,

•

)

Tlf.ID.'! S3JIDl:u"l COLLJ'm'IOa

~ I(!V

Seadnar on Genitourinary Patllology

A.urie&n Society of Cllnicd Pat!lologieta 1

Drake Hotel, Chicago, Illinois

October 15, 19/J!

Presented by:

Doctor R~bert A. Uoorc

Professor or Pathology I Dean or Washington University

School or Hedicine, St. Lruis, r.tissouri

'ibe seu or miero•ecp1c slides for this seminar were prepered

the Army Institute or Pathology, Tlashlngtoc, D. C. as pert or the

~Yi.ties of the A::erican P.egistry of Pathologr in coopuration nth

American Society of Clinical Pattoloc:.L-ts.

Owing to the large nur.lber of :egistranto £or t he ser.>inar it has

aecid~Jd to present the cases by moans of l antern slideo rather

through tho individual use of microscopic sli<:lee. 'l'!'o registr-

. • are requested not to br1."g their microscopes 3ineu there "ill

no provision for tho1r use .

The slide• should be thorcu;;h].y r<ovie..-Ed in connt<:tion nitll

case ldst<>rios prior to the s.:bina,.. Ir. oroer to !aeilltate

preparation of catel"..al for discussion it is requusted tllat

:ll regi.stratnt liat h1o diagnos6s on the fon prO\i.d<>d and ...U

w Dr. llooro b~rorel Sopt.e:>bor 20. '!'be fono need not be signed .

!

ARb~ INSTITvJrE OF PATHOLOGY American Re)>istry of Pathology 7t h & I nde'penda nce Avenue , S . W,

Vlashing:t:on 25,-u.c.

2

Synopses of' clinical his tories of cases t o be pr.~setitcc:l at.

tt.e Seminar on Genitourinary Pa·thology at the meeting 'Of the

can Society of Cl i nical Pathology. Drake . .Hotel, Chicago,

lllino~s, Octobor 15, 1948.

!lil!e llo. 1 Al P Accession No. 11.1.439 (Cont r ibuted by 2.39 t h

~;_,c>ral Hospital , U. S. ftru-.y )'.

A JO yoar old· man ccmplain~rl o£ a painf ul mass in t t)e laft

m encapsula1;-cd node mc:a.suring 4 x 1 .. 5 em. On t.he cut e~ction

~ere l'let e numerous s.'ta.ll, l i o 3 rum .. in di.ame-ter f'oci fi.l.led

tJi·;;..no>< necroti c qebri s ,

AIP Accession No. 174661 {Cont r ibut ed by St ation

:spital, U. S. Army, Camp l.!cCoy, Wi s consin) .

' . A 2l y ear · old l!Wl !irs t no t.iec-tt s\-.illi nz at the pnglo of the

:ght ja w on l!ay .10, 1946. FoUl· 9;J.y$ latw be· complained of s or<>­

. s of both t estes . Ter.1pcrature "'"' 101° to 105°. The white

oo.~ c ell count "'"" 14, 400. On the sht.~ day- t iler;; was s light

tophobi;a J hcalii:!.cho: and s tiffness o:i thu nuek. Ik.at.h -occurred

-the sevcnth 'day preceded by signs of res piratory failur.e .

3 The testes were l arge and t ht<re were nwuer.ous petechiae in

~he .t~ica. The SUb$t ance was e;-re.y in ·Color . other grosS ob-

servation~ were. not ~ifgn~ .. ticant.

R<i~rks :

'Slide l!o, 3 AlP Accession No. 196163 (Contributen by V, A.

P.ospit.al., Kecou~tarr, Virginia) .

A 75 year ol d man CCt."''plained Of t:t'~a.rgeo1ft"::nt of th~ right

1.est:1S follcw,ing t.raWM two weeks previously. The -tes t.is was

fivo._ t.im~s normal, s i oz-e 1 hot J and pa:J;riful. 'ibe~ testi s and cord

nrc. r emoved. D.eat l) occurred on th~ follol·rin.g day. · The cause

o.f deat h W35 ~troporitor!eal he."!'lorrh2g~.

