the vesical part of the vesico-cutaneostoma.

Now, another four years later the patient presented with a tumorous mass, 4 cm in size, within the pouch. Macroscopically the tumor showed a papillary surface. The tumor was resected.
Slide 1H&E slide 1H&E_slide 2H&E_slide 3PAX8_slide 4CK7_slide 5Ki67_slide 6
Ki67_slide 7
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Case 5
Presented by: Larisa Moskvina, Moscow, Russian Federation

Case 1: 58-years old man complained of haematuria and strangury in history. Cystoscopy has been performed and flat white-pink colored spot 2,5x1,5 cm with minimal exophyt was observed just above of the triangle area. Transurethral resection of bladder tumor has been performed.

Histologically, endophytic anastomosing cords and trabeculae of urothelium were detected. Most of the cells have lost their polarity, but citologycal atypia was minimal, no mitosis were seen. Basal membrane was distinct, submucosal and muscle layers were intact. The differential diagnosis included low-grade urothelial carcinoma with an inverted growth pattern and inverted urothelial papilloma. FISH with Uro Vysion (Abbott) has been performed. As a result, the violations of number of copies 3, 7, 17 chromosomes and 9p21 deletion detected.

Case 2. 13-years old girl had microhaematuria and leucocyturia during last 6 months. Grossly (cystoscopy) flat spot 1x1 cm was detected. Transurethral resection of bladder this area has been performed. Histologically, inverted endophytic tumor was covered by normal urothelium. This tumor was characterised by anastomosing trabeculae with minimal mitotic activity. FISH with Uro Vysion (Abbott) has been performed and no chromosome abnormalities were seen.
Slide 1Slide 1, case 1 (HE)Slide 2, case 1(HE)Slede 3, case 1 (HE)Slide 4, case 1(HE)Slide 5, case 2 (HE)Slide 6, case 2 (HE)
Slide 7, case 2 (HE)Slide 8, case 2 (HE)
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Case 6
Presented by: Pilar González-Peramato, Madrid, Spain

A 6-year-old boy was first seen in emergency room because of intestinal intussusception, caused by a hamartomatous polyp. The patient had a 7-month history of bilateral breast enlargement and tenderness. He also had pigmented maculae on his lips, increase in growth velocity and in bone age. He had normal male external genitalia with descended testes measuring 4 ml (normal prepuberal size < 4ml). Ultrasonography of both testes was normal. Laboratory studies showed moderately increased serum estradiol levels (28.5 pg/ml; normal range < 15 pg/ml). Biopsies of both testes were performed (Slides 1-3) followed by bilateral orchidectomy at the age of 8 ½ years (Slides 4-10). After orchidectomy a reduction in breast size, normalization of growth velocity, bone age progression and serum estradiol levels were observed.
Slide 1Slide 1 (HE)Slide 2 (T Masson)Slide 3 (T MAsson)Slide 4 (HE)Slide 5 (HE)Slide 7 (HE)
Slide 9 (T Masson)Slide 10 (HE)Slide 6 (HE)Slide 8 (HE)
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