Urologic Surgical Pathology

Description

With sweeping revisions throughout, the new edition of Urologic Surgical Pathology equips you to accurately diagnose specimens of the entire urinary tract and male reproductive system plus the adrenal glands. Comprehensive in scope, this title begins with a look at normal anatomy and histology for each organ system...followed by discussions of the pathology of congenital anomalies, inflammations, non-neoplastic diseases and neoplasia. Practical guidance in daily urological pathology sign-out and the latest recommended diagnostic approaches - with an emphasis on clinicopathologic and radiographic-pathologic correlations - makes this a true diagnostic decision-making medical reference. A consistent format enables you to locate critical information quickly, and more than 1600 high-quality illustrations - most in full color - make diagnosis even easier. "A great update of a well know textbook. Uropathology colleagues find it useful." Reviewed by: PathLab.org? Date: June 2014 Front cover Inside front cover Urologic Surgical Pathology Copyright page Contributors Preface Table of Contents 1 Nonneoplastic diseases of the kidney Chapter Outline Embryologic development and normal structure Pronephros Mesonephros Metanephros Nephron differentiation Gross anatomy Microscopic anatomy Parenchymal maldevelopment and cystic kidney diseases Abnormalities in form and position Rotation anomaly Renal ectopia Renal fusion Abnormalities in mass and number Supernumerary kidney Hypoplasia Simple hypoplasia Oligomeganephronia Cortical hypoplasia Segmental hypoplasia (Ask-Upmark kidney) Renal agenesis Unilateral renal agenesis Bilateral renal agenesis (Potter syndrome) Syndromic renal agenesis Renal dysplasia Polycystic kidney disease Autosomal recessive polycystic kidney disease Autosomal dominant polycystic kidney disease Cystic diseases (without dysplasia) in hereditary syndromes Nephronophthisis Medullary cystic disease Von Hippel–Lindau disease Tuberous sclerosis Glomerulocystic kidneys Miscellaneous diseases Renal tubular dysgenesis Acquired cystic kidney disease Localized cystic kidney disease Medullary sponge kidney Simple cortical cyst Pyelocalyceal ectasia and diverticula Vascular diseases Hypertension-associated renal disease Benign nephrosclerosis Malignant nephrosclerosis Thrombotic microangiopathy Hemolytic uremic syndrome Thrombotic thrombocytopenic purpura Renal artery stenosis Atherosclerosis-related renal artery stenosis Fibromuscular dysplasia Intimal fibroplasia Medial hyperplasia Medial fibroplasia with aneurysms Perimedial fibroplasia Periarterial fibroplasia Kidney in renal artery stenosis Renal artery dissection Renal artery aneurysm Saccular aneurysm Fusiform aneurysm Intrarenal aneurysm Arteriovenous malformation and fistula Renal emboli and infarcts Renal cortical necrosis Renal papillary necrosis Renal cholesterol microembolism syndrome Renal artery thrombosis Renal vein and renal venous thrombosis Bartter syndrome Vasculitis Tubulointerstitial disease Acute and chronic renal failure Acute tubular injury (necrosis) Acute tubulointerstitial nephritis Herbal remedies and slimming agents and aristocholic acid nephropathy Immunoglobulin G4–related sclerosing tubulointerstitial nephritis Analgesic nephropathy Bacterial infection–associated tubulointerstitial disease Acute pyelonephritis Pyonephrosis Perinephric abscess Emphysematous pyelonephritis Chronic pyelonephritis Reflux nephropathy (chronic nonobstructive pyelonephritis) Chronic obstructive pyelonephritis Viral Infections Granulomatous tubulointerstitial disease Sarcoidosis Xanthogranulomatous pyelonephritis Malakoplakia Tuberculosis Diverse other granulomatous infection–associated disease Metabolic abnormalities, heavy metals, and crystal-associated tubulointerstitial diseases Heavy metals Hypercalcemic nephropathy Nephrolithiasis Oxalate-associated renal disease Cystinosis Uric acid–associated renal disease Amyloidosis and paraprotein-associated tubulointerstitial disease Amyloidosis Light chain cast nephropathy Immunoglobulin and light chain deposition disease Light chain proximal tubulopathy Light chain crystal tubulopathy Crystal-storing histiocytosis Renal transplantation Rejection T-cell–mediated rejection Calcineurin inhibitor nephrotoxicity References 2 Neoplasms of the kidney Chapter outline Benign epithelial neoplasms Papillary adenoma Oncocytoma Renal cell carcinoma General features Incidence and epidemiology Associations with other disorders Clinical presentation Radiologic aspects of renal neoplasms Grading renal cell carcinoma Staging renal cell carcinoma Clear cell renal cell carcinoma Multilocular cystic renal cell carcinoma Papillary renal cell carcinoma Chromophobe renal cell carcinoma Hybrid oncocytic chromophobe tumor Carcinoma of the collecting ducts of Bellini Renal medullary carcinoma MiT family translocation renal cell carcinoma Xp11translocation renal cell carcinoma t(6;11) Renal cell carcinoma Carcinoma associated with neuroblastoma Mucinous tubular and spindle cell carcinoma Tubulocystic carcinoma Acquired cystic disease–associated renal cell carcinoma Clear cell papillary (tubulopapillary) renal cell carcinoma Hereditary leiomyomatosis–associated renal cell carcinoma Renal cell carcinoma, unclassified Sarcomatoid renal cell carcinoma Thyroid-like follicular renal cell carcinoma Succinic dehydrogenase B deficiency–associated renal cell carcinoma ALK-translocation renal cell carcinoma Other rare renal epithelial neoplasms Prognostic factors in renal cell carcinoma Renal cell carcinoma in children Neuroendocrine tumors Renal carcinoid tumor Neuroendocrine carcinoma Primitive neuroectodermal tumor Neuroblastoma Paraganglioma Mixed mesenchymal and epithelial tumors Cystic nephroma Mixed epithelial and stromal tumors Metanephric tumors Metanephric adenoma Metanephric stromal tumor Metanephric adenofibroma Metanephric adenosarcoma Nephroblastic tumors Nephrogenic rests and nephroblastomatosis Nephroblastoma (Wilms tumor) Cystic partially differentiated nephroblastoma Mesenchymal tumors occurring mainly in children Congenital mesoblastic nephroma Rhabdoid tumor of kidney Clear cell sarcoma of kidney Ossifying renal tumor of infancy Anaplastic sarcoma of the kidney Mesenchymal tumors occurring mainly in adults Benign and related tumors