Outcome of Gleason 3 + 5 = 8 Prostate Cancer Diagnosed on Needle Biopsy: Prognostic Comparison with Gleason 4 + 4 = 8.

PURPOSE: ISUP (International Society for Urologic Pathology) and WHO adopted prognostic Grade Groups 1 to 5 that simplify prostate cancer grading for prognosis. Grade Group 4 is Gleason score 8 cancer, which is heterogeneous, and it encompasses Gleason score 4 + 4 = 8, 3 + 5 = 8 and 5 + 3 = 8. The comparative prognostic implications of these various Gleason scores had not been studied by urological pathologists after a re-review of slides. MATERIALS AND METHODS: Patients with a highest biopsy Gleason score of 3 + 5 = 8 or 4 + 4 = 8 were included in the study. Controls were cases with a highest Gleason score of 4 + 3 = 7 or 9-10. A total of 423 prostatic biopsy cases accessioned from 2005 to 2013 at 2 institutions were reviewed. Clinicopathological findings and followup (median 33.4 months) were assessed. RESULTS: Among Gleason score 8 cancers the cancer status outcome in 51 men with Gleason score 3 + 5 = 8 was marginally worse than in 114 with Gleason score 4 + 4 = 8 (p = 0.04). This was driven by a persistent nonmetastatic (after radiation/hormone therapy) cancer rate of 37% among Gleason score 3 + 5 = 8 cases vs 24% among Gleason score 4 + 4 = 8 cases. Conversely, cancer specific survival at 36-month followup was 97.8% in 3 + 5 cases vs 92.6% in 4 + 4 cases but this was not significant (p = 0.089). Cancer specific survival in the Gleason score 8 group was dichotomized by the presence of cribriform growth (p = 0.018). All Gleason score categories did not differ in the fraction of biopsy cores positive, clinical presentation or pathological findings, including the frequency of Gleason pattern 5, in 70 patients who underwent prostatectomy. CONCLUSIONS: Using the most current standards of prostate cancer grading the prognosis is not different in Gleason score 3 + 5 = 8 and 4 + 4 = 8 cancers. This justifies including both in Grade Group 4.

Primary intrinsic chiasmal germinoma.

Intracranial germinomas are typically present in the suprasellar or pineal location, and their origin within the optic nerve or chiasm is extremely rare. We report a 25-year-old woman with an exophytic primary optic chiasm germinoma who underwent partial resection followed by radiation and had no detectable tumor on magnetic resonance imaging at 1-year follow-up.

Bilateral renal dysplasia, nephroblastomatosis, and bronchial stenosis. A new syndrome?

Bilateral nephroblastomatosis (NB) is an uncommon renal anomaly characterized by multiple confluent nephrogenic rests scattered through both kidneys, with only a limited number of cases reported in the medical literature. Some of these children may have associated either Perlman or Beckwith-Wiedemann syndrome and others do not demonstrate syndromic features. We report a full-term boy with anteverted nose, bilateral bronchial stenosis due to lack of cartilage, bilateral obstructive renal dysplasia and NB with glomeruloid features. The infant had visceromegaly, but neither gigantism nor hemihypertrophy. Immunohistochemistry for PAX2 (Paired box gene-2) and WT-1 (Wilms Tumor 1) were strongly positive in the areas of NB. GLEPP-1 (Glomerular Epithelial Protein) did not stain the areas of NB with a glomeruloid appearance, but was positive in the renal glomeruli as expected. We found neither associated bronchial stenosis nor the histology of NB resembling giant glomeruli in any of the reported cases of NB.

Parathyroid Cyst and Micropapillary Thyroid Carcinoma: A Case Study of Unexpected Concurrent Endocrine Pathologies.

