Urologic Surgical Pathology

Cover
Inside Front Cover
UROLOGIC
SURGICAL
PATHOLOGY
Copyright
Contributors
Preface to the Fourth Edition
1
Nonneoplastic Diseases of the Kidney
	Introduction
	Embryologic Development and Normal Structure
		Pronephros
		Mesonephros
		Metanephros
		Nephron Differentiation
	Gross Anatomy
	Microscopic Anatomy
	Parenchymal Maldevelopment and Cystic Kidney Diseases
		Abnormalities in Form and Position
			Rotation Anomaly
			Renal Ectopia
			Renal Fusion
		Abnormalities in Mass and Number
			Supernumerary Kidney
			Hypoplasia
				Simple Hypoplasia
				Oligomeganephronia
				Cortical Hypoplasia
				Segmental Hypoplasia (Ask-Upmark Kidney)
			Renal Agenesis
				Unilateral Renal Agenesis
				Bilateral Renal Agenesis (Potter Syndrome)
				Syndromic Renal Agenesis
		Renal Dysplasia
		Polycystic Kidney Disease
			Autosomal Recessive Polycystic Kidney Disease
			Autosomal Dominant Polycystic Kidney Disease
		Cystic Diseases (Without Dysplasia) in Hereditary Syndromes
			Nephronophthisis
			Autosomal Dominant Tubulointerstitial Disease
			Von Hippel-Lindau disease
			Tuberous Sclerosis
			Glomerulocystic Kidneys
		Miscellaneous Diseases
			Renal Tubular Dysgenesis
			Acquired Cystic Kidney Disease
			Localized Cystic Kidney Disease
			Medullary Sponge Kidney
			Simple Cortical Cyst
			Hydrocalyx, Megacalycosis, and Calyceal Diverticulum
	Vascular Diseases
		Hypertension-Associated Renal Disease
			Benign Nephrosclerosis
			Malignant Nephrosclerosis
		Thrombotic Microangiopathy
			Renal Artery Stenosis
				Atherosclerosis-Related Renal Artery Stenosis
				Fibromuscular Dysplasia
					Intimal Fibroplasia
					Medial Hyperplasia
					Medial Fibroplasia With Aneurysms
					Perimedial Fibroplasia
					Periarterial Fibroplasia
				Kidney in Renal Artery Stenosis
			Hemolytic Uremic Syndrome
			Thrombotic Thrombocytopenic Purpura
		Renal Artery Dissection
		Renal Artery Aneurysm
			Saccular Aneurysm
			Fusiform Aneurysm
			Intrarenal Aneurysm
		Arteriovenous Malformation and Fistula
		Renal Emboli and Infarcts
		Renal Cortical Necrosis
		Renal Papillary Necrosis
		Renal Cholesterol Microembolism Syndrome
		Renal Artery Thrombosis
		Renal Vein Thrombosis
		Bartter syndrome
		Vasculitis
	Tubulointerstitial Disease
		Acute and Chronic Renal Failure
		Acute Tubular Injury (Necrosis)
		Acute Tubulointerstitial Nephritis
		Herbal Remedies, Slimming Agents and Aristocholic Acid Nephropathy
		Immunoglobulin G4-Related Sclerosing Tubulointerstitial Nephritis
		Analgesic Nephropathy
		Bacterial Infection-Associated Tubulointerstitial Disease
			Acute Pyelonephritis
			Pyonephrosis
			Perinephric Abscess
			Emphysematous Pyelonephritis
			Chronic Pyelonephritis
				Reflux Nephropathy (Chronic Nonobstructive Pyelonephritis)
				Chronic Obstructive Pyelonephritis
		Viral Infections
		Granulomatous Tubulointerstitial Disease
			Sarcoidosis
			Xanthogranulomatous Pyelonephritis
			Malakoplakia
			Tuberculosis
			Diverse Other Granulomatous Diseases
	Metabolic Abnormalities, Heavy Metals, and Crystal-Associated Tubulointerstitial Diseases
		Heavy Metals
		Hypercalcemic Nephropathy
		Nephrolithiasis
		Oxalate-Associated Renal Disease
		Cystinosis
		Uric Acid-Associated Renal Disease
	Diabetic Kidney Disease
	Amyloidosis and Paraprotein-Associated Tubulointerstitial Disease
		Amyloidosis
		Light Chain Cast Nephropathy
		Immunoglobulin and Light Chain Deposition Disease
		Light Chain Proximal Tubulopathy
		Light Chain Crystal Tubulopathy
		Crystal-Storing Histiocytosis
		Monoclonal Gammopathy of Renal Significance
	Renal Transplantation
		Evaluation of Preimplantation/Procurement and Zero-Hour Implantation Biopsy
		Evaluation of a Transplant Biopsy
		Antibody-Mediated Rejection
		T-Cell-Mediated Rejection
		Calcineurin Inhibitor Nephrotoxicity
	References
2
Neoplasms of the Kidney
	Renal Cell Carcinomas
		General Considerations
			Incidence
			Epidemiology
			Hereditary Aspects of Renal Cell Neoplasia
			Grading Renal Cell Carcinoma
			Staging Renal Cell Carcinoma
		Clear Cell Renal Cell Carcinoma
		Multilocular Cystic Renal Neoplasm of Low Malignant Potential
		Papillary Renal Cell Carcinoma
		Hereditary Leiomyomatosis and Renal Cell Carcinoma-Associated Renal Cell Carcinoma
		Chromophobe Renal Cell Carcinoma
		Collecting Duct Carcinoma
		Renal Medullary Carcinoma
		MiT Family Translocation Renal Cell Carcinoma
			Xp11 Translocation Renal Cell Carcinoma
			t(6;11) Translocation Renal Cell Carcinoma
		Succinic Dehydrogenase-Deficient Renal Cell Carcinoma
		Mucinous Tubular and Spindle Cell Carcinoma
		Tubulocystic Renal Cell Carcinoma
		Acquired Cystic Disease-Associated Renal Cell Carcinoma
		Clear Cell Papillary Renal Cell Carcinoma
		Renal Cell Carcinoma, Unclassified
		Emerging or Provisional Renal Cell Carcinomas
			Oncocytic Renal Cell Carcinoma Occurring After Neuroblastoma
			Eosinophilic Solid and Cystic Renal Cell Carcinoma
			Thyroid-like Follicular Carcinoma of the Kidney
			ALK Rearrangement-Associated Renal Cell Carcinoma
			Renal Cell Carcinoma With Angioleiomyoma-like Stroma
	Benign Epithelial Neoplasms
		Papillary Adenoma
		Oncocytoma
	Metanephric Tumors
		Metanephric Adenoma
		Metanephric Adenofibroma
		Metanephric Stromal Tumor
	Nephroblastic and Cystic Tumors That Occur Mainly in Children
		Nephrogenic Rests
		Nephroblastoma (Wilms Tumor)
		Cystic Partially Differentiated Nephroblastoma
		Pediatric Cystic Nephroma
	Mesenchymal Tumors
		Mesenchymal Tumors That Occur Mainly in Children
			Clear Cell Sarcoma
			Rhabdoid Tumor
			Congenital Mesoblastic Nephroma
			Ossifying Renal Tumor of Infancy
		Mesenchymal Tumors That Occur Mainly in Adults
			Leiomyosarcoma
			Angiosarcoma
			Rhabdomyosarcoma
			Osteosarcoma
			Synovial Sarcoma
			Ewing Sarcoma
			Angiomyolipoma
			Epithelioid Angiomyolipoma
			Leiomyoma
			Hemangioma
			Lymphangioma
			Hemangioblastoma
			Juxtaglomerular Cell Tumor
			Renomedullary Interstitial Cell Tumor
			Schwannoma
			Solitary Fibrous Tumor
	Mixed Epithelial and Stromal Tumor Family
		Adult Cystic Nephroma
		Mixed Epithelial and Stromal Tumor
	Neuroendocrine Tumors
		Well-Differentiated Neuroendocrine Tumor
		Large Cell Neuroendocrine Carcinoma
		Small Cell Neuroendocrine Carcinoma
		Paraganglioma
	Miscellaneous Tumors
		Renal Hematopoietic Neoplasms
			Lymphoma
			Plasmacytoma
			Leukemia
		Germ Cell Tumors
	Metastatic Tumors
	References
3
Renal Pelvis and Ureter
	Development
	Anatomy
	Congenital Malformations
		Abnormalities in Number or Location of Ureters
		Refluxing Megaureter
		Ureteropelvic Junction Obstruction
		Primary Megaureter
		Ureterocele
		Paraureteral Diverticulum
		Ureteral Dysplasia
	Nonneoplastic Proliferative, Metaplastic, and Inflammatory Lesions
		Hyperplasia, von Brunn Nests, and Ureteropyelitis Cystica and Glandularis
		Squamous and Glandular Metaplasia
		Nephrogenic Adenoma
		Reactive Changes (Reactive Atypia)
		Malakoplakia
		Endometriosis
		Retroperitoneal Fibrosis
	Neoplasms
		Benign Epithelial Neoplasms
			Inverted Papilloma
			Urothelial Papilloma
		Malignant Epithelial Neoplasms
			Urothelial Dysplasia and Carcinoma In Situ
			Urothelial Carcinoma
			Squamous Cell Carcinoma
