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The homologous recombination deficiency (HRD) score integrates three DNA-based measures of genomic instability, and has been understudied in prostate cancer. Given the recent FDA approval of two PARP inhibitors for prostate cancer, HRD score analysis could help to refine treatment selection. We assessed HRD score (defined as the sum of loss-of-heterozygosity, telomeric allelic imbalance, and large-scale state transitions) in three cohorts of primary prostate cancer, including a Johns Hopkins University (JHU) cohort with germline mutations in BRCA2, ATM, or CHEK2 (n = 64), the TCGA cohort (n = 391), and the PROGENE cohort (n = 102). In the JHU cohort, tumors with germline BRCA2 mutations had higher HRD scores (median = 27) than those with germline ATM or CHEK2 mutations (median = 16.5 [p = 0.029] and 9 [p

Grading is one of the best prognostic indicators of prostate cancer with Gleason grade 5 having the worst outcome. The prognostic influence of grade 5 patterns remains uncertain. A total of 646 prostate needle biopsy sets with Gleason score (GS) 9-10 prostatic adenocarcinoma were prospectively analysed. Patterns of grade 5 were correlated with radical prostatectomy (RP) adverse findings of high tumour volume (TV), extra-prostatic extension (EPE), seminal vesicle invasion (SVI) and lymph node involvement (LNI) in 472 and biochemical recurrence (BCR) in 338 patients after RP. Mean age and serum PSA were 69 years (range 37-91) and 26.1 ng/mL (range 1.4-1800), respectively. Gleason scores were 4+5=9 in 539 (83%), 5+4=9 in 94 (15%) and 5+5=10 in 13 cases (2%). Clusters/cords, single cells, sheets and comedocarcinoma were found in 86%, 69%, 26% and 18% with a pure pattern in 25% of cases. Comparing cases with and without sheets, there were no significant differences with RP high TV (p=0.8577), EPE (p=0.5372), SVI (p=0.5183) and LNI (p=0.4323). However, the presence of sheets predicted a significantly higher BCR rate (p=0.0033), while for tumours with single cells, the interval to BCR was significantly shorter (p0.0001). Comparing cases with and without the other patterns, two other significant differences were found. Comedocarcinoma predicted high TV (p=0.0230) and single cells predicted EPE (p=0.0101). This study shows that all patterns currently used to assign a Gleason grade 5, including sheets, comedocarcinoma, single cells and clusters/cords, are associated with aggressive outcomes validating their inclusion in grade 5.

The inflammatory microenvironment plays an important role in the pathogenesis and progression of tumors and may be associated with somatic genomic alterations. We examined the association of tumor-infiltrating T-cell density with clinical-pathologic variables, tumor molecular subtype, and oncologic outcomes in surgically treated primary prostate cancer occurring in patients of European-American or African-American ancestry. We evaluated 312 primary prostate tumors, enriched for patients with African-American ancestry and high grade disease. Tissue microarrays were immunostained for CD3, CD8, and FOXP3 and were previously immunostained for ERG and PTEN using genetically validated protocols. Image analysis for quantification of T-cell density in tissue microarray tumor spots was performed. Automated quantification of T-cell densities in tumor-containing regions of tissue microarray spots and standard histologic sections were correlated (r = 0.73, p

High-intensity focused ultrasound (HIFU) is a focal therapeutic approach for localised non-metastatic prostate cancer. We report a 53-year-old man who failed active surveillance of prostatic adenocarcinoma in the right lobe and underwent HIFU focal therapy. He experienced an outfield recurrence in the contralateral lobe thereafter and underwent salvage radical prostatectomy. We discuss the histopathological features in the salvage radical prostatectomy post HIFU treatment, its relationship to the outfield recurrence and the management.

Renal cell carcinoma (RCC) and prostatic adenocarcinoma (PCa), occurring as a double primary is uncommon, but well documented. However, metastatic PCa in a RCC is quite rare. We report a case of an 81-year old male chemical engineer with history of hematuria and prostatomegaly suspicious for carcinoma, who underwent left radical nephrectomy for a renal mass. Histopathology revealed RCC that harbored an undiagnosed PCa. Periureteral tumor deposit likewise showed combined metastasis of RCC and PCa. Keywords: Tumor-to-tumor metastasis, Collision tumor, Periureteral implants, Prostate adenocarcinoma, Renal cell carcinoma

Primary adenoid cystic carcinoma of the urethra is uncommon with only 9 cases reported in the medical literature; all tumors arose from Cowper's glands. Herein, we report the histological features and immunohistochemical characteristics of 1 patient with primary adenoid cystic carcinoma involving the entire posterior urethra, prostate gland, corpus spongiosum, corpora cavernosa, urogenital diaphragm, perianal soft tissue, and muscularis propria layer of rectum. We also review other published cases to evaluate the prognosis and treatment.

