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PREVIOUS Cases of the Week

2020-47 / November 23

A man in his 50s presented with an elevated PSA of 27 ng/ml.  A prostate biopsy was performed and all cores had prostatic cancer with 80% to 90% involvement of each core. Subsequent radical prostatectomy was performed and revealed the following findings.  


2020-46 / November 16

A woman in her early 50s presented with abdominal pain and was found to have an 8 cm  left retroperitoneal mass on imaging. A resection including the mass and adjacent left kidney was performed.



2020-45 / November 9

A man in his 60s presented with right sided abdominal pain. The CT scan of abdomen and pelvis with contrast showed an enhancing plaque-like thickening of the bladder wall. The patient underwent transurethral resection of bladder tumor and subsequent cystectomy, which revealed the lesion shown below.


2020-44 / November 2

A man in his late 60s underwent a nephrectomy for a slowly growing renal mass.  He had a prior diagnosis of oncocytoma on a core biopsy 7 years ago.


2020-43 / October 26

A man in his early 50s underwent radical orchiectomy due to a 5.5 cm solid mass in the left testis and a partial orchiectomy for a 1.2 cm solid mass in the right testis.


2020-42 / October 19

A man in his mid 60s had a prior history of prostatic adenocarcinoma (Gleason score 5+5=10, involving 12 cores). His PSA level initially declined to undetectable after introducing treatment with abiraterone + prednisone 1.5 years ago. He now presents with rising PSA level and has evidence of new bone metastases identifiable on CT imaging. A TURP was performed to relieve his urinary symptoms.


2020-41 / October 12

Nephrectomy for a renal mass in female patient in her 50s. H&E and CD10 immunostains are shown.


2020-40 / October 5

A woman in her 50s underwent a total nephrectomy for a 2.3 cm complex solid and cystic renal mass.


2020-39 / September 28


A man in his late 30s presented with a 1.5 cm solid nodule at the head of the left epididymis.


2020-38 / September 21


A man in his mid-50s underwent a 12-core prostate biopsy. Extensive glandular atrophy and

basal cell hyperplasia were seen in all cores. In addition, the following focal lesion was identified


2020-37 / September 14

A man in his mid-50s underwent a total nephrectomy due to a 7.5 cm solid tumor.

Imaging suggested intratumoral calcifications. 



2020-36 / September 7


A male patient in his 70s underwent prostatectomy 3 months after 12-core prostate biopsy with the diagnosis of acinar adenocarcinoma Gleason 3+4 (Grade Group 2) in one biopsy site. The images are from the prostatectomy specimen.


2020-35 / August 31

A 66-year old patient underwent 12-core prostate biopsy.


2020-34 / August 24


A woman in her 20s presented with gross hematuria for over 3 months. MRI identified a 7.2 cm left renal mass. Metastatic disease was excluded based on imaging.


2020-33 / August 17

A woman in her early 50s presented with multiple broad-based bladder mucosal lesions seen on cystoscopic examination.



2020-32 / August 10

A woman in her mid 50s presented with persistent microscopic hematuria and declining renal function.  She was found to have a non-functioning right kidney. The CT appearance was suggestive of upper ureteric urothelial carcinoma with no evidence of distant metastases. The patient underwent elective nephroureterectomy.


2020-31 / August 3

A 55-year old male patient underwent a total nephrectomy due to a 7.5 cm solid tumor. Imaging suggested intratumoral calcifications.


2020-30 / July 27

50-year-old male with a 10.8-cm right mid pole kidney mass and lymph nodes suspicious for metastasis.



2020-29 / July 20

On follow up for a renal mass, a man in his early 60s presents with a fracture of his right arm. Imaging revealed a renal mass (5.5 x 1.7cm) in the lower pole, a destructive lesion involving humeral metaphysis, and small satellite nodules in liver. 


2020-28 / July 13

A woman in her early 30s presented with flank pain.  Subsequent MRI confirmed a mixed solid and cystic renal mass (Bosniak IV) measuring 4 cm in greatest dimension, favored to be a cystic carcinoma. Gross and histological images from the partial nephrectomy specimen are shown below.