			Adenocarcinoma
			Metastases
		Mesenchymal Neoplasms
			Fibroepithelial Polyp
			Leiomyoma and Leiomyosarcoma
			Hemangioma
			Other Tumors
	References
4
Fine Needle Aspiration of the Kidney
	Introduction
	Background to Renal Fine Needle Aspiration
		Indications
		Specimen Collection and Preparation
		Complications
		Accuracy
		Adequacy
	Normal Elements
		Glomeruli
		Proximal Tubular Cells
		Distal Tubular Cells
	Benign Lesions
		Oncocytoma
		Papillary Adenoma
		Angiomyolipoma
		Metanephric Adenoma
		Cystic Nephroma/Mixed Epithelial and Stromal Tumor
		Renal Abscess
		Xanthogranulomatous Pyelonephritis
		Renal Infarct
		Renal Cysts
		Acquired Cystic Disease and Adult Polycystic Disease
	Malignant Lesions
		Renal Cell Carcinoma
			Clear Cell Renal Cell Carcinoma
			Papillary Renal Cell Carcinoma
			Chromophobe Renal Cell Carcinoma
			Sarcomatoid Renal Cell Carcinoma
			Collecting Duct Carcinoma
			Translocation-Associated Renal Cell Carcinomas [TFE3-Associated Tumors, Including the MiT Family, Xp11, and t6,11]
			Mucinous Tubular and Spindle Cell Carcinoma
			Clear Cell Papillary Renal Cell Carcinoma
			Other Subtypes of Renal Cell Carcinoma
		Metastases
		Urothelial Carcinoma
		Other Rare Tumors
	Future Trends
		Fine Needle Aspiration in Pediatric Patients
		Renal Mass Ablation
	Conclusions
	References
5
Nonneoplastic Disorders of the Urinary Bladder
	Embryology and Anatomy
		Embryology
		Gross Anatomy
		Histology
	Epithelial Abnormalities
		von Brunn Nests
		Cystitis Glandularis and Intestinal Metaplasia
			Cystitis Glandularis and Cystitis Cystica
			Intestinal Metaplasia (Cystitis Glandularis, Intestinal Type)
		Squamous Metaplasia
		Nephrogenic Adenoma
		Papillary Hyperplasia
	Inflammation and Infection
		Nonspecific Cystitis
			Polypoid and Papillary Cystitis
			Follicular Cystitis
			Giant Cell Cystitis
			Hemorrhagic Cystitis
		Special Types of Cystitis
			Interstitial Cystitis (Bladder Pain Syndrome)
			Eosinophilic Cystitis
			Postsurgical Necrobiotic Granulomas
			Bacillus Calmette-Guérin Granulomas
			Other Noninfectious Granulomas
			Radiation Cystitis
			Reaction to Chemotherapy
			Calculi
		Infectious Cystitis
			Bacterial Cystitis
			Gangrene
			Encrusted Cystitis
			Emphysematous Cystitis
			Other Rare Lesions
			Urachal Abscess
			Malakoplakia
			Tuberculous Cystitis
			Fungal and Actinomycotic Cystitis
		Viral Cystitis
			Human Papillomavirus
			Other Viruses
		Schistosomiasis
	Polyps and Other Mass Lesions
		Ectopic Prostate
		Other Polyps
		Hamartoma
		Amyloidosis
		Proteinoma (Tamm-Horsfall Protein Deposits)
		Fallopian Tube Prolapse
		Postoperative Spindle Cell Nodule
		Inflammatory Myofibroblastic Tumor (Pseudosarcomatous Fibromyxoid Tumor; Inflammatory Pseudotumor)
	Müllerian Lesions
		Endometriosis
		Endocervicosis
		Müllerian Cyst
	Malformations
		Agenesis
		Exstrophy
		Duplication and Septation of the Bladder
		Urachal Cysts and Persistence
		Diverticulum
		Other Congenital Malformations and Anomalies
	References
6
Neoplasms of the Urinary Bladder
	Benign Urothelial Neoplasms
		Urothelial Papilloma and Diffuse Papillomatosis
		Inverted Papilloma
		Squamous Papilloma
	Urothelial Proliferation of Uncertain Malignant Potential
		Papillary Urothelial Hyperplasia/Urothelial Proliferation of Uncertain Malignant Potential
		Flat Urothelial Hyperplasia/Urothelial Proliferation of Uncertain Malignant Potential
	Flat Intraepithelial Lesions
		Histologic Variants of Carcinoma In Situ
			Large Cell Carcinoma In Situ
			Small Cell Carcinoma In Situ
			Denuding and ``Clinging Pattern´´ Carcinoma In Situ
			Pagetoid and Undermining (Lepidic) Carcinoma In Situ
			Carcinoma In Situ With Squamous or Glandular Differentiation
			Carcinoma In Situ With Micropapillary Pattern
			Carcinoma In Situ With Microinvasion
		Urothelial Reactive Atypia
			Reactive Atypia
			Atypia of Unknown Significance
		Therapy-Induced Changes in the Urothelium and Mimics of Urothelial Flat Neoplasia
			Urothelial Dysplasia
			Primary Dysplasia
			Secondary Dysplasia
		Urothelial Carcinoma In Situ (High-Grade Intraurothelial Neoplasia)
			Microscopic Pathology
	Urothelial Carcinoma
		General Features
			Epidemiology and Risk Factors
			Signs and Symptoms
			Field Cancerization and Tumor Multicentricity
			Molecular Taxonomy
			Immune Checkpoint Inhibitor Therapy
		Histologic Grading
			Staging of Invasive Bladder Cancer
			General Features of Invasive Urothelial Carcinoma
			Stage pT1 Tumor
				Histologic Grade
				Stroma-Epithelial Interface
				Invading Epithelium
				Stromal Response
				Diagnostic Pitfalls
				Substaging of pT1 Tumors
			Stage pT2 Tumor
			Stage pT3 Tumor
			Stage pT4 Tumor
			Histologic Grading According to the 1973 World Health Organization Classification
				Grade 1 Urothelial Carcinoma
				Grade 2 Urothelial Carcinoma
				Grade 3 Urothelial Carcinoma
			Histologic Grading According to the 2004/2016 World Health Organization Classification
				Papillary Urothelial Neoplasm of Low Malignant Potential
				Low-Grade Urothelial Carcinoma
				High-Grade Urothelial Carcinoma
			Histologic Grading of Urothelial Carcinoma: The Four-Tier Proposal
				Grade 1 Urothelial Carcinoma (Low Grade)
				Grade 2 Urothelial Carcinoma (Low Grade)
				Grade 3 Urothelial Carcinoma (High Grade)
				Grade 4 Urothelial Carcinoma (High Grade)
			Other Proposals for Bladder Cancer Grading and Tumor Heterogeneity
				The ANCONA 2001 Refinement of the 1973 World Health Organization Classification
				The 1999 World Health Organization Grading Proposal
			Tumor Heterogeneity: Implications for Grading
		Histologic Variants of Urothelial Carcinoma
			Urothelial Carcinoma With Divergent Differentiation
			Micropapillary Urothelial Carcinoma
			Plasmacytoid Urothelial Carcinoma
			Nested Urothelial Carcinoma
			Microcystic Urothelial Carcinoma
			Lymphoepithelioma-like Urothelial Carcinoma
			Lipid-Rich Urothelial Carcinoma
			Clear Cell (Glycogen-Rich) Urothelial Carcinoma
			Sarcomatoid Urothelial Carcinoma
			Giant Cell Urothelial Carcinoma
			Poorly Differentiated Tumors (Including Those With Osteoclast-like Giant Cells)
		Other Aspects and Variants of Urothelial Carcinoma Not Included in the Current World Health Organization Classification
			Urothelial Carcinoma, Inverted Growth (Inverted Papilloma-like)
			Pseudoangiosarcomatous (Pseudoangiosarcoma-like) Urothelial Carcinoma
			Urothelial Carcinoma With Chordoid Features
			Urothelial Carcinoma With Syncytiotrophoblastic Giant Cells
			Urothelial Carcinoma With Acinar/Tubular Differentiation
			Undifferentiated Carcinoma (Including Those With Rhabdoid Features)
			Urothelial Carcinoma With Unusual Stromal Reactions
			Urothelial Carcinoma in Augmentation Cystoplasties and Neurogenic Bladder
			Urothelial Carcinoma in Children and Young Adults
			Urothelial Carcinoma in Bladder Diverticulum
		Specimen Handling and Reporting
	Glandular Neoplasms
		Villous Adenoma
			Clear Cell Carcinoma (Tumors of Müllerian Type)
		Adenocarcinoma
			Hepatoid Adenocarcinoma
			Urachal Adenocarcinoma
	Squamous Cell Neoplasms
		Squamous Papilloma
		Squamous Cell Carcinoma In Situ
		Squamous Cell Carcinoma
