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Diagnosing seminoma: practicalities and problems
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Pathology (2014), 46(S2)
PATHOLOGY 2014 ABSTRACT SUPPLEMENT
Urologic Pathology: SY25-1 NEW AND EMERGING RENAL TUMORS Ming Zhou New York University Medical Center, USA The International Society of Urological Pathology (ISUP) 2012 Consensus Conference on Adult Renal Neoplasia made recommendations regarding the diagnosis and classification of new and emerging adult renal tumors. There was consensus that five entities should be recognized as new histological types: tubulocystic renal cell carcinoma (RCC), acquired cystic disease-associated RCC, clear cell (tubule) papillary RCC, MiT family translocation RCC [in particular t(6;11) RCC] and hereditary leiomyomatosis-associated RCC. In addition, three rare epithelial carcinomas were considered emerging or provisional entities: thyroid-like follicular RCC; succinate dehydrogenase B deficiency-associated RCC; and ALK-translocation RCC. There were also a number of suggested modifications to existing WHO 2004 categories with the new classification. This new classification of renal neoplasia is known as the ISUP Vancouver Classification. These new renal tumor types have clinicopathological and molecular features that are distinct from those included in 2004 WHO classification. Correct diagnosis and classification of these new renal tumor entities have important implications for patient management.
Urologic Pathology: SY25-1 PROGNOSTIC FACTORS IN RENAL CANCER Brett Delahunt Department of Pathology and Molecular Medicine, Wellington School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand A wide variety of histologic prognostic parameters have been proposed for renal cell carcinoma and of these tumor morphotype, tumor grade, sarcomatoid and rhabdoid differentiation, and tumor necrosis were accepted as having utility in clinical practice by the Consensus Conference on Renal Neoplasia assembled by the International Society of Urological Pathology in Vancouver in 2012. With respect to morphotype it was determined that both papillary and chromophobe RCC have a more favourable prognosis than clear cell RCC, while collecting duct RCC was
recognised as having a poor prognosis. At the conference it was agreed that for clear cell and papillary RCC grading should based on nucleolar prominence alone for grade 1 to 3 tumours, and that grade 4 tumors should be defined by the presence of extreme nuclear pleomorphism, tumor giant cells and/or rhabdoid/sarcomatoid differentiation. It was further agreed that chromophobe RCC should not be graded. For necrosis there was consensus that the presence or absence of tumour necrosis should be routinely included in the histological report and that this should be based upon both macroscopic and histological examination. There was also consensus that the area of necrosis should be recorded as a percentage of the total tumour area.
Urologic Pathology: SY25-2 DIAGNOSING SEMINOMA: PRACTICALITIES AND PROBLEMS Dan M. Berney Queen Mary University of London, UK Classical seminoma is the most commonly encountered testicular neoplasm. Most clinically localised seminomas are now managed by surveillance, though adjuvant chemo or radiotherapy can be given. The diagnosis of seminoma can be relatively straightforward, but may present unforseen challenges leading to inappropriate treatment or serious misdiagnosis in a number of ways. 1) Thorough macroscopy. Seminomas require rigorous blocking. This is because tiny amounts of non-seminoma may be missed, leading to potential under-treatment. Inflammatory lesions and granulomatous lesions may also harbour small foci of seminoma and should be treated with suspicion. 2) Unusual histological patterns. Some seminomas show unusual features. They may show frequent syncytiotrophoblastic cells leading to misdiagnosis as choriocarcinoma. A minority show tubular elements or even signet ring change. 3) Mimicks. Solid type yolk sac tumour may mimic seminoma as well as a number of other entities, especially some malignant sex cord stromal tumours. The former should be considered for adjuvant treatment, while the latter may require a prophylactic retroperitoneal lymph node dissection. Spermatocytic seminoma, especially when monomorphic may be mistaken for seminoma. Close morphological inspection allied to to judicious use of immunochemistry and knowledge of clinical details including serology is essential for the accurate diagnosis of seminoma.
Copyright © Royal College of pathologists of Australasia. Unauthorized reproduction of this article is prohibited.
