Abstract
BackgroundThere is a worldwide debate involving clinicians, uropathologists as well as patients and their families on whether Gleason score 6 adenocarcinoma should be labelled as cancer.Case descriptionWe report a case of man diagnosed with biopsy Gleason score 6 acinar adenocarcinoma and classified as low risk (based on a PSA of 5 ng/mL and stage cT2a) whose radical prostatectomy specimen initially showed organ confined Gleason score 3 + 3 = 6, WHO nuclear grade 3, acinar adenocarcinoma with lymphovascular invasion and secondary deposit in a periprostatic lymph node. When deeper sections were cut to the point that almost all the slice present in the paraffin block was sectioned, a small tumor area (<5% of the whole tumor) of Gleason pattern 4 (poorly formed glands) was found in an extraprostatic position.ConclusionThe epilogue was that the additional finding changed the final Gleason score to 3 + 3 = 6 with tertiary pattern 4 and the stage to pT3a.Virtual SlidesThe virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/13000_2014_190
Highlights
There is a worldwide debate involving clinicians, uropathologists as well as patients and their families on whether Gleason score 6 adenocarcinoma should be labelled as cancer.Case description: We report a case of man diagnosed with biopsy Gleason score 6 acinar adenocarcinoma and classified as low risk whose radical prostatectomy specimen initially showed organ confined Gleason score 3 + 3 = 6, WHO nuclear grade 3, acinar adenocarcinoma with lymphovascular invasion and secondary deposit in a periprostatic lymph node
* Correspondence: r.montironi@univpm.it †Equal contributors 1Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Via Conca 71, I − 60126 Torrette, Ancona, Italy Full list of author information is available at the end of the article beyond the prostate and metastasize [2]. Those who speak in favor of removing such label base their orientation on data demonstrating that using a time horizon of 10 to 15 years, less than 3% of men diagnosed with Gleason score 6 and classified as low risk will die as a result of prostate cancer whether treated or not [6]
When the paper based on the current case was considered ready for submission, we thought about a possible comment from a reader: Was the paraffin block containing the prostate slice with the dominant nodule and the lymph node serially sectioned to see whether the lesion changed in deeper sections? To give an answer to this possible question, deeper sections were cut to the point that almost all the slice was sectioned
Summary
The epilogue was that the additional finding changed the final Gleason score to 3 + 3 = 6 with tertiary pattern 4 and the stage to pT3a. Virtual Slides: The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/ vs/13000_2014_190 Keywords: Prostate cancer, Gleason score 6 adenocarcinoma, Gleason score, Lymphovascular invasion, Lymph node metastasis, Periprostatic lymph node
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