			Schistosoma-Associated Squamous Cell Carcinoma
			Verrucous Squamous Cell Carcinoma
			Basaloid Squamous Cell Carcinoma
	Neural and Neuroendocrine Tumors
		Small Cell Carcinoma
			Epidemiology and Clinical Features
			Staging, Treatment, and Outcome
			Histogenesis and Genetics
			Pathology
			Immunohistochemistry
			Differential Diagnosis
		Large Cell Neuroendocrine Carcinoma
		Well-Differentiated Neuroendocrine Tumor (Carcinoid)
		Paraganglioma
			Clinical Features
			Histogenesis
			Genetics
			Pathology
			Immunohistochemistry
			Differential Diagnosis
		Neurofibroma
		Schwannoma
		Primitive Neuroectodermal Tumor
		Malignant Peripheral Nerve Sheath Tumor
	Sarcomatoid Carcinoma
		Definition and Terminology
		Clinical Features
		Histogenesis and Genetics
		Pathology
		Differential Diagnosis and Immunohistochemistry
	Soft Tissue Tumors
		Other Rare Soft Tissue Tumors Arising in the Bladder
		Myofibroblastic Proliferations and Benign Soft Tissue Tumors
			Inflammatory Myofibroblastic Tumor
			Postoperative Spindle Cell Nodule
			Leiomyoma
			Hemangioma
			Granular Cell Tumor
			Solitary Fibrous Tumors
			Perivascular Epithelioid Cell Tumor
		Malignant Soft Tissue Tumors
			Leiomyosarcoma
			Rhabdomyosarcoma
			Angiosarcoma
			Undifferentiated Pleomorphic Sarcoma
			Osteosarcoma
	Miscellaneous Tumors
		Malignant Melanoma
		Germ Cell Tumors
		Hematologic Malignancies
		Metastatic Tumors and Secondary Extension
		Metastatic Urothelial Carcinoma
	References
7
Urine Cytology
	Introduction
	Utility of Urine Cytology
		Indications
		Sources
		Specimen Adequacy
	Reporting and Classification
		The Paris System 2013
	Normal Components of the Urinary Sediment
		Superficial (Umbrella) Cells
		Cells Originating From the Deeper Layers of the Urothelium
		Columnar Cells
		Mucus-Containing Epithelial Cells
		Squamous Cells
		Renal Epithelial Cells
			Convoluted Tubular Cells
			Collecting Duct Cells
		Other Benign Cells
			Inflammatory Cells
		Noncellular Components of the Urinary Sediment
			Pigment and Pigmented Cells
			Cytoplasmic Eosinophilic Inclusions (Melamed-Wolinska Bodies)
			Crystals
			Casts and Other Findings Attributable to Renal Diseases in Urine
	Diagnostic Criteria
		Infections
			Bacteria
			Fungi
			Viruses
			Trematodes and Other Parasites
		Reactive Cytologic Changes
			Lithiasis
			Drug Effects
			Effects of Radiation Therapy
			Degenerative Changes
			Instrumentation Atypia
			Laser-Induced Changes and Other Ablation Changes
			Neobladder and Ileal Conduit Urine
			Urine Cytology in Renal Transplant Recipients
		Other Benign Conditions
		Benign Tumors and Tumor-like Processes
		Atypical Urothelial Cells
		Suspicious
		Low-Grade Urothelial Carcinoma
		High-Grade Carcinoma
		Correlation of Urine Cytology and Biopsy Findings (Diagnostic Accuracy)
		Urinary Cells Originating From Other Sites
			Prostate
			Urethra
			Upper Tract
			Kidney Medulla and Cortex
			Secondary Tumors
		Anticipatory Positive Cytology
		Other Types of Carcinoma
			Squamous Cell Carcinoma
			Adenocarcinoma
			Small Cell Undifferentiated Carcinoma (Oat Cell Carcinoma)
			Mixed Carcinoma
			Rare Variants of Urothelial Carcinoma
		Major Diagnostic Pitfalls
			Trauma or Instrumentation
			Cell Preservation
			Human Polyomavirus
			Lithiasis
			Drugs and Other Therapeutic Procedures
	Ancillary Studies and Immunocytology
		Digital Image Analysis and Morphometry
		Cytochemical Stains
			Acid Hematoxylin Stain
			CellDetect
		Immunocytochemical Stains
			Telomerase
			HER2 and Cytokeratins
			Vimentin
			ImmunoCyt/uCyt Immunocytology
			ProExC
			Other Immunostains
		Fluorescence In Situ Hybridization
	The Problem of Hematuria
		Routine Laboratory Investigation of Hematuria
		Dysmorphic Red Blood Cells Indicate Glomerular Disease
		Comprehensive Analysis of Urine for Evaluation of Hematuria
	References
8
Nonneoplastic Diseases of the Prostate
	Embryology and Fetal-Prepubertal History
	Anatomy
		Zonal Anatomy
		Prostatic Urethra, Verumontanum, and Bladder Neck
		Capsule and the Retroprostatic Fascia (Denonvilliers Fascia)
		Blood Supply
		Nerve Supply
	Prostate Sampling Techniques
		Needle Biopsy
		Fine Needle Aspiration
		Transurethral Resection
		Tissue Artifacts
		Nonprostatic Tissues in Biopsies
			Seminal Vesicle and Ejaculatory Duct Tissue in Biopsies
			Cowper Gland Tissue in Biopsies
			Rectal Tissue in Biopsies
	Benign Epithelium
		Secretory Luminal Cells
		Basal Cells
		Neuroendocrine Cells
		Stem Cells
		Luminal Products
		Pigment
		Immunohistochemistry
			Prostate-Specific Antigen
			Prostatic Acid Phosphatase
			Keratin 34βE12
			p63
			p40
			Racemase
			c-Myc
			Panel of Keratin 34βE12, p63, Racemase, and c-Myc
			NKX3.1
			GATA3
			ERG
			Prostate-Specific Membrane Antigen
			Human Glandular Kallikrein 2
			Androgen Receptors
			Other Immunohistochemical Markers
	Benign Stroma
	Inflammation
		Prostatic Immune Response
		Acute Bacterial Prostatitis
		Chronic Prostatitis
		Granulomatous Prostatitis
			Xanthoma and Xanthogranulomatous Prostatitis
			Idiopathic Granulomatous Prostatitis
			Infectious Granulomatous Prostatitis
			Malakoplakia
			Iatrogenic Granulomatous Prostatitis
				Post-TURP Granulomatous Prostatitis
				Postradiation Granulomatous Prostatitis
				BCG-Associated Granulomatous Prostatitis
				Teflon-Associated Granulomatous Prostatitis
		Systemic Granulomatous Prostatitis
			Allergic (Eosinophilic) Granulomatous Prostatitis
			Granulomatosis With Polyangiitis and Other Forms of Vasculitis
			Autoimmune Prostatitis With Immunoglobulin G4-Related Disease
			Other Rare Forms of Granulomatous Prostatitis
		AIDS-Associated Prostatitis
		Virus-Associated Prostatitis
		Inflammation After Needle Biopsy
		Inflammation and Nodular Hyperplasia
		Inflammation and Prostate Cancer
	Atrophy
	Nonneoplastic Metaplasia
		Squamous Metaplasia
		Mucinous Metaplasia
		Neuroendocrine Cells With Eosinophilic Granules (Paneth Cell-like Change)
		Urothelial Metaplasia
		Nephrogenic Metaplasia
	Hyperplasia and Nodular Hyperplasia
		Nodular Hyperplasia
		Postatrophic Hyperplasia
		Prostatic Stromal Hyperplasia With Atypia
		Basal Cell Hyperplasia and Basal Cell Proliferations
			Typical Basal Cell Hyperplasia
			Atypical Basal Cell Hyperplasia
			Basal Cell Adenoma
			Immunohistochemical Findings
			Differential Diagnosis
		Cribriform Hyperplasia
		Atypical Adenomatous Hyperplasia
		Sclerosing Adenosis
		Verumontanum Mucosal Gland Hyperplasia
		Hyperplasia of Mesonephric Remnants
		Pseudoangiomatous Stromal Hyperplasia
	Benign Nonneoplastic Conditions
		Amyloidosis
		Melanosis
		Endometriosis
	Treatment Changes
		Androgen Deprivation Therapy
			Histopathologic Findings After 5α-Reductase Inhibitors
			Immunohistochemical Findings After Androgen Deprivation Therapy
		Radiation Therapy
			Immunohistochemical Findings After Radiation Therapy
		Cryotherapy (Cryoablation)
		Hyperthermia
		Laser Therapy
		Irreversible Electroporation
		Electrical Membrane Breakdown
	References
9
Neoplasms of the Prostate
	Benign Epithelial Tumors and Tumor-like Proliferations
		Prostatic Cysts
		Ejaculatory Duct Adenofibroma
	Prostatic Intraepithelial Neoplasia
