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Diseases of the Ureter and Renal Pelvis

In the author’s surgical pathology practice at a large tertiary teaching medical center, the upper urinary tract specimens account for 5% to 10% of the genitourinary specimens. The major differences in clinical behavior and management between lesions of the upper and lower urinary tract include: 1. Urothelial carcinoma of the upper tract is generally considered to be more aggressive than its counterpart in the lower tract,…

Introduction to Renal Biopsy

Indication for Renal Biopsy The first aspiration renal biopsy was performed in 1944. The technique was introduced into clinical use in the early 1950s; however, only in the early 1960s was it considered a valuable and safe diagnostic procedure. The first part of this chapter provides an approach to medical renal disease for residents, fellows, and pathologists. Diagnoses in renal allograft and medical kidney diseases represent…

Neoplasms of the Kidney

Renal Cell TUMORS Renal cell carcinomas are tumors that arise from or recapitulate the differentiation of the renal tubular epithelium. They are by far the most common renal cancers and account for more than 90% of all malignancies in the kidney. Renal cell carcinomas vary greatly in incidence from one region to another, but their significant male predominance is maintained throughout the world. Tobacco smoking, obesity,…

Nonneoplastic Diseases of the Kidney

This chapter is divided into the following four sections: gross and histologic features of the normal kidney, congenital anomalies and cystic diseases, vascular diseases, and tubulointerstitial diseases. An understanding of the normal macroscopic and microscopic features of the kidney is essential for recognition of the departures from normal discussed in this chapter. The other three sections contain common or important entities that are encountered in the…

Neoplasms of the Urinary Bladder

Tumors of the urinary bladder include neoplasms of virtually all types of tissue derivation, and the 2004 World Health Organization (WHO) classification of tumors of the urinary system and male genital organs reflects this diversity ( Table 4-1 ). The histologic classification of tumors of the urinary tract includes urothelial tumors, squamous neoplasms, glandular neoplasms, neuroendocrine tumors, melanocytic tumors, mesenchymal tumors, hematopoietic tumors, and miscellaneous tumors.…

Nonneoplastic Diseases of the Urinary Bladder

Anatomy and Histology Located in the pelvis minor, the urinary bladder is shaped like an inverted pyramid. The superior surface, the dome, is covered by peritoneum. The most anterosuperior point, the apex, is where the median umbilical ligament and the urachus insert. The posterior surface forms the base of the bladder. Between the bladder and the rectum lie the lower vasa deferentia and seminal vesicles in…

Neoplastic Diseases of the Prostate

Prostatic Intraepithelial Neoplasia Clinical Features Prostatic intraepithelial neoplasia (PIN) is a noninvasive neoplastic proliferation of the acinar epithelium that arises within preexisting prostatic acini and ducts. PIN glands have a benign architecture but are lined with cytologically atypical cells characterized by cellular stratification, papillary formation, nuclear enlargement, and mitotic activity. Originally, PIN was divided into three grades (PIN I, II, and III); PIN now has been…

Nonneoplastic Diseases of the Prostate

The Prostate Gland Anatomy and Histology In an adult man without prominent prostatic hyperplasia, the average weight of the prostate gland is approximately 20 to 30 g. The shape of the gland roughly resembles an inverted cone (or prolate ellipsoid or spheroid), with the base located at the bladder neck and the apex distally at the urogenital diaphragm ( Fig. 1-1 , A ). The prostatic…

Eye and Orbit

Adult Ocular Lesions External Lesions Malignant Melanoma of the Conjunctiva Clinical Features † Deceased Usually pigmented (may be amelanotic), nodular, elevated lesion with vascularity, anywhere on conjunctiva Usually mobile, but may be fixed to sclera Indistinct edges More common in fair-skinned patients Frequently develops from malignant patches of primary acquired melanosis Metastasize to regional lymph nodes, as well as lungs, liver, brain, bone, and skin through…

Central Nervous System

Diffuse Astrocytic Tumors Diffuse Astrocytomas of Each Grade are Now Divided Into One of Two Diagnostic Categories Based Upon the Isocitrate Dehydrogenase (IDH Gene Mutation Status (IDH Mutant or IDH Wildtype). if the Testing is Not Available or Cannot be Performed the Diagnosis is Specified as Diffuse Astrocytoma, Anaplastic Astrocytoma, or Glioblastoma, NOS (Not Otherwise Specified). The IDH Mutation May be Either in the IDH1 or…

