GU

Question 1

SChLAP1 gene overexpression is associated with :

Answer 1

Associated with acceleration and metastasis of prostate adenocarcinoma
Greater expression in cribriform gland architecture and intraductal ca.

Question 2

Name the tumor that arises from BXO

Answer 2

Differentiated penile intraepithelial neoplasia - seen in older men, setting of BXO, not related to HPV.

Question 3

Sclerosing lipogranuloma in the testis is due to -

Answer 3

Exogenous liquid (e.g. paraffin injection) causes granulomatous reaction.

Question 4

Gleason score for area with paneth cell like neuroendocrine differentiation

Answer 4

Should not be assigned because morphologically they appear as 5 but are not associated with a poorer prognosis.

Question 5

Carbonic anhydrase IX staining patterns

Answer 5

Clear cell papillary RCC- cup like pattern - with membranous staining with lack of luminal staining

Clear cell RCC and Transcription elongation factor B ( TCEB-1) mutated RCC - box like pattern - diffuse membranous staining with no absence on luminal aspect

Papillary RCC - usually neg if present lmtd to tips of papillae

Question 6

Nephrogenic adenoma staining pattern

Answer 6

GATA3 +
PSA +
Ki- 67 0-5%

And importantly- PAX8 strong 💪 + to diff from prostate and urothelial ca

Question 7

Few pitfalls of Gleason scoring

Answer 7

Glomeruloid str + cribriform glands(small or large) are Gleason pattern 4
Comedonecrosis- Gleason pattern 5
Small cell ca- not assigned Gleason score

Question 8

Name the tumor based on IHC pattern

1. PLAP+,SALL4+,CD117+,OCT3/4+,CD30-, glypican 3-
2. PLAP+, SALL4+, CD117-, OCT3/4+,CD30+, glypican 3-
3. PLAP+, PanCK+, OCT3/4-, glypican 3+
4. PLAP-, SALL4+, CD117+,OCT3/4-
5. PLAP-, SALL4-, CD117-, OCT3/4-, Beta catenin +

Answer 8

1.PLAP+,SALL4+,CD117+,OCT3/4+,CD30-, glypican 3-
SEMINOMA
2. PLAP+, SALL4+, CD117-, OCT3/4+,CD30+, glypican 3- EMBRYONAL CA
3. PLAP+, PanCK+, OCT3/4-, glypican 3+ YOLK SAC tumor
4. PLAP-, SALL4+, CD117+,OCT3/4-
SPERMTOCYTIC TUMOR
5. PLAP-, SALL4-, CD117-, OCT3/4-, Beta catenin + SERTOLI CELL TUMOR

Question 9

Significance of amyloidosis of seminal vesicles

Answer 9

Benign with no clinical significance
2-10% of radical prostatectomies
Incidence increase with age
No additional work up needed.

Question 10

Note on hereditary leiomyomatous renal cell carcinoma syndrome (HLRCC)

Answer 10

Micro: oncocytic cells with perinucleolar halos
IHC: Lack staining for fumerate hydratase but positive for 2SC ( Cyto+nuclear staining)
Leiomyomas of skin and uterus
Autosomal dominant , FH gene at 1q42.3-q43
RCC unlike other syndromic tumors is usually UNILATERAL and solitary
Aggressive , usually with early Mets at d/g

Question 11

Scrotal lesion - “sack of marbles”

Answer 11

Answer: Scrotal calcinosis

Other scrotal lesions:
TANCHO’s nodules- implanting glass or beads in the subcutaneous tissue of penis for increasing sexual pleasure.
Paraffin injections- to increase girth give rise to sclerosing lipogranulomas

Question 12

Features of acquired cystic disease associated RCC

Answer 12

Large cells with eosinophilic cytoplasm
Numerous micro and macrocysts with a cribriform or sieve like appearance 
Multiple oxalate crystals 
Associated with dialysis 
RCC type in end stage kidneys 
Usually non- aggressive