		Epidemiology of Prostatic Intraepithelial Neoplasia
		Diagnosis of Prostatic Intraepithelial Neoplasia
		Immunohistochemical Markers for Prostatic Intraepithelial Carcinoma
			Keratin 34βE12 and Other Keratins
			p63
			Racemase
			c-Myc
			ERG
		Molecular Biology of Prostatic Intraepithelial Neoplasia
		Treatment Effects in Prostatic Intraepithelial Neoplasia
			Radiation Therapy
			Androgen Deprivation Therapy and Other Therapies
		Differential Diagnosis of Prostatic Intraepithelial Neoplasia
		Inflammation, Atrophy, and High-Grade Prostatic Intraepithelial Neoplasia
		Clinical Significance of Prostatic Intraepithelial Neoplasia
			Predictive Value of Prostatic Intraepithelial Neoplasia
			Clinical Response to Prostatic Intraepithelial Neoplasia
	Atypical Small Acinar Proliferation
		Diagnosis of Atypical Small Acinar Proliferation
		Subsets of Atypical Small Acinar Proliferation
			Clinical Significance of Atypical Small Acinar Proliferation
			Atypical Small Acinar Proliferation + Prostatic Intraepithelial Neoplasia
	Malignancy-Associated Changes
	Intraductal Carcinoma
		Separation of Intraductal Carcinoma and Prostatic Intraepithelial Neoplasia
		Clinical Significance of Intraductal Carcinoma
	Adenocarcinoma and Other Tumors
		Epidemiology
		Latent Carcinoma
		Prostate Cancer and Benign Prostatic Hyperplasia
		Tissue Methods of Detection
			Needle Core Biopsy
				Detecting Cancer: Factors That Influence Diagnostic Yield in Biopsies
				Number, Length, and Location of Needle Cores Obtained
				Magnetic Resonance Imaging-Transrectal Ultrasound-Guided Fusion-Targeted Biopsies
				Histotechnologists Skill in Processing Biopsies
				Number of Needle Cores Embedded per Cassette
				Number of Tissue Cuts Obtained per Specimen
				Future Trends in Biopsies
			Fine Needle Aspiration
			Transurethral Resection
			Prostatic Enucleation (Suprapubic Prostatectomy; Adenectomy)
			Radical Prostatectomy
		Pathologic Interpretation
			Gross Pathology
			Microscopic Pathology
			Cancer-Associated Pathologic Findings
				Luminal Mucin
				Luminal Proteinaceous Secretions
				Crystalloids
				Collagenous Micronodules
				Perineural Invasion
				Lymphatic and Vascular Invasion
				Microvessel Density (Angiogenesis)
			Significant Problems in Interpretation
				Atypical Small Acinar Proliferation
				Prostatic Intraepithelial Neoplasia Versus Large Acinar Variant of Gleason Grade 3 and Intraductal Carcinoma
				Clear Cell Pattern of Carcinoma Versus Benign Acini
				``Vanishing´´ Prostate Cancer in Radical Prostatectomies
		Grading
			Gleason Grading System
			Recent Trends in Grading
			International Society of Urological Pathology Modifications to the Gleason Grading System
				International Society of Urological Pathology 2005 Modified Gleason Grading System
				International Society of Urological Pathology 2014 Modified Gleason Scoring System (Grade Groupings)
			Biopsy Versus Prostatectomy Grade
			Dedifferentiation
			Other Proposed Grading Changes
				Tertiary Grade
				Nuclear Grading and Morphometric Grading
				Grade Compression (Dichotomization) and Weighted Average Score
				Percent Gleason 4 and 5
				Should Gleason 3 + 3 = 6 Be Called Cancer?
				Gleason 7 Subdivision (3 + 4 Versus 4 + 3)
				Grade Group 4 Heterogeneity
				Gleason Pattern 5
				Reactive Stromal Grading
				Digital Pathology and Deep Learning
			Grading After Therapy
				Grading After Radiation Therapy
				Grading After Androgen Deprivation Therapy
			Clinical Significance of Grading
				Grade and Outcome
				Grade and Cancer Volume
				Grade and Prostate-Specific Antigen
				Grade and Pathologic Stage
				Grade and Cancer Location
		Variants and Other Carcinomas, Including Neuroendocrine Tumors
			Atrophic Adenocarcinoma
			Pseudohyperplastic Adenocarcinoma
			Microcystic Adenocarcinoma
			Foamy Gland Carcinoma (Microvacuolated)
			Mucinous (Colloid) Carcinoma
			Signet Ring Cell Carcinoma
			Pleomorphic Giant Cell Adenocarcinoma
			Sarcomatoid Carcinoma (Carcinosarcoma)
			Ductal Adenocarcinoma
				Cribriform, Papillary, and Solid Carcinomas
				Comedocarcinoma
			Adenocarcinoma With Neuroendocrine Differentiation
				Adenocarcinoma With Neuroendocrine Cells With Large Eosinophilic Granules (Paneth Cell-like Change)
				Low-Grade Neuroendocrine Carcinoma (Carcinoid)
				High-Grade Neuroendocrine Carcinoma (Small Cell and Large Cell Carcinoma)
			Adenocarcinoma With Glomeruloid Features
			Carcinoma With Oncocytic Features
			Lymphoepithelioma-like Carcinoma
			Clear Cell Carcinoma
			Basal Cell Carcinoma (Adenoid Cystic/Basal Cell Carcinoma)
			Squamous Cell and Adenosquamous Cell Carcinoma
			Urothelial Carcinoma
		Immunohistochemistry of Prostate Cancer
			Identifying Prostatic Origin in Metastases
			TMPRSS2:ERG and the ETS Family Gene Fusions
			Phosphatase and Tensin Homolog
			Prostate Cancer Antigen 3
			c-Myc
			Telomerase
			Apoptosis-Suppressing Oncoprotein Bcl-2
			p53
			p16
			p21
			p27Kip1
			Androgen Receptors
			Methylation
			Mitochondrial DNA Testing
			Integrins
			Heat Shock Protein 90
			Pro-PSA
			Prostatic Membrane Antigen
			Proliferating Cell Nuclear Antigen
			Ki67/MIB1
			BRCA1 and BRCA2
			Engrailed Nuclear Protein-2
			Sarcosine and Other Metabolites
			Other Immunohistochemical Markers of Prognosis in Prostate Cancer
		Molecular Biology of Prostate Cancer
			Genetics of Familial Prostate Cancer
			DNA Ploidy
			MicroRNA
			Chromosome 7
			Chromosome 8
			Chromosome 10
			Chromosome 16
			Other Chromosomes
			DNA Mismatch Repair Genes
		Treatment Changes in Prostate Cancer
			Androgen Deprivation Therapy
				Pathologic Findings After Androgen Deprivation
				Pathologic Findings After 5α-Reductase Inhibitors
				Differential Diagnosis
				Stage and Surgical Margins After Androgen Deprivation Therapy
				Immunohistochemical Findings After Androgen Deprivation Therapy
			Radiation Therapy
				Differential Diagnosis of Prostate Cancer After Radiotherapy
				Immunohistochemical Findings After Radiotherapy
			Cryotherapy
			Ultrasound Hyperthermia, Microwave Hyperthermia, Laser Therapy, and Hot Water Balloon Therapy
			High-Intensity Focused Ultrasound
			Irreversible Electroporation
		Predictive Factors in Prostate Cancer
			Prostate-Specific Antigen
			Stage
			National Comprehensive Cancer Network/American Urological Association Risk Classification
			Pathology of Prostate-Specific Antigen-Detected Adenocarcinoma (Clinical Stage T1c)
			Extraprostatic Extension
			Seminal Vesicle Invasion (Stage pT3b Prostate Cancer)
			Microscopic Bladder Neck Invasion (Stage pT3a Prostate Cancer)
			Surgical Margins
			Perineural Invasion
			Biopsy Cancer Volume
			Location of Cancer
			Lymph Node Metastases
			Distant Metastases
			Morphometric Markers
	Benign Mesenchymal Tumors and Tumor-like Conditions
		Stromal Hyperplasia (Stromal Subtype of Nodular Hyperplasia)
		Leiomyoma
		Pseudosarcomatous Myofibroblastic Proliferation
		Postoperative Spindle Cell Nodule (Postsurgical Inflammatory Myofibroblastic Tumor)
		Solitary Fibrous Tumor
		Blue Nevus
		Other Rare Benign Soft Tissue Tumors
	Sarcoma of the Prostate
		Rhabdomyosarcoma
		Leiomyosarcoma
		Phyllodes Tumor
