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Background: A subset of encapsulated/circumscribed follicular variant of papillary thyroid carcinoma (FVPTC) was reclassified as noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) in 2016 to reduce overtreatment of a low-risk tumor. Study objectives were to describe the epidemiology and long-term outcomes of NIFTP in a high-volume, urban, tertiary referral center. Methods: Among patients enrolled in the Boston Medical Center (BMC) Thyroid Cancer Registry, 110 cases of FVPTC underwent index thyroid surgery at BMC between 2000 and 2016. Historically, BMC pathologists assess all malignant nodules using sections ≤0.3 cm with evaluation of the entire nodule and capsule. After review of pathology reports to identify potential NIFTPs, slides were rereviewed using criteria established by the NIFTP Working Group in 2016 and 2018. We evaluated interobserver reliability using Cohen's Kappa coefficient. Results: Among 110 FVPTCs, 15 (13%) met NIFTP criteria; 11 women and 4 men, age range 31–64 (mean 47.5) years. Mean tumor diameter was 1.7 cm (compared with 2.2 cm for FVPTC). Among NIFTP cases, there were no lymph node metastases, distant metastases, or tumor recurrences. All NIFTP cases were American Thyroid Association (ATA) low risk compared with only 68% of FVPTC (p = 0.011). Among FVPTCs, 14% had positive lymph nodes at index operation. Four patients (4%) had distant metastases. Mean follow-up time was 46 and 69 months for FVPTC and NIFTP, respectively. Among FVPTCs with an excellent response to therapy (2015 ATA guidelines), there were no recurrences. Just over half (n = 8) of patients with NIFTP received postoperative radioactive iodine (RAI) therapy. Concordance between pathologists was high for ruling out NIFTP (75%), but only 36% for ruling in NIFTP. Overall, for NIFTP designation, Cohen's Kappa was 0.39, which is considered fair. Conclusions: Although this is a relatively small cohort, all NIFTP specimens underwent updated pathology review consistent with current guidelines; mean follow-up was nearly 6 years. NIFTP represents a small fraction of the total papillary neoplasia diagnosed at this tertiary referral center (2.3%). None of the NIFTP cohort experienced an adverse oncologic event, and there were no regional or distant metastases. Over 50% of patients with NIFTP received RAI. Thus, the NIFTP reclassification may substantially reduce the number of patients who require adjuvant therapies, such as completion surgery or RAI. [ABSTRACT FROM AUTHOR]

The article describes the case of a 54-year-old Hispanic man with bladder cancer and concomitant IgG4-mediated GU disease causing intermittent gross haematuria. Highlights include diffusely thickened bladder wall shown by preoperative imaging, urine cytology collected from the neobladder, and repeat pathological evaluation of the patient's cystectomy specimen.

Purpose: Partial cystectomy (PC) is a bladder sparing option to treat bladder cancer in a carefully selected group of patients. We sought to analyze outcomes of partial cystectomy (PC) in a contemporary cohort of patients at a single institution.Material and Methods: Records were reviewed for 43 patients with a primary urothelial carcinoma (UC) who had a partial cystectomy with curative intent at Columbia University Medical Center from 2004 to 2019. Endpoints of interest were noninvasive recurrence (defined as any recurrent nonmuscle invasive disease), advanced recurrence (defined as a muscle invasive recurrence or metastasis), and death. We used unadjusted Cox proportional hazards regressions and log rank tests to estimate the association between clinical characteristics and endpoints of interest.Results: Among 43 patients with bladder cancer treated with partial cystectomy, median patient age was 73 years (interquartile range 67-77.5) and 86% were male. Twenty-three percent of patients received preoperative neoadjuvant chemotherapy (NAC) and 49% of patients were given perioperative intravesical chemotherapy at the time of PC. Pathologic stage was Conclusions: In well-selected patients, partial cystectomy offers adequate local control of bladder cancer. The risk of systemic progression is similar to reported case series of RC. [ABSTRACT FROM AUTHOR]

