Genitourinary (GU) pathology reporting and terminology continue to evolve at a rapid pace, reflecting advances in molecular diagnostic testing, continued pathology subspecialization, and as a response to new treatment algorithms/guidelines. Some examples include the recognition of new diagnostic entities in the classification of renal tumors (see Figure), the documentation of variant histology and grade heterogeneity in bladder cancer, and the need to document and recognize treatment-related changes seen in advanced prostate cancer and other GU malignancies. Interpreting and translating these complex pathology reports can be challenging and necessitate increased communication between clinicians and pathologists.

Figure. Succinate dehydrogenase–deficient renal cell carcinoma (200× magnification), a rare subtype of renal cell carcinoma officially recognized by the WHO in 2016. The diagnosis of succinate dehydrogenase–deficient renal cell carcinoma is considered an indication for genetic counseling and for testing for germline mutation in the succinate dehydrogenase genes.¹

Recognizing the importance of collaboration and communication between our specialties, a required 4-week GU pathology rotation for postgraduate year 2 urology residents was created since the reestablishment of the University of Vermont Medical Center urology residency program. The goals of the rotation are to increase proficiency in understanding pathology reporting and terminology, introduce new and emerging pathology entities that are less likely to be encountered in daily practice, and provide exposure on how pathological staging of GU malignancies is derived from gross and microscopic exam. Residents also gain knowledge on how specimen acquisition and submission by urologists can impact the ability to make a diagnosis and the inherent limitations of certain specimen types.

During the rotation, urology residents spend most of their time in surgical pathology and are also exposed to cytopathology and the microbiology lab. In surgical pathology, reviewing GU cases with an attending pathologist allows the urology resident to observe how morphological findings inform diagnostic classification and how diagnostic thresholds are established in various organ systems. Further, they have the opportunity to see the strengths and limitations of immunohistochemical stains and both observe and better understand the decision-making process in both routine and challenging cases. Pathologists share some of the diagnostic dilemmas they face in their daily practice (diagnosis of intraductal carcinoma on prostate core biopsies, grading a subset of papillary urothelial tumors, grade grouping small foci of prostate cancer, etc). In turn, urology residents review the most recent clinical guidelines and share what they know about the clinical impact of the diagnoses they see at the microscope. Finally, molecular assays and their minimal tissue requirements are discussed, which allows for basic teaching on molecular testing methodology.

Cytopathology and microbiology are also important components of the rotation. In cytopathology, terminology for the Paris System for Reporting Urinary Cytology is reviewed, and residents learn the impact of collection methods (barbotage, catheterized, voided) and common contaminants (lubricant, squamous cells, etc) on the cytomorphology of urothelial cells. Residents are often surprised to learn that collection methods, providing relevant clinical history, and the presence of contaminants can impact interpretation and results reporting in cytology, too. Similarly in microbiology, the impact of preanalytic variables and collection methods on reporting of urological culture results is emphasized. Culture growth interpretation is discussed in the context of patient history, and residents are reminded of the appropriate specimen collection methods for sexually transmitted disease testing.

Beyond providing exposure to the field of pathology, important questions and lively discussions arise during this rotation, which spark research interest. By sharing their clinical experience about the surgical management of urologic oncology cases, urology residents bring new perspectives and insight into future studies that may be informative in the study of GU disease. Afternoons are available to pursue research projects and prepare abstracts for regional and national meetings.

As pathologists, we strive to ensure that our reports are interpreted correctly, clinically actionable, and discussed with patients with a greater degree of understanding. This can only be achieved with close collaboration with our clinical colleagues. We hope that exposing both pathology and urology trainees to the importance of collaborating with peers in other specialties will strengthen their future career endeavors and benefit patient care.