Atypical Glands Research Articles

Re-evaluation of the role of endoscopic submucosal dissection in the treatment of early gastric cancer based on additional gastrectomy results.

Endoscopic submucosal dissection (ESD) plays a pivotal role in treating early gastric cancer (EGC). Some patients require additional gastrectomy because of non-curative ESD. This study aimed to analyze the clinical factors associated with non-curative ESD and to re-evaluate the role of ESD according to its indication criteria. Altogether, 134 patients who had undergone additional gastrectomy with lymphadenectomy for non-curative ESD based on the pathological results of ESD specimens were included. Their data including pre-ESD diagnosis, reasons for requesting additional gastrectomy, and surgical outcomes were analyzed retrospectively. Of the 134 patients with EGC in the final pathology of ESD specimens, 56 underwent staging ESD for a diagnostic approach, of whom 28 were diagnosed with atypical glands and 28 with high-grade dysplasia (HGD) prior to ESD. The remaining 78 patients of the 134 were identified to have EGC and received ESD for therapy. Based on the pathological results of ESD specimens, additional gastrectomy was commissioned with non-curative ESD because of one or more causes such as deep submucosal invasion, lymphatic invasion, positive vertical margin, undifferentiated histology, positive lateral margin, and venous invasion. Regarding surgical specimens, 13 patients had lymph node metastasis (LNM) and 9 had local residual tumor; one of them had both LNM and a local residual tumor. In patients with atypical glands, 4 had LNM and 3 had a local residual tumor; one of them had both LNM and a local residual tumor, and then died of multiple organ metastasis. In patients with HGD, 4 had LNM and 1 had a local residual tumor. Additionally, 4 patients who were absolutely indicated for ESD had LNM, of whom 2 had atypical glands, and the other 2 had HGD. Similarly, in 6 patients with a local residual tumor absolutely indicated for ESD, 2 had atypical glands and 1 had HGD. Positive vertical margin, lymphatic invasion, and deep submucosal invasion were identified as independent risk factors for LNM. ESD may play diagnostic and therapeutic roles in determining the optimal treatment of EGC when the diagnosis is equivocal or insufficient in endoscopic assessments for gastric cancer screening.

Gastric-type extremely well-differentiated adenocarcinoma of the stomach: A rare tumor with diagnostic difficulties and high inter-observer variation in endoscopic pinch biopsies

Extremely well-differentiated gastric-type adenocarcinoma (EWDGA) is a rare type of gastric cancer composed of deceptively bland-looking malignant cells resembling normal foveolar or pyloric epithelium. The histological features of this tumor have not been recognized by many pathologists, and inter-observer variation studies are lacking. Here, we report seven EWDGAs and inter-observer variation of six preoperative biopsies was evaluated by 11 pathologists in a single institute. Based on the pathological diagnosis of the endoscopic biopsy slides, the average rate of definite malignancy diagnosis was 15.2 %, and the overall diagnostic concordance rate was 34.9 % among 11 pathologists. Microscopically, the surface epithelium was preserved and only a few atypical tumor glands were scattered in most endoscopic biopsies. Structural atypia was minimal, and the tumor glands were barely distinguishable from normal glands. Although nuclear atypia was minimal, enlarged nuclei, relatively large glands with irregular shapes, and abundant cytoplasmic mucin were observed in gastric pinch biopsies. In preoperative biopsies, no cases showed p53 overexpression, and Ki-67 labeling index ranged from 3 % to 35 % and was higher compared to non-neoplastic glands in 3 cases. After gastrectomy, four (57.1 %) patients had advanced gastric cancer and three (42.9 %) had lymph node metastasis. Genomic profiling of the four patients revealed mutations of TP53, BRAF, KRAS, STK11, and MDM2/CCND1 amplification. Immunohistochemistry for p53 was not helpful while Ki-67 may be helpful when staining pattern is distinct from the non-neoplastic mucosa. In conclusion, it is challenging to diagnose EWDGA using biopsy specimens. Recognizing and addressing this rare entity will increase diagnostic accuracy to ensure the early diagnosis of cancer.

Prostate Type Malignancies Arising in Ovarian Teratomas - A Report of Two Patients.

