Comparative study of neuroendocrine acquisition and biomarker expression between neuroendocrine and usual prostatic carcinoma.

BACKGROUND: Neuroendocrine prostatic carcinoma (NEPC) is uncommon. The pathogenesis, clinical association, and clinical implications of this disease are still evolving. METHODS: Clinicopathologic, immunohistochemical and genomic studies were used to investigate the incidence of NEPC in various clinicopathologic settings and the expression of various biomarkers in NEPC and non-NEPC as well as small cell NEPC. The study included 45 treatment-naïve Gleason pattern (GP) 3 and 94 GP 4/5, 43 post-radiation, 60 post-androgen deprivation therapy (ADT), 38 lymph node metastatic and 9 small cell prostatic adenocarcinomas (PCs). RESULTS: NEPC was found in 7% GP3, 10% GP4/5, 9% post-radiation, 18% post-ADT, and 5% lymph node metastatic PCs, respectively. Compared with treatment-naïve PCs, post-ADT PCs showed significantly increased incidence of NEPC (p < .05) while no significant difference was noted between low- and high-grade PCs, post-radiation, and lymph node metastatic PCs. Serotonin was uniformly positive in NE cells of benign glands but negative in NEPC. Significant increase of Bcl-2 and Auro A and decrease of prostein were noted in NEPC (p < .05). No significant changes in the expression of other biomarkers were found. In addition, small cell NEPC was strongly associated with ADT (44%) and high Gleason score (≥8, 100%) and often presented with alterations of TP53/RB1 and ARID1A/B or other genes crucial to genomic fidelity. CONCLUSION: Given that no specific treatment for NEPC is presently available, the findings in this study have significant implications in the better understanding of this often-deadly disease both clinically and pathogenetically as well as future patient management, including targeted therapy.

Continuous ablation improves lesion maturation compared with intermittent ablation strategies.

BACKGROUND: Interrupted ablation is increasingly proposed as part of high-power short-duration radiofrequency ablation (RFA) strategies and may also result from loss of contact from respiratory patterns or cardiac motion. To study the extent that ablation interruption affects lesions. METHODS: In ex vivo and in vivo experiments, lesion characteristics and tissue temperatures were compared between continuous (group 1) and interrupted (groups 2 and 3) RFA with equal total ablation duration and contact force. Extended duration ablation lesions were also characterized from 1 to 5 minutes. RESULTS: In the ex vivo study, continuous RFA (group 1) produced larger total lesion volumes compared with each interrupted ablation lesion group (273.8 ± 36.5 vs 205.1 ± 34.2 vs 174.3 ± 32.3 mm3 , all P < .001). Peak temperatures for group 1 were higher at 3 and 5 mm than groups 2 and 3. In vivo, continuous ablation resulted in larger lesions, greater lesion depths, and higher tissue temperatures. Longer ablation durations created larger lesion volumes and increased lesion depths. However, after 3 minutes of ablation, the rate of lesion volume, and depth formation decreased. CONCLUSIONS: Continuous RFA delivery resulted in larger and deeper lesions with higher tissue temperatures compared with interrupted ablation. This study may have implications for high-power short duration ablation strategies, motivates strategies to reduce variations in ablation delivery, and provides an upper limit for ablation duration beyond which power delivery has diminishing returns.

Updates to Adherence to Hypertension Medications.

PURPOSE OF REVIEW: The purpose of this review is to discuss recent studies that have described approaches or interventions to improve hypertension medication adherence and to suggest how providers can integrate evidenced-based approaches into routine clinical care to improve medication adherence and blood pressure control. RECENT FINDINGS: Factors that can impact medication include patient-related factors, social- and economic-related factors, health system/health care team-related factors, and therapy-related factors. Overall, a multifaceted approach is needed to improve medication adherence. Important components include (1) patient education on hypertension, its treatment modalities and its long-term complications; and (2) patient engagement building on the foundation of education. The various interventions tested have engaged patients through interactive educational sessions, health coaching, motivational interviewing, stage of change behavioral counseling, and pharmacist hypertension management. Strategies utilizing patient education and engagement are needed to improve medication adherence and blood pressure control.

An unusual case of primary acinar cell carcinoma of the liver and its treatment.

Acinar cell carcinoma (ACC) is an epithelial neoplasm characterized by morphological features similar to acinar cells found in exocrine glands. Most cases of hepatic ACC reveal evidence of pancreatic exocrine enzyme production and are considered to be metastatic from the pancreas. However, a small number of hepatic ACC cases have been reported in which the tumor is believed to have originated in the liver rather than being a metastatic lesion. In this report we present a case of primary ACC of the liver. A 59-year-old female with no significant past medical history presented with the chief complaint of abdominal pain. A computed tomography (CT) scan of the abdomen showed innumerable mass lesions throughout the liver, initially concerning for metastatic disease. Histopathologic morphology was most consistent with that of ACC, possibly of pancreatic origin. However, the CA 19-9 level was not elevated and no pancreatic lesions were detected on the CT scan. Similar to a previously reported case, the diagnosis of primary ACC of the liver was made based on: acinar cells seen on histology, findings on immunohistochemical staining, radiographic images of liver masses, and the absence of extrahepatic lesions. Previous case reports of primary ACC have differing hypotheses regarding this rare finding. One hypothesis suggests an ectopic origin of acinar cells within the liver. An alternative hypothesis proposes that hepatic and pancreatic cells are ontogenetically derived from a common progenitor cell, which is thought to result in hepatic cells differentiating into acinar cells. The patient was treated with gemcitabine and paclitaxel every 2 weeks for 8 months and then transitioned to every 3 weeks for better tolerance. The patient's symptoms significantly improved within the first 6 weeks of treatment. At the time of the preparation of this report, it has been 17 months since initiation of therapy, and follow-up imaging continues to demonstrate a dramatic decrease in both size and number of hepatic nodules. ACC's are rare tumors that are usually found in glandular tissues. Primary ACC of the liver is extremely rare with only a few cases having been reported. This article adds to the limited literature available on primary hepatic ACC.