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PREVIOUS Cases of the Week 2020

2020-52 / December 28

A male in his 80s presented with gross hematuria. On CT abdomen, there was a plaque-like thickening of the bladder wall measuring 7 x 6.5 x 2 cm with “fat stranding”.  On cystoscopy, no distinct bladder mass was identified and a biopsy was performed.


2020-51 / December 21

A previously healthy woman in her late 30s presented with a flank pain.                                        A 9.5 cm left renal mass was seen on imaging.


2020-50 / December 14

A man in his early 60s with a history of renal cell carcinoma metastatic to the lung   presented with gastrointestinal bleeding. Endoscopy revealed multiple small polyps              in the second and third segment of the duodenum, which were biopsied.


2020-49 / December 7

Penile lesion in a man in his 40s


2020-48 / November 30


Small incidental renal cortical cyst with small papillary proliferation in a male patient in his 70s operated on for high-grade ureteric urothelial carcinoma


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.


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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