The identification of benign prostatic tissue within ovarian and testicular mature teratomas is an unusual occurrence. While a few documented reports exist in the literature regarding the emergence of benign prostatic tissue within teratomas, the occurrence of prostatic-type adenocarcinoma in a mature ovarian teratoma is an exceptionally rare phenomenon. To date, only two prior reports have documented such instances, and no tumors have been previously reported with prostate-type tissue with morphologically two different malignancies. We outline our experience with two tumors involving prostatic-type carcinoma, both arising in ovarian mature teratomas. Microscopic examination of the first tumor revealed small areas of infiltrative atypical glandular proliferation within the mature teratoma. In the second tumor, prostate-type tissue exhibited a low-grade basal cell carcinoma. Additionally, adjacent minute foci of adenocarcinoma of the prostate (Gleason score 3 + 4 = 7, <5% pattern 4) were identified. Goblet cell adenocarcinoma of appendiceal type was also evident in the latter tumor. In both tumors, immunostains (NKX3.1, PSA) were performed to establish the prostatic origin of these atypical glands and PIN4 was performed to document the absence of basal cell in the atypical glands. On clinical follow-up, both patients have no signs of recurrence at 14 and 11 months after the surgery. Further reports on such neoplasms would contribute to a better understanding of the prognosis and management of such occurrences.

Classification of the parathyroid glands and the frequency of occurrence of their different types in mature rats

The parathyroid glands play an important role in the regulation of calcium and phosphorus metabolism in the body. They are in close anatomical relationship with the thyroid gland and, considering their small size, can be accidentally removed during surgical interventions on it. To avoid mistakes, surgeons need to know the typical location of the parathyroid glands and non-typical variants. The laboratory animals, in particular white rats, can be used to improve the methods of surgical interventions and develop skills. Aim. To study the features of the location of the parathyroid glands relative to the lobes of the thyroid gland, classify into types and establish the frequency of their occurrence in mature rats. Material and methods. The study was carried out on 213 white outbred mature male rats. After taking the lobes of the thyroid gland with the parathyroid glands, the samples were processed according to the standard protocol. The sections of organs were stained with hematoxylin and eosin, toluidine blue, according to Van Gieson and to Grimelius. Light microscopy was used to study the location of the parathyroid glands on histological sections of the thyroid gland; the frequency of occurrence of each type was calculated. Results. In mature male rats, by location, one can distinguish typical, atypical and mixed parathyroid glands, occurring in 53.52, 45.54 and 0.94% of cases, respectively. Typical parathyroid glands in relation to the edge of the lobe of the thyroid gland are divided into centro-lateral and eccentrico-lateral; by invasion in the parenchyma of the lobes – marginal and incomplete; in shape – regular and irregular. Non-typical parathyroid glands are subdivided into single and group ones according to the number on the section of one lobe of the thyroid gland; by location – polar, intracapsular, occupying the center of the lobe or displaced from the center to the capsule; by invasion in the parenchyma of the lobes – without invasion, marginal, incomplete and complete; in shape – regular and irregular. Mixed parathyroid glands involve the presence of the typical and atypical glands by location in the same lobe of the thyroid gland. Conclusions. The parathyroid glands of mature male rats are characterized by a significant variability of localization in relation to the lobe of the thyroid gland – from superficial to complete invasion inside this organ, location in the pole or in the center, variability in shape and quantity.

Nasal and sinonasal tumors formed by atypical adenomatous lesions arising in respiratory epithelial adenomatoid hamartoma/seromucinous hamartoma.

Two benign adenomatous lesions are commonly recognized within the sinonasal tract, namely respiratory epithelial adenomatoid hamartoma (REAH) and seromucinous hamartoma (SH). We present 10 hitherto unrecognized benign polypoid nasal and sinonasal tumoriform lesions having in average 3.6cm in largest dimension, which are histogenetically related to SH and REAH. In addition to typical structures of REAH and SH, these lesions contained an additional characteristic and slightly atypical adenomatous component, which we termed atypical sinonasal glands arising in SH (ASGSH). ASGSH often produced deep red colored secretion with peripheral clearing similar to that seen in thyroid follicles. In contrast to SH, ASGSH was endowed by both secretory and myoepithelial layers and had mostly angulated shapes with snout-like protrusions into the lumens. Both layers were formed by an irregular, disorganized, and often incomplete cell lining, which had slightly atypical cytological features without mitoses. In 3 cases, ASGSHs revealed sebaceous differentiation, and in 3 cases the stroma produced a well-differentiated cartilage. Neoplastic nature of ASGSH was supported by finding of various mutations as revealed by next generation sequencing in five cases. In two cases each, we found identical mutations in BRAF gene (Val600Glu), and RET gene (Arg912Trp), respectively and in one case FAT1 gene alteration (Pro1665Leu).

