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Genitourinary Pathology Recent Advances

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Special Section—Urologic Pathology

Genitourinary Pathology
Recent Advances
Jae Y. Ro, MD, PhD; Alberto G. Ayala, MD

his special section attempts to provide a comprehensive update of genitourinary tumors and their precursor lesions highlighting recent new knowledge and development in a diagnostic and clinical context. Tumors of the genitourinary tract, whether benign, malignant, or precursor conditions, are collectively responsible for significant morbidity and mortality in men and women of all ages throughout the world. In the United States, prostate cancer is the leading noncutaneous cancer in men, accounting for 33% of all cancers, and urinary bladder and kidney cancers account for 7% and 3% of all cancers in men, respectively. In women, the incidence of bladder and kidney cancers is less common than that in men but still accounts for 2% and approximately 2% of all cancers in women, respectively.1 Recent advances in understanding of the molecular and genetic basis of cancer and development of a variety of modern techniques such as immunohistochemistry, cytogenetics, fluorescent in situ hybridization, nucleic acid array, and so forth allow identification of new neoplastic entities as well as better classification of neoplasms that are biologically and clinically relevant. In this issue, we cover 4 specific topics: (1) newly described and recently emphasized entities of renal tumors, (2) histologic variants of infiltrating urothelial carcinoma, (3) prostatic intraepithelial neoplasia (PIN): recent advances, and lastly (4) recent advances in germ cell neoplasms of the testis. In the first subject on newly described and recently emphasized entities of kidney tumors, the authors focus on the most important renal tumors that have been recently defined or emphasized with a brief introduction of the new World Health Organization renal cancer classification.2 The clinical, gross, microscopic, and immunohistochemical features of these tumors are reviewed as well as their relevant cytogenetic and molecular abnormalities. Important differential diagnoses of each of these entities and helpful morphologic features are emphasized. Recognition and awareness of these entities becomes important as some of them have different biologic behavior and treatment strategies.
Accepted for publication April 4, 2007. From the Departments of Pathology, Cornell University, The Methodist Hospital (Dr Ro), and The Methodist Hospital (Dr Ayala), Houston, Tex. The authors have no relevant financial interest in the products or companies described in this article. Reprints: Jae Y. Ro, MD, PhD, Department of Pathology, Cornell University, The Methodist Hospital, 6565 Fannin St, Houston, TX 77030 (e-mail: [email protected]). 1232 Arch Pathol Lab Med—Vol 131, August 2007

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The second subject is histologic variants of infiltrating urothelial carcinoma. The authors focus on the diagnostic problems of infiltrating urothelial carcinoma with emphasis on several important morphologic variants as recognized by the recent World Health Organization classification system.2 Some of these variants are important to recognize because of their unique biologic behavior, different prognosis, or response to therapy. Other morphologic variants exhibit deceptive or subtle histologic features creating diagnostic difficulties for pathologists. Familiarity with the diverse morphologic spectrum of urothelial carcinoma is not simply an academic exercise but is important in providing high-quality care for patients affected by this disease. For each variant of urothelial carcinomas, the characteristic morphologic and salient clinical features and important differential diagnoses are reviewed. The third subject, PIN: recent advances, deals with the morphologic aspects of this well-proven preneoplastic condition. Patterns and diagnostic criteria of PIN, as well as differential diagnoses, are discussed. It is well established that a spatial and temporal relationship exists between high-grade PIN and prostatic acinar adenocarcinoma. Furthermore, high-grade PIN and prostate cancer share similar genetic and molecular changes as well. Thus, high-grade PIN remains a precancerous condition with a high risk for the development of carcinoma or a marker for concurrent carcinoma. With the widespread use of prostatic-specific antigen screening and extended biopsy protocols, there is an increasing number of patients with diagnoses of high-grade PIN that are not showing invasive carcinoma on repeated biopsies. Therefore, the management of patients with PIN is shifting toward a more conservative approach. Atypical adenomatous hyperplasia (adenosis) is no longer considered a premalignant lesion but rather a benign small glandular process of the transition zone that simulates acinar adenocarcinoma and as such is not discussed here. The last subject is recent advances in germ cell neoplasms of the testis. In this review, the authors summarize the current understanding of testicular germ cell neoplasms and their relationship with in situ neoplasia. Testicular germ cell tumors are a heterogeneous group of neoplasms with a diverse histopathology and different behavior and prognosis. The recent World Health Organization classification of testicular neoplasms2 as well as important diagnostic features of each entity are discussed including several newly developed immunohistochemical markers. It is our sincere hope that this review will provide the
Genitourinary Pathology: Recent Advances—Ro & Ayala