Angiomyolipoma Epithelioid angiomyolipoma Leiomyoma Hemangioma Lymphangioma Juxtaglomerular cell tumor Renomedullary interstitial cell tumor Schwannoma Solitary fibrous tumor Other rare neoplasms of mesenchymal or uncertain histogenesis Malignant tumors Leiomyosarcoma Angiosarcoma Malignant fibrous histiocytoma Hemangiopericytoma Osteosarcoma Synovial sarcoma Other rare sarcomas Hematopoietic and lymphoid tumors Lymphoma Leukemia Plasmacytoma Germ cell tumors Metastatic tumors References 3 Renal pelvis and ureter Chapter Outline Development Anatomy Congenital malformations Abnormalities in number or location of ureters Refluxing megaureter Ureteropelvic junction obstruction Primary megaureter Ureterocele Paraureteral diverticulum Ureteral dysplasia Nonneoplastic proliferative, metaplastic, and inflammatory lesions Hyperplasia, von Brunn nests, and ureteropyelitis cystica and glandularis Squamous and glandular metaplasia Nephrogenic adenoma Reactive atypia Malakoplakia Endometriosis Retroperitoneal fibrosis Neoplasms Benign epithelial neoplasms Inverted papilloma Urothelial papilloma Malignant neoplasms Urothelial dysplasia and carcinoma in situ Urothelial carcinoma Gross pathology Grading and staging Microscopic pathology Squamous cell carcinoma Adenocarcinoma Metastases Mesenchymal neoplasms Fibroepithelial polyps Leiomyoma and leiomyosarcoma Hemangioma Other tumors References 4 Fine needle aspiration of the kidney Chapter Outline Background to renal fine needle aspiration Indication for renal fine needle aspiration Specimen collection and preparation Complications Accuracy Adequacy Normal elements Proximal tubular cells Distal tubular cells Benign lesions Oncocytoma Renal cortical adenoma Angiomyolipoma Metanephric adenoma Cystic nephroma/mixed epithelial and stromal tumor Renal abscess Xanthogranulomatous pyelonephritis Renal infarcts Renal cysts Acquired cystic disease and adult polycystic disease Malignant lesions Renal cell carcinoma Clear cell renal cell carcinoma Papillary renal cell carcinoma Chromophobe renal cell carcinoma Sarcomatoid renal cell carcinoma Collecting duct carcinoma (Bellini tumor) Translocation-associated renal cell carcinoma Mucinous tubular and spindle cell carcinoma Metastases Urothelial carcinoma Other rare malignant tumors Future trends Fine needle aspiration in pediatric patients Renal mass ablation Conclusions References 5 Nonneoplastic disorders of the urinary bladder Chapter Outline Embryology and anatomy Embryology Gross anatomy Histology Epithelial abnormalities von Brunn nests Cystitis glandularis and cystitis cystica Squamous metaplasia Nephrogenic adenoma Papillary hyperplasia Inflammation and infection Nonspecific cystitis Polypoid and papillary cystitis Follicular cystitis Giant cell cystitis Hemorrhagic cystitis Special types of cystitis Interstitial cystitis Eosinophilic cystitis Postsurgical necrobiotic granulomas Bacillus Calmette-Guérin granulomas Other noninfectious granulomas Radiation cystitis Reaction to chemotherapy Infectious cystitis Bacterial cystitis Gangrene Encrusted cystitis Emphysematous cystitis Xanthogranulomatous cystitis Urachal abscess Malakoplakia Tuberculous cystitis Fungal and actinomycotic cystitis Viral cystitis Human papillomavirus Other viruses Schistosomiasis Calculi Polyps and other mass lesions Ectopic prostate Other polyps Hamartoma Amyloidosis Postoperative spindle cell nodule Pseudosarcomatous fibromyxoid tumor (inflammatory pseudotumor) Müllerian lesions Endometriosis Endocervicosis Müllerian cyst Malformations Agenesis Exstrophy Duplication and septation of the bladder Urachal cysts and persistence Diverticulum References 6 Neoplasms of the urinary bladder Chapter Outline Benign urothelial (transitional cell) neoplasms Urothelial papilloma and diffuse papillomatosis Inverted papilloma Squamous papilloma Papillary urothelial hyperplasia Flat intraepithelial lesions Flat urothelial hyperplasia (simple hyperplasia) Urothelial reactive atypia Reactive atypia Atypia of unknown significance Urothelial dysplasia (low-grade intraurothelial neoplasia) Primary dysplasia Secondary dysplasia Urothelial carcinoma in situ (high-grade intraurothelial neoplasia) Microscopic pathology Histologic variants Large cell carcinoma in situ Small cell carcinoma in situ Denuding and “clinging pattern” carcinoma in situ Pagetoid and undermining (lepidic) carcinoma in situ Carcinoma in situ with squamous or glandular differentiation Carcinoma in situ with microinvasion Therapy-induced changes in the urothelium and mimics of urothelial flat neoplasia Urothelial (transitional cell) carcinoma General features Epidemiology and risk factors Signs and symptoms Field cancerization and tumor multicentricity Histologic grading Histologic grading according to the 1973 World Health Organization classification Grade 1 urothelial carcinoma Grade 2 urothelial carcinoma Grade 3 urothelial carcinoma Histologic grading according to the International Society of Urological Pathology 1998 and World Health Organization 2004 classifications Papillary urothelial neoplasm of low malignant potential Low-grade urothelial carcinoma High-grade urothelial carcinoma Histologic grading of urothelial carcinoma: the four-tier proposal Grade 1 urothelial carcinoma (low grade) Grade 2 urothelial carcinoma (low grade) Grade 3 urothelial carcinoma (high grade) Grade 4 urothelial carcinoma (high grade) Other proposals for bladder cancer grading and tumor heterogeneity Ancona 2001 refinement of the World Health Organization 1973 classification The World Health Organization 1999 grading proposal Tumor heterogeneity Staging of invasive bladder cancer General features of invasive urothelial carcinoma Stage pT1 tumor Histologic grade Stroma–epithelial interface Invading epithelium Stromal response Diagnostic pitfalls Substaging of pT1 tumors Stage pT2 tumor Stage pT3 tumor Stage pT4 tumor Histologic variants Urothelial carcinoma with mixed differentiation Urothelial carcinoma, nested variant Urothelial carcinoma, inverted variant Urothelial carcinoma, micropapillary variant Urothelial carcinoma, microcystic variant Lymphoepithelioma-like (urothelial) carcinoma Urothelial Carcinoma, Plasmacytoid Variant Urothelial carcinoma, clear cell (glycogen-rich) variant Urothelial carcinoma, lipid cell variant Urothelial carcinoma with syncytiotrophoblastic