Grade group 4 prostate cancer without intraductal carcinoma on biopsy is more likely to be downgraded on prostatectomy than with intraductal carcinoma.

In this study, we investigated the association between intraductal carcinoma of the prostate (IDCP) along with several histopathological features on prostate biopsy and downgrading of grade group 4 (GG4) prostate cancer (PCa) in patients with the highest grade tumor of GG4 PCa in at least one core. A total of 29 cases had the highest grade tumor of GG4 PCa and radical prostatectomy performed between 2016 and 2021. IDCP was detected in 11 out of 29 cases on biopsy. The cases without IDCP were more likely to be downgraded on prostatectomy than with IDCP, with statistical significance (88.9% vs 36.4%, p = 0.003). The proportions of the highest-grade tumors by length and cores involved, average numbers of PCa-positive cores, and mean patient's age did not differ between cases that were downgraded and not downgraded at prostatectomy. Our results suggest that the absence of IDCP on biopsy could be a predictor of downgrading at prostatectomy for patients with the highest grade tumor of GG4 PCa.

Blastomycosis of the Central Nervous System.

The reported incidence of blastomycosis is increasing in certain regions of the United States. The diagnosis is primarily made via urine antigen testing, culture, or cytology smear. The differential diagnosis for blastomycosis includes pneumonia, tuberculosis, and non-infectious pulmonary disease. Clinical context and epidemiologic exposure play a crucial role in diagnosis. However, the differential can expand significantly if there is disseminated central nervous system involvement, especially if pulmonary manifestations are not seen. Imaging begins to play a vital role when differentiating disseminated blastomycosis from other etiologies such as malignancy. Herein we present a case of a 58-year-old male who presented with seizures and right sided gaze preference found to have disseminated central nervous system blastomycosis. In this article, we will discuss symptoms and imaging findings of disseminated blastomycosis to help guide diagnosis and management.

Contrasting presentations of the same disease: A comparison of two cases of amyloidosis presenting with eyelid involvement.

Purpose: Localized amyloidosis can affect numerous tissues throughout the body and can also affect a variety of peri-ocular tissues including the conjunctiva, extra-ocular muscles, peri-orbital soft tissue, and lacrimal gland. We report two cases of amyloidosis presenting with eyelid involvement. Observations: The first case represented a more subtle presentation of skin thickening with a pre-septal cellulitis, while the second case had a dramatic presentation of edema evolving into tissue dehiscence and spontaneous hemorrhage with ongoing angioedema and systemic coagulopathy. Conclusions and importance: The two cases of biopsy-proven orbital/peri-ocular amyloidosis demonstrate the different clinical presentations that may go from the subtle to dramatic, depending on which peri-ocular tissues are affected and to what degree. Standards for treatment of amyloidosis remain conservative initially with surgery or radiation recommended only for refractory cases, but additional therapies are under investigation. Clinicians should have high clinical suspicion for amyloidosis with findings such as skin thickening or significant periorbital edema and should always consider tissue biopsy and further workup for amyloidosis if the findings worsen or do not resolve with treatment of more common conditions such as cellulitis.

Expression of CD47 and SIRPα Macrophage Immune-Checkpoint Pathway in Non-Small-Cell Lung Cancer.

BACKGROUND: Cancer cells escape macrophage phagocytosis by expressing the CD47 integrin-associated protein that binds to the SIRPα ligand (signal regulatory protein alpha) expressed by macrophages. Immunotherapy targeting this pathway is under clinical development. METHODS: We investigated the expression of CD47/SIRPα molecules in a series of 98 NSCLCs, in parallel with the infiltration of tumor stroma by CD68+ macrophages, tumor-infiltrating lymphocytes (TILs), and PD-L1/PD-1 molecules. RESULTS: Extensive membranous CD47 expression by cancer cells characterized 29/98 cases. SIRPα and CD68 were expressed, to a varying extent, by tumor-associated macrophages (Μφ, TAMs). A high CD68Mφ-score in inner tumor areas was linked with improved overall survival (p = 0.005); and this was independent of the stage (p = 0.02, hazard ratio 0.4). In contrast, high SIRPα expression by CD68+ TAMs (SIRPα/CD68-ratio) was linked with CD47 expression by cancer cells, low TIL-score, and poor prognosis (p = 0.02). A direct association of CD47 expression by cancer cells and the % FOXP3+ TILs (p = 0.01, r = 0.25) was also noted. CONCLUSIONS: TAMs play an important role in the prognosis of operable NSCLC. As SIRPα+ macrophages adversely affect prognosis, it is suggested that the CD47/SIRPα axis is a sound target for adjuvant immunotherapy policies, aiming to improve the cure rates in operable NSCLC.

Intraorbital Expansion of an Intradiploic Frontal Epidermoid Cyst: A Case Report and Short Review of the Literature.

BACKGROUND Calvarial epidermoid cysts (EC) are encased remnants of ectoderm at the third week of gestation. There are also reports which consider them sequelae of head trauma. They are benign lesions. As they develop, they exert a mass effect to adjacent anatomical structures. CASE REPORT We report the case of a 58-year-old male patient with left-sided exophthalmos. His radiologic examinations depicted an oval cystic lesion (7×5×5.5 cm) arising from the left frontal bone and abutting the ipsilateral orbital roof. Our patient underwent a total extirpation of the lesion through a frontal craniectomy. Cranioplasty was then performed with a Porex® graft. The pearl-hued lamellae of the lesion macroscopically resembled keratin tissue. Histopathological findings supported the diagnosis of an epidermoid cyst. Postoperatively, our patient had no neurologic deficits and a computed tomography scan showed no residual effects. CONCLUSIONS Large calvarial EC with intraorbital expansion in adults are rare clinical entities. Gross total resection with the infiltrated bone and cranioplasty is the treatment of choice, which also establishes the diagnosis.

Primary gastric melanoma of unknown origin: a case report and short literature review.

Though being usually a cutaneous tumor, melanomas can occur in several extracutaneous sites. Primary mucosal melanomas are rare, and primary gastric mucosal melanomas are considered extremely rare. Compared with cutaneous and ocular melanoma, mucosal melanomas have the lowest five-year survival. High level of suspicion of such rare condition may be the only way for early detection, diagnosis and chance for successful management of similar cases. In the present report, a case of a primary gastric melanoma in a 73-year-old man is described, along with a short review of the literature.

Intranodal palisaded myofibroblastoma expressing DOG1: focusing on the potential diagnostic pitfalls.

Intranodal palisaded myofibroblastoma (IPM) is a rare, benign mesenchymal neoplasm of the lymph nodes with a broad differential diagnosis. We report a case of an 82-year-old woman presenting with a slow growing, right inguinal mass. The tumor arose as a circumscribed neoplasm inside a lymph node and consisted of bland spindle cells with nuclear palisading and intervening areas of amianthoid-like fibers among interstitial hemorrhage and hemosiderin-laden histiocytes in the stroma, typical histomorphological characteristics of IPM. Immunohistochemically, the neoplastic cells were positive for vimentin, smooth muscle actin (SMA), ß-catenin, cyclin D1 and discovered on gastrointestinal stromal tumor (GIST) 1 (DOG1) immunostainings. A literature review and differential diagnosis of IPM are discussed. To the best of our knowledge, this is the first case of DOG1 immunoexpression in a case of IPM.