Clinicopathological features of olfactory carcinoma

Objective: To investigate the clinicopathological features and differential diagnosis of olfactory carcinoma (OC). Methods: Twenty-one cases of sinonasal tumors, including those initially diagnosed as olfactory neuroblastoma (ONB) and those with uncertain diagnosis, were collected from the Department of Pathology, the First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital) from January 2016 to August 2022, among which 3 cases were reclassified as OC. The clinicopathological features were investigated, and the remaining 18 cases were used as control. Results: Of the three OC patients, 2 were male and 1 was female, with an average age of 57 years ranging from 35 to 74 years. Microscopically, the tumor cells were arranged in solid, nested or lobulated patterns with occasional palisading around the solid nests. The stroma was highly vascular with focal neurofibrillary areas. There were prominent rosettes or pseudorosettes formation. The tumor cells were mainly ovoid to spindly with scant to moderate amount of cytoplasm, one or several small nucleoli, and fine chromatin content. Brisk mitotic figures were seen. In all 3 cases of OC, there were scanty atypical glands and some were ciliated. Immunohistochemically, at least one epithelial marker and neuroendocrine marker were diffusely expressed in the tumor. Some of the tumor cells were positive for p40 and p63, and the sustentacular cells showed the expression of S-100 protein. All cases tested were negative for NUT, CD99 and desmin, with intact expression of SMARCA4 (BRG1) and SMARCB1 (INI-1). Ki-67 proliferation index varied from 20% to 80%. Follow-up after 16-18 months showed no mortality with tumor recurrence from 1 patient after 16 months. Conclusion: OC is a rare sinonasal tumor with neuroepithelial differentiation, its histomorphology is diverse, and the combination of immunohistochemical markers is essential for appropriate diagnosis.

Relationship between Clinicohistomorphology Profile of Atypical Prostate Gland and Diagnosis Benign Lesion or Prostate Adenocarcinoma

BackgroundAtypical prostate gland especially atypical small acinar proliferation (ASAP) is a histopathological diagnosis that requires a follow-up biopsy 3-6 months after the first biopsy, because 17-60% of cases potentially to be malignant. The varied clinical and histomorphological characteristics of the atypical prostate gland make it difficult to confirm the final diagnosis as a benign lesion or prostate adenocarcinoma. This study aims to describe clinicohistomorphological cases of atypical prostate gland at Anatomical Pathology Department FKUI/RSCM and to identify histomorphological features of the atypical prostate gland as benign lesions or prostate adenocarcinoma on immunohistochemistry diagnosis.MethodsA histopathological investigation of prostate gland cases with atypical nuclei was carried out in 2011-2021 from archives of Anatomical Pathology Department FKUI/RSCM. Clinical and histomorphological characteristics were assessed and categorized into benign lesions or prostate adenocarcinoma based on immunohistochemistry appearance.ResultsThere were 109 cases of atypical prostate gland, 49 of which met the inclusion and exclusion criteria and could be analyzed. Corpora amylacea was found in 11 cases (84.6%) in the benign lesion group, statistically significant (p-value 0.005). Intraluminal crystalloids were found in 4 cases (100%) in the prostate adenocarcinoma group with p-value 0.050, close to significant. Other clinicohistomorphological characteristics did not show a significant relationship both in benign lesions and prostate adenocarcinoma groups (p-value 0.05).Conclusion On histopathological examination of the atypical prostate gland that is difficult to re-biopsy, the discovery of corpora amylacea may lead to the diagnosis of a benign lesion, while the discovery of intraluminal crystalloids may lead to the diagnosis of prostate adenocarcinoma. The diagnosis must be supported by immunohistochemistry characteristics.

A Case of Primary Mucinous Adenocarcinoma of the Renal Pelvis: A Rare Occurrence

Adenocarcinoma represents only 1% of renal pelvis malignancies and can have three subtypes: tubulovillous, mucinous, and papillary non intestinal. Primary mucinous adenocarcinomas are very rare in the renal pelvis. We report a case of a 62-year-old male patient who presented with bilateral dull aching flank pain for 15 years. No flank tenderness was observed on clinical examination. Magnetic Resonance Imaging of the Kidney, Ureters, and Bladder (MRI KUB) showed marked dilation of the left kidney's pelvicalyceal system with irregular thinning of renal parenchyma, as well as a large filling defect. Percutaneous Nephrolithotomy (PCNL) obtained gelatinous material, and the Carcinoembryonic Antigen (CEA) level was found to be high. The patient underwent left radical nephrectomy, and gross examination of the kidney revealed staghorn calculi and multiple cavities filled with pus and gelatinous material. Microscopic examination showed atypical glands infiltrating the parenchyma with abundant extracellular mucin. Immunohistochemical (IHC) examination showed cytoplasmic positivity for CK7, CK20, and CEA, while PAX8 and GATA3 were negative. The Ki67 labeling index was more than 20%. The case was diagnosed as mucinous adenocarcinoma of the renal pelvis.