Heart, Pericardium, and Blood Vessels

Heart Cardiomyopathy Clinical Features Hypertrophic Cardiomyopathy Myocardial disease characterized by left ventricular hypertrophy in the absence of systemic hypertension, aortic valve stenosis, or overt infiltrative diseases Associated with normal systolic function and diastolic dysfunction; systolic dynamic obstruction of the left ventricular outflow tract occurs in 25% Estimated prevalence of unexplained left ventricular hypertrophy on echocardiography compatible with a diagnosis of hypertrophic cardiomyopathy is 1 in 500…

Soft Tissue

Nodular Fasciitis Clinical Features Primarily affects young adults aged 20 to 40 years; occasionally seen in children Presents as a rapidly growing solitary mass; may be painful Inconsistently associated with recognized previous trauma (10% to 15%) Can involve any site; flexor aspect of forearm, chest, and back are common sites Spontaneous regression is expected Gross Pathology Located in the deep dermis or subcutis; occasionally occurs intramuscularly…

Bones and Joints

Osteoid Tumors Osteoma Clinical Features Male predominance (2:1 to 3:1) Age ranges from second decade to elderly, with most cases occurring in fourth and fifth decades Occurs most commonly in skull bones, including mandible, maxilla, frontal sinuses, ethmoid sinuses, paranasal sinuses, orbital bones, and calvarium; rarely involves the clavicles and long bones May be asymptomatic or, if in sinuses, may present with signs of obstruction, including…

Spleen

Non-Neoplastic Diseases Involving the Splenic White Pulp Reactive Follicular Hyperplasia With Germinal Center Formation Clinical Features Occurs at any age; more common in children and younger adults Caused by a variety of both acute and chronic immunologic stimuli (e.g., bacterial infections, autoimmune diseases including hemolytic processes) May represent an incidental finding Gross Pathology May present with splenomegaly, usually mild to moderate in degree ( Figure 15.1…

Lymph Nodes

Normal Lymph Node Histopathology A lymph node contains a cortex, a paracortex, a medulla, sinuses, a hilum, and a fibrous capsule The cortex is a B-cell area, which contains primary (nonstimulated) lymphoid follicles composed of small mature lymphocytes and secondary (activated) follicles with germinal centers composed of a mixture of small cleaved lymphocytes (centrocytes) and large noncleaved lymphoid cells (centroblasts), as well as numerous tingible-body macrophages…

Breast

Subareolar Abscess Clinical Features Develops in lactating and nonlactating breasts, usually in nonlactating breasts Found in women of any age, typically during reproductive years Can be seen after reduction mammoplasty May resemble inflammatory carcinoma clinically May present as a painful, erythematous, and edematous breast Organisms associated with abscess formation include bacteria such as Staphylococcus, Proteus, Bacteroides , and Streptococcus species Tuberculosis may be the cause in…

Female Reproductive System

Vulva Inflammatory dermatologic diseases that affect hair-bearing skin elsewhere on the body may also occur on the vulva (see Chapter 2 ). A selected group of disorders are addressed here primarily because of the frequency with which they are seen on the vulva. Lichen Sclerosus (Chronic Atrophic Vulvitis) Clinical Features Most common in postmenopausal white women Tends to develop slowly but is insidious and progressive Stenosis…

Male Genitourinary System

Prostate Gland Acute and Chronic Prostatitis Clinical Features Clinical classification of acute and chronic prostatitis Acute bacterial prostatitis Chronic bacterial prostatitis Chronic abacterial prostatitis Prostate is swollen and tender on palpation Often refractory to antibiotic therapy because the prostate is a “safe haven” for bacteria Patients may present with recurrent urinary tract infections Cultured organisms are the same as those seen in urinary tract infections (i.e.,…

Ureter, Urinary Bladder, and Kidney

Ureter Ureteritis Cystica Et Glandularis Clinical Features One of the most common non-neoplastic urothelial proliferations Reactive urothelial proliferation that develops following an inflammatory stimulus Typically asymptomatic and found incidentally Gross Pathology Nodular cobblestone appearance due to numerous small, superficial, fluid-filled cysts Histopathology Ureteritis Cystica Von Brunn nests (small nests of normal urothelial cells within lamina propria) with central lumens (cystic dilatation) lined by urothelial cells Ureteritis…

Adrenal Gland

Adrenal Cortical Insufficiency (Addison Disease) Clinical Features Primary Adrenal Cortical Insufficiency Etiology Autoimmune etiology in 75% to 90% of cases, with circulating autoantibodies to endocrine antigens (21-OH, P-450scc, and 17-OH) Other causes include infectious diseases such as tuberculosis, hemorrhage (sepsis), metastatic tumors, amyloidosis, adrenoleukodystrophy, and drugs Signs and symptoms: weakness, fatigue, salt craving, hypotension, anorexia and weight loss, hyperpigmentation (due to elevated adrenocorticotropic hormone [ACTH] and…