DIAGNOSES FOR CASES SUBMITTED BY DR J.H. SHANKS (The Christie NHS Foundation Trust, Manchester) Case 1: Diagnosis = spermatocytic tumour (WHO 2016 terminology) Case 2: Diagnosis = sclerosing Sertoli cell tumour Case 3: Diagnosis = keratinising squamous metaplasia with dysplasia and tiny focus in one of the sections cut for teaching, suspicious of the very earliest stage of invasive SCC (difficult to be certain). Case 4: Diagnosis = chromophobe renal carcinoma (mistaken for clear cell carcinoma) Case 5: Diagnosis = oncocytoma (referred initially as a grade 2 RCC) Case 6: Diagnosis = Leydig cell tumour. Case 7: Diagnosis = basaloid squamous carcinoma (has bilateral groin lymph node mets) Case 8: Diagnosis = MiT family translocation renal cell carcinoma (Xp11 subtype) Has focal calcn; MNF116, AE1/3, CK7 and EMA –ve; TFE3 +ve. Case 9: Diagnosis = renal oncocytoma. Sent for opinion with ext. report suggested diagnosis given as renal cell carcinoma, grade 2. It involves perinepric fat and shows some focal calcification. It also shows prominent scattered small tubules in sclerotic stromal areas which unlike the rest of the tumour are vimentin and CK7 +ve (only scatted CK7 in individual cells elsewhere). Case 10: Diagnosis = seminoma Case 11: Diagnosis = angiomyolipoma Case 12: Diagnosis = invasive well differentiated squamous cell carcinoma Case 13: R10-5159. Diagnosis = oncocytoma – this case has slightly less oncocytic look but full histochemical/immunohistochemical support for diagnosis. Focal cytological atypia present (referred initially as renal cell carcinoma). Case 14: Diagnosis = yolk sac tumour with v focal teratoma. Serum AFP was raised. Tumour expresses patchy AFP. OCT (done on 3 blocks on two occasions) was consistently negative. Case 15: Diagnosis = poorly differentiated adenocarcinoma, almost certainly metastatic from stomach [Hx of gastric cancer]. Sent as ?could this be mesothelioma on basis of calretinin staining] however, focal CK7 and CK20 with strong BerEP4 and LeuM1. CK5/6 almost negative, WT1-ve, glands contain D/PAS +ve mucin.
Case 16: Diagnosis = nephrogenic adenoma. PAX-2 was +ve, AMACR v focally +ve, CK7+ve Case 17: Differential; diagnosis between multilocular cystic renal neoplasm of low malignant potential and conventional RCC. Features exclude cystic nephroma.TFE3 was -ve, CAIX >90% Case 18: Diagnosis = Intertubular seminoma with atrophy, germ cell neoplasia in situ and intratubular seminoma Case 19: Diagnosis : favour collecting duct carcinoma (differential diagnoses=urothelial carcinoma or metastasis) Case 20: Diagnosis = seminoma [put in to show ’compact’ areas sometimes encountered in retroperitoneal core biopsies]. c-kit was diffusely +ve. PLAP was +ve; cytokeratins and lymphoid markers –ve Case 21: Diagnosis = sex cord stromal tumour, unclassified Case 22: Diagnosis = lymphoma (DLBCL) Case 23: Diagnosis = oncocytoma with striking degenerate nuclear atypia. C-kit +ve; CK7 focal scattered cells Case 24: Diagnosis = Invasive adenocarcinoma with focal mucinous differentiation. Gleason at least 4+3=7 (grade group 3). 70% core length involved Case 25: Diffuse large B cell lymphoma, arising in MALT with angiotropism. Also present is keratinising squamous metaplasia (a risk factor for the development of squamous cell carcinoma).