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Background. Neuroendocrine differentiation in the prostate gland ranges from clinically insignificant neuroendocrine differentiation detected with markers in an otherwise conventional prostatic adenocarcinoma to a lethal high-grade small/large cell neuroendocrine carcinoma. The concept of neuroendocrine differentiation in prostatic adenocarcinoma has gained considerable importance due to its prognostic and therapeutic ramifications and pathologists play a pivotal role in its recognition. However, its awareness, reporting, and resource utilization practice patterns among pathologists are largely unknown. Methods. Representative examples of different spectrums of neuroendocrine differentiation along with a detailed questionnaire were shared among 39 urologic pathologists using the survey monkey software. Participants were specifically questioned about the use and awareness of the 2016 WHO classification of neuroendocrine tumors of the prostate, understanding of the clinical significance of each entity, and use of different immunohistochemical (IHC) markers. De-identified respondent data were analyzed. Results. A vast majority (90%) of the participants utilize IHC markers to confirm the diagnosis of small cell neuroendocrine carcinoma. A majority (87%) of the respondents were in agreement regarding the utilization of type of IHC markers for small cell neuroendocrine carcinoma for which 85% of the pathologists agreed that determination of the site of origin of a high-grade neuroendocrine carcinoma is not critical, as these are treated similarly. In the setting of mixed carcinomas, 62% of respondents indicated that they provide quantification and grading of the acinar component. There were varied responses regarding the prognostic implication of focal neuroendocrine cells in an otherwise conventional acinar adenocarcinoma and for Paneth cell-like differentiation. The classification of large cell neuroendocrine carcinoma was highly varied, with only 38% agreement in the illustrated case. Finally, despite the recommendation not to perform neuroendocrine markers in the absence of morphologic evidence of neuroendocrine differentiation, 62% would routinely utilize IHC in the work-up of a Gleason score 5 + 5 = 10 acinar adenocarcinoma and its differentiation from high-grade neuroendocrine carcinoma. Conclusion. There is a disparity in the practice utilization patterns among the urologic pathologists with regard to diagnosing high-grade neuroendocrine carcinoma and in understanding the clinical significance of focal neuroendocrine cells in an otherwise conventional acinar adenocarcinoma and Paneth cell-like neuroendocrine differentiation. There seems to have a trend towards overutilization of IHC to determine neuroendocrine differentiation in the absence of neuroendocrine features on morphology. The survey results suggest a need for further refinement and development of standardized guidelines for the classification and reporting of neuroendocrine differentiation in the prostate gland.

Although the association of discoid lupus erythematosus (DLE) with squamous cell carcinoma has been described in the literature, coexistence with a basal cell carcinoma is very rare. The indolent and non-pruritic nature of the lesion cause it often to be diagnosed at the late stage of the disease. Long-standing photosensitivity and chronic inflammation later lead to scarring and hypopigmentation, which are considered as the risk factors for the malignant changes over DLE. Incisional biopsy is often performed from the erythematosus lesion which does not respond to medical treatment. Here we have reported a rare case of basal cell carcinoma of the skin developing in the background of long-standing DLE, which was successfully managed with cold knife local excision.

Triple-negative breast cancers (TNBCs) are characterized by negative expression for estrogen (ER), progesterone (PR), and human epidermal growth factor 2 (HER2) receptors. Although the majority of basal-like breast cancers (BLBCs) diagnosed based on gene expression profiling belong to the TNBC group, both entities are not synonymous. Core BLBCs are TNBCs, which are positive for basal cytokeratin (CK) and/or epidermal growth factor receptor (EGFR). We aimed to study and correlate a TNBC cohort for various histomorphological features and immunohistochemical (IHC) profile in Indian patients. We studied 205 naïve TNBCs for histopathological features, which were further evaluated for basal CKs-namely, CK5/6, CK14, CK17-and EGFR expression to classify them as core BLBCs, using criteria of any basal CK and/or EGFR positivity and 7-negative phenotype (7NP). Among 205 TNBCs, 91% of cases were core BLBCs, and absence of ductal carcinoma in situ (DCIS) was significantly associated ( P = .014) with core BLBC. Geographic necrosis was correlated with expression of CK17 ( P = .002) and EGFR ( P = .038). A ribbon-like trabecular pattern and absence of DCIS were associated with CK17 ( P = .0002 and P = .043, respectively) and CK14 ( P = .04 and P = .0008, respectively). TNBC is a heterogeneous subgroup with adverse clinicopathological features, and many of them show significant correlation with basal CKs. TNBCs cannot be classified as core BLBC or 7NP based on morphological features, except absence of DCIS. However, this study illustrates the heterogeneity in TNBCs on the basis of IHC markers.

This study uses data from the NICHD/MMIHS to examine the relationship among maternal characteristics and (a) whether mothers were asked by their prenatal providers to consider breastfeeding and (b) mothers' prenatal plans on how to feed their infants. Only 37% of the study population reported that their providers advised them to consider breastfeeding. Proportions of women who received prenatal advice to breastfeed and who intended to breastfeed were higher among married, Caucasian non-Hispanic, primiparous mothers, and women who were not enrolled in WIC. Women who received advice to breastfeed had significantly higher rates of planning to breastfeed (61.1%) than women who did not receive this advice (34.7%; p < 0.005). Efforts to meet the DHHS Healthy People 2000 objective for 75% of women to breastfeed in the early postpartum period will require a concentrated effort by prenatal providers to help women overcome their resistance to breastfeeding by offering support and encouragement.

Objectives: The purposes of the study were (a) to examine the relationship between the health behavior advice recommended by the Public Health Service Expert Panel on the Content of Prenatal Care and the risk of low birth weight and (b) to describe the type and frequency of health behavior advice offered to a group of pregnant women., Methods: The authors used data from the National Institute of Child Health and Human Development/Missouri Maternal and Infant Health Survey, a follow-back survey of women who had delivered very low birth weight infants and of matched control subjects who had delivered moderately low birth weight and normal birth weight infants. Frequency distributions for different types of prenatal health behavior advice were examined for the 2205 participants, and logistic regression analyses were used to determine whether there was a relationship between birth weight and receiving the advice recommended by the Expert Panel., Results: Only 10.4% of mothers reported receiving all seven types of health behavior advice recommended by the Expert Panel. Women who did not receive all seven types of advice were 1.5 times more likely to deliver a very low birth weight infant than a normal birth weight infant., Conclusions: Further research is needed to better understand the relationship between health education and birth weight.

Inadequate prenatal care has previously been identified as a significant risk factor for women who have low birth weight infants and infants who die during the neonatal period. Postpartum interviews with 1,484 primarily low-income women were conducted during 1987-88 in three areas of Missouri with the highest rates of inadequate prenatal care. The purpose of the study was to identify barriers to prenatal care and to determine which barriers differentiated between women receiving adequate and those receiving inadequate prenatal care. Women who received inadequate prenatal care were more likely to be black, unmarried, higher parity, and have less education than those who received adequate care. These women were also more likely to be poor, Medicaid-eligible, to have had an unwanted pregnancy, more stress and problems during pregnancy, and less social support. In the multivariate analysis, race and marital status lost their importance. The strongest predictor of inadequate prenatal care was women not knowing that they were pregnant in the first 4 months of pregnancy (adjusted odds ratio 9.28). To improve the rate of adequate prenatal care, society must address the issues of poverty and wantedness of pregnancy.