giant cells Urothelial carcinoma with small tubules Urothelial carcinoma with chordoid features Urothelial carcinoma with rhabdoid features Sarcomatoid urothelial carcinoma Small cell carcinoma Large cell undifferentiated carcinoma Osteoclast-rich undifferentiated carcinoma Pleomorphic giant cell carcinoma Urothelial carcinoma with prominent stromal reaction Other uncommon morphologic variations in bladder cancer Specimen handling and reporting Glandular neoplasms Villous adenoma Adenocarcinoma Clear cell adenocarcinoma Hepatoid adenocarcinoma Urachal adenocarcinoma Squamous cell neoplasms Squamous cell carcinoma in situ Squamous cell carcinoma Schistosoma-associated squamous cell carcinoma Verrucous squamous cell carcinoma Basaloid squamous cell carcinoma Neural and neuroendocrine tumors Small cell carcinoma Epidemiology and clinical features Staging, treatment, and outcome Histogenesis and genetics Pathology Immunohistochemistry Differential diagnosis Large cell neuroendocrine carcinoma Carcinoid Paraganglioma (pheochromocytoma) Clinical features Histogenesis Genetics Pathology Immunohistochemistry Differential diagnosis Neurofibroma Schwannoma Primitive neuroectodermal tumor Malignant peripheral nerve sheath tumor Sarcomatoid carcinoma Definition and terminology Clinical features Histogenesis and genetics Pathology Differential diagnosis and immunohistochemistry Soft tissue tumors Myofibroblastic proliferations and benign soft tissue tumors Inflammatory myofibroblastic tumor Postoperative spindle cell nodule Leiomyoma Hemangioma Granular cell tumor Solitary fibrous tumors Perivascular epithelioid cell tumor Malignant soft tissue tumors Leiomyosarcoma Rhabdomyosarcoma Angiosarcoma Malignant fibrous histiocytoma Osteosarcoma Other rare soft tissue tumors arising in the bladder Malignant melanoma Germ cell tumors Hematologic malignancies Metastatic tumors and secondary extension Metastatic urothelial carcinoma References 7 Urine cytology Chapter outline Utility of urine cytology Indications Types of cytology specimens Normal components of the urinary sediment Superficial (umbrella) cells Cells originating from the deeper layers of the urothelium Columnar cells Mucus-containing epithelial cells Squamous cells Renal epithelial cells Convoluted tubular cells Collecting duct cells Other benign cells Inflammatory cells Noncellular components of the urinary sediment Renal casts in urine sediment Diagnostic criteria Inflammatory processes Bacteria Fungi Viruses Trematodes and other parasites Reactive cytologic changes Lithiasis Drug effects Effects of radiation therapy Degenerative changes Instrumentation atypia Laser-induced changes Neobladder and ileal conduit urine Urine cytology in renal transplant recipients Other benign conditions Benign tumors and tumor-like processes “Atypical” Cytologic diagnosis of urothelial tumors Dysplasia Carcinoma in situ Papilloma, World Health Organization grade 1 carcinoma, papillary neoplasm of low malignant potential, and low-grade papillary carcinoma World Health Organization grade 2 (low-grade) and grade 3 (high-grade) urothelial carcinoma Correlation of urine cytology and biopsy findings (diagnostic accuracy) Other types of carcinoma Rare variants of urothelial carcinoma Squamous cell carcinoma Adenocarcinoma Small cell undifferentiated carcinoma (oat cell carcinoma) Mixed carcinoma Other malignant tumors Major diagnostic pitfalls Trauma or instrumentation Cell preservation Human polyomavirus Lithiasis Drugs and other therapeutic procedures Special aspects of anatomic sites other than urinary bladder Secondary tumors Ancillary studies Acid hematoxylin stain Flow cytometry Digital image analysis Blood group antigens and other tumor markers detected by immunohistochemistry Nuclear matrix protein-22 HER2 and high-molecular-weight cytokeratin Tyrosine-phosphorylated proteins Fluorescence in situ hybridization The problem of hematuria Routine laboratory investigation of hematuria Dysmorphic red blood cells indicate glomerular disease Comprehensive analysis of urine for evaluation of hematuria References 8 Nonneoplastic diseases of the prostate Chapter outline Embryology and fetal-prepubertal history Anatomy and histology of the prostate Capsule Prostatic urethra and verumontanum Zonal anatomy of the prostate Nerve supply Blood supply Normal epithelium of the prostate Pigment Luminal products Stromal hyaline bodies Seminal vesicles and ejaculatory ducts Cowper glands Immunohistochemistry Prostate-specific antigen Prostatic acid phosphatase Keratin 34βE12 (keratin 903; high-molecular-weight keratin) p63 α-Methylacyl–coenzyme A racemase/P504S (AMACR, P504S, racemase) c-myc Combination of racemase, keratin 34βE12, p63, and c-myc ERG Prostate-specific membrane antigen Human glandular kallikrein 2 Other markers of basal cells Androgen receptors Neuroendocrine markers Prostate sampling techniques Needle biopsy Fine needle aspiration Transurethral resection Tissue artifacts Rectal tissue in needle biopsies Prostatic inflammation Prostatic immune response Acute bacterial prostatitis Chronic prostatitis Granulomatous prostatitis Granulomatous infection Postsurgical granulomatous prostatitis Bacillus Calmette-Guérin–induced granulomatous prostatitis Teflon-induced granulomatous prostatitis Malakoplakia Allergic (eosinophilic) granulomatous prostatitis Wegener granulomatosis and other forms of vasculitis Other rare forms of granulomatous prostatitis Idiopathic prostatitis Xanthoma and xanthogranulomatous prostatitis AIDS-associated prostatitis Virus-associated prostatitis Pathologic changes following needle biopsy Atrophy Nonneoplastic metaplasia Squamous metaplasia Mucinous metaplasia Neuroendocrine cells with eosinophilic granules (Paneth cell–like change) Urothelial metaplasia Nephrogenic adenoma (nephrogenic metaplasia) Hyperplasia and nodular hyperplasia Usual acinar and stromal hyperplasia Postatrophic hyperplasia (postinflammatory hyperplasia; postsclerotic hyperplasia) Prostatic stromal hyperplasia with atypia Basal cell hyperplasia and basal cell proliferations Basal cell hyperplasia Basal cell hyperplasia with florid appearance (florid basal cell hyperplasia) Atypical basal cell hyperplasia Basal cell adenoma Immunohistochemical findings Differential diagnosis Cribriform hyperplasia Atypical adenomatous hyperplasia (atypical