Pathology (2014), 46(S2)
PATHOLOGY 2014 ABSTRACT SUPPLEMENT
Urologic Pathology: SY25-1 NEW AND EMERGING RENAL TUMORS Ming Zhou New York University Medical Center, USA The International Society of Urological Pathology (ISUP) 2012 Consensus Conference on Adult Renal Neoplasia made recommendations regarding the diagnosis and classification of new and emerging adult renal tumors. There was consensus that five entities should be recognized as new histological types: tubulocystic renal cell carcinoma (RCC), acquired cystic disease-associated RCC, clear cell (tubule) papillary RCC, MiT family translocation RCC [in particular t(6;11) RCC] and hereditary leiomyomatosis-associated RCC. In addition, three rare epithelial carcinomas were considered emerging or provisional entities: thyroid-like follicular RCC; succinate dehydrogenase B deficiency-associated RCC; and ALK-translocation RCC. There were also a number of suggested modifications to existing WHO 2004 categories with the new classification. This new classification of renal neoplasia is known as the ISUP Vancouver Classification. These new renal tumor types have clinicopathological and molecular features that are distinct from those included in 2004 WHO classification. Correct diagnosis and classification of these new renal tumor entities have important implications for patient management.
Urologic Pathology: SY25-1 PROGNOSTIC FACTORS IN RENAL CANCER Brett Delahunt Department of Pathology and Molecular Medicine, Wellington School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand A wide variety of histologic prognostic parameters have been proposed for renal cell carcinoma and of these tumor morphotype, tumor grade, sarcomatoid and rhabdoid differentiation, and tumor necrosis were accepted as having utility in clinical practice by the Consensus Conference on Renal Neoplasia assembled by the International Society of Urological Pathology in Vancouver in 2012. With respect to morphotype it was determined that both papillary and chromophobe RCC have a more favourable prognosis than clear cell RCC, while collecting duct RCC was
recognised as having a poor prognosis. At the conference it was agreed that for clear cell and papillary RCC grading should based on nucleolar prominence alone for grade 1 to 3 tumours, and that grade 4 tumors should be defined by the presence of extreme nuclear pleomorphism, tumor giant cells and/or rhabdoid/sarcomatoid differentiation. It was further agreed that chromophobe RCC should not be graded. For necrosis there was consensus that the presence or absence of tumour necrosis should be routinely included in the histological report and that this should be based upon both macroscopic and histological examination. There was also consensus that the area of necrosis should be recorded as a percentage of the total tumour area.
Urologic Pathology: SY25-2 DIAGNOSING SEMINOMA: PRACTICALITIES AND PROBLEMS Dan M. Berney Queen Mary University of London, UK Classical seminoma is the most commonly encountered testicular neoplasm. Most clinically localised seminomas are now managed by surveillance, though adjuvant chemo or radiotherapy can be given. The diagnosis of seminoma can be relatively straightforward, but may present unforseen challenges leading to inappropriate treatment or serious misdiagnosis in a number of ways. 1) Thorough macroscopy. Seminomas require rigorous blocking. This is because tiny amounts of non-seminoma may be missed, leading to potential under-treatment. Inflammatory lesions and granulomatous lesions may also harbour small foci of seminoma and should be treated with suspicion. 2) Unusual histological patterns. Some seminomas show unusual features. They may show frequent syncytiotrophoblastic cells leading to misdiagnosis as choriocarcinoma. A minority show tubular elements or even signet ring change. 3) Mimicks. Solid type yolk sac tumour may mimic seminoma as well as a number of other entities, especially some malignant sex cord stromal tumours. The former should be considered for adjuvant treatment, while the latter may require a prophylactic retroperitoneal lymph node dissection. Spermatocytic seminoma, especially when monomorphic may be mistaken for seminoma. Close morphological inspection allied to to judicious use of immunochemistry and knowledge of clinical details including serology is essential for the accurate diagnosis of seminoma.
Copyright © Royal College of pathologists of Australasia. Unauthorized reproduction of this article is prohibited.