Resume Introduction La scintigraphie osseuse est indiquee dans le bilan d’extension des adenocarcinomes prostatiques a risque metastatique intermediaire ou eleve selon la classification de d’Amico. L’equipe de medecine nucleaire du centre hospitalier de Haguenau realise depuis fevrier 2014, en plus du balayage corps entier, une acquisition TEMP/TDM double-lit systematique dans le bilan d’extension initial des adenocarcinomes prostatiques. L’objectif de cette etude est d’evaluer la valeur ajoutee de cette pratique. Materiels et methodes Tous les patients ayant beneficie d’une scintigraphie osseuse pour le bilan d’extension d’un adenocarcinome prostatique entre fevrier 2014 et juillet 2015 ont ete inclus retrospectivement. Les acquisitions planaires et TEMP/TDM ont ete cotees par region d’interet, selon un score diagnostique dependant de l’interpretation des foyers d’hyperfixation. Les resultats obtenus a partir des acquisitions planaires, TEMP/TDM simple-lit et TEMP/TDM double-lit ont ete compares. Resultats Au total, 201 patients ont ete inclus retrospectivement. L’acquisition TEMP/TDM a permis de reclasser 81,4 % des examens non conclusifs sur l’acquisition planaire. Seuls 2,4 % des examens auraient ete faussement negatifs en l’absence d’acquisition TEMP/TDM double-lit realisee d’emblee. Trois pour cent de la population presentait des hyperfixations sur l’acquisition planaire, situees en dehors des champs de la TEMP/TDM double-lit. Conclusion Notre etude confirme l’interet d’une acquisition TEMP/TDM double-lit realisee d’emblee dans le bilan d’extension des patients presentant un adenocarcinome prostatique a risque metastatique intermediaire ou eleve.

Intravenous location of lobular capillary haemangioma/ pyogenic granuloma is rare with less than 50 cases reported. It is extremely unusual to get a metastatic carcinoma within an intravascular lobular capillary haemangioma (IVLCH). To our knowledge, there are no reported cases of intravenous lobular capillary haemangioma harbouring a metastatic carcinoma. Here we discuss a case of metastatic prostatic carcinoma within an IVLCH along with a review of literature of intravenous pyogenic granuloma and analysis of the possible aetiological factors for the development of lobular capillary haemangioma in our patient.

In the past several years, modifications have been made to the original Gleason system with resultant therapeutic and prognostic implications. Several morphologic variants of prostatic adenocarcinoma have also been described. Prostate pathology has also evolved over the years with the discovery and utility of new immunohistochemical stains. The topics discussed in this update include the Gleason grading system, prognostic grade grouping, variants of prostatic adenocarcinoma, and the application of immunohistochemistry to prostate pathology.

Resume Introduction La collision tumorale est la rencontre de deux tumeurs provenant de deux sites topographiques distincts. Les cas de collisions metastatiques ganglionnaires sont exceptionnels. Nous rapportons le cas d’une collision metastatique ganglionnaire d’un carcinome urothelial et d’un adenocarcinome prostatique. Observation Un homme de 61 ans etait hospitalise pour une nephro-ureterectomie droite avec curage peri-ureteral. Il etait suivi depuis 2004 pour un adenocarcinome prostatique et traite par prostatectomie radicale puis radiotherapie 4 ans plus tard du fait d’une reascension du PSA. Dans le cadre du suivi, un carcinome urothelial du bas uretere a ete decouvert en 2014. L’analyse anatomopathologique du curage ganglionnaire montrait, dans un ganglion, une double metastase d’origine urotheliale et prostatique de type acinaire et ductal. L’etude immuno-histochimique incluant les anticorps CK7, CK20, PSA, GATA3, P63 a confirme le phenotype distinct des 2 proliferations tumorales. Discussion La collision metastatique d’un carcinome urothelial et d’un adenocarcinome prostatique a ete rapportee dans 4 cas seulement. Notre revue de la litterature montre que l’adenocarcinome prostatique precede toujours le carcinome urothelial. L’etude immuno-histochimique, lorsqu’elle est realisee, repose sur les CK7, CK20 et PSA. Elle peut etre completee dans un second temps par le GATA3, le recepteur aux androgenes et la P63.

