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When multiple cores are biopsied from a single magnetic resonance imaging (MRI)-targeted lesion, Gleason grade may be assigned for each core separately or for all cores of the lesion in aggregate. Because of the potential for disparate grades, an optimal method for pathology reporting MRI lesion grade awaits validation. We examined our institutional experience on the concordance of biopsy grade with subsequent radical prostatectomy (RP) grade of targeted lesions when grade is determined on individual versus aggregate core basis. For 317 patients (with 367 lesions) who underwent MRI-targeted biopsy followed by RP, targeted lesion grade was assigned as (1) global Grade Group (GG), aggregated positive cores; (2) highest GG (highest grade in single biopsy core); and (3) largest volume GG (grade in the core with longest cancer linear length). The 3 biopsy grades were compared (equivalence, upgrade, or downgrade) with the final grade of the lesion in the RP, using κ and weighted κ coefficients. The biopsy global, highest, and largest GGs were the same as the final RP GG in 73%, 68%, 62% cases, respectively (weighted κ: 0.77, 0.79, and 0.71). For cases where the targeted lesion biopsy grade scores differed from each other when assigned by global, highest, and largest GG, the concordance with the targeted lesion RP GG was 69%, 52%, 31% for biopsy global, highest, and largest GGs tumors (weighted κ: 0.65, 0.68, 0.59). Overall, global, highest, and largest GG of the targeted biopsy show substantial agreement with RP-targeted lesion GG, however targeted global GG yields slightly better agreement than either targeted highest or largest GG. This becomes more apparent in nearly one third of cases when each of the 3 targeted lesion level biopsy scores differ. These results support the use of global (aggregate) GG for reporting of MRI lesion-targeted biopsies, while further validations are awaited.

Ciliated muconodular papillary tumor (CMPT) of the lung is a newly defined distinct entity in the spectrum of mucinous tumors of the peripheral lung. Previously regarded as a low-grade adenocarcinoma, CMPT is currently considered an indolent neoplasm with characteristic tubulopapillary, glandular, or papillary architecture showing tripartite morphology including basal cells, mucinous cells, and ciliated cells. The diagnosis can be made by identifying a tumor that shows proliferation of basal cells, mucinous cells, and ciliated cells without nuclear atypia or mitotic activity and demonstrating a continuous layer of p40/p63 or CK5/6 staining basal cells. These tumors were shown to harbor BRAF(V600E), EGFR(E746-T751/S752V), AKT1 (E17K), and rarely KRAS(G12C) mutations. The diagnosis of this entity may be particularly difficult on small biopsies, fine-needle aspirates, and frozen sections. The prognosis is excellent after limited resection.We present a case of CMPT incidentally identified in a lung explant with emphysema; review the clinical, histopathologic, and molecular features of CMPT and its differential diagnosis; and explore the controversial aspects regarding diagnosis, origin, and classification of these neoplasms.