hyperplasia; adenosis) Sclerosing adenosis Verumontanum mucosal gland hyperplasia Hyperplasia of mesonephric remnants Benign nonneoplastic conditions Amyloidosis Melanosis Endometriosis Treatment changes Androgen deprivation therapy Histopathologic findings after 5α-reductase inhibitors Immunohistochemical findings after androgen deprivation therapy Radiation therapy Cryotherapy (cryoablation) Hyperthermia References 9 Neoplasms of the prostate Chapter outline Epithelial neoplasms Prostatic intraepithelial neoplasia Epidemiology of prostatic intraepithelial neoplasia Diagnosis of prostatic intraepithelial neoplasia Useful immunohistochemical markers for the diagnosis of prostatic intraepithelial neoplasia Differential diagnosis of prostatic intraepithelial neoplasia Inflammation, atrophy, and high-grade prostatic intraepithelial neoplasia Clinical significance of prostatic intraepithelial neoplasia Prostatic intraepithelial neoplasia does not elevate prostate-specific antigen Imaging cannot detect prostatic intraepithelial neoplasia Prostatic intraepithelial neoplasia predicts coexistent or subsequent prostate cancer Clinical response and chemoprevention of high-grade prostatic intraepithelial neoplasia Prostatic intraepithelial neoplasia may or may not predict cancer extent and recurrence Androgen deprivation therapy eliminates prostatic intraepithelial neoplasia Radiation therapy eliminates prostatic intraepithelial neoplasia Molecular biology of prostatic intraepithelial neoplasia Animal models of prostatic intraepithelial neoplasia and prostate cancer Intraductal carcinoma Separation of intraductal carcinoma and prostatic intraepithelial neoplasia Clinical significance and response to intraductal carcinoma Malignancy-associated changes Atypical small acinar proliferation Diagnosis of atypical small acinar proliferation Subsets of atypical small acinar proliferation Atypical small acinar proliferation is predictive of cancer on repeat biopsy Atypical small acinar proliferation plus prostatic intraepithelial neoplasia Adenocarcinoma Epidemiology Latent carcinoma Etiology and pathogenesis Family history Hormones Race Aging and oxidative stress Diet Endocrine-disrupting chemicals Occupation and other factors Genotoxic Nongenotoxic Prostate cancer and benign prostatic hyperplasia Signs and symptoms Tissue methods of detection Needle core biopsy Detecting cancer: factors that influence diagnostic yield in biopsy specimens. Number of needle cores obtained. Method of biopsy. Location of biopsy. Amount of tissue obtained. Histotechnologist skill in processing and cutting prostate biopsies. Number of needle cores embedded per cassette. Number of tissue cuts obtained per specimen. Future trends in prostate biopsies. Fine needle aspiration Transurethral resection Prostatic enucleation (suprapubic prostatectomy and adenectomy) Radical prostatectomy Blocking the apex and the base. Gross pathology Microscopic pathology Cancer-associated pathologic findings Luminal mucin Luminal proteinaceous secretions Crystalloids Collagenous micronodules Perineural invasion Vascular and lymphatic invasion Increased microvessel density (angiogenesis) Significant problems in biopsy specimen interpretation and handling Atypical small acinar proliferation Prostatic intraepithelial neoplasia versus large acinar variant of Gleason grade 3 carcinoma Clear cell pattern of carcinoma versus benign acini “Vanishing” prostate cancer in radical prostatectomies Grading Gleason grading system Reproducibility of Gleason grading Recent trends in grading International Society of Urological Pathology 2005 modified Gleason scoring system Concordance of biopsy findings and prostatectomy grade Proposed modifications to Gleason grading Tertiary grade Nuclear grading and morphometric grading Grade compression and weighted average score Amount of high-grade adenocarcinoma Gleason 7 subdivision (3 + 4 versus 4 + 3) Dedifferentiation Grading after therapy Grading after radiation therapy. Grading after androgen deprivation therapy. Clinical significance of grading Correlation of grade with recurrence and survival Correlation of grade and tumor volume Correlation of grade and prostate-specific antigen concentration Correlation of grade and pathologic stage Correlation of grade and tumor location Variants of prostatic adenocarcinoma and other carcinomas Ductal adenocarcinoma Mucinous (colloid) carcinoma Signet ring cell carcinoma Atrophic adenocarcinoma Pseudohyperplastic adenocarcinoma Adenocarcinoma with microvacuolated cytoplasm (foamy gland carcinoma and xanthomatoid carcinoma) Comedocarcinoma Cribriform carcinoma Adenocarcinoma with glomeruloid features Adenocarcinoma with neuroendocrine differentiation Adenocarcinoma with neuroendocrine cells with large eosinophilic granules (Paneth cell–like change) Low-grade neuroendocrine carcinoma (carcinoid) High-grade neuroendocrine carcinoma (small cell carcinoma) Large cell neuroendocrine carcinoma Sarcomatoid carcinoma (carcinosarcoma) Carcinoma with oncocytic features Lymphoepithelioma-like carcinoma Clear cell carcinoma Microcystic adenocarcinoma Giant cell adenocarcinoma Adenoid cystic/basal cell carcinoma Squamous cell and adenosquamous cell carcinoma Urothelial carcinoma Treatment changes in prostate cancer Androgen deprivation therapy Pathologic findings after androgen deprivation Pathologic findings after 5α-reductase inhibitors Differential diagnosis Stage and surgical margins after androgen deprivation therapy Immunohistochemical findings after androgen deprivation therapy Radiation therapy Differential diagnosis of prostate cancer after radiotherapy Immunohistochemical findings after radiotherapy Cryotherapy Ultrasound hyperthermia, microwave hyperthermia, laser therapy, and hot water balloon therapy High-intensity focused ultrasound Predictive factors in prostate cancer Prostate-specific antigen Stage Pathology of prostate-specific antigen–detected adenocarcinoma (clinical stage T1c) Extraprostatic extension Microscopic bladder neck invasion (stage pT3a prostate cancer) Surgical margins Perineural invasion Vascular and lymphatic invasion Cancer volume Location of cancer Lymph node metastases Distant metastases Microvessel density Morphometric markers Molecular biology of prostate cancer Genetics of familial prostate cancer DNA ploidy Chromosome 