Th~ r es.ovcd te~t.is mea~red 6 .x. 4 x 3 em. It Ttos firm and

tbe subs.ta.nce Y;as a uniform y-.'1l.low- gra.y color.

/J ~ ,-..t 'l.:4.c... / 0 ~

_z-;lide No. 4 AlP Accession· tio. ).82217 (Contri'bttt<Jii by Til:ton

::cner il Hospital, U. S. Army} .

A 22 yeo:r ol d white = 7<as adrni ttecl t o. t he 25oth St.atior.

~ospital w;ith si gns o.f renal f ailure on bia!"'Ch ; .,. ~91~6. Death

cr:llrrad 01.'1 August li , 194& in ur tW'iiia . Hi story- o£ vener eal

'7he. p!'incipal diagnosis at autopsy wa4 subacut.~ glo.'net-ulo-

·~rhritis . The -prostat e ''tr1s grossly no.rmal.

Slide No .• 5 .AlP .Ace.es.sion 209205 (Contril>"ted by Washington

l.hlvcrsity, School of lb;dic-i.rte : St.. l.o" .. ds _, Mis souri) .

The pat-ient. was a 24 ·>"oor old male -who first. noted a small

FQP111o on his l eft J:cg v;hi<:lt cn:J.crged.. and crus t ed. I n "the coursa

of L )leeks, &eve:,ral oth!.!r lesion.s app eared on toe body and fe:.ce.

'I!IG lesions grad!jl!ll;.V b~came clevnted ttt;td v.irrucou~ and failed

to hell. Approx:it:·~tely 12 montbs attar the firs t l"esio'r. wes

not<d, t he patient dev-.roped progres·s ivo eyspnca . He lost 15

to ro poUnds in )'t(l'..ig!'l~· X--rays of t ha lungs sha.r;cd a reas of

rr.!lnnt'Y consolidation and, quei t i Qhablf;;) a:bscess formation . Xt

wtopq -tho px:ostata \'1:1.5 5 x ; x 3 em.. i n size. It -v;a;s-

-2C-:!ilJ"tr~el¥ f ' r:m nitll s-eve ral no<!u.lcf; . The centers of aost

~ t he nodul .;.:s were soft. and frqm s ome an-exudate could be

t~ressod.

_,.,c<s : ./ft(t.,_ "~·~ <-•

de No. 6 AIP A\>CQss.i_on No. 209212 ( ecntribut~ci b)" Barnes

!ospit3l , St . Loo~is., tliasouri) .

C. W • ., ~ "'hi t e Gan, .ago 76, \•tas hospit.aliz~d f ·o:r ~...cac.~rbalion

· a duodenal u.lcer of sovcraJ. ;,·ea.:t·S' duration. Dent1l lollow~d a

and a ~oca!'dial i.ni=Oll'ction. Ther e had bean no '

i2.e and r egular structure on section.

<

5

Side No. 7 kiP Accession 209214 (Contributed by Barnes Hospital,

St. Louis, l!i$souri) •

J. R., a white :ran, .age 781 hac:l an ncutc:ly inc.a.rcerot<.d

Inguinal hOrnie •nhich ""s r educed with clifticulty ~0 dlcys

l:c!oro dea th. Thereafter hu had por•istont, severe abdominal

plin. Ho w:us odr.titto:xl in shock, tm:s oliauric 1 became c~toso,

eod died 3 do,ys 1\fter admission. J.t. IWt.op~y th<>re 1ms a l.arj;c

.rteriosel~rotic aneurysm o£ til« abd<milul a orte >tith r upture and

retrOJ"'ritoncal. hernorrhoge . The proot<>to " 4" enlarged t o 6 x 6

x ~2 em. and throughout the lateroJ. loboa there were ·firlll, <li•tinct

Otdllles 1 most of which wen grey in color t but many ''or o dark r od

md olightly ooftoned.