Leiomyomas are common smooth muscle neoplasms; however, leiomyomas of the seminal vesicles are extremely rare. We report a case of seminal vesicle leiomyoma in a 55-year-old African American male who underwent robot assisted laparoscopic prostatectomy (RALP) for Gleason 8 (4 + 4) adenocarcinoma. An incidental nodule arising from the left seminal vesicle was discovered during surgery, complicating the surgical dissection and suggesting extra-prostatic extension. The histologic findings in this case raised the possibility that this seminal vesicle leiomyoma may have arisen from a remnant of the mid-portion of the Müllerian duct; however, a thorough immunohistochemical (IHC) workup disproved this theory.

Background Prostate cancer (PC) is a common noncutaneous malignancy in men. The incidence of PC is increasing at an alarming rate across the globe. Progression of PC is associated with elevated levels of interleukin-8 (IL-8) and cyclooxygenase-2 (COX-2) in malignant cells. Overexpression of these players is accompanied by chronic inflammation, increased angiogenesis, proliferation, migration, and inhibition of apoptosis. Moreover, their elevated circulating levels promote the disease progression from androgen-dependent to androgen-independent state. Thus, inhibiting the expression of IL-8 and COX-2 would be a promising target in the development of PC therapeutics. In this study, we investigated the inhibitory effects of Withania somnifera extract on highly metastatic, androgen-independent prostate cancer cell line (PC3). Additionally, we compared the real-time expression of IL-8 and COX-2 in prostate tissue samples. Materials and methods The cell viability and cytotoxicity of W. somnifera extract in PC3 cells was quantified colorimetrically by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide and lactate dehydrogenase leakage assay, respectively. Hematoxylin and eosin staining for histological examination, trypan blue, and acridine orange dyes to enumerate apoptotic and live cells, quantitative real-time polymerase chain reaction to determine the expression and flow cytometry to study the cell cycle analysis were used. Results We observed a significant decrease in the cell viability with a half-maximal inhibitory concentration (IC 50 ) of 10 μg/mL. The expression levels of IL-8 and COX-2 in prostate tissue samples and in PC3 cells were predominantly high; however, the lowest dose of W. somnifera significantly inhibited the enhanced expression of IL-8 and COX-2 in PC3 cells in 24 hours. Furthermore, W. somnifera extract (10 μg/mL) irreversibly arrested the cell cycle in G 2 /M phase, which was evident from the rapid accumulation of PC3 cells significantly. Conclusion Our results indicate that inherent metastatic and selective inhibitory potential of W. somnifera against PC. W. somnifera may be a good therapeutic agent in addition to the existing drugs for PC. Further studies with more prostate tissue samples are warranted.

Objective To examine variation in the open market cost of a radical prostatectomy (RP) procedure in the US hospitals for an uninsured patient, as many proposals for health care reform highlight the importance of individuals actively participating in selecting care. However, reports suggest that obtaining procedure prices remains challenging and highly variable. Materials and Methods We used 2011-2012 US News and World Report rankings to identify a cohort of 100 hospitals making an effort to include an equal distribution of both academic and private centers, city size, and geographic region. Each hospital was called and the essence of the script included a caller stating he was a healthy, uninsured 55-year-old man recently diagnosed with Gleason 3 + 4 prostatic adenocarcinoma with no metastases. Facility, surgeon, and anesthesia fees were solicited. Results Seventy hospitals provided facility prices. Facility estimates averaged $34,720 (±20,335; range, $10,100-$135,000), which was statistically higher at academics centers. No significant differences were seen by region, population, or hospital ranking. Surgeon and anesthesia fees were provided by 10%, averaging $8280 (±$4282; range, $4028-$18,720). Thirty-three hospitals provided discounted fees for prompt payment averaging 34% (±16%; range, 10%-80%). Conclusion There is wide variation in pricing for RP, with higher rates found in academic centers. Wide variation in facility costs were observed, and nearly all were unable to provide surgeon and/or anesthesia fees. Currently, it appears to be unacceptably difficult for men with prostate cancer without insurance to obtain prices for an RP procedure.

The design, synthesis, characterization and in vitro anticancer activity of a series of Ir(I) NHC complexes derived from 5,6-dinitrobenzimidazole is reported. The evaluation was performed in five human cancer cell-lines, namely glioblastoma (U-251), prostatic adenocarcinoma (PC-3), colorectal adenocarcinoma (HCT-15), mammary adenocarcinoma (MCF-7) and lung adenocarcinoma (SKLU-7), including healthy cells of African green monkey kidney (COS-7) for comparative purposes. The complexes exhibited better activity in comparison with the corresponding NHC ligand precursors. In particular, complex (4a) exhibited a good performance against PC-3 and SKLU-1 with IC50 values of 10.6 ± 0.9 μM and 10.4 ± 1.5 μM, respectively.