Parathyroid cysts (PCs) are rare tumors that predominantly affect middle-aged women and are characterized by symptoms of hyperparathyroidism, including fatigue, bone pain, and gastrointestinal issues. Management typically involves surgical resection due to their potential to cause profound hyperparathyroidism and hypercalcemia. PCs occasionally coexist with thyroid malignancies, including micropapillary thyroid carcinoma (MPTC), although the pathophysiological link between PCs and thyroid cancers remains unclear. We present a case of a 62-year-old woman with symptomatic hypercalcemia and a large cystic mass adjacent to the left inferior thyroid pole, initially suspected to be a PC. Preoperative imaging, including an ultrasound (US) and sestamibi scan, guided surgical intervention, resulting in en bloc resection of the PC along with a left hemithyroidectomy. Pathological examination confirmed the presence of both a PC and MPTC, raising the question as to whether there is a possible correlation between primary hyperparathyroidism (PHPT) and thyroid malignancy. This report aims to highlight the current PC management protocol, underscore the importance of thorough diagnostic evaluation and surgical strategies in addressing concurrent parathyroid and thyroid pathologies, and explore potential pathophysiological connections between these conditions.

A case of bilateral renal oncocytomas in the setting of Birt-Hogg-Dube syndrome.

Birt-Hogg-Dube syndrome is a rare autosomal dominant disorder characterized by pulmonary cysts, renal tumors, and dermal lesions. This syndrome results from a mutation in the gene folliculin, located on chromosome 17p11.2. Herein, a case is described in which the presence of bilateral renal oncocytomas led to the diagnosis of Birt-Hogg-Dube syndrome via an interdisciplinary effort by radiology, pathology, and primary care medicine. No radiographic features alone are sufficient to confirm the diagnosis of Birt-Hogg-Dube. A high index of suspicion must be maintained by both the pathologist and radiologist in the appropriate clinical setting.

This mood is familiar and I don't deserve to feel better anyway: mechanisms underlying self-esteem differences in motivation to repair sad moods.

Why are people with low self-esteem (LSE) less motivated than people with high self-esteem (HSE) to improve sad moods? The present research examined whether feelings of personal deservingness contribute to this difference. Four experiments with undergraduate participants involved a sad mood induction, a manipulation of personal deservingness, or both. Results suggested that (a) LSEs feel less deserving of positive outcomes and of positive moods than do HSEs, (b) feelings of personal deservingness can vary with the situation, and be lowered through reminders of social rejection and personal flaws, and (c) feeling relatively undeserving dampens LSEs', but not HSEs', motivation to repair sad moods. These results have implications for the emotion regulation, self-esteem, and social justice literatures.

Rete Testis Invasion Is Consistent With Pathologic Stage T1 in Germ Cell Tumors.

OBJECTIVES: Rete testis invasion by germ cell tumors is frequently concomitant with lymphovascular or spermatic cord invasion (LVI/SCI); independent implications for staging are uncertain. METHODS: In total, 171 seminomas and 178 nonseminomatous germ cell tumors (NSGCTs; 46 had 1%-60% seminoma component) came from five institutions. Metastatic status at presentation, as a proxy for severity, was available for all; relapse data were unavailable for 152. Rete direct invasion (ReteD) and rete pagetoid spread (ReteP) were assessed. RESULTS: ReteP and ReteD were more frequent in seminoma than NSGCT. In seminoma, tumor size bifurcated at 3 cm or more or less than 3 cm predicted metastatic status. Tumors with ReteP or ReteD did not differ in size from those without invasions but were less than with LVI/SCI; metastatic status or relapse did not show differences. In NSGCT, ReteP/ReteD did not correlate with size, metastatic status, or relapse. CONCLUSIONS: Findings support retaining American Joint Committee for Cancer pathologic T1 stage designation for rete testis invasion and pT1a/pT1b substaging of seminoma.

Solitary fibrous tumor of the infratemporal fossa.

Solitary fibrous tumors represent fewer than 2% of all soft tissue tumors, and only about 12-15% of them occur in the head and neck. We report a case of a 38-year-old male who presented with a six-month history of increasing right cheek swelling. Computed tomography of the paranasal sinuses with contrast demonstrated a well-circumscribed avidly enhancing mass in the right retroantral fat. On magnetic resonance imaging the lesion was homogenously slightly hyperintense to muscle on T1 weighted and T2 weighted images and enhanced avidly with contrast. Surgical resection was performed and pathology was consistent with solitary fibrous tumor. There have been very few reported cases of solitary fibrous tumors in the infratemporal fossa and none described as originating in the retroantral fat.