		Stromal Sarcoma
		Other Sarcomas
	Other Malignancies of the Prostate
		Hematologic Malignancies
			Leukemia
			Malignant Lymphoma
			Multiple Myeloma
		Germ Cell Tumors
		Other Rare Malignancies
		Metastases to the Prostate
	References
10
Seminal Vesicles
	Introduction
	Embryology and Anatomy
		Age-Associated Changes
	Congenital and Acquired Malformations
		Cysts
		Ectopic Prostatic Tissue
	Nonneoplastic Abnormalities
		Amyloidosis
		Stromal Hyaline Bodies
		Fibrosis
		Inflammation
		Calcification and Calculi
		Radiation Changes
	Neoplasms
		Adenocarcinoma
		Metastasis and Contiguous Spread
		Soft Tissue Tumors and Other Tumors
	References
11
Urethra
	Embryologic Development and Normal Anatomy
	Congenital Anomalies
		Urethral Valves
		Urethral Diverticula
		Duplication of the Urethra
		Congenital Urethral Polyp
	Nonneoplastic Diseases
		Urethritis
		Caruncle
		Polypoid Urethritis
		Nephrogenic Adenoma (Metaplasia)
		Malakoplakia
		Amyloidosis
		Condyloma Acuminatum
		Metaplasia of the Urothelium
		Ectopic Prostatic Tissue and Prostatic Urethral Polyp
	Neoplastic Diseases
		Benign Neoplasms
			Papilloma
			Inverted Papilloma
			Malignant Neoplasms
			Urothelial Carcinoma in Association With Carcinoma of the Urinary Bladder
			Primary Urethral Carcinoma
			Urethral Carcinoma in Women
			Adenocarcinoma
			Adenocarcinoma of Accessory Glands
			Clear Cell Carcinoma
		Other Histologic Types of Carcinoma
			Malignant Melanoma
		Soft Tissue Tumors
	References
12
Nonneoplastic Diseases of the Testis
	Embryology and Anatomy of the Testis
		Embryology
			Development of the Testis
				Genetic Mechanisms Involved in Sex Determination and Testicular Differentiation
			Development of the Bipotential Gonad
				Formation of the Gonadal Ridge
				Primordial Germ Cells: Origin, Migration, and Formation of the Gonadal Blastema
				Male-Female Determination
				Testis Differentiation: Development of Seminiferous Cords and Interstitium
					Early Organization of the Gonadal Blastema
					Differentiation of Primordial Germ Cells
					Sertoli Cell Differentiation
					Peritubular Myoid Cell Differentiation
					Leydig Cell Development
					Rete Testis Formation
					Development of the Urogenital Tract
				Hormonal Control of Male Genital Tract Differentiation
				Fetal Testis Structure
					Supporting Structures
					Seminiferous Cords
					Germ Cells
					Sertoli Cells
					Peritubular Myoid Cells
					Leydig Cells
					Other Testicular Cell Types
					Vascularization of the Fetal Testis
					Fetal Epididymis
				Testicular Descent
					Anatomic Structures Involved in Testicular Descent
					Prerequisites for Testicular Descent
					Normal Hormonal Stimulation
					Adequate Intraabdominal Pressure
					Adequate Development of the Processus Vaginalis
					Factors That Regulate Testicular Descent
		Prepubertal Testis
			Development of the Testis From Birth to Puberty
				The Testis at Birth
				Neonatal Development of the Testis
				Testis in Infancy
				The Testis in Childhood
			Relationship of Testis and Epididymis During Infancy, Childhood, and Puberty
			Interpretation of Testicular Biopsy From Prepubertal Testes
				Tunica Albuginea
				Seminiferous Tubules
					Mean Tubular Diameter
					Germ Cell Number
					Sertoli Cell Number
				Leydig Cell Number
				Intertubular Connective Tissue
		Adult Testis
			Anatomy
			Supporting Structures
			Seminiferous Tubules
				Sertoli Cells
				Germ Cells
					Spermatogonia
					Spermatocytes
					Spermiogenesis
					Cycle of the Seminiferous Epithelium
				Tunica Propria
			Testicular Interstitium
				Connective Tissue Cells
				Leydig Cells
				Macrophages, Neuron-like Cells, and Mast Cells
				Blood and Lymphatic Vessels
				Nerves
				Rete Testis
	Congenital Anomalies of the Testis
		Alterations in Number, Size, and Location
			Anorchidism
				Monorchidism
				Testicular Regression Syndrome
					True Agonadism (46,XY Gonadal Agenesis Syndrome)
					Rudimentary Testes Syndrome
					Congenital Bilateral Anorchidism
					Vanishing Testes Syndrome
					Leydig Cell-Only Syndrome
			Microorchidism
			Polyorchidism
			Testicular Hypertrophy (Macroorchidism)
				Congenital Leydig Cell Hyperplasia
				Compensatory Hypertrophy of the Testis
				Idiopathic Benign Macroorchidism
				Bilateral Megalotestes With Low Gonadotropins
				Fragile X Chromosome; Martin-Bell Syndrome
				Other Causes of Testicular Hypertrophy
				Testicular Hypertrophy Secondary to Follicle-Stimulating Hormone-Secreting Pituitary Adenoma
			Precocious Puberty
				Central Precocious Puberty
				Peripheral Precocious Puberty
					Familial Testotoxicosis: Gonadotropin-Independent Precocious Puberty or Familial Male-Limited Precocious Puberty
					Precocious Pseudopuberty Secondary to Functioning Tumors
					Precocious Pseudopuberty Secondary to Disorders in Aromatase Activity
					Aromatase Excess Syndrome
					Aromatase Deficiency Syndrome
					Precocious Pseudopuberty Secondary to Leydig Cell Hyperplasia With Focal Spermatogenesis
				Mixed Precocious Puberty
			Testicular Ectopia
			Testicular Exstrophy (Scrotoschisis)
			Testicular Fusion
			Bilobed Testis
		Hamartomatous Testicular Lesions
			Cystic Dysplasia of the Testis
				Cystic Dysplasia of the Rete Testis
				Cystic Dysplasia of the Epididymis
			Hamartoma of the Rete Testis
			Fetal Gonadoblastoid Testicular Dysplasia
			Sertoli Cell Nodule (Hypoplastic Zones or Dysgenetic Tubules)
			Tubular Hamartoma (Androgen Insensitivity Syndrome)
			Lymphangiectasis
				Congenital Testicular Lymphangiectasis
				Epididymal Lymphangiectasis
			Other Hamartomatous Testicular Lesions
		Ectopias
			Persistence of Gonadal Blastema
			Seminiferous Tubule Ectopia
			Leydig Cell Ectopia
			Adrenal Cortical Ectopia
			Other Ectopias
		Undescended Testes
			True Cryptorchidism
				Etiology
					Congenital Cryptorchidism
					Acquired Cryptorchidism
				Pathogenesis
				Histology
					Prepubertal Testes: Morphologic Classification
					Pubertal and Adult Testes
				Validation of the Morphologic Classification of the Prepubertal Undescended Testes Lesions
				Effectiveness of Treatment in Undescended Testes
				Congenital Anomalies Associated With Undescended Testes
				Complications of Cryptorchidism
					Testicular Cancer
					Infertility
					Testicular Torsion
					Iatrogenic Atrophy
					Psychological Problems
				Benefit of Testicular Biopsy in Patients With Cryptorchidism
			Obstructed Testes
			Retractile Testes
		Testicular Microlithiasis
			Incidence
			Pathology and Histogenesis
			Microlithiasis and Testicular Cancer
			Rete Testis, Epididymis, and Vaginal Microlithiasis and Calcifications
	Disorders of Sex Development
		Gonadal Dysgenesis
			Types of Gonads in Patients With Gonadal Dysgenesis and Correlation With Clinical Syndromes
				Classic Streak Gonad
				Hypoplastic Ovary (Dysgenetic Ovary)
				Streak Gonad With Epithelial Cord-like Structures
				Dysgenetic Testis
				Streak Testis
			True Agonadism
			45,X0 Gonadal Dysgenesis
				Patients With Chromosomal Mosaicisms
			46,XX Gonadal Dysgenesis
			46,XY Gonadal Dysgenesis
			Mixed Gonadal Dysgenesis
			Dysgenetic Male Pseudohermaphroditism
