Prostatic adenocarcinoma in the setting of persistent müllerian duct syndrome: a case report.

Persistent müllerian duct syndrome (PMDS) is a form of disordered sex development in which rudimentary müllerian structures are identified in phenotypically and genotypically normal males. It is caused by defects in the anti-müllerian hormone (AMH) system. Since patients with PMDS present with undescended testes, testosterone production by Leydig cells later in life is often decreased. The role of androgens in prostate cancerogenesis is well known. Cryptorchid testes and diminished testosterone levels in post-pubertal life in patients with PMDS play a protective role against prostate cancer, and hence, prostate cancer is a rare event in patients with PMDS. Herein, we present a patient who underwent prostatectomy for high-grade prostatic adenocarcinoma with persistent müllerian structures (such as rudimentary uterus, fallopian tubes, and cervix) identified during surgery. To our knowledge, this is the second case reported in the English language literature where PMDS was associated with prostate cancer.

Limiting the use of atypical/inconclusive as a category in nongynecologic cytology specimens.

CONTEXT: 'Atypical' has served as a descriptive term in cytology since the birth of the specialty by Dr Papanicolaou. This indeterminate diagnosis often results in repeat biopsies or additional tissue sampling and a needless delay in patient care if used inappropriately. Because of the definitional ambiguity of this term and the associated physician frustration, we have made a concerted effort at Methodist Hospital since 1995 to minimize the use of 'atypical' as a diagnostic category. OBJECTIVE: To evaluate whether the dissolution of the 'atypical' category has increased our cytologic-histologic discordance rate to more than the published reference range. DESIGN: From March 3, 2006, through December 31, 2008, all nongynecologic cases with 'atypical/indeterminate' listed as the general diagnostic category were identified and retrieved from our laboratory data files. We then assessed the cytologic-histologic correlation rate during the corresponding time frame. RESULTS: A total of 48 'atypical' cases (0.2%) from 19 347 nongynecologic specimens were identified. Of the 'atypical' cases, 52% (25 of 48) had intradepartmental consultation, 58% (28 of 48) had additional preparations examined, and 29% (14 of 48) documented limitations because of poor preservation. Our cytologic-histologic discrepancy rate for the period was 5.5% (214 of 3912 cases), with 89.3% (191 of 214 cases) resulting from sampling issues. On review of the small percentage of cytologic interpretative discrepancies, only one case was unhampered by less than 10% tumor cellularity or poor preservation. CONCLUSIONS: Not using 'atypical' as a diagnostic category, unless defined by Bethesda guidelines, has not affected our cytologic-histologic correlation rate.