Case of the Month (COTM) Submissions
We invite you to contribute to our popular Case of the Month series on the ISUP website.
If you have an educational case to share, please email it to: cotm@isupweb.net
20 year-old male diagnosed with 21α-hydroxylase deficiency/congenital adrenal hyperplasia
49 year-old male who presented with a right inguinal hernia and right testicular mass
May 2017
A 54 year old male with past medical history of hydrocele, presents with onset of bilateral scrotal masses and buried penis 6 months status post uncomplicated left inguinal herniorrhaphy. Sonographic imaging demonstrated skin thinking with underlying amorphous subcutaneous mass involving the scrotum, left > right, with compression of and atrophy of the left testis. Patient underwent resection of bilateral scrotal masses, which measured 21×16.5×4.5cm and 14x9x3.5cm.
81 year-old man presenting with an isolated leukoplakia-like penile (preputial) lesion of unknown duration.
A 0.3 cm incisional biopsy was performed.
A 73-year- old male with LUTS and s-PSA 6.6. A 10-core prostate biopsy was taken. In addition to a conventional prostate cancer GS 7 (neg for p63, pos for AMACR), a glandular proliferation is seen in 4 cores.
A 42-year-old male with right ureteric stricture
4-year history of recurrent right ureteric calculi, status post ureteroscopic lithotripsy (USRL) twice
Cystoscopy: Stenosis of right ureteric orifice, which was unable to pass guide wire
Treatment: Ureteric reimplantation with lysis of adhesion was performed; ureteric wall was sent to pathology
Gross findings: Thickened ureteric wall lined by smooth and flat mucosa
44-year-old man with right renal mass, retroperitoneal and mediastinal lymphadenopathy
An adrenal-sparing left radical nephrectomy was performed
Patient underwent several cycles of chemotherapy and biological treatment
Patient is alive with residual disease (retroperitoneal lymph nodes) 9 years after nephrectomy
71 year-old male with a 3.4 cm, mid-pole, left renal mass
An adrenal-sparing left radical nephrectomy was performed
Gross Description
Radical nephrectomy specimen
Single 3.4 cm yellow-brown, focally hemorrhagic mass in the mid-pole aspect of the kidney
Tumour grossly confined to the kidney – abutting the middle renal calyx and bulging into the renal sinus
No involvement of the renal vein or its segmental branches
A 68 year-old male with HIV and clinical benign prostatic hyperplasia underwent TURP.
In one of the TURP chips a glandular proliferation is seen streaming between benign glands.
October 2016
A 53 year-old female with an incidentally found 2.9 cm right renal mass on abdominal ultrasound.
Percutaneous needle biopsy was performed
limited lesion sampling (1-2 mm of tumor in a 15 mm core)
bland ovoid and spindle cells with no overt malignant features
positive for CD34 and SMA; negative for epithelial markers
reported as “mesenchymal neoplasm – definitive classification not possible on biopsy”
Patient chose surgical management over active surveillance with serial imaging
A right partial nephrectomy was performed
JULY 2016
– 55 year old male with long term use of exogenous testosterone.
– PSA- 6.9 ng/ml
– Digital rectal exam – large, firm prostate gland
– U/S imaging – anterior nodule, possible extraprostatic disease
– TRUS guided biopsies – 12 core set, anterior nodule not targeted for biopsy
64 year old male
5 year history of intermittent gross hematuria
Social history: Non-smoker, metal plater with exposure to trichloroethylene 15-20 years ago
No history of previous bladder lesions
3.5 cm bladder neck / trigone tumor
Cystoscopic examination: Papillary tumor with a narrow stalk, suspicious for urothelial carcinoma
Treatment: Transurethral resection of tumor
– 35 year old female with a history of ovarian serous borderline tumor (treated by resection only)
– Incidentally detected heterogeneous, enhancing 5 cm upper pole renal mass on an otherwise negative follow-up CT scan for her ovarian tumor
– Lesion was deemed suspicious for renal cell carcinoma (RCC) by imaging criteria
– Right radical nephrectomy was recommended and performed, with a 6.3 cm predominantly solid mass in the upper pole of the right kidney
64 year-old male
PSA – 33 ng/ml
Digital rectal exam – right posterolateral nodule
Prostate biopsy – Gleason 8/10 (4+4) (ISUP 4), involving 1 of 12 cores and 100% of the positive core, right lateral
Staging work-up – negative for metastases
Treatment – radical prostatectomy performed according to patient preference
MARCH 2016
57 year old man presented with a 3 cm incidental renal mass. A tumorectomy was performed. Patient is alive and well 7 months after surgery
February 2016
Clinical history: 57 y/o male with 3 cm right renal mass. Partial nephrectomy was performed
January 2016
A 68 year-old man with PSA-elevation and negative DRE undergoes a 12-core prostate biopsy. Five of the cores show extensive glandular atypia.
A 54 year-old female with incidentally detected tumor in the left kidney. Partial nephrectomy was performed an a 2.8 x 2 x 2 cm rounded tumor with solid cut surfaces was found.
A 58-year-old man underwent radical prostatectomy. In the prostatectomy specimen, an organ-confined cancer Gleason score 3+3=6 was found. However, there was also a separate lesion in the peripheral zone measuring 15 x 10 mm.