			Persistent Müllerian Duct Syndrome
			Other Forms of Gonadal Dysgenesis
		Ovotesticular Disorder (True Hermaphroditism)
		Undermasculinization (Male Pseudohermaphroditism)
			Impaired Leydig Cell Activity
				Androgen Synthesis Deficiencies
					Congenital Lipoid Adrenal Hyperplasia
					3β-Hydroxysteroid Dehydrogenase Deficiency
					17α-Hydroxylase/17,20-Lyase Deficiency
					17,20-Desmolase Deficiency
					17β-Hydroxysteroid Dehydrogenase Deficiency
				Leydig Cell Hypoplasia
			Impaired Androgen Metabolism in Peripheral Tissues
				Androgen Insensitivity Syndromes
					Complete Androgen Insensitivity Syndrome (Complete Testicular Feminization Syndrome)
					Partial Androgen Insensitivity Syndrome (Partial Testicular Feminization Syndrome)
					Mild Androgen Insensitivity Syndrome
					Kennedy Disease
				5α-Reductase Deficiency
			Other Forms of Male Undermasculinization
				Smith-Lemli-Opitz Syndrome
				Opitz Syndrome
				ATRX Syndrome
	Infertility
		Testicular Biopsy
			Indications
			Qualitative and Quantitative Evaluation
			Common Lesions
				Sertoli Cell-Only Syndrome
					Sertoli Cell-Only Syndrome With Immature Sertoli Cells
					Sertoli Cell-Only Syndrome With Dysgenetic Sertoli Cells
					Sertoli Cell-Only Syndrome With Mature Sertoli Cells
					Sertoli Cell-Only Syndrome With Involuting Sertoli Cells
					Sertoli Cell-Only Syndrome With Dedifferentiated Sertoli Cells
				Tubular Hyalinization
					Dysgenetic Hyalinization
					Hyalinization Caused by Hormonal Deficit
					Ischemic Hyalinization
					Postobstructive Hyalinization
					Postinflammatory Hyalinization
					Hyalinization Caused by Physical or Chemical Agents
				Diffuse Lesions in Spermatogenesis
					Lesions in the Adluminal Compartment of Seminiferous Tubules
					Young Spermatid Sloughing
					Late Primary Spermatocyte Sloughing
					Early Primary Spermatocyte Sloughing
					Etiology Overview
					Rete Testis Obstruction
					Seminiferous Tubule Obstruction
					Lesions in the Basal and Adluminal Compartments of Seminiferous Tubules
					Hypospermatogenesis: Types and Etiology
					Etiology of Hypospermatogenesis: Overview
					Hormonal Dysregulation
					Congenital Germ Cell Deficiency
					Sertoli Cell Dysfunction
					Leydig Cell Dysfunction
					Androgen Insensitivity
					Physical and Chemical Agents
					Etiology of Hypospermatogenesis Associated With Primary Spermatocyte Sloughing
					Spermatogonial Maturation Arrest
					Focal Lesions in Spermatogenesis (Mixed Atrophy)
			Germ Cell Anomalies in Infertile Patients
				Giant Spermatogonia
				Multinucleate Spermatogonia
				Dislocated Spermatogonia
				Megalospermatocytes
				Multinucleate Spermatids
				Malformed Spermatids
			Morphologically Abnormal Spermatozoa
				Anomalies of the Spermatozoal Head
				Anomalies of the Spermatozoal Tail
					Cytoplasmic Remnants
					Bent Tail
					Coiled Tail
					Tail Stump (Short-Tail Spermatozoa)
					Multiple Tails
					Sperm Tail Agenesis
					Sperm With Abnormal Elongation of the Tail
				Anomalies of the Connecting Piece
				Anomalies of the Axoneme
				Anomalies of Periaxonemal Structures
			Presence of Tumoral Cells
			Anomalies of Leydig Cells
			Mast Cells
			Macrophages
		Correlation Between Testicular Biopsy and Spermiogram
			Obstructive Azoospermia and Oligozoospermia
				Classification of Obstructive Azoospermia by Location
					Proximal Obstruction
					Distal Obstruction
					Mixed Obstruction
				Etiology of Obstructive Azoospermia
					Congenital Azoospermia
					Agenesis of All Mesonephric Duct Derivatives
					Epididymal Anomalies
					Vas Deferens Anomalies
					Anomalies of Seminal Vesicle and Ejaculatory Duct
					Acquired Azoospermia
					Testicular and Epididymal Lesions Resulting From Obstruction of Sperm Excretory Ducts
					Location of Obstruction
					Etiology of Obstruction
					Duration of Obstruction
			Functional Azoospermia and Oligozoospermia
				Young Syndrome
				Alterations in Spermatozoon Transport
			Summary of Diagnostic Groups Suggested by Testicular Biopsy
		Infertility and Chromosomal Anomalies
			Abnormalities in Sex Chromosomes
				Klinefelter Syndrome
					Genetic and Clinical Aspects
					Klinefelter Syndrome 46,XY/47,XXY
					Klinefelter Syndrome 48,XXYY
					Klinefelter Syndrome 48,XXXY and 49,XXXYY
					Association With Malignancy
					Occurrence in Childhood
					Association With Precocious Puberty
					Association With Hypogonadotropic Hypogonadism
				46,XX Males (XX Sex Reversal, Testicular Disorder of Sex Development)
					46,XX Males With Male Phenotype and Normal External Genitalia
					46,XX Males With Ambiguous External Genitalia
					Etiology
				47,XYY Syndrome
				Structural Anomalies of the Y Chromosome
				Deletions and Microscopically Visible Rearrangements in Infertile Patients
					Monocentric Deleted Yq Chromosome
					Dicentric Yq Isochromosomes
					Ring Y Chromosome
					Y/Y Translocation Chromosome
					Translocation of Y Chromosome to X Chromosome
					Autosomal translocation of Y Chromosome
					Microdeletions of Y Chromosome
				Structural Anomalies of the X Chromosome
			Anomalies in Autosomes
				Chromosomal Translocations and Inversions
				Down Syndrome
		Other Syndromes Associated With Hypergonadotropic Hypogonadism
		Secondary Idiopathic Hypogonadism
			Gonadotropin-Releasing Hormone Deficit
			Constitutional Delay of Growth and Puberty
			Isolated Gonadotropin Deficit
			Idiopathic Normosmic Hypogonadotropic Hypogonadism
			Hypogonadism Associated With Anosmia
				Kallmann Syndrome
				CHARGE Syndrome
			Isolated Luteinizing Hormone Deficiency
			Isolated Follicle-Stimulating Hormone Deficiency
			Bioinactive Follicle-Stimulating Hormone and Luteinizing Hormone
			Mutations in Gonadotropin Receptor Genes
			Growth Hormone Deficit
			Prader-Willi Syndrome or Hypotonia-Hypomentia-Hypogonadism-Obesity Syndrome
			Bardet-Biedl Syndrome
			Hypogonadotropic Hypogonadism Associated With Dermatologic Diseases
			Hypogonadotropic Hypogonadism Associated With Ataxia
				Ataxia-Telangiectasia
				Friedreich Ataxia
				Boucher-Neuhäuser Syndrome
				Gordon-Holmes Syndrome
				Carpenter Syndrome
				Biemond Syndrome
				Fraser Syndrome (Meyer-Schwickerath Syndrome or Ullrich-Feichtiger Syndrome)
		Hypogonadism Secondary to Endocrine Gland Dysfunction and Other Disorders
			Hypothalamus-Hypophysis
				Hypopituitarism
				Hyperprolactinemia
			Thyroid Gland
			Adrenals
				Congenital Adrenal Hypoplasia With Hypogonadotropic Hypogonadism
				Congenital Adrenal Hyperplasia
					Deficit in 17β-Hydroxylase
					Deficit in 20α-Hydroxylase
					Deficit in 3β-Hydroxysteroid Dehydrogenase
					Steroid 17α-Hydroxylase Deficiency
				Cushing Syndrome
				Adrenal Cortical Tumors
				Primary Pigmented Adrenocortical Disease
				Adrenocorticotropic Hormone-Independent Macronodular Adrenal Hyperplasia
			Pancreas
				Diabetes Mellitus
				Mucoviscidosis
			Liver
				Hypogonadism, Liver Disease, and Excessive Alcohol Consumption
				Nonalcoholic Liver Diseases and Infertility
			Kidney
				Autosomal Dominant Polycystic Renal Disease
				Chronic Renal Insufficiency