Case Report : Cervical Cellular Angiofibroma

Background: Cellular angiofibroma is a rare benign tumor in the distal genitalia introduced by Nucci et al in 1997 that can occur in both women and men with an age range of 46 – 54 years. In women it usually occurs in the vulva and vagina. These tumors are often diagnosed as Bartholin cysts, vulvar cysts, myomas, and unspecified complex tumors.&#x0D; Objective: Report a case of cellular angiofibroma previously diagnosed with cervical myoma&#x0D; Case: A 51-year-old female patient para 5 abortion 0 with complaints of lumps that have been felt to come in and out since 4 months but since 1 week it feels enlarged and cannot be inserted again, and diagnosed as cervical tumor. History of menopause since 1 year ago. The general condition of the patient is good with vital signs within normal limits. On physical examination of the abdomen, there was no tumor mass, tenderness or flux. On inspection, there was a reddish mass coming out of the vaginal introitus with some blackish necrotic appearance. On vaginal examination, a mass with a solid consistency was found with the impression of the cervix with a border of the tumor stalk that was not palpable. In this patient, Total Abdominal Hysterectomy and Bilateral Salpingoophorectomy were performed and the tissue was examined for anatomical pathology with cervical angiofibroma results with non-specific chronic inflammation and atypical complex endometrial gland hyperplasia. &#x0D; Conclusion : Cellular angiofibroma is a rare tumor that usually occur in the vulva and vagina, which is often diagnosed as Bartholin's cyst, vulvar cyst, myoma and unspecified complex tumor. Action in the form of total excision of tumor tissue gives a low recurrence.&#x0D; Keywords : Cervical angiofibroma, cervical tumor

Diagnostic significance of combined immunohistochemical panel of p63, High Molecular Weight Cytokeratin (34betaE12) and α‑Methyl Acyl Co A Racemase (AMACR) in resolving suspicious foci in prostatic lesions

Background: The assessment of small foci of atypical glands in prostatic needle biopsy specimens is a key diagnostic challenge in routine histopathology for pathologists. Due to the presence of mimickers of prostate carcinoma, at times making a definitive diagnosis becomes difficult. The use of immunomarkers like α‑Methyl Acyl Co A Racemase (AMACR), p63 and High Molecular Weight Cytokeratin (HMWCK/34betaE12) has made it easier for us to reach the diagnosis in such cases. Material and methods: All the cases which were received in the Department of Pathology, JNMCH, AMU from January 2015 to December 2018 were categorized into four histomorphologic groups on the basis of histopathology, and immunohistochemistry was applied on all the cases which were rendered ‘suspicious’ on histomorphology. Result: One hundred twenty-one prostatic specimens were received. Out of which, 13 biopsies were found to be inadequate for analysis and hence were not included in the study. Out of the rest 108 cases, (1) 52 were benign, (2) 19 were premalignant, (3) 25 were carcinoma and (4) 12 were signed as ‘suspicious’ on histopathology. These 12 suspicious cases were true cut needle biopsies which were considered appropriate for applying immunomarkers along with control cases. Out of 12 suspicious cases, 8 cases (66.7%) were negative and 3 cases (25%) were weakly positive for p63, 1 case showed moderate immunostaining. HMWCK was completely negative in 7 cases (58.33%), 3 cases (25%) showed weak positivity, 1 case showed moderate and 1 case showed strong positivity. While 5 cases (41.67%) were negative and 7 cases (58.33%) were positive for AMACR mostly showing moderate to strong positivity Conclusion: The application of immunomarkers helped us to reach a definite diagnosis in 10 out of 12 cases, which were otherwise difficult to classify. Judicious use of immunomarkers can help in differentiating mimickers of prostate carcinoma from true cancer cases and assist in reaching a definitive diagnosis.

Diagnostic performance of volumetric laser endomicroscopy for Barrett's esophagus dysplasia amongst gastroenterology trainees.

Volumetric laser endomicroscopy (VLE) is an advanced imaging modality used in Barrett's esophagus (BE) surveillance. VLE image interpretation is challenged by subtle grayscale image variation across a large amount of data. Training in VLE interpretation is not standardized. This study aims to determine if VLE training can be incorporated into a gastroenterology (GI) fellowship curriculum with the use of a self-directed module. A standardized, self-directed training module (30 min) was created explaining the background and established VLE criteria for the diagnosis of BE dysplasia. A VLE image dataset was generated from a multicenter VLE database of targeted biopsies. GI trainees were asked to grade each image for the presence or absence of the following criteria (I) increased surface optical frequency domain imaging (OFDI) signal intensity and (II) atypical glands and provide a final diagnosis (dysplastic vs. non-dysplastic). Diagnostic performance was calculated and results compared to VLE expert interpretation using histology as the gold-standard. The dataset included 50 VLE images (10 high-grade dysplasia, 40 non-dysplastic BE). VLE images were reviewed in a randomized and blinded fashion by 5 GI trainees with no prior VLE experience and 5 experienced VLE users. Sensitivity, specificity and accuracy of GI trainees was 83.3% (95% CI: 71.5-91.7%), 59.0% (95% CI: 51.6-66.0%), and 64.8% (95% CI: 58.5-70.7%) compared to 80.0% (95% CI: 67.7-89.2%), 79.5% (95% CI: 73.0-85.0%), and 79.6% (95% CI: 74.1-84.4%) for VLE experts respectively. The difference in specificity and accuracy between the two groups were statistically significant with P<0.001. A brief training session on VLE is inadequate to reach competency in interpretation of VLE by GI trainees. Additional experience is required to accurately interpret VLE images.

