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Practical Applications of Immunohistochemistry in the Diagnosis of Genitourinary Tumors

Xiao, Xiuli; Hu, Rong; Deng, Fang-Ming; Shen, Steven S; Yang, Ximing J; Wu, Chin-Lee
CONTEXT: - Pathologic diagnosis of tumors in the genitourinary system can be challenging based on morphology alone, particularly when diagnostic material is limited, such as in core biopsies. Immunohistochemical stain can be a useful tool to aid in the diagnosis. OBJECTIVE: - To provide an update on practical applications and interpretation of immunohistochemical stains in the diagnosis of tumors in prostate, kidney, bladder, and testis. We particularly focus on difficult differential diagnoses, providing our insights in frequently encountered challenging situations. Commonly used immunohistochemical panels are discussed. DATA SOURCES: - Review of literature and our own experience. CONCLUSION: - Immunohistochemical stain is a valuable tool in the diagnosis of genitourinary tumors when appropriately used.
PMID: 28608721
ISSN: 1543-2165
CID: 2733352

NON-INVASIVE FOLLICULAR TUMOR WITH PAPILLARY-LIKE NUCLEAR FEATURES (NIFTP): NOT A TEMPEST IN A TEAPOT

Agrawal, Nidhi; Abbott, Collette E; Liu, Cheng; Kang, Stella; Tipton, Laura; Patel, Kepal; Persky, Mark; King, Lizabeth; Deng, Fang-Ming; Bannan, Michael; Ogilvie, Jennifer B; Heller, Keith; Hodak, Steven P
BACKGROUND: Encapsulated non-invasive follicular variant papillary thyroid cancer (ENIFVPTC) has recently been re-termed noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). This designation specifically omits the word "cancer" to encourage conservative management since patients with NIFTP tumors have been shown to derive no benefit from completion thyroidectomy or adjuvant radioactive iodine (RAI) therapy. METHODS: IRB approved retrospective study of consecutive cases of tumors from 2007 to 2015 that met pathologic criteria for NIFTP. The Conservative Management (CM) group included patients managed with lobectomy alone or appropriately indicated total thyroidectomy. Those included in the Aggressive Management (AM) group received either completion thyroidectomy or radioactive iodine or both. RESULTS: From 100 consecutive cases of ENIFVPTC reviewed, 40 NIFTP were included for the final analysis. Of these, 10 (27%) patients treated with initial lobectomy received completion thyroidectomy and 6 of 37 (16%) also received post-surgical adjuvant RAI. The mean per-patient cost of care in the AM group was $17629+/-2865 nearly twice the $8637+/- 309 costs in the CM group, and was largely driven by the cost of completion thyroidectomy and RAI. CONCLUSIONS: The term NIFTP has been recently promulgated to identify a type of thyroid neoplasm, formerly identified as a low-grade cancer, for which initial surgery represents adequate treatment. We believe that since the new NIFTP nomenclature intentionally omits the word "cancer" the clinical indolence of these tumors will be better appreciated, and cost savings will result from a more conservative and appropriate clinical management.
PMID: 28095037
ISSN: 1530-891x
CID: 2413802

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

Benign-Appearing Thyroid Follicles in Cervical Lymph Nodes from Patients with Papillary Thyroid Microcarcinomas: A Histologic and Immunohistochemical/Molecular Study [Meeting Abstract]

Chang, Qing; Liu, Ying; Hiltzik, David; Deng, Fang-Ming; Chen, Xiaowei; Hamele-Bena, Diane; Tong, Guo-Xia
ISI:000393724400569
ISSN: 1530-0307
CID: 2506642

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

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:000394467301366
ISSN: 1530-0285
CID: 2517582

Live Digital Telepathology Enables Rapid Remote Frozen Section Diagnosis and Cytology Adequacy Assessment by Subspecialists [Meeting Abstract]

Kane, Yehonatan; Darvishian, Farbod; Deng, Fang-Ming; Moreira, Andre L; Simsir, Aylin; William, Christopher; Snuderl, Matija
ISI:000394467302170
ISSN: 1530-0285
CID: 2517622

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

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

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