#Prostate is, by far, the most common specimen type in the workflow of genitourinary #pathologists. One of the major concerns is missing #cancer, resulting in false negative diagnosis. Common pitfalls summarized below. #surgpath #pathX #pathtwitter #pathology #gupath 🧵1/12

Post-treatment prostate cancer is something I struggle with. I feel evaluation for margin status and deciding on whether to grade or not is challenging. Of course, in some cases, finding prostatic adenocarcinoma in itself, especially in lymph nodes, can be difficult too, but

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RT @GladellPaner: Unique pattern of an uncommon #testis tumor. What’s is your diagnosis #GUPath tweeps? #OnePicDx . Answer in comment👇👇👇 h….

p53 in this case shows a wild type pattern (shown below). Ki-67 show low proliferation index of approximately 1%.

Immunohistochemistry stains show positive PAX8, WT1, ER, and patchy PR (shown here). While negative for germ cell tumor and sex-cord stromal tumor markers (not shown).

Müllerian serous tumors of the paratesticular region. In this case, the tumor shows morphologic features of serous borderline tumor. There is abundant inflammation associated with the tumor, resulting in areas that appear "invasive" or "infiltrative.".#surgpath #pathX

Kidney tumor from an adult female. Eosinophilic tumor, essentially positive for only CK AE1/AE3 and PAX8; while negative for markers including, but not limited to, CK7, CD117, CAIX, TFE3, cathepsin-K, and GPNMP. What would be your diagnosis?. #surgpath #pathX #pathtwitter

What would be your top differential diagnosis?.

Immunohistochemistry stains show the tumor cells to be positive for PAX8; negative for CK7; positive for cathepsin K; and positive for GPNMB. Molecular testing is pending.

Kidney tumor in an allograft kidney with the following morphologic features: tumor cells with abundant clear cytoplasm growing in papillary to nested pattern with delicate vasculatures. Prominent nucleoli are easily seen. #surgpath #pathX #pathtwitter #pathology #gupath #kidney

Immunohistochemistry stains show positive CK AE1/AE3, PAX-8, and CAIX (circumferential); and negative CK7, SMA, MelanA, etc. My limited experience would indicate that sometimes CK and PAX-8 may be lost and CAIX is very helpful in cases where clear cell RCC history is known.

Sometimes it is surprising to me how bland sarcomatoid renal cell carcinoma can look. Without relevant clinical history, the first thought that comes to mind for me is usually some benign entity. #surgpath #pathX #pathtwitter #pathology #gupath #kidney #cancer

And if there is, would that be considered as HG-PIN or intraductal carcinoma? I guess one would have to see one first to think about these types of things.

I've always been curious about whether there is a glomeruloid variant of in-situ prostatic adenocarcinoma. (this one is not) #surgpath #pathX #pathtwitter #pathology #gupath #prostate #cancer

This is from a testicular lesion ~ 6 cm. If this is all you have (IHCs are OCT3/4 and beta-HCG), would it be sufficient for you to consider a choriocarcinoma component, in an otherwise pure embryonal carcinoma? . #surgpath #pathX #pathtwitter #pathology #gupath #pathologist

Yes, the diagnosis would Leydig cell tumor, one of the sex cord stromal tumors of the testis.

What would be your diagnosis?.

#Immunohistochemistry stains show the following, positive inhibin, positive SF1, no nuclear beta-catenin, and negative SALL4, amongst others.

A 1.0 cm nodule is found in the testis, the histology is as shown: well circumscribed lesion with eosinophilic tumor cells. There is mild to moderate atypia and no seen mitoses. #surgpath #pathX #pathtwitter #pathology #gupath #pathologist #testis

Pacinian (lamellar) corpuscle - Sometimes is easy to forget that lymph nodes have feelings too. However, I am still quite surprised to see it here, as Pacinian corpuscles are nerve endings responsible for sensitivity to vibration and pressure. #surgpath #pathX #pathtwitter