Intrabiliary Metastasis of Colon Cancer Mimicking Cholangiocarcinoma and Chemotherapy-Induced Sclerosing Cholangitis: A Case Report

Intrabiliary metastasis of colon cancer without the involvement of the hepatic parenchyma is very rare and can cause biliary obstruction. We herein present a rare case of colon cancer metastasis that developed after right hemicolectomy and while undergoing chemotherapy. Computed tomography (CT) of the abdomen and percutaneous transhepatic cholangiography and drainage (PTCD) was performed because of obstructive jaundice. CT-guided biopsy showed high-grade atypical glands that were CK7(−), CK20(+), and CDX-2(+); metastatic adenocarcinoma would be considered first rather than cholangiocarcinoma. Clinicians should be aware that intrabiliary metastasis of colon cancer can mimic cholangiocarcinoma and chemotherapy-induced sclerosing cholangitis.

S1783 Recurrent Metastatic Appendiceal Adenocarcinoma Presenting as Non-Specific Colitis – A Case Report

Introduction: Malignancies of the appendix are rare and there is a known association of appendicular carcinoid of the appendix and Crohn's disease. Appendicular carcinoid can be mixed with mucinous adenocarcinoma in both primary and metastatic lesions. We present an unusual case of a patient who presented with nonspecific colitis as a manifestation of recurrent metastatic appendiceal adenocarcinoma. Case Description/Methods: A 57-year-old male patient presented with 2 weeks of left lower quadrant pain, diarrhea, and hematochezia. Two years prior to this presentation, he had a perforated appendicitis due to poorly differential adenocarcinoma and goblet cell carcinoid. He was then found to have peritoneal metastasis treated with omentectomy, right hemicolectomy, multiple peritonectomy, and hyperthermic intraperitoneal chemotherapy. He also had multiple intra-abdominal abscesses requiring drainage and a Colo-cutaneous fistula requiring closure. A CT scan showed distal sigmoid colon and rectal thickening. Colonoscopy with biopsies of the terminal ileum showed mild acute inflammation, atypical submucosal glands suspicious for mucinous adenocarcinoma and acute colitis of the entire colon and rectum. After ruling out infectious etiologies, he was started on a prednisone taper with significant improvement in his symptoms. He was then referred to an outside institution for surgical considerations. However, he continued to have intermittent abdominal pain workup revealed a new peritoneal nodule consistent with his prior adenocarcinoma. He was given FOLFOX and bevacizumab for chemotherapy for metastatic disease as he was not a surgical candidate. Discussion: Appendicular carcinoid can be associated with Crohn’s colitis and this has been reported in the literature. This a unique case in which patient had a nonspecific inflammatory colitis which responded well to corticosteroid treatment and imaging identified recurrence of appendicular mucinous adenocarcinoma. If infectious etiologies for non-specific colitis have been excluded, thorough evaluation needs to be performed to rule out metastatic disease in patients with appendicular adenocarcinoma and/or carcinoid as treatment options can vary.

V14-07 TRANSPERINEAL ULTRASOUND WITH TRANSPERINEAL NEEDLES FOR MRI FUSION PROSTATE BIOPSY: DEMONSTRATION OF A NOVEL TECHNIQUE

