Discover and read the best of Twitter Threads about #GUpath

Pelvic biopsy on a 20yo boy. Clinically presented with a large mass inseparable from the bladder and widespread mets. Radiology strongly favored a UCA and patient was transferred to the GU service. Continued 👇#GUpath

The young age of the pt and the morphology didn't make sense for UCa to me. D/D considerations included
NET & SBRCT.

I did a limited panel. Pos stains: Ker, desmin, CD99 Neg stains: CG, Syn, GATA

Continued: 👇#GUPath

Diagnosis: Diagnosis: Desmoplastic small round cell tumor (pending FISH conf).

Lessons learned:
1. Trust your instincts, esp if the clinical scenario isn't making sense
2. I am glad my Soft Tissue Pathology fellowship from 12 years ago hasn't completely failed me #GUPath

Brian Cox, MD, MAS

@Dr_Brian_Cox

Yesterday was a fun day on #GUPath. PGY1s, how many of these renal cell tumors can you name?

The oncocytic one is strongly and diffusely CK7+. What does this help differentiate it from?

Oncocytoma. Both chromophobe and oncocytoma are associated with Birt-Hogg-Dubé syndrome, an AD syndrome where you get papular fibrofolliculomas of face, neck, and trunk as well as multiple oncocytic RCCs. It is associated with 17p12q11 abnormality involving folliculin protein.

Read 11 tweets

Brian McMillen

@Teclis82

@slusagar

#GUpath
So many great tutorials lately, I’ll contribute this review on some prostate cancer basics.
Prostate cancer 101
Random section from a prostatectomy for cancer.
@slusagar @TheKarenPinto @Williamson_SR @ariella8 @MELanocyteMD @TedFarMD @mhassanaimc

2. Slightly higher power, ill address each of the circled areas.

3. Orange box: Atrophy. Make a mental note of the lobulated architecture (red circles), a benign feature.

Read 11 tweets

Bladder tumor in a 60 y. Stains and D/D below 👇#GUpath

D/D considerations of a tumor with glandular features include:
1. UCa with glandular features
2. Urachal carcinoma
3. Clear cell adenocarcinoma
4. Metastasis

This case was PAX8+ CK7+ HNF1B+(pics) GATA3-

Diagnosis: Clear cell adenocarcinoma #GUPath

Continued 👇

Always be suspicious of glandular bladder tumors , esp if there isn't a typical UCa component present.

CC AdenoCa can occur anywhere in the GU tract with a propensity for the urethra and diverticulae.

Stains can help distinguish from urachal Ca. History is important #GUPath

Karen Pinto DNB, FRCPath

@TheKarenPinto

History: Female, 50-ish, presented with hematuria.

Cystoscopy: Congested mucosa with bleeding ulcers

Biopsy from urinary bladder lesion

#pathology #GUPath

What should I do?

I should call the surgeon

“Did the patient have urinary bladder cancer before?”

NO
Patient had cervix cancer, a year back

Read 17 tweets

Renal bx from a woman in her late 50s, with a renal mass and metastasis. This biopsy is from the kidney. This was a highly infiltrative, high grade tumor with a desmoplastic background. Continued 👇 #GUpath

The referring institute reported + PAX8, CK7, - GATA3, CK20, TTF1. O/S diagnosis was collecting duct carcinoma.

Upon review by us, we realized that the pt was AA and ordered an INI-1 which was negative.

Diagnosis: Renal medullary carcinoma (confirmed by Hb electophoresis) 👇

@PavlosMsaouel

True CDC of the kidney is extremely rare and is a diagnosis of exclusion. All tumors that look like a high grade adenoca, automatically get an INI-1. (I always exclude Uca and mets.)

RMC is usually a disease in younger pts, but can present at any age. #GUpath @PavlosMsaouel 👇

Continuing yesterdays theme. Renal bx from a mass in a 55 yo. This one showed more stroma and the nuclei lining the cysts were less "ugly". Continued 👇#GUpath

Mass was resected and was <4 cm and well circumscribed. 👇

Always run an FH stain (pic) on anything that looks tubulocystic . This was also positive for CK7, P504S and neg for CAIX and CD117.

Final diagnosis: Tubulocystic RCC

Continued 👇

Rib mass in a young male with a renal mass (not biopsied). Morphology was entirely tubulocystic. Thread continued below. 👇 #GUpath

This is what the follow up resection looked like. I received this a few years ago, before we had the FH stain in house. Given the extensive tubulocystic morphology and high grade nuclei, I asked the clinician to test the pt for an FH gene mutation (he was + for the mutation). 👇

Final diagnosis: HLRCC.

Tumors may be extensively tubulocystic (TC), especially on bx. These are far more common (in my practice) than true TC RCC's. I run the FH stain on all RCCs with TC features.

Bx was signed out as RCC with TC features, clinically exclude HLRCC. #GUpath

Incidental renal mass. Stains and diagnosis 👇#GUpath

PAX8 (highlighting epithelium) and HMB45 (stains stromal component).

Diagnosis: Angiomyolipoma with epithelial cysts (AMLEC) ER highlights condensed subepithelial stroma below the cyst epithelium. Cystic change may be very focal or extensive. Pay attention, especially on biopsies, for a cyst lining. #GUpath

Histologic features of RCC, status post immunotherapy.
These features include extensive lymphoplasmacytic infiltrate, hemosiderin deposition, hylanization and fibrosis. Continued 👇 #GUpath

As in this example, tumor can be obscured by inflammation and need a CK (pic) to make a diagnosis. Also pictured is CD10 . Continued 👇 #GUpath

In my practice, I give an estimate of residual tumor burden, which is a more accurate assessment of tumor response as the gross size may stay the same (or even increase- called "pseudoprogression") due to the intense inflammatory infiltrate, which can mimic a mass. #GUpath

Renal tumor in a 19 year old. Stains and diagnosis 👇 #GUpath

CD117 and Synaptophysin (pictures) +. PAX8 -

CD34+ (pic) keratin -

I present to you, the single best case of my life.

36 yo woman with a kidney tumor. This was sent to me in consultation by a very smart friend in private practice because she thought it "looked funny". Thread continues 👇#GUpath

All keratins negative, PAX8 (pic), CAIX (pic) and S100 + ki-67=10% . Only very rare mitoses identified, which was also odd.

Still funny. I had a diagnosis in mind, so I ran more stains. All melanocytic markers and TFE3 -. Inhibin (pic1) strongly positive. CD31 (pic2) positive in vascular network. Of note, no tumors anywhere else in the body.