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Treatment-related neuroendocrine prostate cancer is a distinctive category of prostate cancer that arises after intensive suppression of the androgen receptor by next-generation therapeutic inhibition of androgen receptor signaling. The biological processes that set in motion the series of events resulting in transformation of adenocarcinoma to neuroendocrine carcinoma include genomic (loss of tumor suppressors TP53 and RB1, amplification of oncogenes N-MYC and Aurora Kinase A, dysregulation of transcription factors SOX2, achaete-scute-homolog 1, and others) as well as epigenomic (DNA methylation, EZH2 overexpression, and others). Pathologic diagnosis is key to effective therapy for this disease, and this is aided by localizing metastatic lesions for biopsy using radioligand imaging in the appropriate clinical context. As our understanding of biology evolves, there has been increased morphologic recognition and characterization of tumor phenotypes that are present in this advanced post-treatment setting. New and promising biomarkers (delta-like ligand 3 and others) have been discovered, which opens up novel therapeutic avenues including immunotherapy and antibody-drug conjugates for this lethal disease with currently limited treatment options., Competing Interests: The authors have no funding or conflicts of interest to disclose., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

We present a case of diffuse large B-cell lymphoma CD5 negative, Cyclin D1 positive presenting as ruptured spleen in a 63-year-old man requiring emergent splenectomy. Tumor cells showed marked pleomorphism, anaplasia, and increased mitotic figures with positive Cyclin D1, BCL6, MUM1, P53, and a high MIB1 proliferative fraction. The patient received multiple therapies and ultimately died. This case raises the differential diagnoses of pleomorphic mantle cell lymphoma and other aggressive lymphomas with pleomorphic, anaplastic, and Reed-Sternberg-like cells.

Over 25 years ago, McNeal described a model of prostatic zonal anatomy based on autopsy dissections in various planes. As opposed to the cone-shaped organ seen in vivo, radical prostatectomy specimens are typically spherical, owing to tissue contraction at surgical removal and subsequent processing. Sectioning from apex to base yields topography at the Surgical Pathology "sign-out" that may vary from McNeal's descriptions. There are no in depth studies of anterior prostatic anatomic variability, including the periurethral region, peripheral (PZ) and transition (TZ) zones, anterior fibromuscular stroma (AFMS), and anterior extraprostatic space (EPS) using modern prosecting techniques. Detailed analysis of 197 entirely submitted, whole-mounted radical prostatectomy specimens focused on differences in zonal anatomy from apex through base, the relationship of AFMS to PZ and TZ, and the nature of the anterior EPS revealed features that may have significant impact on determination of zonal origin and pathologic staging of anteriorly situated prostate cancer. Among these observations are the predominant nature of the anterior PZ at the apex and the potential for its broad contact with the AFMS at this location, the differing volumes and location of the TZ in prostates with and without benign prostatic hyperplasia, and the composition of the anterior EPS, including adipose tissue, blood vessels, and skeletal muscle at the apex varying to include medium to large smooth muscle bundles at the base.