2020-27 / July 6

A man in his late 80s underwent a transurethral resection of the bladder due to clinical diagnosis of bladder cancer.



2020-26 / June 29

A 30 year-old male presented with long history of back pain and pain with ejaculation, which led to imaging studies that revealed left renal (3.5cm) and large retroperitoneal mass (6.5cm). He has a history of left undescended testicle as a child. Grossly, the kidney tumor exhibits solid and cystic cut surface on partial nephrectomy. Immunohistochemical stains show positive PAX8, GATA3 and AMACR expression in tumor cells, and negative immunoreactivity for CK7.


2020-25 / June 22

A man in his mid 30s presented with a testicular mass. Areas represented by the photomicrograph encompassed several low magnification fields. A minor percentage of seminoma was present, while the majority of the lesion was teratoma. WT1 was expressed by lesional tissue shown.


2020-24 / June 15


2020-24 / June 15

A 60-year old patient underwent a transurethral resection of the prostate due to clinical diagnosis of nodular hyperplasia.


2020-23 / June 8


A 4 month-old boy with an unremarkable past medical history presented with a 9.0 cm renal mass. The patient was radiographically diagnosed and underwent 5 weeks of pre-surgical chemotherapy.  


2020-22 / June 1

A woman in her 60s with a well circumscribed mass in the renal cortex.


2020-21 / May 25

A male in his 40s presented with left testicular swelling and pain. On ultrasound, a solid mass was identified in the left testis. Pre-operative AFP and HCG serum levels were not elevated. Serum LDH was mildly elevated preoperatively. The patient underwent a left radical orchiectomy for a presumed testicular tumor.


Grossly, no discrete mass was noted in the specimen, but the cut surface of the testis was remarkable for hemorrhage. Given the discrepancy between the clinical impression and gross findings, the orchiectomy specimen was extensively sampled for microscopic examination and the main findings are shown in the accompanying photomicrographs.


2020-20 / May 18

A 64 year-old-male presented with hematuria and a mass in the fossa navicularis of the anterior urethra. Past history was notable for Grade Group 5 (Gleason score 4+5=9) pT3b pN0 acinar adenocarcinoma of the prostate. His PSA had an interval increase to 0.569 ng/mL. PSA immunohistochemistry on the tumor showed scattered patchy expression.


2020-19 / May 11

A 53 year old male with pT3b prostate cancer developed gross hematuria 20 months after receiving external beam radiation. A cystoscopy showed friable mucosa, which was thought to be suspicious for bladder cancer.


2020-18 / May 4

The patient in his 40s presented with a complaint of a right testicular mass. Ultrasound revealed a 2.0 cm cystic mass. Serum tumor markers (HCG, AFP, LDH) were all normal. Positive immunohistochemical stains are shown. Additional stains performed (all negative) included CK5/6, calretinin, and OCT4.


2020-17 / April 27

A 55-year-old man presented with paratesticular pain and swelling. A hydrocelectomy was performed.



2020-16 / April 20


2020-16/ April 20

An man in his 80s with a history of painless hematuria has a small polypoid lesion within the proximal prostatic urethra.  


2020-15/ April 13


 A 65 year old male was found to have a 2.6 cm partially renal mass. A robotic partial nephrectomy was performed. Special stains for microorganisms were negative.



2020-14 / April 6


2020-14/ April 6

A middle-aged man with no prior medical history presents with hematuria.  A TURBT was performed.


2020-13 / March 30


A 29-year-old man presented with symptoms of lithiasis and was found to have a heavily calcified 1.9 cm renal mass, interpreted radiographically as a benign process. IHC was performed for CK7 (diffuse positive), and CA-IX (diffuse positive, picture shown) and CD10 (negative). 


2020-12 / March 23


55 year old male with a 0.5 cm bladder polypoid lesion.



2020-11 / March 16


71 y/o male with an incidental 4.8 cm renal tumor treated with partial nephrectomy.  The tumour is positive for PAX8, CK7 and KSP-Cadherin. CK20, Vimentin, CD10, AMACR and CA IX are negative. SDHB and Fumarate Hydratase are retained. The Ki-67/MIB1 index is low (≤5%).