Ureteral metastases of prostatic adenocarcinoma are very rare. We report the case of a 66-year-old man with a right ureteral metastasis of prostate cancer. Only 10 cases have been reported in the literature these last 30 years. Most patients had a multimetastatic prostate cancer. Local treatment is not standardized. Hormonotherapy seems to be the most appropriate treatment in first intention.

GLTSCR2 is a nuclear/nucleolar protein that translocates to the nucleoplasm, suppressed and mutated in human cancers. Our aim in this study was to investigate whether downregulation or cytoplasmic expression of GLTSCR2 has any pathological significance in prostatic cancer development or progression. In this study we show that GLTSCR2 is suppressed in prostatic cancers and its expression is significantly associated with Gleason's scores. Furthermore, we investigated the pathogenetic mechanism of downregulation and cytoplasmic expression of GLTSCR2 in development or progression of prostatic cancers. Taken together, our results indicate that GLTSCR2 functions as a tumor suppressor in prostatic adenocarcinomas.

Tumours of the male genital tract are diverse. Prostatic adenocarcinoma is important because of its high incidence and mortality, the increased frequency of detection following a drive towards early diagnosis and the need to identify those early cancers requiring immediate intervention and those suitable for an active surveillance programme. Testicular germ cell tumours are relatively uncommon but are important because they involve a young patient group and, although potentially highly aggressive, have been a remarkable success story of modern chemotherapy with current cure rates of approximately 97–98%. Penile cancer largely overlaps with the more common cutaneous cancer types.

The objective of this study was to assess the possibility of improving the reliability of preoperative detection of extracapsular extension (ECE) in each prostate lobe by using a new sign called sum of positive sextants per lobe (SPS-L), combining interpretation of MRI and prostate biopsy results.We reviewed the charts of 590 patients undergoing radical prostatectomy between 2002 and 2007. All patients were assessed by preoperative 1.5 Tesla MRI using an integrated endorectal and pelvic phased array coil. A sextant was defined as "positive" when tumor infiltration was observed on a biopsy sample or a pathologic image was observed on MRI (0 = absent, 1 = present). A score, called sum of positive sextants per lobe (SPS-L), was defined as the sum of positive sextants on biopsy samples and positive sextants on MRI (MRI-L) for each lobe. A second score taking into account the presence or absence of ECE visualized on MRI (T3 MRI-L + SPS-L) was also tested for the detection of ECE per lobe.On multivariate analysis, the SPS-L and T3 MRI-L + SPS-L scores were significantly higher in the presence of ECE and extensive ECE (P .0001). The areas under receiver operating characteristic (ROC) curves were significantly greater for the T3 MRI-L + SPS-L score than for the positive biopsy result per lobe (PB(+)/L) rate (P .0001).The use of indirect signs (SPS-L) associated with direct signs (T3 MRI) allows the preoperative detection of ECE per lobe by endorectal 1.5 Tesla MRI with high sensitivity.

The objectives of this study are to report the findings in prostatic needle biopsies positive for cancer seen in our practice with regard to the frequency of cancer detected at various sites, the cancer volume, Gleason grade, presence of perineural invasion, and others; to correlate cancer volume with Gleason grade, perineural invasion, and serum prostate-specific antigen (PSA) levels; and to correlate Gleason grade with serum PSA levels. The study was conducted at The Section of Histopathology, Department of Pathology and Microbiology, Aga Khan University Hospital, Karachi, Pakistan. All consecutive needle biopsies received from January 1, 2011 to June 30, 2012, which were positive for prostatic adenocarcinoma, were included in the study. Statistical analysis was carried out using SPSS 19.0 software package (SPSS Hong Kong Headquarters, Quarry Bay, Hong Kong). A total of 97 needle biopsies positive for carcinoma in this period were included. Prostate-specific antigen levels were available in 60.8% cases and ranged from 5.0 to 1747 ng/mL. Tumor was bilaterally present in 54.6% cases. Tumor positivity in right apex, mid, and base was 52.6%, 54.6%, and 51.5%, respectively. Tumor positivity in left apex, mid, and base was 55.7%, 63.9%, and 59.8%, respectively. Average tumor volume in right apex, mid, and base was 51.2%, 50.6%, and 49.9%, respectively. Average tumor volume in left apex, mid, and base was 49.8%, 49.1%, and 51.6%, respectively. Gleason score was 6 in 52.6% cases and 7 in 28.9% cases. Perineural invasion was positive in 46.4% cases. High-grade prostatic intraepithelial neoplasia was seen in 4 (4.1%) of 97 cases. On statistical analysis, no significant correlation was found between tumor volume and serum PSA levels. However, significant correlation was found between tumor volume and Gleason grade and between tumor volume and presence of perineural invasion. No significant correlation was found between Gleason grade and serum PSA level. To our knowledge, these are the first reported findings in prostatic needle biopsies from Pakistan. Most prostatic carcinomas in our country are still diagnosed on transurethral resection specimens, and needle biopsies are quite uncommon. Findings in needle biopsies will help in predicting adverse prognostic factors on radical prostatectomies and in planning surgery accordingly.