			Chronic Inflammatory Bowel Disease
				Celiac Disease
				Inflammatory Bowel Disease
			AIDS
			Chronic Anemia
				β-Thalassemia
				α-Thalassemia
				Sickle Cell Anemia
				Fanconi Anemia Syndrome
			Obesity
			Starvation
			Autoimmune Polyglandular Syndrome
				Features of Hypogonadism in Patients With Polyglandular Autoimmune Syndrome
			Inherited Metabolic Diseases
				Hemochromatosis and Infertility
				Galactosemia
				Kearns-Sayre Syndrome
				Adrenoleukodystrophy (Adrenal Testicular Myeloneuropathy)
				Primary Hyperoxaluria
				D-Bifunctional Protein Deficiency
				Fabry Disease
				Wolman Disease
				Niemann-Pick Disease
				Cystinosis
				CDG1 (Abnormal Glycosylated Proteins)
				Alström Syndrome
				Selenoprotein Deficiency Disorder
		Infertility Secondary to Physical and Chemical Agents
			Occupational Exposure
				Carbon Disulfide
				Dibromochloropropane
				Lead
				Oral Contraceptive Manufacture
			Endocrine-Disrupting Compounds
			Recreational Drugs and Doping
			Radiation
			Heat
			Testicular Trauma
				Traumatic Hematocele
				Testicular Dislocation or Luxation
				Testicular Trauma and Infertility
			Cancer Therapy
				Radiation Therapy
				Chemotherapy
				Potential for Fertility After Cancer Treatment in Childhood
			Estrogen and Antiandrogen Therapy
			Surgery
		Infertility in Patients With Spinal Cord Injury
	Inflammation and Infection
		Orchitis
			Viral Orchitis
			Bacterial Orchitis
			Granulomatous Orchiepididymitis
				Tuberculosis
				Syphilis
				Leprosy
				Brucellosis
				Sarcoidosis
			Malakoplakia
			Orchiepididymitis Caused by Fungi and Parasites
			Idiopathic Granulomatous Orchitis
			Peritumoral Granulomatous Orchitis
			Focal Orchitis (Primary Autoimmune Orchitis)
		Testicular Pseudolymphoma
		Histiocytosis With Testicular Involvement
	Other Testicular and Epididymal Lesions
		Epididymitis Nodosa
		Epididymitis Induced by Amiodarone
		Ischemic Granulomatous Epididymitis
		Vasculitis
			Polyarteritis Nodosa
			Wegener Disease
			Thromboangiitis Obliterans
			Giant Cell Arteritis
			Henoch-Schönlein Purpura
			Cogan Disease
			Behçet Disease
		Amyloidosis
		Testicular Infarct
			Spermatic Cord Torsion
			Other Causes of Testicular Infarct
	Other Testicular Diseases
		Cystic Malformation
			Cyst of the Tunica Albuginea
			Cyst of the Rete Testis
			Simple Cyst of the Testis
		Disorders of the Rete Testis
			Dysgenesis
			Acquired Disorders of the Rete Testis
				Metaplasia
				Reactive Hyperplasia of the Rete Testis
				Cystic Ectasia of the Rete Testis (Acquired Cystic Transformation)
				Simple Cystic Transformation
				Cystic Transformation With Epithelial Metaplasia
				Cystic Transformation With Crystalline Deposits
				Adenomatous Hyperplasia
				Hyperplasia With Hyaline Globule Formation
				Intracavitary Polypoid Nodular Proliferation
	References
13
Neoplasms of the Testis
	Staging
	Patterns of Metastasis
	Gross Examination
	Germ Cell Tumors
		Classification
		Histogenesis
		Epidemiology
			Cryptorchidism
			Prior Testicular Germ Cell Tumor
			Family History
			Disorders of Sex Development
			Infertility
			Other Associations
		Germ Cell Neoplasia in Situ and Related Germ Cell Tumors
			Germ Cell Neoplasia in Situ
				Special Studies
				Differential Diagnosis
				Prognosis
				Biopsy Diagnosis
				Treatment
			Seminoma
				Clinical Features
				Pathologic Findings
			Seminoma With Syncytiotrophoblast Cells
				Special Studies
				Differential Diagnosis
				Treatment and Prognosis
			Embryonal Carcinoma
				Clinical Features
				Pathologic Features
				Special Studies
				Differential Diagnosis
				Treatment and Prognosis
			Yolk Sac Tumor, Postpubertal-Type
				Clinical Features
				Pathologic Features
				Special Studies
				Differential Diagnosis
				Treatment and Prognosis
			Choriocarcinoma and Other Trophoblastic Neoplasms
				Clinical Features
				Pathologic Features
				Special Studies
				Differential Diagnosis
				Treatment and Prognosis
			Nonchoriocarcinomatous Trophoblastic Tumors
			Teratoma, Postpubertal-Type
				Clinical Features
				Pathologic Features
				Special Studies
				Differential Diagnosis
				Treatment and Prognosis
			Teratoma With Somatic-Type Malignancy
			Primitive Neuroectodermal Tumor
			Mixed Germ Cell Tumor
				Clinical Features
					Pathologic Features
				Polyembryoma and Diffuse Embryoma
				Treatment and Prognosis
			Germ Cell Tumors of Unknown Type
				Regressed Germ Cell Tumors
				Postchemotherapy Specimens
		Germ Cell Tumors Not Derived From Germ Cell Neoplasia in Situ
			Spermatocytic Tumor
				Clinical Features
				Pathologic Features
				Special Studies
				Treatment and Prognosis
				Differential Diagnosis
			Spermatocytic Tumor With Sarcoma
			Teratoma, Prepubertal-Type
			Dermoid Cyst
			Epidermoid Cyst
			Well-Differentiated Neuroendocrine Tumor (Monodermal Teratoma)
			Mixed Teratoma and Yolk Sac Tumor, Prepubertal-Type
			Yolk Sac Tumor, Prepubertal-Type
	Sex Cord-Stromal Tumors
		Leydig Cell Tumor
			Clinical Features
			Pathologic Features
			Treatment and Prognosis
			Differential Diagnosis
		Sertoli Cell Tumor, Not Otherwise Specified
			Clinical Features
			Pathologic Features
			Differential Diagnosis
			Treatment and Prognosis
		Large Cell Calcifying Sertoli Cell Tumor
		Intratubular Large Cell Hyalinizing Sertoli Cell Neoplasia
		Granulosa Cell Tumor
			Adult Granulosa Cell Tumor
			Juvenile Granulosa Cell Tumor
		Tumors in the Fibroma-Thecoma Group
		Myoid Gonadal Stromal Tumor
		Mixed and Unclassified Sex Cord-Stromal Tumors
	Tumors Containing Both Germ Cell and Sex Cord-Stromal Elements
		Gonadoblastoma
			Clinical Features
			Pathologic Features
			Special Studies
			Treatment and Prognosis
			Differential Diagnosis
	Miscellaneous Tumors of the Testis and Paratesticular Tissue
		Ovarian-Type Epithelial Tumors
	Miscellaneous Lesions
		Juvenile Xanthogranuloma
		Hemangioma
		Other Soft Tissue Tumors
	Hematolymphoid Tumors
		Lymphoma
			Clinical Features
			Pathologic Features
			Prognosis
			Differential Diagnosis
		Plasmacytoma
		Leukemia, Including Myeloid Sarcoma
		Rosai-Dorfman Disease
	Tumors of Collecting Duct and Rete Testis
		Adenoma
		Cystic Dysplasia
		Adenocarcinoma
	Metastatic Tumors
	Diagnostic Approach to Testicular Tumors
	References
14
Spermatic Cord and Testicular Adnexa
	Introduction
	Embryology and Normal Anatomy
		Embryology
		Anatomy
			Scrotum and Testicular Tunics
			Rete Testis
			Epididymis
			Vas Deferens (Ductus Deferens) and Spermatic Cord
	Congenital Anomalies
		Splenogonadal Fusion
		Adrenal Heterotopia and Renal Ectopia
		Wolffian and Müllerian Remnants
			Appendix Testis (Hydatid of Morgagni)
			Appendix Epididymis (Vestigial Caudal Mesonephric Collecting Tubule)
			Paradidymis (Organ of Giraldes)
			Vasa Aberrantia (Organ of Haller)
			Other Lesions Associated With the Epididymis
			Walthard Rest
		Hernia Sac Specimens: Glandular Inclusions Versus Vas Deferens or Epididymis
		Cystic Fibrosis
	Nonneoplastic Diseases of the Spermatic Cord and Testicular Adnexa
		``Celes´´ and Cysts
			Hydrocele
			Hematocele (Hematoma)
			Varicocele
			Spermatocele (Acquired Epididymal Cyst)
			Mesothelial Cyst