?.s:arks: L .N G.?. ?.4. ,., . .2{~~

AlP Accession 2092:15 (Contributed bl' &rnes Hospitel,

Louis, ),(iosouri) .

S: W. , B white man , age 70, developed purulent arthritis ot

right knee following ca~heriution for acute urinary Nlen~ion .

had cccplaints of dysw-1!> lti.th opisodoo at rete<r..ion tor 20

A transurethernl rcscetion was pcrforo-ccl 21 days be!oro

but penis tent urinary >'<>tent ion neeassi teted a suprapubic

totooo,y 3 duyo later and thoro "~"" continued, ele\tat.ed t cmpora­

. ond dioor1entetion. Ho died o1.1dd~nly !rO<• Ofllbo1.i to tho

tu~~Y arteries ~ ~t autopsy thorv waa ~ bilateral acute

In the prost:tt<l th<Cre were rul.tipl.e, cleep:l¥

6

~nv~ted grooves along tho sit• oc tho urethr~ creating cavities

Into which bulged fi.rtJ nodules !ra:o the latoraJ. Wl1!ls. On section

IJlc:ro were many small, soft, gray-yellow foci, 2 to l, nm. in diru!letor,

lhr<lue)lout tho glnnd.

Slide h'o. 9 AlP AcC<l3!1ion l!o. 209206 (Contributed by St. w.>is

City Hospital, St. Lollis, W.o•our1).

J. N., a whit e "'-"'• 4SO 54, 1-.3.<1 11 th~:-apcutic orchioct01:11 nnd

>u started on atilbcskrol t!!erspy 7 :oonths bofore dttth. Four

!lllrlths before doath he IIllO admitted for ~rr.atmcnt of thranbo-

jl!lobitis and uriMr:r infection and dovoloped a s pontaneous fracture

of the right !Cil!Ur. At 4Utopsy the prostate-wo.s small<1r thM nor::JO>l ,

1vry rirlll, and contained o don•• tieoue which sprood throughout the

jlan~ and into tho s~l vesicl.,. Addit ional nodules wcro pre-

rnnt in tho pol vic lymph node•, iliuzn end vertebrae . -icmarks: I -~

£lido No. lO AlP Accassion No , 209126 (Contributed by St . L~uls

~drens Hospital, St. Louis, ~souri).

Tl. H., a colored malo infant., ~o 23 months, dovol oped

<lifficulLy in uri1V.tion three months before doath. A permanent

'7't.ostcccy """ const""ckd but a l~go, irregulAr, bloody, necrotic

l.l.>O W"" t hrough tho "'ound o.nd tho l"ltient~ """ rendmitt.od 4 dsYs

!».lore death in urOlllia and acidosis. At autopsy there """ tWI!Or

' .....

7 l!ssuo invnding ~nd enlarging tho prost a te an<! foming a t•••• l x 7 x 4 em. which fUle<! t ho bl Adder . Sindl>r t issue wns p""sent

t.IP ACcession No. 117743 (ContributO'd by •'ll'lll}' <m<l

'1 General Hospit<>,U. ·s . i.m,y) .

I. 5.3 yc:1r old. whi<e t:l;td noticed a small ulcerated aroa on

ventral aspect or the prepuce 1o Mar ch 1944. rt incrcosed

stzo s lowly but prcg::essi voly, and """ r~vod 1o Sept<.:;bcr

In t he fix4d spcc:!Ll¢n tho losi<>r. """ rod, firm an~ oluvated.

S:

12 AlP ;,cc.,ssion :;o. 173054 (ContribuWd by St<>tivn

A LO ye:u: old white =n ~t! had " Ita~ nodulo i.~ the tcll. o!

cpidiey,:,is since chil.!hood . It fust "I'P•nred -.ttor trr.urr.a.