Simple Summary: Immunotherapy has changed the landscape of treatment modalities available for many different types of malignancies. However, the factors that influence the success of immunotherapeutics have not been as clearly seen in advanced prostate cancer, likely due to immunosuppressive factors that exist within the prostate cancer tumor microenvironment. While there have been many immunotherapeutics used for prostate cancer, the majority have targeted a single immunosuppressive mechanism resulting in limited clinical efficacy. More recent research centered on elucidating the key mechanisms of immune resistance in the prostate tumor microenvironment has led to the discovery of a range of new treatment targets. With that in mind, many clinical trials have now set out to evaluate combination immunotherapeutic strategies in patients with advanced prostate cancer, in the hopes of circumventing the immunosuppressive mechanisms. The use of immunotherapy has become a critical treatment modality in many advanced cancers. However, immunotherapy in prostate cancer has not been met with similar success. Multiple interrelated mechanisms, such as low tumor mutational burden, immunosuppressive cells, and impaired cellular immunity, appear to subvert the immune system, creating an immunosuppressive tumor microenvironment and leading to lower treatment efficacy in advanced prostate cancer. The lethality of metastatic castrate-resistant prostate cancer is driven by the lack of therapeutic regimens capable of generating durable responses. Multiple strategies are currently being tested to overcome immune resistance including combining various classes of treatment modalities. Several completed and ongoing trials have shown that combining vaccines or checkpoint inhibitors with hormonal therapy, radiotherapy, antibody–drug conjugates, chimeric antigen receptor T cell therapy, or chemotherapy may enhance immune responses and induce long-lasting clinical responses without significant toxicity. Here, we review the current state of immunotherapy for prostate cancer, as well as tumor-specific mechanisms underlying therapeutic resistance, with a comprehensive look at the current preclinical and clinical immunotherapeutic strategies aimed at overcoming the immunosuppressive tumor microenvironment and impaired cellular immunity that have largely limited the utility of immunotherapy in advanced prostate cancer. [ABSTRACT FROM AUTHOR]

For patients with muscle invasive bladder cancer (MIBC), the standard of care is platinum-based neoadjuvant chemotherapy (NAC) followed by radical cystectomy (RC). However, many patients refuse or are medically unfit for RC. Furthermore, between 20% and 30% of patients treated with NAC have no evidence of disease at RC. Therefore, patients who achieved a clinical complete response (cCR) to NAC and refused definitive treatment were placed on an active surveillance cCR protocol. Previous studies have reported on the long-term outcomes of this cohort. This study presents the incidence and management of non-muscle invasive bladder cancer (NMIBC) recurrence in patients while on cCR surveillance protocol. This was a retrospective review of a prospectively-maintained database of all patients on a cCR surveillance protocol. To enter cCR protocol, patients must have received platinum-based NAC for MIBC followed by negative cross-sectional imaging, negative cytology, and negative post-NAC maximal endoscopic resection. Patients were followed with office cystoscopy and cytology every three months and cross-sectional imaging every six months, with repeat transurethral resections (TURs) for suspicious-appearing lesions or positive cytology. Patients with MIBC recurrence or metastases within six months were deemed to be misclassified cCR and excluded from analysis. Any cCR without MIBC recurrence or metastases was considered durable, even with NMIBC recurrence. Any intravesical recurrence prompted a recommendation for definitive treatment with RC. However, patients who recurred with NMIBC and wished to continue bladder-sparing were treated, and outcomes are reported here. Outcomes of interest were number of NMIBC recurrences, grade and stage, and treatment. A total of 61 patients had cCR, of whom 14 (23%) had history of prior NMIBC. Median time in cCR protocol was 28.3 months (IQR 10.1-58.9). Overall, 49 (80%) had durable response without MIBC recurrence or metastases. In total, 28 patients (46%) experienced a median of one NMIBC recurrence (IQR 1-2, range 0-7) with 20 (33%) having one recurrence, five (8%) having two recurrences, and three (5%) having three or more recurrences. Median time to recurrence was 11.5 months (IQR 5.2-20.3). There were 46 total recurrences; nine (20%) were LGTa, 11 (24%) were HGTa, nine (20%) were HGT1, and 17 (37%) were CIS. LGTa recurrences were all treated with TUR alone. HG recurrences were treated with BCG in 22 (59%), induction chemotherapy in one (3%), TUR alone in four (11%), and cystectomy in seven (19%). Patients with NMIBC recurrences were not more likely to recur with muscle-invasive or metastatic disease. Many patients who develop a cCR after NAC for MIBC achieve a durable response without MIBC or metastatic recurrence. However, a large proportion of these patients will experience NMIBC recurrence, primarily with HG disease. The majority of these are single recurrences managed with BCG. In this small subset, it did not appear that NMIBC recurrences resulted in higher rates of subsequent MIBC or metastatic recurrences. These data are important to appropriately counsel patients that those who achieve a cCR still have a substantial risk of NMIBC recurrence and require careful surveillance. [ABSTRACT FROM AUTHOR]

Congenital megalourethra, first described in 1955, is a rare urethral anomaly resulting from dysgenesis of the penile corpus spongiosum, with or without corpus cavernosum involvement, leading to dilatation of the penile urethra. Presentations come in two forms, scaphoid and fusiform, with the former being more common and resulting from deficient or absent corpus spongiosum. Fusiform types are much rarer, and consist of absence of both the corpus spongiosum and cavernosum.3 Here, we present a case involving the surgical correction of an isolated scaphoid-type congenital megalourethra with significantly improved postoperative cosmetic and functional outcomes.