This is a case-based session at the USCAP meeting in Palm Springs that examines difficult genitourinary (GU) consultation cases and the diagnostic reasoning used to resolve them. GU pathology experts present real consultation examples to highlight common pitfalls, differential diagnoses, and practical approaches to specimen interpretation and reporting. The session is aimed at pathologists, trainees, and clinicians seeking hands-on strategies for managing challenging GU specimens and interprofessional consultations.