Search

Context.--In prostate cancer, 'tertiary' higher-grade patterns (TPs) have been associated with biochemical recurrence after radical prostatectomy. Objective.--To determine variation regarding definition and application of TPs. Design.--Online survey regarding TPs in a range of grading scenarios circulated to 105 experienced urologic pathologists. Results.--Among 95 respondents, 40 of 95 (42%) defined TPs as 'third most common pattern' and 55 (58%) as 'minor pattern/less than 5% of tumor.' In a tumor with pattern 3 and less than 5% pattern 4, of the 95 respondents, 35 (37%) assigned 3 + 3 = 6 with Tp4, while 56 (59%) assigned 3 + 4 = 7. In a tumor with pattern 4 and less than 5% pattern 5, of the 95 respondents, 51 (54%) assigned 4 + 4 = 8 with TP5, while 43 (45%) assigned 4 + 5 = 9. Six scenarios were presented in which the order of most common patterns was 3, 4, and 5 (Group 1) or 4, 3, and 5 (Group 2) with varying percentages. In both groups, when pattern 5 was less than 5%, we found that 98% and 93% of respondents would assign 3 + 4 = 7 or 4 + 3 = 7 with TP5. In scenarios with 15% or 25% pattern 5, most respondents (70% and 80%, respectively) would include pattern 5 as the secondary grade, that is, 3 + 5 = 8 (Group 1) or 4 + 5 = 9 (Group 2). For 85 of 95 (89%), a TP would not impact Grade Group assignment. Conclusions.--This survey highlights substantial variation in practice patterns regarding definition and application of 'tertiary' grading in radical prostatectomy specimens. High consistency was observed in 3 + 4 = 7/4 + 3 = 7 scenarios with truly minor pattern 5. These findings should inform future studies assessing the standardization and predictive value of 'tertiary' patterns. (Arch Pathol Lab Med. 2020;144:356-360; doi: 10.5858/arpa.2019-0224-OA), It is well known that some prostate cancers comprise more than 2 grades. (1-5) While most of so-called tertiary grading reported in the literature refers to a higher grade--typically pattern [...]

* Context.--Phosphatase and tensin homolog (PTEN) is a promising prognostic and potentially predictive biomarker in prostate cancer. Objective.--To assess the effects of preanalytic variables on an analytically validated and fully automated PTEN immunohistochemistry assay. Design.--PTEN immunohistochemistry was performed on Ventana immunostaining systems. In benign prostate tissues, immunostaining intensity across variable conditions was assessed by digital image analysis. In prostate tumor tissues, immunostaining was scored visually. Results.--Delay of fixation for 4 hours or longer at room temperature or 48 hours or longer at 4[degrees]C and duration of formalin fixation did not significantly alter immunostaining intensity. Intensity of staining was highest in 10% formalin compared with other fixatives. Tumor tissues with PTEN loss processed using protocols from 11 academic institutions were all evaluable and scored identically. PTEN immunostaining of needle biopsies where tissue blocks had been stored for less than 10 years was more frequently scored as nonevaluable compared with blocks that had been stored for 10 years or longer. This effect was less evident for radical prostatectomy specimens, where low rates of nonevaluable staining were seen for 23 years or more of storage. Storage of unstained slides for 5 years at room temperature prior to immunostaining resulted in equivalent scoring compared with freshly cut slides. Machine-to-machine variability assessed across 3 Ventana platforms and 2 institutions was negligible in 12 tumors, and platform-to-platform variability was also minor comparing Ventana and Leica instruments across 77 tumors (k = 0.926). Conclusions.--Automated PTEN immunostaining is robust to most preanalytic variables in the prostate and may be performed on prostate tumor tissues subjected to a wide range of preanalytic conditions. These data may help guide assay development if PTEN becomes a key predictive biomarker. doi: 10.5858/arpa.2018-0068-OA, Tissue-based biomarkers hold great promise for the practice of personalized medicine in oncology. In particular, immunohistochemistry (IHC) assays, which enable the detection of proteins in situ in tissue specimens, are [...]

Author(s): Rohit Bose [1, 2]; Wouter R. Karthaus [1]; Joshua Armenia [1, 3]; Wassim Abida [2]; Phillip J. Iaquinta [1]; Zeda Zhang [1, 4]; John Wongvipat [1]; Elizabeth V. Wasmuth [...]

Context.--While biopsies are now increasingly being performed for the diagnosis of renal cortical neoplasms, the influence of the rendered pathological diagnoses on the clinical management is only rarely documented. Objectives.--To report our experience with consecutively performed renal biopsies and the potential impact of the diagnosis on subsequent clinical management. Design.--Material from needle biopsies performed consecutively at our institution between 2006 and 2011 was reviewed. The influence of the reported pathology results on the clinical management was determined from patient follow-up medical record review. Results.--In total, 218 percutaneous biopsies for renal masses were performed during this period. Among them, 181 (83%) yielded neoplastic tissue, including 81 clear cell renal cell carcinomas, 29 low-grade oncocytic neoplasms, 7 papillary renal cell carcinomas, 5 clear cell papillary renal cell carcinomas, 5 angiomyolipomas, and 14 urothelial carcinomas. Fourteen additional cases (6%) contained lesional material from clinically known nonneoplastic processes, for a total diagnostic yield of 89%. Twenty-three (11%) were nonrepresentative of lesional tissue. In 10 of these, repeat biopsies or resections established the diagnosis of renal tumors. Biopsy diagnosis was confirmed in 29 of 30 cases (97%) on subsequent nephrectomy. Following the biopsy diagnosis, there were significant differences in the clinical management; overall, 79% of clear cell renal cell carcinomas received therapeutic interventions, and 17% were put on active surveillance. In contrast, 77% of the benign or low-grade lesions were put on active surveillance. Conclusions.--Accurate and specific diagnosis can be rendered on renal core biopsy in most renal tumors, and the biopsy diagnosis can have a definitive role in their clinical management. (Arch Pathol Lab Med. 2014;138:1673-1679; doi: 10.5858/arpa.2013-0574-0A), With increased popularity and the improvements in imaging modalities, up to 70% of renal cortical tumors are now discovered incidentally, most with a median tumor size of less than 4 [...]

Arising from: Tomlins et al. Nature 448, 595-599 (2007) The first recurrent translocation event in prostate cancer has been recently described'; it results in the translocation of an ETS (E26 [...]