7 Chromosome 8 Chromosome 10 Chromosome 16 Other chromosomes TMPRSS2-ERG and the ETS family gene fusions PCA3 C-myc Apoptosis-suppressing oncoprotein bcl-2 p53 p21 p27Kip1 Androgen receptors Glutathione S-transferases hypermethylation Mitochondrial DNA testing Integrins Heat shock protein 90 Pro-PSA Prostate-specific membrane antigen Proliferating cell nuclear antigen Engrailed nuclear protein-2 Sarcosine and other metabolites Other factors Combining multiple predictive factors Other epithelial neoplasms Other rare epithelial neoplasms Carcinoma metastatic to prostate Soft tissue neoplasms Benign tumors and tumor-like conditions Stromal hyperplasia (Stromal Subtype of Nodular Hyperplasia) Leiomyoma Pseudosarcomatous myofibroblastic proliferation Postoperative spindle cell nodule (postsurgical inflammatory myofibroblastic tumor) Solitary fibrous tumor Blue nevus Other rare benign soft tissue tumors Sarcoma Rhabdomyosarcoma Leiomyosarcoma Phyllodes tumor Stromal sarcoma Other sarcomas Other neoplasms and tumor-like proliferations Prostatic cysts Ejaculatory duct adenofibroma Hematologic malignancies Leukemia Malignant lymphoma Multiple myeloma Germ cell tumors Melanoma Rhabdoid tumor Other rare tumors and tumor-like conditions References 10 Seminal vesicles Chapter outline Embryology and anatomy Age-associated changes Congenital and acquired malformations Cysts Ectopic prostatic tissue Nonneoplastic abnormalities Amyloidosis Stromal hyaline bodies Fibrosis Inflammation Calcification and calculi Urothelial metaplasia Treatment changes (hormonal and radiation therapy) Neoplasms Adenocarcinoma Metastasis and contiguous spread Soft tissue tumors and other tumors References 11 Urethra Chapter outline Embryologic development and normal anatomy Congenital anomalies Urethral valves Urethral diverticula Duplication of the urethra Congenital urethral polyp Nonneoplastic diseases Urethritis Caruncle Polypoid urethritis Nephrogenic adenoma (metaplasia) Malakoplakia Amyloidosis Condyloma acuminatum Metaplasia of the urothelium Ectopic prostatic tissue and prostatic urethral polyp Neoplastic diseases Benign neoplasms Papilloma Inverted Papilloma Malignant neoplasms Urothelial carcinoma in association with carcinoma of the urinary bladder Primary urethral carcinoma Urethral carcinoma in women Adenocarcinoma Adenocarcinoma of accessory glands Clear cell adenocarcinoma Other histologic types of carcinoma Malignant melanoma Soft tissue tumors References 12 Nonneoplastic diseases of the testis Chapter Outline Embryology and anatomy of the testis Embryology Development of the testis Genetic mechanisms involved in sex determination and testicular differentiation Development of the bipotential gonad Formation of the gonadal ridge. Primordial germ cells: origin, migration, and formation of the gonadal blastema. Male-female determination Testis differentiation: development of seminiferous cords and interstitium Early organization of the gonadal blastema. Differentiation of primordial germ cells. Sertoli cell differentiation. Peritubular myoid cell differentiation. Leydig cell development. Rete testis formation. Development of the urogenital tract Hormonal control of male genital tract differentiation Fetal testis structure Supporting structures Seminiferous cords Germ cells Sertoli cells Peritubular myoid cells Leydig cells Other testicular cell types Vascularization of the fetal testis Fetal epididymis Testicular descent Anatomic structures involved in the testicular descent Prerequisites for testicular descent Normal function of the hypothalamopituitary-testicular axis. Adequate intraabdominal pressure. Adequate development of the processus vaginalis. Factors that regulate testicular descent Prepubertal testis Development of the testis from birth to puberty The testis at birth Neonatal development of the testis Testis in infancy The testis in childhood Relationship of testis and epididymis during infancy, childhood, and puberty Interpretation of testicular biopsy from prepubertal testes Tunica albuginea Seminiferous tubules Mean tubular diameter. Germ cell number. Sertoli cell number Leydig cell number Intertubular connective tissue Adult testis Anatomy Supporting structures Seminiferous tubules Sertoli cells Germ cells Spermatogonia. Spermatocytes. Spermiogenesis. Cycle of the seminiferous epithelium. Tunica propria Testicular interstitium Connective tissue cells. Leydig cells. Macrophages, neuron-like cells, and mast cells. Blood and lymphatic vessels. Nerves. Rete testis Congenital anomalies of the testis Alterations in number, size, and location Anorchidism Types Monorchidism. Testicular regression syndrome. True agonadism (46,XY gonadal agenesis syndrome). Rudimentary testes syndrome. Congenital bilateral anorchidism. Vanishing testes syndrome. Leydig cell–only syndrome. Macroscopic and microscopic findings Etiology Micro-orchidism Polyorchidism Testicular hypertrophy (macro-orchidism) Congenital Leydig cell hyperplasia Compensatory hypertrophy of the testis Idiopathic benign macro-orchidism Bilateral megalotestes with low gonadotropins Fragile X chromosome; Martin-Bell syndrome Other testicular hypertrophies Testicular hypertrophy secondary to follicle-stimulating hormone–secreting pituitary adenoma. Precocious puberty. Central precocious puberty. Peripheral precocious puberty. Familial testotoxicosis: gonadotropin-independent precocious puberty or familial male-limited precocious puberty. Precocious pseudopuberty secondary to functioning tumors. Precocious pseudopuberty secondary to disorders in aromatase activity. Aromatase excess syndrome. Aromatase deficiency syndrome. Precocious pseudopuberty secondary to Leydig cell hyperplasia with focal spermatogenesis. Mixed precocious puberty. Testicular ectopia Testicular exstrophy Testicular fusion Bilobed testis Hamartomatous testicular lesions Cystic dysplasia of the testis Hamartoma of the rete testis Fetal gonadoblastoid testicular dysplasia Sertoli cell nodule (hypoplastic zones or dysgenetic tubules) Tubular hamartomas (androgen insensitivity syndrome) Congenital testicular lymphangiectasis Other hamartomatous testicular lesions Ectopias Persistence of gonadal blastema Seminiferous tubule ectopia Leydig cell ectopia Adrenal cortical ectopia Other ectopias Undescended testes True cryptorchidism Etiology Congenital