2020-10 / March 9


52 year old male presented with chronic left epididymal pain and discomfort. On physical examination, the posterior portion of left epididymis felt “nodular”.  The patient had a vasectomy more than 20 years ago. Images are from the epididymectomy specimen.



2020-9 / March 2


36 year old male with hematuria was found to have a renal mass, enlarged regional lymph nodes and metastatic lesions in the liver. A biopsy of the renal mass was performed.



2020-8 / February 24


2020-8 / February 24

43 year old female with a 1.7cm renal cortical mass found incidentally on imaging.



2020-7 / February 17


A 72-year old patient underwent a transurethral resection of the prostate due to clinical diagnosis of nodular hyperplasia. He had a previous transurethral resection of the prostate 18 months earlier. Micrographs show one or two areas of interest in the specimen, the largest area measuring 2.5 mm. The lesion was positive for PAX8 (photo), negative for PSA and Ki67 stained less than 5% of the cells. 


2020-6 / February 10


A 58 year old man presented with a cystic 8.0 cm. mass in the testis. 



2020-5 / February 3


80 y/o male with hematuria and a bladder tumor. NKX3.1 and prostein immunostains are shown. Otherwise the tumor is positive for AR, PSMA and PSAP and is negative for  GATA3, UroplakinII, CKHMW, p63, CK5/6.


2020-4 / January 27

A 17-year-old patient with a paratesticular mass.



2020-3 / January 20


A 39-year old male presented with a painful slowly enlarging left testicle with mass. A left radical orchiectomy was performed.



2020-2 / January 13

A 31 year-old male was treated with chemotherapy for clinical retroperitoneal metastases a malignant germ cell tumor composed of 90% embryonal carcinoma, 9% yolk sac tumor (YST), and 1% teratoma. Post chemotherapy there was residual retroperitoneal tumor. A retroperitoneal lymph node dissection was performed.  


2020-1 / January 6

A 56 yo man presented with a complaint of hoarseness. Imaging studies revealed multiple nodules in his right lung and an 11 cm mass in his left kidney. Clinically, he was thought to have a kidney cancer with lung metastases. He underwent a radical nephrectomy. PAX8 (image 4) and TTF1 (image 5) immunostains are shown.


2019-45 / December 30

A 46 y/o male with a testicular mass undergoes orchiectomy. On gross examination a well demarcated 1,5 cm tumor with spongy appearance confined to testis is seen.



2019-44 / December 24

76 y/o M, presents with hematuria. On cystoscopy, bladder lesion found and biopsied.


2019-43 / December 16

A 55 year old male had neurogenic bladder secondary to spinal cord injury and paraplegia. The patient performs self-catheterization for urination. He had history of repeated urinary tract infections with cultures showing Klebsiella and E. coli infections. He complained of bleeding during catheterization two months prior to the presentation. A cystoscopy showed diffuse erythema in the dome of the bladder and a nodule in the anterior wall of the bladder. A biopsy of the nodule was performed.


2019-42 / December 9

A 55-year-old male with paratesticular mass with clinical suspicious of an epididymal tumor. Intra-operative frozen section was requested due to ultrasound finding of hypervascularity. A 3.8 cm tumor was received with grossly multilobular appearance. Cut surface showed multilobular lesion with fibrous septae and myxoid/edematous areas.


2019-41 / December 2

A 36 year-old male underwent an orchiectomy for a 1.1 cm. testicular mass.  



2019-40 / November 25

10-year-old girl with 15 cm renal mass and multiple pulmonary metastases. She received neoadjuvant chemotherapy according to the SIOP Umbrella Protocol followed by radical nephrectomy. The immunophenotype was as follows: diffusely positive for vimentin, INI1, CD99, focally positive for cyclin D1, PAX2, S100, and negative for EMA, WT1, AE1/AE3, TLE1, ERG, FLI1, CD56, BCL2, PAX8, desmin. FISH analysis was carried out using EWSR1/FLI1 TriCheck Probe, which identified an EWSR1 rearrangement, but the FLI1 was intact.   


