PD-L1 expression in muscle invasive urothelial carcinoma: Comparison of SP142 and SP263 assay

Introduction: High-grade urothelial carcinoma has a different molecular pathway than superficial low grade urothelial carcinoma, and is characterized by genomic instability. The high tumor mutation burden leads to neoantigen formation, evoking an immune response. The immune response has been keenly studied in last two decades and programmed death ligand-1 (PDL-1) has emerged as acceptable immunohistochemical marker for assessment of response to therapy, prognostication and patient selection for immunotherapy. The targeting of PD-1 and PDL-1 by checkpoint inhibitors (CPIs) is an attractive strategy to unblock the inhibitor and induce cytotoxic cell death. However, the presence of complementary and companion diagnostic testing with multiple PDL-1 assays and platforms for various CPIs make a diagnostic quagmire. Thus, it is the need of hour to harmonize these assays. In this undertaken study we evaluated the concordance in PD-L1 expression between the two PD-L1 clones: SP263 and SP142, in treatment naïve muscle invasive bladder cancer (MIBC). Methods: We evaluated Ventana PD-L1 “SP263 and SP142” qualitative immunohistochemical assay using rabbit monoclonal anti-PD-L1 clones in evaluation of PDL-1 immunoexpression on Ventana autostainer platform. The study includes 30 muscle invasive urothelial carcinomas, with 10 of 30 having nodal metastasis. Results: SP263 assay was statistically more sensitive than SP142 for tumor cell (TC) scoring (P = 0.0009), whereas SP142 was more sensitive for immune cell (IC) scoring (P = 0.0067). There was no statistical significant discordance for TC or IC scoring between primary tumor and metastatic lymph node. Conclusion: PD-L1 testing status can be done on both primary tumor and metastatic site, however in metachronous metastatic setting, testing on recent metastatic site should be preferred. The harmonization of immunoexpression between 2 PD-L1 clones could not be achieved.

Epidermoid Cyst of Glans Penis in an Adolescent Male: A Common Entity at an Uncommon Site.

Epidermoid cysts are benign lesions occurring anywhere in the body, but it is a rare entity over glans penis. Even though a few cases are been reported in adult age group, epidermoid cyst occurring at glans penis in young age is very rare. The etiology in penile area is not specific, but it may represent a monolayer teratoma of germ cell origin or an abnormal embryogenic closure of the median raphe. Being benign its harmless, but secondary infections are common which gives an indication for surgical removal of the cyst. Here, we report a case of epidermoid cyst in a 14-year-old boy who came with painless swelling over the glans penis.

Epidermoid Cyst of Ovary: A Rare Entity.

Rare instances of epidermoid cyst of ovary have been reported in literature with incidence of <1% among all the ovarian tumors. It often mimics mature cystic teratoma of the ovary and needs extensive sampling and careful microscopic examination to rule out the presence of adnexal structures and other tissues. Most of the cases in literature were reported as an incidental finding, but large epidermoid cyst of the ovary is seen as a rare entity. We present one such quizzical case of a large epidermoid cyst of ovary occurring in a 44-year-old female presenting with multiple fibroids of uterus.