Intraductal carcinoma of the prostate is a marker of aggressive disease. However, intraductal carcinoma exists on a morphologic continuum with high grade prostatic intraepithelial carcinoma (PIN) and distinguishing intraductal carcinoma from PIN is a common diagnostic dilemma with significant clinical implications. We evaluated whether immunostains for PTEN and ERG can sensitively identify intraductal carcinoma and accurately distinguish it from high grade PIN. A combined immunostain for PTEN, ERG, p63 and CK903 was developed and validated. Radical prostatectomy specimens with lesions meeting criteria for intraductal carcinoma (n=45), intraductal cribriform proliferations falling short of intraductal carcinoma (n=15), and PIN lesions (n=39) were retrospectively identified and assessed for PTEN and ERG. Cytoplasmic PTEN loss was identified in 84% (38/45) of the intraductal carcinoma and 100% (15/15) of intraductal cribriform proliferation cases. In contrast, cytoplasmic PTEN loss was never observed in PIN (0/39) (p95% and p

Objective To evaluate the usefulness of phytotherapy in the treatment of the benign prostatic hyperplasia (BPH) and prostatic adenocarcinoma (ADCP). Acquisition of evidence Systematic review of the evidence published until January 2011 using the following scientific terms: phytotherapy, benign prostate hyperplasia, prostatic adenocarcinoma, prostate cancer and the scientific names of compounds following the rules of the International Code of Botanical Nomenclature. The databases used were Medline and The Cochrane Library. We included articles published until January 2011 written in English and Spanish. We included studies in vitro/in vivo on animal models or human beings. Exclusion criteria were literature not in English and Spanish or articles with serious methodological flaws. Synthesis of the evidence We included 65 articles of which 40 met the inclusion criteria. BPH : the most studied products are serenoa repens and pygeum africanum. There are many studies in favor of the use of phytotherapy but its conclusions are inconsistent due to the small number of patients, the lack of control with placebo or short follow-up. However, the use of these products is common in our environment. ADCP : there is no evidence to recommend phytotherapy in the treatment of the ADCP. There are works on prevention but only at experimental level so there is no evidence for its recommendation. Conclusions The scientific evidence on the use of phytotherapy in prostatic pathology is conclusive not recommending the use of it for BPH or the ADCP.

Prostatic immunohistochemistry is commonly used to either distinguish prostatic adenocarcinoma from benign prostate glands or to establish the prostatic lineage of a poorly differentiated carcinoma. Awareness of the many potential pitfalls in prostatic immunohistochemistry is essential to avoid serious misdiagnosis. Histopathologists must be particularly aware of the pitfalls in the interpretation of immunostained sections (identifying immunostaining as positive or negative) and in the interpretation of the immunoprofile of a tumour. This review describes pitfalls at the pre-analytic, analytic and post-analytic stages of testing with a particular focus on the pitfalls in the interpretation stage together with advice on steps that must be taken to avoid these pitfalls. The importance as well as the limitations of using external and internal tissue controls in prostatic immunohistochemistry are presented. Recent advances in prostatic immunohistochemistry are also briefly outlined.

Seminal vesicle (SV) invasion by prostatic adenocarcinoma is a poor prognostic indicator. Despite this, there are currently no guidelines regarding SV sampling in radical prostatectomy specimens. This study examines the distribution of invasive prostatic adenocarcinoma in SVs and makes recommendations regarding sampling procedures.The SVs from 773 consecutive radical prostatectomy specimens were serially sectioned and blocked entirely, with sections grouped into the proximal, mid and distal thirds of the glands. The site of invasive prostatic carcinoma within the muscular wall of the SV and its presence in the ejaculatory duct was recorded.SV invasion (pT3b) was present in 56 (7.2%) cases. Patients ranged in age from 52 to 73 years (mean 64 years), with a serum prostatic specific antigen ranging from 3.7 to 46 ng/mL (mean 10.6 ng/mL). Fourteen patients (25%) had a palpable nodule or induration on digital rectal examination. Ejaculatory duct involvement was present in 49 cases. Forty-seven of 49 (95.9%) cases with ejaculatory duct involvement also had SV invasion. The mean tumour volume was 5.53 cm(3) (range 1.0-12.1 cm(3)). The tumours had a Gleason score of 4 + 3 in five cases, 4 + 3 with tertiary pattern 5 in 12 cases, 8 in two cases and 5 + 4/4 + 5 in 37 cases. All but one of the SV positive cases (98.2%) had involvement of the proximal third (15 right, 17 left and 23 both) of the gland, 35 of which (63.6%) had infiltration only of the proximal SV. For the remainder, 11 also had mid third and nine had mid and distal third involvement. Lymphovascular invasion within the prostate was seen in 71.4% of cases. In one of these cases involvement of the distal right SV was present in the absence of involvement of the proximal or mid SV.In this study, as distal SV invasion in the absence of proximal SV invasion was found in2% of cases, we conclude that sampling of the proximal third of the SVs is sufficient to identify virtually all cases of tumour infiltration into the SVs. If lymphovascular invasion is present in the absence of proximal SV invasion, then the remaining parts of the SV must be examined. Also, in cases with involvement of the ejaculatory duct, thorough examination of the SV is warranted.

