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Diagnostic Criteria for Oncocytic Renal Neoplasms: A Survey of Urologic Pathologists
Williamson, Sean R; Gadde, Ramya; Trpkov, Kiril; Hirsch, Michelle S; Srigley, John R; Reuter, Victor E; Cheng, Liang; Priya Kunju, L; Barod, Ravi; Rogers, Craig G; Delahunt, Brett; Hes, Ondrej; Eble, John N; Zhou, Ming; McKenney, Jesse K; Martignoni, Guido; Fleming, Stewart; Grignon, David J; Moch, Holger; Gupta, Nilesh S
Renal oncocytoma and chromophobe renal cell carcinoma (RCC) have been long recognized as distinct tumors; however, it remains unknown if uniform diagnostic criteria are used to distinguish these tumor types in practice. A survey was distributed to urologic pathologists regarding oncocytic tumors. Responses were received from 17/26 invitees. Histologically, >1 mitotic figure was regarded as most worrisome (n=10) or incompatible (n=6) with oncocytoma diagnosis. Interpretation of focal nuclear wrinkling, focal perinuclear clearing, and multinucleation depended on extent and did not necessarily exclude oncocytoma if minor. Staining techniques most commonly used included: CK7 (94%), KIT (71%), vimentin (65%), colloidal iron (59%), CD10 (53%), and AMACR (41%). Rare CK7-positive cells (=5%) was regarded as most supportive of oncocytoma, although an extent excluding oncocytoma was not universal. Multiple chromosomal losses were most strongly supportive for chromophobe RCC diagnosis (65%). Less certainty was reported for chromosomal gain or a single loss. For tumors with mixed or inconclusive features, many participants use an intermediate diagnostic category (82%) that does not label the tumor as unequivocally benign or malignant, typically "oncocytic neoplasm" or "tumor" with comment. The term "hybrid tumor" was used variably in several scenarios. A slight majority (65%) report outright diagnosis of oncocytoma in needle biopsies. The morphologic, immunohistochemical, and genetic characteristics that define oncocytic renal tumors remain incompletely understood. Further studies correlating genetics, behavior, and histology are needed to define which tumors truly warrant classification as carcinomas for patient counseling and follow-up strategies.
PMID: 28315424
ISSN: 1532-8392
CID: 2499262
Atypical Intraductal Cribriform Proliferations of the Prostate Exhibit Similar Molecular and Clinicopathologic Characteristics as Intraductal Carcinoma of the Prostate
Hickman, Richard A; Yu, Hui; Li, Jianhong; Kong, Max; Shah, Rajal B; Zhou, Ming; Melamed, Jonathan; Deng, Fang-Ming
Atypical intraductal cribriform proliferations of the prostate (AIP) are loose cribriform proliferations of luminal cells that exhibit greater architectural complexity and/or nuclear atypia than high-grade prostatic intraepithelial neoplasia (HGPIN), but lack the diagnostic criteria for intraductal carcinoma (IDC). The significance of AIP has not been formally established. We compared the clinical, morphologic, and immunohistochemical characteristics of AIP with classic IDC in 310 radical prostatectomy specimens that were received over an 18-month period. Of the 310 cases, 46 cases had AIP only (n=10), IDC only (n=6), or AIP coexisting with IDC (n=30). The ERG status of all 46 AIP/IDC cases was identical to the nearby acinar carcinoma, contrasted to just 3 cases of HGPIN (7%, P<0.01). The degree of uniform phosphatase and tensin homolog (PTEN) loss in 34 selected cases was identical in AIP and IDC (66.7%). No foci of HGPIN showed uniform PTEN loss; there was only 38% concordance of PTEN expression pattern between HGPIN and the nearby acinar carcinoma, unlike AIP and IDC (77% and 81%, respectively, P<0.01). AIP-associated and/or IDC-associated carcinoma (n=46) showed a higher stage and grade compared with acinar-only carcinoma (n=264, P<0.01). AIP-associated carcinoma had similar clinicopathologic features as IDC-associated carcinoma, including preoperative prostate-specific antigen, Gleason score, extraprostatic extension, seminal vesicle invasion, and lymph node metastasis (n=36, P>0.05). In conclusion, AIP shares similar ERG/PTEN immunoprofiles and exhibits similar clinical behavior as IDC, warranting immediate repeat biopsy when AIP is identified on biopsy, as is recommended in the most recent WHO Classification of Tumours of the Urinary System and Male Genital Organs, 2016.
