Metastatic Involvement of the Prostatic Anterior Fat Pad: Implications for the Pathologist.

OBJECTIVES: There is little information regarding the utility of pathologic evaluation of the prostatic anterior fat pad (PAFP) in patients with a low preoperative probability of recurrence. Our study aimed to determine the utility of PAFP pathologic examination, especially for this group of patients. METHODS: We analyzed a tertiary care academic center's radical prostatectomy (RP) specimens from 2009 to 2017. RESULTS: Of 602 RP specimens, 420(70%) included the PAFP; four of 420 (1%) had lymph node involvement (LNI) in the PAFP. In two of four cases with LNI in the PAFP, this was the only site of LNI. Of these two cases, one occurred in a patient with low probability of recurrence and involved a nonpalpable PAFP lymph node. CONCLUSIONS: Pathologic evaluation of the PAFP may be useful even in patients with low probability of recurrence because it may change staging by detecting metastatic involvement of small PAFP lymph nodes.

Diagnosis of melanoma aspirates on ThinPrep: the University of Michigan experience.

The purpose of this study was to compare the cytologic features of melanoma fine-needle aspirates (FNAs) prepared by ThinPrep (TP) with those in conventional smears (CS) and to identify any diagnostic pitfalls. Fifty-one aspirates diagnosed as melanoma were obtained, 36 of which were prepared by both TP and CS. The preparations were evaluated for cellularity, cell aggregates, cellular appearance, melanin pigment, cytoplasmic, and nuclear features. Categorical data were analyzed by the chi-square test and continuous data by the Wilcoxin-signed rank test. Correlation was determined by Spearman's test for bivariate correlations (rho). Good correlation between the two methods was identified for the following features: cellularity, cell type, bi/multinucleated cells, cytoplasmic features, NC ratio, and presence of macronucleoli. TP exhibits coarser chromatin compared to CS (P = 0.005). Six of 36 CS contained large cellular groups; none of the TP contained them (P = 0.018). Twenty-five of 36 CS contained intranuclear inclusions as opposed to 12/36 TP (P < 0.001). The number of inclusions was significantly reduced on TP. The amount of intracellular melanin was the same with both techniques. Background melanin was markedly reduced on TP except when either trapped by fibrin or attached to cellular clusters (P = 0.006). Background blood was also markedly reduced on TP (P < 0.005). In summary, the cytological features of TP and CS for FNA evaluation of melanoma correlate well; however, one needs to be aware of the cytologic alterations introduced by TP. TP is a sufficient preparation method in the diagnosis of melanoma FNA aspirates when performed by clinicians. It is also a useful adjunct in bloody or low-cellular aspirates, where it tends to reduce the background blood and concentrate the cells.

Vagus nerve regulates breast cancer metastasis to the adrenal gland.

BACKGROUND: Metastasis of breast cancer to adrenal glands may alter neuroendocrine functions which increase the severity of the disease. In this study the role of vagus nerve activity in adrenal metastases was examined. MATERIALS AND METHODS: 48 Balb/c mice (n=48) were divided into four groups; control, sham-operated, right vagotomy or left vagotomy. Vagotomies were performed one week before orthotopic injection of 4THM breast carcinoma cells and the degree of adrenal metastasis was assessed. RESULTS: In control animals, besides extensive metastases within and around the adrenal, 70% loss of medulla was observed which was significantly more than cortical loss. Sham operation by itself significantly decreased both the extent of metastases and medullary loss. Compared to sham group, vagotomy increased intra- and extra-adrenal metastasis. There was laterality in the regulation of metastasis by the vagus nerve, such that the right adrenal gland was affected the most. CONCLUSION: Vagus nerve activity may reduce adrenal metastasis as well as tumor-induced alterations of adrenal functions.

Primary synovial sarcoma of the parotid gland.

Synovial sarcoma typically develops in the deep soft tissues of the extremities in adolescents and young adults. Uncommonly, these tumors may arise (9%) in the head and neck region (9%), especially at the cervical and parapharyngeal sites. Primary synovial sarcoma of the parotid gland is a rare occurrence that may not uncommonly cause differential diagnostic difficulties. In these cases, an origin from within the gland rather than a secondary involvement by tumor from a surrounding structure must be confirmed. We report a new case of biphasic synovial sarcoma arising in the parotid gland and review the previously documented cases.

Are epidermal growth factor and transforming growth factor responsible for pseudoepitheliomatous hyperplasia associated with granular cell tumors?

Granular cell tumors (GCT) are uncommon benign neoplasms that have a predilection for the head and neck region. These tumors can frequently be associated with pseudoepitheliomatous hyperplasia (PEH), which in turn may be mistaken for squamous cell carcinoma. Although epidermal growth factors are overexpressed in squamous cell carcinomas of the head and neck, their presence in PEH, especially its relation to GCT, is unknown. We hypothesize that the expression of epidermal growth factor receptor (EGFR), epidermal growth factor (EGF), and transforming growth factor alpha (TGFalpha) in GCT have a role in the development of PEH overlying some GCT. Sections from 13 cases of GCT (five with overlying PEH) were examined histologically and evaluated immunohistochemically using monoclonal antibodies for EGFR, EGF, and TGFalpha. These were compared with nine cases of PEH independent of GCT. Two of five GCT with overlying PEH and two of six GCT without overlying PEH stained positively for TGFalpha. None of the GCT stained with EGFR or EGF. All cases of PEH, whether or not associated with GCT, were reactive for EGFR and EGF. Four of the five cases of PEH overlying GCT stained with TGFalpha. The staining pattern and intensity of all three antibodies were comparable to that of the adjacent normal squamous mucosa. Among the three antibodies, only TGFalpha in GCT appears to be related to the development of PEH. Epidermal growth factor receptor and EGF do not seem to be directly involved. The reason of PEH formation associated with GCT in the absence of growth factors is unknown.