!l nodule i'1"4-S firrn1 2 Clil. in di.o.moter , end attAched to tho sur.f.:1ce

AIP Acco,sion 1:o. 165661 (Conlrlhutod by !lUshnoll

o.l Hospit.col Gnd 6th Station Hospital, U. S. ·l.=;i.

A /,8 year old man i".Ad removal of a_ -tumor, 4 CM. in din.ov.,t er,

chad to tho lett spun:.atic cord in February 1946. Tho tw-..or

enccl'3Uk~cd and yoU<lWish b:oo.., in color . It r<;currc~ witr.in

=nths.

lea :

8

i.IP l.cca .. !.on no. 103217 (Contril:u~"- by stAtion

s. Arrtt:l' New Orlenns Port of fl',lb.:.rkation) .

11 . of t he right testis II 2:7 yoar old ll'.al\ ned a painlooa swc l.n&

tor h months • Tntre 'InS no history o! trnuma.

Hi~hin th<> t estis wns a woll domrcat~d LUCOr 4 x 3 x 3 em.

" 1 \o. ... d nbout the tumor not ~ tcsticulor ti•ouo formed a per ipnora ~

ll):ceeding 6 trm.. in thiclcr.cs·s. On cut section the. tumor consisted

-• t ·'uc:"'n~ tia.suo i.Tl "hic.lot were tS".bGdded m<"i<lro\iS lf grn,y 8Cw.A. ran~ ... "' .

cyst s up to 3 """· in ditu>Ct cr.

15 l.lP Ae<:esoion No. 93648 {Contributed b;- Station

u. s. Arm;-, Hrunilton Field) .

;;. 33 year <>ld ..,_.., had had sor::c swelling of the lurt tostis

tor one ~r, but ther e had beon s udllon pro~aaive incraMc <n

Jizc 1n the last 2 months. /ill Aschvir.>-Zondc~ test on urine was

~ x-ray of the chest shorted no signi.fic.::nt change s

•

The t estis m""llUred 7 .5 x 5.5 x 5 em. The greater part was

pied by discroto and connuont. 1rrogula r nodUles ot gra)' Ussuc.

ol necrosis and h"""rr~ . '0>11 opi~ 4lld cord

· s : ... a .c..-..- 4,

~ro. 16 i.IP ncccssion llo. 10692:7 (C<>ntril:uted b;- Barnes

,oral Hospital , St Louis , liissouri) .

9

:. 22 yo<U" old = notic¢d gac!uo.l incre>Se in the size ot the

right tostio tor 5 vrcoks . the t<:otio muourcd 6 x 4. 5 x J em. c.nd

WllS r <.pl.ncod by f i nn, <rot.>ttlod, yello>~ish-sray tissue i."\ Y.hich Vt~re

vJmerouo foci or nccroeis and h~~orrhcgu~

• -.... ~ ..J

Slide No. 17 (Contribtr..ed cy lialter R.•od

G·>!lcral Ho•pital, u . S . Army) .

A 22 yoor old mo.n wa• first a~t,tod to tho StA~ion Hoo)JJ.tul,

Fort Knox, complaining of pnin in tlu! right chost, cough, ::.nd he:ao­

Jltrsi.s or 2 wonks euration. !!e h:::d b;d " pninful cnhrg<r.~Lnt ot

tbo right wetis tor 5 """ths. There ><ore raCio-<>?"'l'!" r.<Xiuleo in

th~ lun&• · An /,!ch<dr.l- Zor.dok test woo pcsiW:ro with 0 . 2 cc . of

urine; . Ho v.n3 fs-ivcn x - ray t.ht.!'"npy but dit.:d ono n:::>nth after onsot .

'lllo r ight testi s v(ci a,l>ted lli sroms and wns replaced c<>11J)lotGly

by yellol'liJh bl•otm tissue '<lith hcmorrhng'"' t ltrooghout . There, ·:m.s

:Wl.a.r tissuo in the SJX.IZ3. tic cord., p.'\rnol-tic r.odcs, 1W'IJ3,0 I a:>d

te":rt..