You have accessJournal of UrologyProstate Oncology II & Testis Oncology & Misc. Oncology (V14)1 Sep 2021V14-07 TRANSPERINEAL ULTRASOUND WITH TRANSPERINEAL NEEDLES FOR MRI FUSION PROSTATE BIOPSY: DEMONSTRATION OF A NOVEL TECHNIQUE Luke P. O'Connor, Patrick T. Gomella, Michael A. Daneshvar, Cheyenne Williams, Nabila Khondakar, Jeunice Owens-Walton, Nitin K. Yerram, Sandeep Gurram, Michael Ahdoot, Nicole Varble, Sheng Xu, Baris Turkbey, Peter A. Pinto, and Bradford J. Wood Luke P. O'ConnorLuke P. O'Connor More articles by this author , Patrick T. GomellaPatrick T. Gomella More articles by this author , Michael A. DaneshvarMichael A. Daneshvar More articles by this author , Cheyenne WilliamsCheyenne Williams More articles by this author , Nabila KhondakarNabila Khondakar More articles by this author , Jeunice Owens-WaltonJeunice Owens-Walton More articles by this author , Nitin K. YerramNitin K. Yerram More articles by this author , Sandeep GurramSandeep Gurram More articles by this author , Michael AhdootMichael Ahdoot More articles by this author , Nicole VarbleNicole Varble More articles by this author , Sheng XuSheng Xu More articles by this author , Baris TurkbeyBaris Turkbey More articles by this author , Peter A. PintoPeter A. Pinto More articles by this author , and Bradford J. WoodBradford J. Wood More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002111.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There has been a push towards transperineal approaches for prostate biopsy to help reduce risk of sepsis related complications seen in transrectal ultrasound (TRUS) guided procedures. Current commercial platforms allow urologists to perform transperineal MRI/TRUS fusion biopsies (TRUS-TP); however, this requires the use of a TRUS probe which can be a source of discomfort to patients leading to avoidance of repeat surveillance biopsies. We pioneered a novel technique that allows a completely TP approach, without any entry into the rectum. In this video, we demonstrate the transperineal freehand ultrasound and guided needle TP (TPUS-TP) biopsy technique using our custom in-house software. METHODS: We present the case of a 64-year-old-male who was self-referred to our institution for a second opinion regarding his Grade Group (GG) 1 prostate cancer. He has been on active surveillance after initial standard biopsy revealed GG1 disease in 1/14 biopsy cores. After repeat MRI at our institution, the patient was found to have two suspicious lesions. He underwent a subsequent TP biopsy given the anterior location of these lesions. RESULTS: The patient first underwent systematic TP biopsy using a modified 12 core Barzell template followed by targeted fusion biopsy via a standard TRUS-TP with grid. The patient then underwent a TPUS-TP guided biopsy as demonstrated in this video. In this technique, the TPUS ultrasound probe and guided biopsy needle are placed directly on the perineum. The patient was discharged home same-day without any post-operative complications. Upon pathologic review, TPUS-TP biopsy detected GG2 cancer in both targeted lesions with TRUS-TP showing GG2 in only one target and atypical glands in the other. CONCLUSIONS: Transperineal freehand ultrasound and guided needle transperineal (TPUS-TP) prostate biopsy utilizing our custom in-house software offers a novel way to sample the prostate without the use of a transrectal ultrasound probe. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1167-e1167 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Luke P. O'Connor More articles by this author Patrick T. Gomella More articles by this author Michael A. Daneshvar More articles by this author Cheyenne Williams More articles by this author Nabila Khondakar More articles by this author Jeunice Owens-Walton More articles by this author Nitin K. Yerram More articles by this author Sandeep Gurram More articles by this author Michael Ahdoot More articles by this author Nicole Varble More articles by this author Sheng Xu More articles by this author Baris Turkbey More articles by this author Peter A. Pinto More articles by this author Bradford J. Wood More articles by this author Expand All Advertisement Loading ...

The current value of histological findings in negative prostate biopsies to predict the future risk of clinically significant prostate cancer

BackgroundRepeat prostate biopsy (PBx) is recommended under persistent suspicion of prostate cancer (PCa) or in the face of the following findings: atypical small acinar proliferation (ASAP); extense (≥3 biopsy sites) high-grade prostatic intraepithelial neoplasia (HGPIN); or HGPIN with atypical glands; suspicious for adenocarcinoma (PIN-ATYP). Nowadays; multiparametric magnetic resonance imaging (mpMRI) and mpMRI targeted PBx (MRI-TBx) are recommended in repeat PBx. Our objective was to analyze the current value of ASAP; mHGPIN; PIN-ATYP and other histological findings to predict clinically significant PCa (csPCa) risk. MethodsRetrospective analysis of 377 repeat PBxs. MRI-TBx was performed when Prostate Imaging-Reporting and Data System (PI-RADS) score >3 and 12-core transrectal ultrasound (TRUS) systematic PBx when ≤2. ASAP; HGPIN; mHGPIN; PIN-ATYP; and 8 other histological findings were prospectively reported in negative PBx. CsPCa was defined as ISUP group grade >2. ResultsIncidence of ASAP; multifocal HGPIN (mHGPIN) and PINATYP was 4.2%; 39.7% and 3.7% respectively; and csPCa rate was statistically similar among men with these histological findings. However; the rate of csPCa was 22.2% when proliferative inflammatory atrophy (PIA) was present; and 36.1% when it was not. PIA was the only histological finding which predicted lower risk of csPCa; with an OR of 0.54 (95%CI: 0.308−0.945; P = .031). In addition; PIA was an independent predictor of a model combining clinical variables and mpMRI which reached area under de ROC curve of 0.86 (95%CI: 0.83−0.90). ConclusionPIA emerged as the only predictive histological finding of csPCa risk and can contribute to a predictive model. mHGPIN failed to predict csPCa risk. The low incidence of ASAP (4.2%) and PIN-ATYP (3.7%) prevented us from drawing conclusions.