			Epidermoid Cyst (Epidermal Cyst)
			Dermoid Cyst (Mature Teratoma)
			Simple Cyst and Cystic Dysplasia of the Rete Testis
		Inflammatory and Reactive Diseases
			Epididymitis
				Acute Epididymitis
				Chronic Epididymitis
				Sperm Granuloma
			Vasitis and Vasitis Nodosa
				Funiculitis (Inflammation of the Spermatic Cord)
			Meconium-Induced Inflammation
			Vasculitis
		Other Nonneoplastic Diseases
			Torsion of the Spermatic Cord and Embryonic Remnants
			Calculi and Calcification
	Neoplasms
		Benign Neoplasms and Pseudotumors
			Lipoma
			Adenomatous Hyperplasia
			Adenomatoid Tumor (Benign Nonpapillary Mesothelioma)
			Hamartoma (Smooth Muscle Hyperplasia)
			Reactive Mesothelial Hyperplasia
			Benign Papillary Mesothelioma
			Papillary Cystadenoma of the Epididymis
			Fibrous Pseudotumor (Nodular and Diffuse Fibrous Proliferation)
			Leiomyoma
			Melanotic Neuroectodermal Tumor of Infancy (Progonoma; Retinal Anlage Tumor)
			Brenner Tumor
			Gonadal Stromal Tumor
			Other Benign Tumors
		Malignant Neoplasms
			Liposarcoma
			Rhabdomyosarcoma
			Leiomyosarcoma
			Malignant Mesothelioma
			Papillary Serous Tumor of Müllerian Epithelium (Benign and Malignant)
			Adenocarcinoma of the Epididymis
			Malignant Fibrous Histiocytoma
			Other Sarcomas and Malignancies
			Germ Cell Tumor
			Malignant Lymphoma and Hematopoietic Neoplasms
			Metastases
	References
15
Penis and Scrotum
	Penis
		Normal Anatomy and Histology
		Congenital Anomalies
		Nonneoplastic Diseases
			Inflammation
				Phimosis and Paraphimosis
				Fibroepithelial (Lymphedematous) Polyp
				Plasma Cell Balanitis (Zoon Balanitis)
				Balanitis Xerotica Obliterans (Penile Lichen Sclerosus)
				Reiter Syndrome
				Peyronie Disease
				Cutaneous Horn and Leukoplakia
				Penile Prosthesis
				Priapism
			Infections
				Gonorrhea
				Syphilis
				Herpes Simplex and Zoster
				Lymphogranuloma Venereum
				Granuloma Inguinale (Donovanosis)
				Chancroid (Soft Chancre)
				Candidiasis and Other Fungal Infections
				Scabies
				Pediculosis Pubis
				Molluscum Contagiosum
				Erythrasma
				Penile Lesions in AIDS
		Tumor-like Conditions
			Condyloma Acuminatum
			Pearly Penile Papules
			Penile Cysts
			Pseudoepitheliomatous Keratotic and Micaceous Balanitis
			Verruciform Xanthoma
		Neoplastic Diseases
			Benign Neoplasms
			Premalignant Lesions of the Penis
			Malignant Neoplasms
				Squamous Cell Carcinoma
				Variants of Squamous Cell Carcinoma (Human Papillomavirus Related)
					Basaloid Carcinoma, Including Papillary Variant
					Warty (Condylomatous) Carcinoma
					Warty-Basaloid Carcinoma
					Clear Cell Carcinoma
					Medullary Carcinoma of the Penis
				Variants of Squamous Cell Carcinoma: Non-Human Papillomavirus Related
					Verrucous Carcinoma
					Papillary Carcinoma, Not Otherwise Specified
					Carcinoma Cuniculatum
					Pseudohyperplastic Nonverruciform Squamous Cell Carcinoma
					Spindle Cell (Sarcomatoid) Squamous Cell Carcinoma
					Mixed Carcinoma
					Adenosquamous Carcinoma
					Acantholytic Squamous Cell Carcinoma
			Molecular Pathology of Penile Squamous Carcinoma
			Other Malignant Tumors (Nonsquamous Neoplasms)
				Basal Cell Carcinoma
				Malignant Melanoma
				Sarcoma and Other Tumors
				Lymphoma
				Germ Cell Tumors
				Metastases to the Penis
	Scrotum
		Normal Anatomy and Histology
		Nonneoplastic Diseases
			Fournier Gangrene
			Hidradenitis Suppurativa
			Idiopathic Scrotal Calcinosis
			Lipogranuloma
			Epidermal Cyst
			Fat Necrosis
		Neoplastic Diseases
			Squamous Cell Carcinoma
			Basal Cell Carcinoma
			Paget Disease
			Sarcoma
	References
16
Adrenal Glands
	Embryology and Normal Gross Anatomy
		Adrenal Cortex
		Adrenal Medulla
	Microscopic Anatomy
		Examination of the Adrenal Glands
	Congenital and Other Abnormalities
		Congenital Adrenal Aplasia and Hypoplasia
		Adrenal Heterotopia
		Union and Adhesion
		Adrenal Cytomegaly
		Adrenoleukodystrophy
		Congenital Adrenal Hyperplasia
			Pathology of Adrenal Glands in Congenital Adrenal Hyperplasia
			Testicular Adrenal Rest Tumors in Congenital Adrenal Hyperplasia
			Other Tumors Associated With Congenital Adrenal Hyperplasia
		Stress-Related Changes of the Adrenal Gland
		Other Abnormalities
	Nonneoplastic Diseases
		Chronic Adrenal Cortical Insufficiency (Addison Disease)
			Idiopathic or Autoimmune Addison Disease
			Adrenal Tuberculosis
			Histoplasmosis and Other Fungal Infections
			Amyloidosis
		Acute Adrenal Cortical Insufficiency
		Inflammation and Other Infections
			Nonspecific Adrenalitis
			Herpetic Adrenalitis
			Rare Infections
		Adrenal Cortical Hyperplasia
			Nodular Adrenal Gland
			Incidental Cortical Nodule/Adenoma at Autopsy
			Incidental Adrenal Mass Discovered in Vivo
			Incidental Pigmented Cortical Nodule
			Management of the Incidental Adrenal Mass Discovered in Vivo
			Adrenal Cortical Hyperplasia With Hypercortisolism
			Pituitary or Adenocorticotropic Hormone-Dependent Hypercortisolism (Cushing Disease)
				Diffuse and Micronodular Adrenal Cortical Hyperplasia
				Macronodular Hyperplasia
				Ectopic Adrenocorticotropin Hormone Syndrome With Secondary Hypercortisolism
				Primary Pigmented Nodular Adrenal Cortical Disease
				Complex of Myxomas, Spotty Pigmentation, and Endocrine Overactivity: Carney Complex
				Macronodular Hyperplasia With Marked Adrenal Enlargement
		Multiple Endocrine Neoplasia Type 1
		Other Rare Causes of Cushing Syndrome
		Adrenal Cortical Hyperplasia With Hyperaldosteronism
		Adrenal Cortical Hyperplasia With Excess Sex Steroid Secretion
		Adrenal Medullary Hyperplasia
		Adrenal Cyst
		Adrenal Hemorrhage
	Adrenal Neoplasms
		Adrenal Cortical Neoplasms
			Adrenal Cortical Adenoma With Cushing Syndrome
			Adrenal Cortical Adenoma With Primary Hyperaldosteronism (Conn Syndrome)
			Functional Pigmented (Black) Adrenal Cortical Adenoma
			Adrenal Cortical Neoplasms With Virilization or Feminization
			Oncocytic Adrenal Cortical Neoplasms (Adrenal Oncocytoma)
			Adrenal Cortical Carcinoma
			Other Adrenal Cortical Neoplasms
		Pheochromocytoma
			Hereditary Pheochromocytoma-Paraganglioma
			Pathology of Pheochromocytoma
			Pheochromocytoma in Multiple Endocrine Neoplasia Type 2
			Composite Pheochromocytoma
			Pseudopheochromocytoma
			Immunohistochemistry and Other Features
			Malignant Pheochromocytoma
	Peripheral Neuroblastic Tumors: Neuroblastoma, Ganglioneuroblastoma, and Ganglioneuroma
		In Situ Neuroblastoma
		Peripheral Neuroblastic Tumors
		Original Age-Linked Classification of Neuroblastoma
		International Neuroblastoma Pathology Classification
		Ancillary Techniques
		Molecular Genetics in Neuroblastomas
		Staging of Neuroblastoma and Ganglioneuroblastoma
		Stage IV-S Neuroblastoma and Patterns of Spread by Peripheral Neuroblastic Tumors
		Ganglioneuroma
	Other Adrenal Tumors
		Myelolipoma
		Adenomatoid Tumor
		Malignant Lymphoma
		Mesenchymal Tumors
		Malignant Melanoma
		Other Unusual Tumors and Tumor-like Lesions
	Tumors Metastatic to the Adrenal Glands
	References
Index
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	D
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	H
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