2019-39 / November 17

24-year-old male with congenital adrenal hyperplasia and bilateral testicular masses.



2019-38 / November 10

A 45 year old female presented with abdominal pain during her menstrual cycle. Abdominal imaging showed a right ureteral mass and obstruction. The patient underwent right segmental ureterectomy.



2019-37 / November 3

70 year old male with a bladder mass. CT with contrast showed a 2 cm left sided well-circumscribed bladder mass in the wall. Robotic partial cystectomy was performed. Pictures: 1-3 H&E’s, 4- CD34, 5- STAT6


2019-36 / October 28


A 74 year-old female presented with a bladder mass obstructing the left ureteral orifice.


2019-35 / October 21

72 y/o male with hematuria, bladder lesion found on cystoscopy.


2019-34 / October 14

A 70 year old man underwent a TURB for a large hyperkeratotic lesion involving the entire bladder. The lesion could not be totally resected with only partial sampling performed.


2019-33 / September 30

An 82-year-old male with a prior history of rectal adenocarcinoma (treated surgically, followed by adjuvant chemo and radiation therapy) and upper tract urothelial disease (treated with a right sided nephroureterectomy) was recently diagnosed with penile cancer.


2019-32 / September 23

69-year-old male with an elevated PSA and a cluster of somewhat dilated glands on prostate needle biopsy (images 1-3: low and high magnification images & PIN-4 IHC triple stain); images 4-5 depict a similar cluster in a prostatectomy specimen from a different patient.


2019-31 / September 16

A 53-year-old woman presented with right upper quadrant fullness, increasing abdominal discomfort and a dull ache on her right flank over three months. Subsequently, she underwent excision of a large retroperitoneal peri-pancreatic solid and cystic mass, measuring 17cm in greatest linear dimension. This neoplasm did not appear to involve the adrenal gland. Histopathologic examination revealed a paraganglioma.


2019-30 / September 9

A 78-year-old male underwent a transurethral resection of the prostate and representative images are shown.

The immunophenotype is as follows:

Positive: CK7 & focal, patchy expression of CK20, CKAE1/3 and CK-HMW

Negative: NKX3.1, PSA, PSAP, P40, GATA3, synaptophysin and chromogranin

Retained: PTEN


2019-29 / September 2

A 4 year old boy presented with gross hematuria and a solitary bladder mass was identified on a renal/bladder ultrasound.   Cystoscopic biopsy confirmed malignancy, and a partial cystectomy was performed.  Representative H&E images and an immunostain for INI1 are shown.   The tumor was also negative for pan-cytokeratin, EMA, S100, desmin, myogenin, myoD1, and CD34. 


2019-28 / August 26

Representative images of transurethral resections of bladder tumors taken from a 33-year-old male have been depicted.


2019-27 / August 19

74 year old male presenting with gross hematuria and a bladder mass on cystoscopy.



2019-26 / August 12

A 30 year old male who  immigrated from Africa presents with gross hematuria. Cystoscopy and biopsy are performed.



2019-25 / August 5

A 55-year-old female was found to have a 5.9 cm solid-cystic renal mass. Representative H&E images and an immunostain for Cathepsin K are shown.



2019-24 / July 29

26-year-old male presents with a “fibrous plaque” of the penis associated with curvature.  The patient undergoes surgery for presumed Peyronie’s disease at which time the surgeon excises the plaque material. The tumor is Keratin-positive. The immunostain shown is INI-1.


2019-23 / July 22

A 33-year old male with a prior history of a desmoplastic medulloblastoma was found to have a 1 cm left testicular mass on follow up. Representative images of this lesion are shown. The immunophenotype is as follows:

Positive: SF1, S100, CD68 and vimentin

Negative: calretinin, inhibin, CK AE1/3, CD31, CD34, SMA, melan A, HMB45, CD163


2019-22 / July 15

65-year-old gentleman presents with elevated PSA. Transrectal biopsies performed.