Benign vs malignant pancreatic lesions: Molecular insights to an ongoing debate.

Several benign conditions such as chronic pancreatitis, autoimmune pancreatitis, and paraduodenal pancreatitis can present as mass lesions and may mimic pancreatic ductal adenocarcinoma (PDAC) clinically and radiologically. Thorough histologic examination with attention to certain morphologic features can assist in deciphering neoplastic from reactive, however small biopsies often remain a challenge. Variable histologic patterns in conventional PDAC may also confound the diagnosis of PDAC. Uncommon subtypes of pancreatic carcinoma such as adenosquamous and squamous cell carcinoma, colloid carcinoma, medullary carcinoma, hepatoid carcinoma and signet ring cell carcinoma necessitate excluding metastasis from other sites prior to rendering the diagnosis of pancreatic carcinoma. The use of immunohistochemical staining and molecular markers can aid in separating benign from malignant and PDAC from metastasis. PDAC expresses a few non-specific epithelial and mucin immunomarkers such as CK7, CK19, MUC1, MUC4 and MUC5AC. However, the only immunohistochemical marker that is specific for PDAC in the right clinical context is SMAD4. Loss of SMAD4 within atypical glands and ducts supports the diagnosis of PDAC in a limited sample. Unfortunately, this finding is seen only in 50% of PDAC cases. The identification of certain mutations can help support a diagnosis of PDAC when benign conditions are in the differential. At the molecular level, KRAS oncogene mutations are seen in approximately 93% of PDACs. Subsequent neoplastic progression is driven by additional mutations of tumor suppressor genes, such as CDKN2A, TP53, and SMAD4. Molecular markers can also provide an insight to the prognosis. For instance, the loss of SMAD4 is associated with a poor outcome whereas mutations in MLL, MLL2, MLL3, and ARID1A are associated with improved survival.

Valor actual de los hallazgos histológicos de biopsias de próstata negativas en la predicción del riesgo futuro de cáncer de próstata clínicamente significativo

IntroductionRepeat prostate biopsy (PBx) is recommended under persistent suspicion of prostate cancer (PCa) or in the face of the following findings: atypical small acinar proliferation (ASAP), extense (≥3 biopsy sites) high-grade prostatic intraepithelial neoplasia (HGPIN), or HGPIN with atypical glands, suspicious for adenocarcinoma (PIN-ATYP). Nowadays, multiparametric magnetic resonance imaging (mpMRI) and mpMRI targeted PBx (MRI-TBx) are recommended in repeat PBx. Our objective was to analyze the current value of ASAP, mHGPIN, PIN-ATYP and other histological findings to predict clinically significant PCa (csPCa) risk. MethodsRetrospective analysis of 377 repeat PBxs. MRI-TBx was performed when Prostate Imaging-Reporting and Data System (PI-RADS) score>3 and 12-core transrectal ultrasound (TRUS) systematic PBx when≤2. ASAP, HGPIN, mHGPIN, PIN-ATYP, and 8 other histological findings were prospectively reported in negative PBx. CsPCa was defined as ISUP group grade>2. ResultsIncidence of ASAP, multifocal HGPIN (mHGPIN) and PINATYP was 4.2%, 39.7% and 3.7% respectively, and csPCa rate was statistically similar among men with these histological findings. However, the rate of csPCa was 22.2% when proliferative inflammatory atrophy (PIA) was present, and 36.1% when it was not. PIA was the only histological finding which predicted lower risk of csPCa, with an OR of .54 (95% CI: .308-.945, P=.031). In addition, PIA was an independent predictor of a model combining clinical variables and mpMRI which reached area under de ROC curve of .86 (95% CI: .83-.90). ConclusionsPIA emerged as the only predictive histological finding of csPCa risk and can contribute to a predictive model. mHGPIN failed to predict csPCa risk. The low incidence of ASAP (4.2%) and PIN-ATYP (3.7%) prevented us from drawing conclusions.

Patterns of SATB2 and p16 reactivity aid in the distinction of atypical polypoid adenomyoma from myoinvasive endometrioid carcinoma and benign adenomyomatous polyp on endometrial sampling.