R~: ~ .. ..:.-/:;--,..,. ~<

Sli de No. 18 t.IP Accession No. 2093:l6 (Contr ibut,ed \>; B;.rnos

t03pitol, s~. L<>uis' l.!issouri ) .

G. R. , 11 uhitc r.an, age 22., wc:s: 1n good haalth fot" t. yc:llr

.,tie cord tor painless swelling ~f t.hc U.st1~ . Qr.o ,..~~ bc!cro

10

~gh o.nd dy-opnoo bt.:Cf"..!!te ~orv sevurc a.nd ther~ were s ever.l.l hv:no-

pcys•• before dunth . J.L au topsy ill tho left rotrop"ritono.'ll ep~eo

:i:J<.r" W~O 4 lollullttod J:".a!lS J.4 Y. l) X 6t Cll. '>f fi= grcy MU yul.lo\'1

'issue 1tit.h :~eett.er;.;;d reC. and eyst.ic foci up t.o s ever3...1. ct.:nt.i.=.ut.crs

l:i<!o No. 19 t.l!! ;,eccssion ~o. 212178 (Contriwtod by ~moo

~ttt. suprael.a.vieul.:u- nod~s, and b)'W.:c01:16sti a . An i\~ehu.i.m-Z::mtlvk

;t,st "~"' poeit ive . •too~e 'I'Lns soniC improvement after r:ldi.lltion '-o

Section !roo tbu ~s<>inll -·~ which was son ' '""t tlcd gr.>y

: rod, ><ith large f«i oi be:torrhag<>.

rks:

ide No. 20 IU? f.ccesBi<:n 209210 (Contributed by <it . Wuis

ternl.ty Hospit.~l, St. Lo>.1i.s , ta•souri) .

&. II".' " ><hitc c:al~ inf:>nt, birth wol.g'tt noo ;;r,..!S, ,. ••

·v.c~d by eacs~ean ~e~tion at 0 s~•t~ticn uf 7 ~cnthz ,

11

loll<ll<ihg homorrhage due to " pl<'.conta previa . lho infant ~d good

1•!.or but did not cry and died 28 hQUI"s after birth. '---r-1,_ u_ ""~ -~ ~rr-- ~6-1

o;i.i._ ,~

Slide No. :U !i!P Accession 202333 (Contributed by 37t h Station

l!l>spit.al, U. S. Anr~) .

l&!t breast for 6 r:;,tonths.

The spccil!ten rr.a-aslJ'tcd 7 en. in di.ametar ~nd 2 em.. i:n thiekn&ss.

tte t issue i s firJll .::md yellowish "q;ray With largG· .Coei <)(' yellow fat .

llide No. 22

ibs.pi t.:U., St. Lcuis, Yiescu.ri) .

A 28 year old ~.an cc:npl£.1ncd 01 .... dyt; pnea .::.nd swt.::lling of the

Exrunin-o:tion revealed a r.t&diastinal res-a, enlargement of left.

~prac~Yiculo.r nvdea and gynoc-coa-st.ia. :m .Ase1~eim-Zondek t est vms

'l'h~e was s·~ ir:..proveu.ent after r~diation to the t horax

'JOOO r), liut dQath CCcurrad 2 ·months ~ft?r .•

Mr..arks:

Slide NO. 23 AI~ ,;cccssion P.o. 2018al { Con~·ributud by Letterr."o3"n

S<ttcral Hospital, IJ. S. Army) .

rrnon bilateral hemi-ls were repD.ir.ed in 1945 t he tes-tes y;ere

12

pl4cod 11!tra-abdooitt"~ly. Thd test"• wer & r anovcd i n Dccotlbnr 1947

ooc:&<rn> of pain 1n the groin.

R«:.:rks :

&1<!<1 tr o • 24 AlP Ace. osion lfo . 125410 (C-ontributod by l7oshingt.on

S&.nitnrium and Hospital, St . Loui $, Missouri) .

