Background
The loss of PTEN tumor suppressor gene is one of the most common somatic genetic aberrations in prostate cancer (PCa) and is frequently associated with high‐risk disease. Deletion or mutation of at least one PTEN allele has been reported to occur in 20% to 40% of localized PCa and up to 60% of metastases. The goal of this study was to determine if somatic alteration detected by PTEN immunohistochemical loss of expression is associated with specific histologic features.
Methods
Two hundred sixty prostate core needle biopsies with PCa were assessed for PTEN loss using an analytically validated immunohistochemical assay. Blinded to PTEN status, each tumor was assessed for the Grade Group (GG) and the presence or absence of nine epithelial features. Presence of stromogenic PCa was also assessed and defined as grade 3 reactive tumor stroma as previously described: the presence of carcinoma associated stromal response with epithelial to stroma ratio of greater than 50% reactive stroma.
Results
Eight‐eight (34%) cases exhibited PTEN loss while 172 (66%) had intact PTEN. PTEN loss was significantly (P < 0.05) associated with increasing GG, poorly formed glands (74% of total cases with loss vs 49% of intact), and three well‐validated unfavorable pathological features: intraductal carcinoma of the prostate (IDC‐P) (69% of total cases with loss vs 12% of intact), cribriform Gleason pattern 4 (38% of total cases with loss vs 10% of intact) and stromogenic PCa (23% of total cases with loss vs 6% of intact). IDC‐P had the highest relative risk (4.993, 95% confidence interval, 3.451‐7.223, P < 0.001) for PTEN loss. At least one of these three unfavorable pathological features were present in 67% of PCa exhibiting PTEN loss, while only 11% of PCa exhibited PTEN loss when none of these three unfavorable pathological features were present.
Conclusions
PCa with PTEN loss demonstrates a strong correlation with known unfavorable histologic features, particularly IDC‐P. This is the first study showing the association of PTEN loss with stromogenic PCa.
Background
Urinary cytology is a noninvasive and cost‐effective diagnostic and surveillance test in the clinical management of urothelial carcinoma (UC). The Paris System for Reporting Urinary Cytology (TPS), published in 2016, introduced definite diagnostic criteria aimed at improving performance in detecting high‐grade UC (HGUC) and decreasing the indeterminate (atypical) diagnosis.
Methods
The authors retrospectively reviewed and compared urinary cytology diagnoses reported between January 2013 and December 2014 (pre‐TPS, 7658 cases) and between May 2016 and April 2018 (post‐TPS, 20,026 cases) to assess the influence of TPS in their practice. The time in between was used as a learning period. Follow‐up information and correlation with the UroVysion fluorescence in situ hybridization test were obtained when available.
Results
Urinary cytology diagnoses pre‐TPS included negative for UC (NUC) (n = 5293; 69.2%), atypical urothelial cells (AUC) (n = 2227; 29%), and suspicious/positive for HGUC (SHGUC/HGUC) (n = 138; 1.8%). Diagnoses post‐TPS included negative for HGUC (NHGUC) (n = 18,507; 92.4%), AUC (n = 1237; 6.2%), and SHGUC/HGUC (n = 282; 1.4%). Comparing the pre‐TPS and post‐TPS periods, AUC diagnoses decreased from 29% to 6.2% (P < .00001), and the specificity and positive predictive value of AUC to detect HGUC significantly improved from 49% to 86% (P < .00001) and from 9% to 39% (P = .002), respectively. The correlation of an AUC diagnosis with a positive UroVysion test improved from 17% to 38% (P < .00001), whereas overall use of the UroVysion test was decreased.
Conclusions
Implementation of TPS resulted in a significant reduction in AUC diagnoses that had a superior correlation with a subsequent biopsy and a UroVysion test, resulting in potential reductions in test use and medical cost.
We report a case of a 65-year-old man with alpha-fetoprotein (AFP)-producing esophageal adenocarcinoma that microscopically consisted of a polymorphous blend of enteroblastic, yolk sac-like, and hepatoid carcinoma components of variable proportions. No histological evidence of Barrett's esophagus was identified. Two weeks post-endoscopic mucosal mass resection, the serum AFP level was 1434.6 ng/mL. The patient underwent radiation and chemotherapy but developed metastatic lung lesions. At 18 months post-resection, the patient is alive. AFP-producing esophageal adenocarcinoma is a rare entity. We reviewed reported cases for clinicopathological features, treatment strategies, and prognosis.
Patients with NASH were identified (ICD-10 diagnosis code K7581). Patients were split into elective and non-elective cohorts. Length of stay and cost estimates were evaluated. Cost estimates were calculated using total charges for hospital services using hospital specific cost-to-charge ratios based on all-payer inpatient costs derived from the Centers for Medicare and Medicaid Services (CMS). Statistical analysis was performed with SPSS version 25 (2017 IBM Corporation, Armonk NY). Results: 223 patients admitted for non-elective TIPS were identified; of these 33 patients carried a diagnosis of NASH. Length of stay was significantly higher for patients admitted for non-elective TIPS with NASH (13.8 versus 9.4 days, P ¼ 0.008). Estimated cost for an inpatient admission for patients with NASH was not significantly different than those with other causes of cirrhosis ($50,506.94 vs $46,137.01, P ¼ 0.32). Risk of mortality for patients with NASH between the two groups (OR 0.17, 95% CI 0.02 -1.32).103 patients were admitted for elective TIPS; of these 19 patients carried a diagnosis of NASH. In the elective group there was no difference for patients with NASH versus those with other causes of cirrhosis in length of stay (2.3 vs 3.6 days, P ¼ 0.174), estimated cost (14,794.56 vs 20,744.55, P ¼ 0.110), or mortality (OR -0.12, 95% CI -0.06 -0.038). Conclusions: Patients with NASH admitted for non-elective TIPS experience statistically significantly longer hospital stays than those admitted with other causes of cirrhosis. While length of stay and estimated cost are higher in the setting of non-elective versus elective TIPS admissions in both groups, there is no difference in length of stay for patients with NASH versus those with other causes of cirrhosis admitted for elective TIPS placement. This suggests that extended length of stay after non-elective TIPS in patients with NASH may be mitigated with planned admission for TIPS placement.
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