Atypical polypoid adenomyoma (APAM) is an uncommon uterine lesion composed of complex endometrioid glands with frequent squamous morular metaplasia and fibromuscular stroma. On endometrial curettage, biopsy or polypectomy specimens, the admixture of endometrioid glands and smooth muscle raises the differential diagnosis of myoinvasive endometrioid carcinoma. Reproductive-age APAM patients may opt for fertility preservation, whereas myoinvasive carcinoma is treated surgically. One previous study reported an incidental finding that the stroma of APAM, in contrast to that of other polypoid lesions, was SATB2-positive. APAM has also been reported to show increased stromal p16 staining. We aimed to assess whether SATB2 and p16 are useful stains for the distinction of APAM from myoinvasive carcinoma and benign adenomyomatous polyps. Cases of 'atypical polypoid adenomyoma' (n=32), 'adenomyomatous polyp' (n=39) and 'myoinvasive endometrioid carcinoma' (n=30) were identified. Morphological features were assessed, along with the intensity and extent of SATB2 and p16 staining in the stromal component of each lesion. SATB2 expression was seen in the stromal components of 30 of 32 (94%) APAMs, versus none of 39 (0%) benign adenomyomatous polyps and five of 30 (17%) myoinvasive endometrioid carcinomas. Stromal p16 expression was seen in 31 of 31 (100%) APAMs, versus 20 of 39 (51%) benign adenomyomatous polyps and 12 of 30 (40%) myoinvasive endometrioid carcinomas. Patchy to diffuse SATB2 and block-type p16 staining of fibromuscular stroma separating atypical endometrioid glands is more consistent with APAM than with myoinvasive endometrioid carcinoma. These stains are potentially useful adjuncts to careful morphological evaluation of endometrial biopsies/curettings.

Next Generation Sequencing of Renal Medullary Carcinoma Diagnosed Concurrently with Sickle Cell Trait: A Case Report and Literature Review

Abstract Casestudy We present a 33-year-old African American male with 4 months of intermittent right flank pain and gross hematuria with hypermetabolic retroperitoneal lymphadenopathy, persistent right-sided hydronephrosis, perinephric fat stranding and a 5.5-cm hypermetabolic right lower pole mass demonstrated on imaging. Results Core needle biopsies of the mass contained atypical glands composed of epithelioid cells with pleomorphic nuclei, prominent nucleoli, eosinophilic cytoplasm and abundant mitoses infiltrating through desmoplastic stroma. Immunohistochemical staining demonstrated CK7 and PAX8 reactivity of the tumor cells, and negative staining for CK20, WT1, PSA, PLAP and CD10. The patient underwent a radical right nephrectomy; microscopic examination illustrated invasion of the renal sinus, perirenal fat, and lymphovascular space by the neoplastic glands and sickling erythrocytes in the vasculature. Further IHC staining revealed intact mismatch repair proteins (MLH1, PMS2, MSH2, and MSH6) and a loss in expression of INI1 (SMARCB1), leading to the concurrent diagnoses of renal medullary carcinoma and sickle cell trait (confirmed with hemoglobin fractionation). Next generation sequencing of 144 clinically significant genes detected no mutations. Conclusion Renal medullary carcinoma is a rare, aggressive neoplasm that accounts for less than 0.5% of all renal cell carcinomas and presents at an advanced stage. Patients are usually young males who are of African or Mediterranean descent with comorbid sickling disease. Although loss of SMARCB1/INI-1 gene expression is associated with this neoplasm, no effective therapeutic targets have yet been established. Renal medullary carcinomas are usually resistant to chemotherapy and radiotherapy, making the identification of an immunotherapy target paramount. With a median survival of four months from diagnosis, additional genetic studies of these malignancies may identify an effective treatment option for renal medullary carcinoma.

Bilateral ovarian carcinoma with colorectal metastases - An unusual presentation

Primary ovarian carcinoma may metastasize to the peritoneum leading to malignant ascites. Four percent cases of primary ovarian carcinoma can involve the colorectum. We present a case report of a 50-year-old women who had complaints of bilateral adnexal mass and disturbed menstruation with altered bowel habits. Computed tomography scan of the abdomen and pelvis showed a bilaterally enlarged ovaries and a lobular rectal mass. Proctoscopy substantiated the rectal mass as an ulcerated lesion. Histopathology confirmed the diagnosis as bilateral serous papillary cystadenocarcinoma. Left hemicolectomy specimen illustrated foci of atypical glands. Immunohistochemical staining of both the tumor masses showed strong cytokeratin 7 positivity with negative cytokeratin 20 expression. Bilateral involvement of the ovaries with colorectal metastasis is very uncommon, which is highlighted in this paper. Keywords: Bilateral, Cancer, Colorectum, Immunohistochemistry, Ovary, Metastasis.