Beyond the typical acinar morphology observed in most prostatic adenocarcinoma, a spectrum of morphologic variants and prostate cancer subtypes exists. These unusual entities may be further classified into (1) cancer morphologies arising by divergent differentiation of prostatic ductal, acinar, or basal cells and associated with unique clinical features or therapeutic approaches, and (2) histologies occurring in the context of usual prostatic adenocarcinoma that may result in diagnostic misinterpretation or difficulties in Gleason grade assignment, especially in limited samples. This article details several variants, with emphasis on diagnostic criteria, differential diagnoses, and clinical significance.

Summary Aims The diagnosis of prostate carcinoma is based on a constellation of architectural, nuclear, cytoplasmic, and ancillary features. The aim of this study was to determine if the Ventana Symphony H&E protocol can improve on the detection of prominent nucleoli in foci of prostate cancer. Methods One hundred and twenty cases of Gleason score 3 + 3 = 6 cancers involving 10–30% of one core were retrieved from four academic institutions and two large laboratories (20 cases per institution). The routine H&E and Symphony™ H&E protocol stained slides from the same case were reviewed centrally in a blinded fashion at the Johns Hopkins Hospital. The mean percentages of prominent nucleoli in malignant and benign glands by visual estimation were recorded for each case. After unblinding, the routine H&E slides were compared in a pair-wise t-test with the corresponding Symphony™ stained slide. Results Within all sites, the Symphony™ slides showed statistically significantly more prominent nucleoli in the malignant glands than the routine slides. Conclusions The Symphony™ H&E staining protocol consistently highlights nucleoli in cancer to a greater extent than routine H&E stains and may increase the likelihood of making a diagnosis of limited adenocarcinoma of the prostate in challenging cases.

En este trabajo de revisión se exponen los criterios diagnósticos de cáncer en la biopsia prostática así como el significado de otras lesiones morfológicas (PIN de alto grado, hiperplasia adenomatosa atípica, ASAP y atrofia proliferativa inflamatoria) o variaciones histológicas en el contexto de la biopsia. Se presentan los parámetros histológicos fundamentales de utilidad pronóstica que se recomienda informar en la biopsia prostática de rutina: grado histológico de Gleason, tipo histológico del tumor, nº de cilindros invadidos, cuantificación tumoral, localización de la biopsia y permeación linfovascular. Se destacan asimismo otros marcadores pronósticos y predictivos de carácter molecular, actualmente en estudio y probablemente involucrados en la progresión tumoral.

Typically glands of prostatic adenocarcinoma have a single cell lining, although stratification can be seen in invasive carcinomas with a cribriform architecture, including ductal carcinoma. The presence and diagnostic significance of stratified cells within non-cribriform carcinomatous prostatic glands has not been well addressed. The histomorphological features and immunohistochemical profile of cases of non-cribriform prostatic adenocarcinoma with stratified malignant glandular epithelium were analyzed. These cases were identified from needle biopsy cases from the consultation files of one of the authors and from a review of 150 consecutive in-house needle biopsy cases of prostatic adenocarcinoma. Immunohistochemistry was performed utilizing antibodies reactive against high molecular weight cytokeratin (34betaE12), p63 and alpha-methylacyl-coenzyme-A racemase (AMACR). A total of 8 cases were identified, including 2 from the 150 consecutive in-house cases (1.3%). In 4 cases, the focus with glands having stratified epithelium was the sole carcinomatous component in the biopsy, while such a component represented 5-30% of the invasive carcinoma seen elsewhere in the remaining cases. The main attribute in all these foci was the presence of glandular profiles lined by several layers of epithelial cells with cytological and architectural features resembling flat or tufted high-grade prostatic intraepithelial neoplasia, but lacking basal cells as confirmed by negative 34betaE12 and/or p63 immunostains in all cases. The AMACR staining profile of the stratified foci was variable, with 4 foci showing positivity, and 3 foci being negative, including two cases that displayed AMACR positivity in adjacent non-stratified prostatic adenocarcinoma. Prostatic adenocarcinoma with stratified malignant glandular epithelium can be identified in prostate needle biopsy samples harboring non-cribriform prostatic adenocarcinoma and resembles glands with high-grade prostatic intraepithelial neoplasia. These 'PIN-like' carcinomas can present in pure form. Recognition of this pattern of prostatic adenocarcinoma is necessary to correctly diagnose such cases as invasive carcinoma.

