Questions in Daily Urologic Practice: Updates for Urologists and Diagnostic Pathologists

Front Matter....Pages I-X
Front Matter....Pages 1-1
Does a prostatic capsule exist? Pathologists and urologists use the word “capsule” when evaluating the extent of prostatic cancer in prostatectomy specimens....Pages 3-6
What is the anatomic structure of the prostate? Where is the transition zone? Where does carcinoma develop? Where does benign prostatic hyperplasia occur?....Pages 7-11
What is the clinical significance of perineural invasion reported on prostate needle core biopsy?....Pages 12-15
What is the difference between a positive surgical margin and extraprostatic extension in pathology reports of radical prostatectomy? What is the clinical relevance of these findings?....Pages 16-20
What is the clinical significance of prostate cancer incidentally discovered in tissue removed to relieve urinary tract obstruction mostly by transurethral resection (stage T1a and T1b cancers)?....Pages 21-24
What are the characteristics of transition zone cancer? Is it less aggressive than the non-transition-zone cancer?....Pages 25-28
Is there a significant difference in prognosis between Gleason score 3 + 4 and 4 + 3 prostate cancers in radical prostatectomy specimens? What is the prognostic implication of Gleason score 3 + 4 versus 4 + 3 prostate cancer assigned to prostate needle core biopsy specimens?....Pages 29-33
A positive surgical margin associated with an extraprostatic extension of prostate carcinoma is a significant risk for disease progression. What, then, is the risk of a positive margin created by an inadvertent surgical incision into cancerous prostate parenchyma?....Pages 34-38
What are the neuroendocrine cells in prostate cancer? From where are these cells derived? What is the clinical implication of neuroendocrine differentiation in prostate cancer?....Pages 39-48
What is prostatic ductal adenocarcinoma? How is it clinically and pathologically different from the conventional (acinar) adenocarcinoma?....Pages 49-54
What immunohistochemical markers are useful for the diagnosis of prostate cancer?....Pages 55-61
When a basal cell-specific marker (34βE12 or p63) is negative in an atypical focus, can the diagnosis of adenocarcinoma be rendered? By the same token, if 34βE12- or p63-positive cells are present, can carcinoma be ruled out?....Pages 62-63
How often is cancer detected when serum PSA is elevated? What factors affect the prostate cancer detection rate?....Pages 64-67
What is the clinical significance of isolated high-grade prostatic intraepithelial neoplasia discovered on a prostate needle core biopsy? How often does it occur? Does its presence predict cancer on a subsequent biopsy? Are there any specific clinical or pathologic findings that favorably predict cancer on a subsequent biopsy?....Pages 68-76
What is the clinical significance of a Gleason pattern 4 or 5 tumor found on a prostate needle core biopsy? What impact does a Gleason pattern 4 or 5 tumor have on the prognosis after radical prostatectomy?....Pages 77-81
What clinically useful information should be included in the pathology report on a prostate needle core biopsy? Are there specific microscopic findings useful when assessing cancer staging?....Pages 82-83
What is the meaning of “atypical glands suspicious but not diagnostic of adenocarcinoma” in a pathology diagnosis? Is “atypical small acinar proliferation” a pathologic entity?....Pages 84-85
Front Matter....Pages 87-87
What are the essential features of renal neoplasms based on the current (2004) WHO classification system? What is the clinical implication of the new classification? How does the Fuhrman grading system work? What are the factors affecting survival of renal cell carcinoma patients?....Pages 89-93
Does granular cell type renal cell carcinoma exist? What are the features of clear cell renal cell carcinoma? What are the pathologic characteristics and the clinical implication of multilocular cystic renal cell carcinoma?....Pages 94-97
What is the definition of papillary adenoma? What is the relationship of papillary adenoma to papillary renal cell carcinoma? Do we need to divide papillary renal cell carcinoma into two subtypes?....Pages 98-102
Front Matter....Pages 87-87
How is chromophobe renal cell carcinoma diagnosed? How does one distinguish chromophobe renal cell carcinoma from oncocytoma?....Pages 103-107
What are the features of collecting duct carcinoma? What is mucinous tubular spindle cell carcinoma?....Pages 108-112
Why is sarcomatoid renal cell carcinoma not an independent subtype? What is the clinical significance of unclassified renal cell carcinoma?....Pages 113-116
What molecular and genetic changes are characteristic of renal tumors? Based on the new knowledge, is molecular targeting feasible?....Pages 117-124