58 yo:u- old !!'.An. Th<> tcetis h.'ld cnlnrgcd in the lnst oor.th ond

au tender.

The test.io t"o..asuree S. S x 4. 5 x 4. 0 c... Four fiitt.s o t tl>.e

tosti• was occupied by n sh;:rply circ1l.!"tcrioo<! tUillo:- cO<>po•ed of

.. rt gray-tan tissue witn !<>ci cr hc:.orrhagc •

~cw.rks : • ·I

Slldo rio, 25 .

ffo~pitol, St. Louis , l.!isoouri }.

~ring t hG preceding 6 m.?nths. Thero was a strikingly reanculi.no

ll}.bio. mljora and smooth., un..1l.terod Vi\ginal. mueo:m . Bl ood pr<essure:

U.0/105 r.:m. ot fig. At operation a lliD.SS, 10 Ct.l. 1n dia;;,otor of

frO!:! the r egion of th" lo!L lldrcnal, vthich co••ld not be !rcpanat»l y

ic!<lnt.iricd. ~o y~ otter oper,tion the )'Oticnt is O<ell end

"'!.lire• no r.<ed1C4tion, Tho pubic hair M! di""P!"'al'\.'<l and tho

thel'- G:dtrrull C!"-.31\G').S h3.VC roturncd to the no!Tk'U ::ppot.Arc.nco Of

1 chUd of her ~go .

rko : ~ ( c_;e-4~( €4_

• THE AlUI'i INS'l'I'i'O'i'E OF i'A'IHOI.OGY

7th & lndepend~~• Ave, s.W. T/ashington 25, D. C.

DiaFCno-S"es

n.ase send to Dr. Robert 1.. lloore, Oeparment. of Pathology, llashingt.on llUversity School of l:e<Ucine, St. LO'ns 10, l:issouri, before September

w. l 2 3 4 5

6 7 8 9

10

ll 12 l3 14 15

16 17 18 19 20

21 22 23 21. 25

•

. ~~ diagnooes will be tabW.ated and serve as the basis tor discwosion

,. differential diao>osia.

Groupn

I

II

III

IV

v

A .S • C .P. S!'-'llliL'\R 1948

Losions of t l\c 1-\.~lc Oen1tll.l Tmot

Sl ides

#l - Lympbopo. tr.lA Venoroulu - Lymph node ., i4 - Gonococc<>l pl'Ootatitia •

{}?. - H1wpba Orc!l1 tia ' #3 - Non-spaeific Granol.ore ol" Tutis ....

W5 - lll.Jlot Ollllfcosia of proatnte ...-

~ - SCnlle Fros tnte

Ia - Wound of Fros tat eotcmy

VU D9 - O<ll"cinom!l of Proatnta wltl:l StUoaatorol 'l'rentment

VIII

#18 - O<lrcinaoa of Prost.:>.tc vl.t h StUbeoterol 'rreotment ._.. (History io confusin8 - !lot t~e ri{!llt ens<>)

410 - Sercc=e of Proatn to

n §ll - Cl'lrci llOO>a 1n Situ (Erythropl.Jlni~) o r ponl a .......

X ;!\12 - Adcn=tei d twnor of the ePid!d;;t>i3 ...­~13 - 1..oto:cyos~rcoao. o.f cord -

;(I 'fH - Adult 'fumtom v Tl5 - Seml.nom ~ WllG - CytotTopboblnotoon (l!bbrY"l"•'ll carc1n<=.) -Ul7 - Ohorio -o~rcinomn #19 · ChOr!O-C:lN!.'l~ H20 - lnf<lntilc Proat zte /2.1 - Gynocooos t 1A .... #n - P!t.Utory - Pre~cy Colle 1/23 - Abdoml.nnl Teotis - Atrophy /21 - Intant!tl.nl coil tumor of tootis 1/25 - Adreu;l Cortical Cc.rcincm