readers a concise and quick reference for the recent advances and development of these 4 selective topics of genitourinary tumor pathology. Each mini-review emphasizes the important morphologic features and their clinical relevance. Awareness of these entities and new advances will enable pathologists and pathology trainees to strengthen their diagnostic abilities and to acquire a better understanding of the pathogenesis of these processes, which

will lead to better communication with clinicians and will develop common language for the treatment and followup of patients.
References
1. Jemal A, Siegel R, Ward E, et al. Cancer statistics, 2006. CA Cancer J Clin. 2006;56:106–130. 2. Eble JN, Sauter G, Epstein JI. Pathology and Genetics of Tumours of the Urinary System and Male Genital Organs. Lyon, France: IARC Press; 2004. World Health Organization Classification of Tumours.

Jae Y. Ro, MD, PhD Jae Y. Ro earned his MD and PhD degrees from Yonsei University School of Medicine in South Korea in 1969 and 1973, respectively. Following residency in anatomic pathology at Yonsei University Severance Hospital in Korea, he received additional residency training in anatomic and clinical pathology at Case Western Reserve University Institute of Pathology in Cleveland, Ohio. He then completed his fellowship in surgical pathology in 1985 at The University of Texas M. D. Anderson Cancer Center at Houston, and remained at the same institution as an assistant professor, becoming a full professor in 1992. He served as surgical pathology fellowship program director and codirector for 6 years from 1996 until 2001. From 2001 to 2005, he was the chairman and director of Anatomical Pathology at Ulsan University Asan Medical Center in Seoul, Korea. In 2005, Dr Ro moved back to Houston, Tex, and joined the Department of Pathology at The Methodist Hospital, where he is currently the director of Surgical Pathology and professor of pathology at Weill Medical School of Cornell University. Dr Ro is the recipient of the 2007 Harlan J. Spjut Award from the Houston Society of Clinical Pathologists. He is also a section editor and member of the Executive Advisory Board for the Archives of Pathology & Laboratory Medicine.

Alberto G. Ayala, MD Dr Alberto G. Ayala earned his MD degree from University of Nuevo Leon School of Medicine in Monterrey, Mexico, in 1962. Following a residency in anatomic pathology at the University of Texas Medical Branch in Galveston (1963–1967), he then completed a fellowship in surgical pathology (1967–1968) at The University of Texas M. D. Anderson Cancer Center in Houston. He remained there as an assistant professor of pathology and eventually, in the 1980s, became a full professor of pathology. He served as director of Surgical Pathology (1980–2000), deputy chairman for 10 years, and interim chairman from 1996 to 1998. He retired from The University of Texas M. D. Anderson Cancer Center in 2000 but remained active as a parttime pathologist (4 years). He also worked part time at the University of Texas Medical Branch (2001–2004), and his primary job was to instruct and interact with residents in pathology. From 2004 to the present, he joined the Department of Pathology at The Methodist Hospital, Houston, Tex, where he is currently the deputy chief of service for Pathology and Laboratory Medicine and has a title of professor of pathology conferred by Weill Medical School of Cornell University. He is also a section editor and member of the Executive Advisory Board for the Archives of Pathology & Laboratory Medicine.

Arch Pathol Lab Med—Vol 131, August 2007

Genitourinary Pathology: Recent Advances—Ro & Ayala

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