2019-21 / July 8

25-year-old white male presents with large renal mass with pulmonary metastases.   A nephrectomy was performed. SDH B immunostain is shown.


2019-20 / July 1

35-year-old female presents with hematuria.   She has a history of hypertension.  Cystoscopy revealed a 3 cm bladder mass and transurethral resection was performed.   The tumor is positive for GATA3 and synaptophysin.


2019-19 / June 24

 A 69 year old male presented with a 9.2 cm well circumscribed renal mass.


2019-18 / June 17

A 58-year-old male presented with urinary obstruction and elevated PSA of 12 ng/ml. He underwent transurethral resection of the prostate (TURP).


2019-17 / June 10

A 78 year old man presented with a mass in the left seminal vesicle. A cystoprostatectomy was performed.


2019-16 / June 3

40 year old male with a 9.5 cm cystic and solid renal mass. All images are from the radical nephrectomy specimen.



2019-15 / May 27

A 65 year old male with a bladder mass. Transurethral resection is performed.



2019-14 / May 20

84-year-old male with a history of follicular lymphoma, melanoma, and a 3.6 cm kidney mass, present with inguinal lymphadenopathy. Images are from biopsy of left inguinal lymph node.


2019-13 / May 13

54 yo male with a testicular mass. By immunohistochemistry, tumor cells are positive for cytokeratin AE1/AE3, desmin (perinuclear dot pattern) and WT1.


2019-12 / May 6

A 70 year old man underwent a 12 part needle biopsy of the prostate due to elevated serum PSA levels. In one part, an atypical focus at the end of the needle biopsy was noted.



2019-11 / April 29

A 57 year-old male underwent radical prostatectomy for Grade group 2 prostatic adenocarcinoma diagnosed on biopsy. Upon microscopic examination, a glandular lesion was identified in the left anterior prostate, in addition to a large tumor nodule of Grade group 2 cancer in the right posterior.  The following images are representative of the left anterior lesion which showed strong and diffuse staining with PAX2 (shown) and racemase, and negativity for PSA and WT-1. 


2019-10 / April 22

 A 67-year-old male with a 2.9 cm organ-confined renal mass.



2019-9 / April 15

A 65 year old man presented with a 3 mm nodule in the bladder.


2019-8 / April 8

A 35-year-old male presented with a 2-week history of discomfort and enlargement of the right testis. He was eventually treated with a right orchiectomy which revealed involvement by seminoma. Subsequently, he presented with early retroperitoneal relapse while on surveillance.



2019-7 / April 1

40-year-old female with a 4.5 cm solid and cystic renal mass. Images are from the radical nephrectomy specimen.


2019-6 / March 25

A 54 year old man presented with multiple bone metastases and a mass involving the bladder neck. A TUR of the bladder was performed. On outside stains, the tumor was negative for CD138, kappa and lambda light chains, CD56, CD45, CK7, HMWCK, AE1/3, desmin, and GATA3. Stains performed at our institution were positive for NKX3.1, P501S, PSA and negative for GATA3 and Uroplakin II. E-cadherin was lost in the tumor.

2019-5 / March 18

The cut surface of the kidney reveals a diffusely cystic appearance in an adult (Case 1) and in a separate pediatric patient (Case 2), respectively.


2019-4 / March 11
A 43-year-old male presented with a painless testicular mass. Representative histopathologic images and results of molecular testing are shown.


2019-3 / March 4
A 25 year old man was found to have a 5.0 cm. paratesticular mass.

2019-2 / February 25
A 79 year old male underwent a TURP due to obstruction. The tumor was stained at the outside institution and was diffusely positive for high molecular weight cytokeratin and negative for PSA, PSAP, GATA3, synaptophysin, with a ki67 of 90%.

2019-1 / February 18
68 year old male with large bladder mass. Transurethral resection is performed.


About GUPS

The Genitourinary Pathology Society (GUPS) was formed with the vision of advancing the care of patients with urologic diseases through enhancements of best practices, research, and education in the subspecialty of Urological Pathology.

GUPS is an official Companion Society of the United States and Canadian Academy of Pathology (USCAP).

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