Are there immunohistochemical markers for the differential diagnosis of renal cell neoplasms, especially when tumor cells have an eosinophilic/granular cytoplasm?....Pages 125-132
How does adrenal gland involvement by renal cell carcinoma affect the prognosis, if any? Should a tumor directly infiltrating the ipsilateral adrenal gland be kept as a pT3a tumor?....Pages 133-135
How does the tumor thrombus in the renal vein or inferior vena cava and its level of extension affect the prognosis of renal cancer?....Pages 136-138
How does the renal sinus involvement in renal cell carcinoma affect the prognosis?....Pages 139-141
What is the significance of microvascular tumor invasion observed in a renal cell carcinoma?....Pages 142-144
How does one distinguish benign from malignant renal cysts clinically? Which renal neoplasms are characterized by cyst formation?....Pages 145-151
Is angiomyolipoma a neoplasm or a hamartoma? Does cytologic atypia seen in angiomyolipomas denote aggressive behavior? Does an angiomyolipoma need treatment if it is benign? What is the indication for surgical intervention if it is required?....Pages 152-160
Front Matter....Pages 161-161
What are the advantages and disadvantages, if any, of the revised (2004) WHO classification of urinary bladder neoplasms?....Pages 163-173
What are the features of inverted papilloma of the urinary tract? How does it differ from papillary urothelial carcinoma? Is there a malignant counterpart of inverted papilloma? What are the differential diagnoses?....Pages 174-180
What is small cell carcinoma of the urinary bladder? What are the biologic behaviors of this tumor and its relationship to the conventional urothelial carcinoma?....Pages 181-184
What is nephrogenic adenoma? What is the histogenesis of nephrogenic adenoma? What is the immunohistochemical profile of the lesion? Is there any relation between the development of a nephrogenic adenoma and kidney transplant?....Pages 185-190
What are the clinical and pathologic features needed for the diagnosis of interstitial cystitis? What are the most important entities that should be considered in the differential diagnosis?....Pages 191-198
What are the possible etiology and pathogenesis of interstitial cystitis?....Pages 199-208
What are the treatment options for patients with interstitial cystitis?....Pages 209-212
Is there a difference in clinical behavior between urothelial carcinoma of the upper urinary tract and that of the lower urinary tract? What is the risk of developing tumors in the contralateral and lower urinary tracts in patients presenting initially with an upper urinary tract cancer? Conversely, what is the risk of developing an upper urinary tract tumor in patients who initially present with a lower urinary tract tumor?....Pages 213-221
Do multifocal or recurrent urothelial carcinomas originate from a single transformed cell or from multiple transformed cells? What is the clinical significance of this argument?....Pages 222-230
Front Matter....Pages 231-231
What is the latest classification of male germ cell tumors? How do the pathology subtypes relate to their biologic behavior and malignant potential?....Pages 233-247
What is the pathogenesis of testicular germ cell tumors? Are there specific changes that characterize the development of germ cell tumors?....Pages 248-252
How do germ cell tumors in infants and children differ from those in postpubertal males and females?....Pages 253-257
What is the malignant transformation (or somatic malignancy) of germ cell tumors? What is the clinical significance of this transformation?....Pages 258-260
When a man presents with a germ cell tumor localized in the mediastinum or retroperitoneum, how can one decide whether it is a primary extragonadal tumor or a metastasis?....Pages 261-264
How does the late recurrence of testicular germ cell tumors occur? What are the prognostic factors to predict the late recurrence?....Pages 265-268
Front Matter....Pages 269-269
What are the pathologic criteria for distinguishing benign from malignant adrenal cortical neoplasms? What diseases should be considered for the differential diagnosis? Are there significant differences in clinical behavior between adult and pediatric adrenal cortical neoplasms?....Pages 271-276
When a patient presents with a clinical picture of adrenal cortical hyperfunction, what would be the anatomic changes in the adrenal cortex?....Pages 277-279
What is the difference between pheochromocytoma and paraganglioma? What are the familial syndromes that have pheochromocytoma as a component? What are the pathologic features of pheochromocytoma indicating malignancy?....Pages 280-284
Back Matter....Pages 285-287