cryptorchidism Acquired cryptorchidism Pathogenesis Histology Prepubertal testes: morphologic classification Pubertal and adult testes Validation of the morphologic classification of the prepubertal undescended testes lesions Effectiveness of treatments in undescended testes Congenital anomalies associated with undescended testes Complications of cryptorchidism Testicular cancer Infertility Testicular Torsion Iatrogenic atrophy Psychological problems Benefit of testicular biopsy in patients with cryptorchidism Obstructed testes Retractile testes Testicular microlithiasis Incidence Pathology and histogenesis Microlithiasis and testicular cancer Rete testis, epididymis, and vaginal microlithiasis and calcifications Disorders of sex development Gonadal dysgenesis Types of gonads and correlation with clinical syndromes Classic streak gonad. Hypoplastic ovary. Streak gonad with epithelial cord–like structures. Dysgenetic testis. Streak testis. True agonadism 45,X0 Gonadal dysgenesis Patients with X monosomy. Patients with chromosomal mosaicisms. 46,XX Gonadal dysgenesis 46,XY Gonadal dysgenesis Mixed gonadal dysgenesis Dysgenetic male pseudohermaphroditism Persistent müllerian duct syndrome Other forms of gonadal dysgenesis Ovotesticular disorder (true hermaphroditism) Undermasculinization (male pseudohermaphroditism) Impaired Leydig cell activity Androgen synthesis deficiencies Congenital lipoid adrenal hyperplasia 3β-Hydroxysteroid dehydrogenase deficiency 17α-Hydroxylase/17,20-lyase deficiency 17,20-Desmolase deficiency 17β-Hydroxysteroid dehydrogenase deficiency Leydig cell hypoplasia Impaired androgen metabolism in peripheral tissues Androgen insensitivity syndromes Complete androgen insensitivity syndrome (complete testicular feminization syndrome). Partial androgen insensitivity syndrome (partial testicular feminization syndrome). Mild androgen insensitivity syndrome. Kennedy disease. 5α-Reductase deficiency Other forms of male undermasculinization RSH syndrome (Smith-Lemli-Opitz syndrome) Opitz syndrome (GBBB syndrome) ATR-X syndrome Infertility Testicular biopsy Indications Qualitative and quantitative evaluation Common lesions Sertoli cell–only syndrome Sertoli cell–only syndrome with immature Sertoli cells. Sertoli cell–only syndrome with dysgenetic Sertoli cells. Sertoli cell–only syndrome with mature Sertoli cells. Sertoli cell–only syndrome with involuting Sertoli cells. Sertoli cell–only syndrome with dedifferentiated Sertoli cells. Tubular hyalinization Dysgenetic hyalinization. Hyalinization caused by hormonal deficit. Ischemic hyalinization. Postobstructive hyalinization. Postinflammatory hyalinization. Hyalinization caused by physical or chemical agents. Diffuse lesions in spermatogenesis Lesions in the adluminal compartment of seminiferous tubules. Young spermatid sloughing. Late primary spermatocyte sloughing. Early primary spermatocyte sloughing. Etiology overview. Rete testis obstruction. Seminiferous tubule obstruction. Lesions in the basal and adluminal compartments of seminiferous tubules. Hypospermatogenesis: types and etiology. Etiology of hypospermatogenesis: overview. Hormonal dysregulation. Congenital germ cell deficiency. Sertoli cell dysfunction. Leydig cell dysfunction. Androgen insensitivity. Physical and chemical agents. Etiology of hypospermatogenesis associated with primary spermatocyte sloughing. Spermatogonial maturation arrest. Focal lesions in spermatogenesis (mixed atrophy). Germ cell anomalies in infertile patients Giant spermatogonia Multinucleate spermatogonia Dislocated spermatogonia Megalospermatocytes Multinucleate spermatids Malformed spermatids Morphologically abnormal spermatozoa Anomalies of the spermatozoal head Anomalies of the spermatozoal tail Generalized anomalies of the tail Cytoplasmic remnants. Bent tail. Coiled tail. Tail stump (short-tail spermatozoa). Multiple tails. Sperm tail agenesis. Sperm with abnormal elongation of the tail. Anomalies of the connecting piece. Anomalies of the axoneme. Anomalies of periaxonemal structures. Presence of tumoral cells Anomalies of Leydig cells Mast cells Correlation between testicular biopsy and spermiogram Obstructive azoospermia and oligozoospermia Classification of obstructive azoospermia by location Proximal obstruction. Distal obstruction. Mixed obstruction. Etiology of obstructive azoospermia Congenital azoospermia. Agenesis of all mesonephric duct derivatives. Epididymal anomalies. Vas deferens anomalies. Anomalies of seminal vesicle and ejaculatory duct. Acquired azoospermia. Testicular and epididymal lesions resulting from obstruction of sperm excretory ducts. Location of obstruction. Etiology of obstruction. Duration of obstruction. Functional azoospermia and oligozoospermia Young syndrome Alterations in spermatozoon transport Summary of diagnostic groups suggested by testicular biopsy Infertility and chromosomal anomalies Abnormalities in sex chromosomes Klinefelter syndrome Genetic and clinical aspects. Variants Klinefelter syndrome 46,XY/47,XXY. Klinefelter syndrome 48,XXYY. Klinefelter syndrome 48,XXXY and 49,XXXYY. Association with malignancy. Occurrence in childhood. Association with precocious puberty. Association with hypogonadotropic hypogonadism. 46,XX males (XX sex reversal, testicular disorder of sex development) 46,XX males with male phenotype and normal external genitalia. 46,XX males with ambiguous external genitalia. Etiology. 