Purpose To quantitate the impact of a number of variables within the American Society of Therapeutic Radiology and Oncology consensus definition (ACD) of biochemical failure (bF) for prostate cancer. Methods and materials The prostate-specific antigen (PSA) data of 1050 men with prostatic adenocarcinoma treated between 1990 and 1997 with external beam radiotherapy monotherapy was examined. A total of 10,872 PSA results were examined for the effect of backdating, stable values, possible nadir date variations, assay resolution, and assay lower limit. Test timing was analyzed according to attendance frequency (mean time between tests [MTBT]) and regularity (using a derived "Irregularity Index" [II]). Results Median biochemical follow-up was 76 months. Nadir date alterations varied the rate of bF beyond 5 years between 0.8% and 5.3%. The bF rate of all MTBT and II quartiles subgroups differed significantly except between the two most regular and the two most infrequent quartiles. Multivariate analysis showed PSA, MTBT, and II to be statistically significant independent predictors of bF ( p Conclusions Many variables exist within the ACD that can produce inconsistencies in bF determination or alter the calculated date of bF. Detection bias issues, especially related to test timing, play a significant role in the derived outcomes.

Despite the high incidence of prostate carcinoma, metastases of the uvea are very rare and bilateral localization is even more. We report here the case of a 77-year-old man diagnosed with a metastatic prostate carcinoma. Two months later, he presented a decreased vision in his right eye and blurred vision in the left eye relevant to metastatic lesion on his right iris and left choroidal metastasis. The urologist should evoke possibility of ocular metastasis in patients with prostate cancer presenting visual disorders.

The aims of this study were to evaluate the accuracy of Gleason grading for prostatic adenocarcinoma among practicing pathologists in Japan and to determine the influence of education on this accuracy. Using a case-oriented approach, 16 hematoxylin and eosin-;stained glass slides with consensus scores established by 4 urologic pathologists were reviewed by 91 pathologists, divided into 2 groups. In group A, average agreements with consensus scores before and after an educational lecture were 55.7% (n = 17) and 68.4% (n = 25), and average kappa values were 0.43 and 0.67, respectively. Twelve pathologists reviewed slides twice in a different order, with average agreements of 59.5% and 77.6%, and average kappa values of 0.48 and 0.69 before and after the lecture, yielding a statistically significant improvement. In group B, the average agreement before providing an atlas with a tutorial was 61.3% (n = 61), and the kappa value was 0.44. In the second round, the average agreement was 74.5% (n = 39), and the kappa value was 0.68. Among 39 pathologists who reviewed slides twice, the average agreement in the first round was 58.8%, and the kappa value was 0.42. Improvement of both the average agreement and the kappa value were statistically significant. The average improvement in kappa values among participants who reviewed slides twice was 0.22 in group A and 0.27 in group B, a difference that is not statistically significant. Combining both groups, the incidence of concordant scores for 16 cases rose from 58.9% to 75.4%, an average increase of 16.5%. The undergrading of score 5–7 lesions was significantly reduced, from 36.3% to 14.2%. With respect to demographic factors, pathologists signing out more than 5000 cases per year showed a better agreement than those with more than 1000 cases per year (48.9% versus 78.8%; P = 0.031). These results indicate that the general agreement of Gleason scores among practicing pathologists in Japan was comparable with those in the Western countries as reported in the literature. Although this requires further improvement, both the lecture and the printed material had a similar influence on the degree of improvement.

Bronchogenic cysts are benign congenital malformations usually. A retroperitoneal location is extremely uncommon. We reported a case of bronchogenic cyst occurred in the retroperitoneum in a 60-year-old patient. An abdominal CT for a prostatic adenocarcinoma staging has reported this incidental lesion. Biological, radiological and histological assessment confirmed the bronchogenic cyst diagnosis. The treatment of choice for most authors is surgical excision. However, because of a low malignant transformation risk, we have chosen a follow-up with abdominal computerized tomography every 6 months. During 3 years, biological and radiological assessments have shown a stable lesion. Therefore, it seems reasonable to propose a simple radiological monitoring for bronchogenic cysts in selected patients.

