Category Archives: genitourinary

Another Chromophobe RCC :-)  

Image_427

Things to note :

  • well defined cell border
  • fluffy , moth-eaten cytoplasm
  • accentuation at the periphery
  • dark irregular nuclear membranes ( rasinoid)
  • inconspicuous nucleoli

Image_417 Image_419Image_420 Image_425

Advertisements

Renal Rhabdoid Tumor, Case of 2 Years Old Infant with Large Right Renal Mass

Image_301
Renal Rhabdoid Tumor :
Touch Imprints:
   -Hyper cellular.
   -Vesicular nuclei with reniform indented contour.
   -Prominent nucleolus.
   -Abundant pink cytoplasm.
   – Frequent mitotic figures.
Image_302 Image_303 Image_304
H & E Sections:
INI immunostain is negative
Image_297 Image_298 Image_299
The rhabdoid tumor is an exceedingly rare renal tumor that occurs predominantly in infants and young children. The tumor is highly aggressive and has a poor prognosis (Weeks et al, 1989, 1991). The histogenesis is unknown. Rhabdoid tumors have now been reported in all age groups and in sites other than the kidney (Parham et al, 1994; Fanburg-Smith et al, 1998; Ogino et al, 2000).
In tissue sections, the tumor is composed of a single population of cells that may vary in size and configuration from round or oval to spindly. The characteristic feature of these tumors is the presence of large, eosinophilic cytoplasmic inclusions that displace the nucleus of the cell to the periphery. On electron microscopy, the inclusions are composed of intermediate filaments. There is no evidence that the cytoplasmic inclusions represent an accumulation of myoglobin, but it is the appearance that gave the tumor its name. Similar cytoplasmic inclusions that stain with an antibody to myoglobin may be observed in cells of rhabdomyosarcoma. From time to time, similar cytoplasmic inclusions may be observed in other tumors, including undifferentiated large-cell lung cancer. To our knowledge, there is only one published description of the cytologic findings in FNA biopsies of rhabdoid renal tumors. In three patients, Akhtar (1991) observed large polygonal cells with abundant dense pink cytoplasm, large intracytoplasmic eosinophilic inclusions, and large nuclei with macronucleoli.   “Koss’ Diagnostic Cytology and Its Histopathologic Bases, 5th Edition”

Adenomatoid Tumor, with Signet Ring like morphology

OLYMPUS DIGITAL CAMERA

Adenomatoid tumors are composed of two major elements the epithelial component and the fibrous stroma. the epithelial component is arranged in tubules, cords and nests withe cells that are flat, cuboidal to low columnar with round or oval nuclei and abundant dense cytoplasm however the cells might contain cytoplasmic vacuols and sometimes it’s so extensive that it results in signet ring like morphology as in the case of this gentle man how presents with painless small 2 cm mass in the epididymis. one should not confuse this with metastasizing signet ring carcinoma as adenomatoid tumors are very common only second to cord lipomas in such locations.  Negative CEA immunostain will rule out adenocarcinoma.

OLYMPUS DIGITAL CAMERA OLYMPUS DIGITAL CAMERA

OLYMPUS DIGITAL CAMERA OLYMPUS DIGITAL CAMERAOLYMPUS DIGITAL CAMERA OLYMPUS DIGITAL CAMERA OLYMPUS DIGITAL CAMERA OLYMPUS DIGITAL CAMERA

Angiomyolipoma

OLYMPUS DIGITAL CAMERA

AMLs are composed of variable amounts of adipose tissue, smooth muscle, and vasculature . More than 90% of tumors contain at least focal areas of mature adipose tissue . Fat cells resembling lipoblasts are rarely seen. The smooth muscle component ranges from fascicles of elongated spindle cells with cigar-shaped nuclei to sheets of epithelioid cells with abundant eosinophilic granular cytoplasm. The smooth muscle cells often appear to originate and radiate from vessel walls. The morphology of the vascular component is variable. Thickened and hyalinized vessels with eccentric lumens are seen in most cases. Antibodies to several melanoma-related antigens, including HMB-45 and A-103 (melan-A/MART-1), are at least focally positive in the majority of cases. In general, from 5% to 10% of cells are immunoreactive with these antibodies . The epithelioid smooth muscle cell components are most consistently positive with these antibodies, although the spindled smooth muscle and adipose tissue components also may be positive. This observation is of particular importance in the subset of AML with a predominance of adipose tissue or spindled smooth muscle. (Sternberg’s 5th ed).

OLYMPUS DIGITAL CAMERA   OLYMPUS DIGITAL CAMERA  OLYMPUS DIGITAL CAMERA   OLYMPUS DIGITAL CAMERAOLYMPUS DIGITAL CAMERA

Renal Cell Carcinoma, Chromophobe Type “ChRCC”

OLYMPUS DIGITAL CAMERA

Hi there, few days ago i stumbled upon this relatively uncommon renal tumor and misdiagnosed it as Conventional renal cell carcinoma on smears. ” seams i got so much to learn ”

So lets review the Cytological Characteristics of this tumor :

  • polygonal cells.
  • well defined borders.
  • granular to light transparent cytoplasm, clear cells are rare.
  • accentuation of the granularity at the periphery of the cell.
  • central halo giving the cell koilocyte like appearance.
  • the nuclei are eccentric with anisonucleosis.
  • some of the nuclei are condensed with raisinoid appearance.

Beware of the Eosinophilic Variant of Chromophobe RCC as it very hard to differentiate from  Renal Oncocytoma which is a benign tumor.

OLYMPUS DIGITAL CAMERA OLYMPUS DIGITAL CAMERA OLYMPUS DIGITAL CAMERA OLYMPUS DIGITAL CAMERA OLYMPUS DIGITAL CAMERA OLYMPUS DIGITAL CAMERA OLYMPUS DIGITAL CAMERA

Testicular Seminoma

OLYMPUS DIGITAL CAMERA

    40 years old male patient with testicular mass, the patient underwent radical orchidectomy and this is a smear from the tumor. you can see here the typical features of the germ cell tumor Seminoma classical variant, which are :

– highly cellular smears

– multiple bizarre nucleoli seen in side the nuclei

-infiltrating reactive lymphocytes ” smaller and darker in color ”

OLYMPUS DIGITAL CAMERA OLYMPUS DIGITAL CAMERA