PMID: 28009609
ISSN: 1532-0979
CID: 2374592
Gleason Score 7 and 8 Prostate Cancer with Cribriform Morphology Diagnosed in Prostate Biopsy Is More Likely to Have Seminal Vesicle Invasion and Pelvic Lymph Node Metastasis in Radical Prostatectomy [Meeting Abstract]
Wang, Ling; Deng, Fang-Ming; Huang, Hongying; Lee, Peng; Melamed, Jonathan; Zhou, Ming
ISI:000393724401340
ISSN: 1530-0307
CID: 2506732
NKX3.1 and PSMA Are Reliable Markers for Prostatic Carcinoma in Bone Metastasis After Decalcification [Meeting Abstract]
Guma, Sergei R; Melamed, Jonathan; Zhou, Ming; Deng, Fang-Ming
ISI:000393724401194
ISSN: 1530-0307
CID: 2506712
Gleason Score 3+4=7 Prostate Carcinomas Detected by MRI-Targeted Biopsies Contain Higher Percentage of Pattern 4 and Are Less Likely to Be Upgraded in Radical Prostatectomies [Meeting Abstract]
Zhao, Yani; Deng, Fang-Ming; Huang, Hongying; Lee, Peng; Melamed, Jonathan; Zhou, Ming
ISI:000393724401366
ISSN: 1530-0307
CID: 2506762
Comparison of Standard and MRI Targeted Biopsy in Anterior Predominant Prostate Cancer [Meeting Abstract]
Peng, Yu-Ching; Wang, Ying; Huang, Hongying; Lee, Peng; Melamed, Jonathan; Zhou, Ming; Deng, Fang-Ming
ISI:000393724401274
ISSN: 1530-0307
CID: 2506722
Clinical Significance of Tertiary Pattern 4 in Gleason 3+3=6 Adenocarcinoma of the Prostate [Meeting Abstract]
Barna, Nicholas; Ettel, Mark; Chen, Fei; Lee, Peng; Huang, Hongying; Melamed, Jonathan; Zhou, Ming; Deng, Fang-Ming
ISI:000393724401129
ISSN: 1530-0307
CID: 2506702
MRI-Targeted Prostate Biopsy Detects More Cribriform Prostate Carcinoma Than Standard Sextant Prostate Biopsy [Meeting Abstract]
Wang, Ying; Deng, Fang-Ming; Huang, Hongying; Lee, Peng; Melamed, Jonathan; Zhou, Ming
ISI:000393724401341
ISSN: 1530-0307
CID: 2506742
Prostate Neuroendocrine Tumors: Clinicopathological Study of 15 Cases with Emphasis on the Neuroendocrine Tumors of the "Intermemdiate Grade" and Overlapping Features [Meeting Abstract]
Zhao, Yani; Deng, Fang-Ming; Huang, Hongying; Lee, Peng; Melamed, Jonathan; Zhou, Ming
ISI:000393724401365
ISSN: 1530-0307
CID: 2506752
NKX3.1 and PSMA Are Reliable Markers for Prostatic Carcinoma in Bone Metastasis After Decalcification [Meeting Abstract]
Guma, Sergei R; Melamed, Jonathan; Zhou, Ming; Deng, Fang-Ming
ISI:000394467301194
ISSN: 1530-0285
CID: 2517532