Scant data are available comparing sampling methods of radical prostatectomy specimens performed for clinical stage T1c (nonpalpable) cancer. Seventy-eight stage T1c radical prostatectomies that had 1 or more of the following adverse pathologic findings—Gleason score ≥ 7, positive margins, and extraprostatic extension—were compared using 10 different sampling techniques. Of the 78 entirely submitted cases, 52 had Gleason score ≥ 7, 14 had positive margins, and 54 had extraprostatic extension (mean 34 slides). Of the partial sampling methods, we favor the following two methods. The first is submitting every posterior section plus 1 midanterior section from right and left sides; if either of these anterior sections show sizeable tumor, all ipsilateral anterior slides are examined. This method detects 98% of tumors with Gleason score ≥ 7, 100% of positive margins, and 96% of cases with extraprostatic extension (mean 27 slides). The second method is to use the above method but restrict it to sections ipsilateral to the previous positive needle biopsy. This method detects 92% of tumors with Gleason score ≥ 7, 93% of positive margins, and 85% of cases with extraprostatic extension (mean 17 slides). Partial sampling can detect important prognostic parameters. By balancing the extra expense and time involved to process and examine additional sections with the risk of missing important prognostic parameters, pathologists can decide which sampling method to use. HUM PATHOL 32:494-499. Copyright © 2001 by W.B. Saunders Company

The intracranial metastasis due to prostatic adenocarcinoma are quite rare, inside them, the ones placed in the parasellar region on the cranial base are exceptional. There are only 3 clinical cases found in the literature consulted, now we report here two more cases and we review the etiopathogenia, clinic presentation, diagnosis and treatment for this type of lesions. Usually there are very undifferentiated neoplasms, developed stages and with multiple metastasis at others levels. A patient with prostatic carcinoma known and neurological signs we should suspect the presence of intracranial metastasis. The diagnosis is made with image tests (basically with CT and MRI), being necessary in some cases the histological confirmation with a biopsy. Although the prognostic of these patients (less than 6 months in our cases) depends more of the evolutive stage of the illness than the type of treatment that the patients will be someated, we should establish it rapidly, on this way we can revert the neurological status and we will improve the quality of life of these patients.

Resume Les metastases du cancer de la prostate sont frequentes. Qu'elles soient revelatrices d'un cancer prostatique encore meconnu ou qu'elles surviennent au cours de l'evolution d'une tumeur connue dont elles traduisent alors l'extension et le caractere diffus, ces lesions ont la particularite d'avoir une image radiologique assez evocatrice par leur caractere osteoformateur. Elles sont surtout faciles a mettre en evidence par biopsie osteomedullaire ou ponction cytologique grâce aux marqueurs immunohistochimiques dont nous disposons, marqueurs qui sont a la fois tres sensibles et tres specifiques. La prostate est en effet le tissu dont l'origine est actuellement la plus facile a mettre en evidence, quel que soit le degre de differenciation de la tumeur, a l'aide de techniques simples realisables dans tous nos laboratoires.

Objectives : It is the objective of this study to present the use of knowledge-guided procedures in quantitative image analysis and interpretation in histopathology. Methods : The knowledge-guided procedures were implemented in the form of N-gram encoding methods for the search and detection of areas of atypicality or abnormality in histopathologic sections ; they were implemented as expert system for automated scene segmentation based on an associative network with frames at each node. The extraction of histometric features from the basal cell layer of prostatic lesions is presented as an example of automated image interpretation. Results : Rapid search algorithms for lesion detection were able to identify approximately 90% of areas labelled as atypical or abnormal by visual assessment, in lesions of colon, prostate and breast. Automated segmentation of very complex histopathologic imagery was possible with a success rate of approximately 80-90%, in sections of prostatic and colonic lesions. Histometry of the deterioration of the basal cell layer in prostatic lesions provided a monotonic trend curve suitable for the measurement of progression or regression. Conclusions : Knowledge-guided procedures bring external information, not offered by the imagery itself, to bear on image processing and image analytic methods. This has enabled automated analysis and interpretation of very complex imagery, such as from cribriform glands, resulting in quantitative diagnostic information.

We report the case of a 69-year-old man who presented with an adrenal angiosarcoma which had been discovered during prostatic adenocarcinoma staging. Twenty-two cases have been reported in the literature. All of them were of epithelioid type. Because of the epithelioid appearance and frequent expression of epithelial immunohistochemical markers, they can be confounded with adrenal carcinomatous metastases. Careful screening for vascular differentiation and immunohistochemistry with endothelial markers are essential for the diagnosis.