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Case 1

Case 1A

This kidney is from an autopsy of a 65 year old man. His death was related to myocardial infarction. He had a serum creatinine of 1.5 mg/dl. Other findings were pulmonary edema and prostatic hyperplasia. Photos A-B show dilatation of the pelvic calyceal system with extensive chronic inflammation. B shows the thinning of the cortex.

Case 1B

Case 1C

High power of B where you can observe severe chronic changes of the cortex with tubular atrophy and dilatation and chronic inflammation. Normal glomeruli are not seen.

Case1 D-E-F

D-F: To show areas of affected parenchyma related to normal parenchyma

G

High power of pelvis with chronic inflammation lined by normal transitional epithelium.

Case 2

A

Fibrous tissue (capsule) separates the renal cell carcinoma from compressed renal parenchyma.

B

Compressed renal parenchyma with interstitial fibrous tubular atrophy and chronic inflammation and normal renal parenchyma.

C

Renal cell carcinoma with fribrous capsule. The neoplasm do not extend into the capsule.

D-E-F-G

Higher power. The neoplastic cells have clear cytoplasm and round small nuclei of a low grade neoplasm. The cells are often arranged in a tubular pattern.

Case 3

A-B

Renal papilla with extensive necrosis and acute inflammation.

C

High power of A and B showing the area of necrosis with acute inflammatory cells.

D-E

Dilated tubules with acute inflammatory cells in the tubular lumens and interstitium.

F

Renal tubules with acute inflammatory cells in area of viable renal medulla.

G

Renal cortex with patchy area of interstitial fibrosis chronic inflammation and sclerosed glomeruli.

Case 4

A

Papillary RCC well demarcated by fibrous tissue from the related renal parenchyma.

B-C-D

The papillary features of this neoplasm are well demonstrated. Kodachrome D represents cross sections of the papillary projections. Note that several cells have clear cytoplasm.

E-F

The papillae are formed by few layers of cells (no more than 2-3) in contrast to transitional cell carcinoma (case 5) which has many layers of cells. The nuclei are large and irregular (nuclear grade 3) as compared to nuclear grade 1-2 of case 2. The nucleoli are prominent.

G-H-I

The cells have irregular nuclei and prominent nucleoli as observed by light microscopy. The cells are attached to each other with desmosomes (features of epithelial cells). H and I show the cells arranged toward a lumen with microvilli (features of some renal cell carcinoma and also adenocarcinomas). The cytoplasm contains large amount of glycogen granules.

Case 5

A-B

Showing a papillary neoplasm growing toward the lumen (like a cauliflower). The wall of the ureter is well identified in B.

C

Ureter wall showing normal transitional epeithelium and muscular wall.

D-E

The transitional cell carcinoma do not extend into the muscular wall.

F-G

Neoplasm showing features of transitional cells in a papillary pattern. Note the numerous layers of cells characteristic of TCC. This neoplasm is well differentiated (histological grade I to II).

Case 6

A-B

Necrotic tubules related to normal tubules and normal glomeruli. Note that no nuclei are seen in necrotic tubules.

C

Granular casts in the lumen of tubules.

D

Necrotic tubules and tubules with casts and mitosis (sign of regeneration).

E

Casts including crystals (related to glycerol) are seen in the lumen of viable tubules.

Case 7

A-B

Interstitial fibrosis and tubular atrophy is observed (sign of chronic rejection). There is also an extensive mononuclear cellular infiltrate (acute cellular rejection).

C-D-E-F

Several vessels showing mild intimal fibrosis (chronic rejection) and mild intimal arteries (acute rejection).

Prominent interstitial cellular infiltrate (acute cellular rejection). Tubulitis is observed in kodachromes H and I.