47,XYY syndrome Structural anomalies of the Y chromosome Deletions and microscopically visible rearrangements in infertile patients Monocentric deleted Yq chromosome. Dicentric Yq isochromosomes. Ring Y chromosome. Y/Y translocation chromosome. Translocation of Y chromosome to X chromosome. Autosomal translocation of Y chromosome. Microdeletions of Y chromosome. Structural anomalies of the X chromosome Anomalies in autosomes Chromosomal translocations and inversions. Down syndrome. Other syndromes associated with hypergonadotropic hypogonadism Secondary idiopathic hypogonadism Gonadotropin-releasing hormone deficit Constitutional delay of growth and puberty Isolated gonadotropin deficit Idiopathic normosmic hypogonadotropic hypogonadism Hypogonadism associated with anosmia Kallmann syndrome CHARGE syndrome Isolated luteinizing hormone deficiency Isolated follicle-stimulating hormone deficiency Bioinactive follicle-stimulating hormone and leuteinizing hormone Mutations in gonadotropin receptor genes Growth hormone deficit Prader-Willi syndrome or hypotonia-hypomentia-hypogonadism-obesity syndrome Bardet-Biedl syndrome Hypogonadotropic hypogonadism associated with dermatologic diseases Hypogonadotropic hypogonadism associated with ataxia Ataxia-telangiectasia Friedreich ataxia Kearns-Sayre syndrome Boucher-Neuhauser syndrome Gordon-Holmes syndrome Other forms of hypogonadotropic hypogonadism Carpenter syndrome Biemond syndrome Fraser syndrome (Meyer-Schwickerath syndrome or Ullrich-Feichtiger syndrome) Hypogonadism secondary to endocrine gland dysfunction and other disorders Hypothalamus-hypophysis Hypopituitarism Hyperprolactinemia Thyroid gland Adrenals Congenital adrenal hypoplasia with hypogonadotropic hypogonadism Congenital adrenal hyperplasia Deficit in 17β-hydroxylase. Deficit in 20α-hydroxylase. Deficit in 3β-hydroxysteroid dehydrogenase. Steroid 17α-hydroxylase deficiency. Cushing syndrome Adrenal cortical tumors Primary pigmented adrenocortical disease Adrenocorticotropic hormone–independent macronodular adrenal hyperplasia Adrenocortical hyperplasia associated with McCune-Albright syndrome Pancreas Diabetes mellitus Mucoviscidosis Liver Hypogonadism, liver disease, and excessive alcohol consumption Nonalcoholic hepatic disease Hemochromatosis Kidney Polycystic renal disease Chronic renal insufficiency Chronic inflammatory bowel disease Acquired immunodeficiency syndrome Chronic anemia β-Thalassemia α-Thalassemia Sickle Cell Anemia Fanconi anemia syndrome Obesity Autoimmune polyglandular syndrome Features of hypogonadism Lysosomal and peroxisomal diseases Fabry disease Adrenoleukodystrophy (adrenal testicular myeloneuropathy) Wolman disease Cystinosis Niemann-Pick disease Infertility secondary to physical and chemical agents Occupational exposure Carbon disulfide Dibromochloropropane Lead Oral contraceptive manufacture Endocrine-disrupting compounds Recreational drugs and doping Radiation Heat Testicular trauma Traumatic hematocele Testicular dislocation or luxation Testicular trauma and infertility Cancer therapy Radiation therapy Chemotherapy Potential for fertility following cancer treatment in childhood Surgery Infertility in patients with spinal cord injury Inflammation and infection Orchitis Viral orchitis Bacterial orchitis Granulomatous orchiepididymitis Tuberculosis Syphilis Leprosy Brucellosis Sarcoidosis Malakoplakia Orchiepididymitis caused by fungi and parasites Idiopathic granulomatous orchitis Focal orchitis Testicular pseudolymphoma Histiocytosis with testicular involvement Other testicular and epididymal lesions Epididymitis nodosa Epididymitis induced by amiodarone Ischemic granulomatous epididymitis Scrotal calculi, scrotal pearl Polyarteritis nodosa Testicular infarct Spermatic cord torsion Other causes of testicular infarct Other testicular diseases Cystic malformation Disorders of the rete testis Dysgenesis Acquired disorders of the rete testis Metaplasia Cystic ectasia of the rete testis (acquired cystic transformation) Simple cystic transformation. Cystic transformation with epithelial metaplasia. Cystic transformation with crystalline deposits. Adenomatous hyperplasia Hyperplasia with hyaline globule formation Intracavitary polypoid nodular proliferation References 13 Neoplasms of the testis Chapter outline Staging Patterns of metastasis Gross examination Germ cell tumors Classification Histogenesis Epidemiology Cryptorchidism Prior testicular germ cell tumor Family history Disorders of sex development Infertility Other associations Intratubular germ cell neoplasia Special studies Differential diagnosis Prognosis Biopsy diagnosis Treatment Seminoma Clinical features Pathologic findings Seminoma with syncytiotrophoblastic cells Special studies Differential diagnosis Treatment and prognosis Spermatocytic seminoma Clinical features Pathologic features Special studies Treatment and prognosis Differential diagnosis Spermatocytic seminoma with sarcoma Embryonal carcinoma Clinical features Pathologic features Special studies Differential diagnosis Treatment and prognosis Yolk sac tumor Clinical features Pathologic features Special studies Differential diagnosis Treatment and prognosis Teratoma Clinical features Pathologic features Special studies Differential diagnosis Treatment and prognosis Teratoma with a secondary malignant component Monodermal teratoma Carcinoid tumor Primitive neuroectodermal tumor Epidermoid cyst Choriocarcinoma and other trophoblastic neoplasms Clinical features Pathologic features Special studies Differential diagnosis Treatment and prognosis Mixed germ cell tumor Clinical features Pathologic features Polyembryoma and diffuse embryoma Treatment and prognosis Regression of germ cell tumor (“burnt-out” germ cell tumor) Postchemotherapy specimens Sex cord–stromal tumors Leydig cell tumor Clinical features Pathologic features Treatment and prognosis Differential diagnosis Sertoli cell tumor Usual type (Sertoli cell tumor, not otherwise specified) Clinical features Pathologic features Differential diagnosis Treatment and prognosis Sclerosing Sertoli cell tumor Large cell calcifying Sertoli cell tumor Sertoli cell tumors in Peutz–Jeghers syndrome Granulosa cell tumor Adult type Juvenile type Tumors in the fibroma and thecoma group Mixed and unclassified sex cord–stromal tumors Mixed germ cell and sex cord–stromal tumors Gonadoblastoma Clinical features Pathologic features Special studies Treatment and prognosis Differential diagnosis Other mixed germ cell sex cord–stromal tumors Ovarian-type epithelial tumors Neoplasms and tumor-like lesions of the rete testis Adenocarcinoma Adenoma Adenomatous hyperplasia Cystic dysplasia Neoplasms of lymphoid and hematopoietic cells Lymphoma Clinical features Pathologic features Prognosis Differential diagnosis Plasmacytoma Leukemia (including myeloid sarcoma) Miscellaneous lesions Soft tissue tumors Metastatic tumors Diagnostic approach to testicular tumors References 14 Spermatic cord and testicular adnexa Chapter outline Embryology and normal anatomy Embryology Anatomy Scrotum and testicular tunics Rete testis Epididymis Vas deferens (ductus deferens) and spermatic cord Congenital anomalies Splenogonadal fusion Adrenal heterotopia and renal ectopia Wolffian and müllerian remnants Appendix testis (hydatid of Morgagni) Appendix epididymis (vestigial caudal mesonephric collecting tubule) Paradidymis (organ of Giraldes) Vasa aberrantia (organ of Haller) Other lesions associated with the epididymis Walthard rest Hernia sac specimens: glandular inclusions versus vas deferens or epididymis Cystic fibrosis Nonneoplastic diseases of the spermatic cord and testicular adnexa “Celes” and cysts Hydrocele Hematocele (hematoma) Varicocele Spermatocele (acquired epididymal cyst) Mesothelial cyst Epidermoid cyst (epidermal cyst) Dermoid cyst (mature teratoma) Simple cyst and cystic dysplasia of the rete testis Inflammatory and reactive diseases Epididymitis Acute epididymitis Chronic epididymitis Sperm granuloma Vasitis and vasitis nodosa Funiculitis (inflammation of the spermatic cord) Meconium-induced inflammation Vasculitis Other nonneoplastic diseases Torsion of the spermatic cord and embryonic remnants Calculi and calcification Neoplasms Benign neoplasms and pseudotumors Lipoma Adenomatous hyperplasia Adenomatoid tumor (benign nonpapillary mesothelioma) Hamartoma (smooth muscle hyperplasia) Reactive mesothelial hyperplasia Benign papillary mesothelioma Papillary cystadenoma of the epididymis Fibrous pseudotumor (nodular and diffuse fibrous proliferation) Leiomyoma Melanotic neuroectodermal tumor of infancy (progonoma and retinal anlage tumor) Brenner tumor Gonadal stromal tumor Other benign tumors Malignant neoplasms Liposarcoma Rhabdomyosarcoma Leiomyosarcoma Malignant mesothelioma Papillary serous tumor of müllerian epithelium (benign and malignant) Adenocarcinoma of the epididymis Malignant fibrous histiocytoma Other sarcomas and malignancies Germ cell tumor Malignant lymphoma and hematopoietic neoplasms Metastases References 15 Penis and scrotum Chapter outline Penis Normal anatomy and histology Congenital anomalies Nonneoplastic diseases Inflammation Phimosis and paraphimosis Fibroepithelial (lymphedematous) polyp Plasma cell balanitis (Zoon balanitis) Balanitis xerotica obliterans (penile lichen sclerosus) Reiter syndrome Peyronie disease Cutaneous horn and leukoplakia Penile prosthesis Priapism Infections Gonorrhea Syphilis Herpes simplex and zoster Lymphogranuloma venereum Granuloma inguinale (donovanosis) Chancroid (soft chancre) Candidiasis and other fungal infections Scabies Pediculosis pubis Molluscum contagiosum Erythrasma Penile lesions in acquired immunodeficiency syndrome Tumor-like conditions Condyloma acuminatum Pearly penile papules Penile cysts Pseudoepitheliomatous keratotic and micaceous balanitis Verruciform xanthoma Neoplastic diseases Benign neoplasms Premalignant lesions of the penis Erythroplasia of Queyrat. Bowen disease. Bowenoid papulosis. Malignant neoplasms Squamous cell carcinoma Variants of squamous cell carcinoma Basaloid carcinoma. Warty (condylomatous) carcinoma. Verrucous carcinoma. Papillary carcinoma, not otherwise specified. Carcinoma cuniculatum. Pseudohyperplastic nonverruciform squamous cell carcinoma. Spindle cell (sarcomatoid)–squamous cell carcinoma. Mixed carcinoma. Adenosquamous carcinoma. Acantholytic squamous cell carcinoma. Clear cell carcinoma. Molecular pathology of penile squamous carcinoma Basal cell carcinoma Malignant melanoma Sarcoma and other tumors Lymphoma Germ cell tumors Metastases to the penis Scrotum Normal anatomy and histology Nonneoplastic diseases Fournier gangrene Hidradenitis suppurativa Idiopathic scrotal calcinosis Lipogranuloma Epidermal cyst Fat necrosis Neoplastic diseases Squamous cell carcinoma Basal cell carcinoma Paget disease Sarcoma References 16 Adrenal glands Chapter outline Embryology and normal gross anatomy Adrenal cortex Adrenal medulla Microscopic anatomy Examination of the adrenal glands Congenital and other abnormalities Adrenal aplasia and hyperplasia Adrenal heterotopia Union and adhesion Adrenal cytomegaly Adrenoleukodystrophy Congenital adrenal hyperplasia Pathology of adrenal glands in congenital adrenal hyperplasia Testicular tumors in congenital adrenal hyperplasia (testicular adrenogenital tumors) Other tumors associated with congenital adrenal hyperplasia Stress-related changes of the adrenal gland Other abnormalities Nonneoplastic diseases Chronic adrenal cortical insufficiency (Addison disease) Idiopathic or autoimmune Addison disease Adrenal tuberculosis Histoplasmosis and other fungal infections Amyloidosis Acute adrenal cortical insufficiency Inflammation and other infections Nonspecific adrenalitis Herpetic adrenalitis Rare infections Adrenal cortical hyperplasia Nodular adrenal gland Incidental cortical nodules Incidental pigmented cortical nodule Approach to the nodular adrenal discovered in vivo Adrenal cortical hyperplasia with hypercortisolism Pituitary or adenocorticotropic hormone–dependent hypercortisolism (Cushing disease) Diffuse and micronodular adrenal cortical hyperplasia Macronodular hyperplasia Ectopic adrenocorticotropin hormone syndrome with secondary hypercortisolism Primary pigmented nodular adrenal cortical disease Complex of myxomas, spotty pigmentation, and endocrine overactivity: Carney complex Macronodular hyperplasia with marked adrenal enlargement Multiple endocrine neoplasia type 1 Other rare causes of Cushing syndrome Adrenal cortical hyperplasia with hyperaldosteronism Adrenal cortical hyperplasia with excess sex steroid secretion Adrenal medullary hyperplasia Adrenal cyst Myelolipoma Adrenal hemorrhage Adrenal neoplasms Adrenal cortical neoplasms Adrenal cortical adenoma with Cushing syndrome Adrenal cortical adenoma with primary hyperaldosteronism (Conn syndrome) Functional pigmented (black) adrenal cortical adenoma Adrenal cortical neoplasms with virilization or feminization Oncocytic adrenal cortical neoplasms (adrenal oncocytoma) Adrenal cortical carcinoma Other adrenal cortical neoplasms Pheochromocytoma Pheochromocytoma in multiple endocrine neoplasia Composite pheochromocytoma Pseudopheochromocytoma Immunohistochemistry and other features Neuroblastic tumors: neuroblastoma, ganglioneuroblastoma, and ganglioneuroma Ganglioneuroma Other adrenal tumors Adenomatoid tumor Malignant lymphoma Mesenchymal tumors Malignant melanoma Other unusual tumors and tumor-like lesions Tumors metastatic to the adrenal glands References Index A B C D E F G H I J K L M N O P Q R S T U V W X Y Z Inside back cover