A grading dilemma; Gleason scoring system: Are we sufficiently compatible? A multi center study.

OBJECTIVE: Gleason scoring is the grading system which strongly predicts the prognosis of prostate cancer. However, even being one of the most commonly used systems, the presence of different interobserver agreement rates push the uropathologists update the definitons of the Gleason patterns. In this study, we aimed to determine the interobserver agreement variability among 7 general pathologists, and one expert uropathologist from 6 different centers. METHODS: A set of 50 Hematoxylin & Eosin stained slides from 41 patients diagnosed as prostate cancer were revised by 8 different pathologists. The pathologists were also grouped according to having their residency at the same institute or working at the same center. All pathologists' and the subgroups' Gleason scores were then compared for interobserver variability by Fleiss' and Cohen's kappa tests using R v3.2.4. RESULTS: There were about 8 pathologists from 6 different centers revised all the slides. One of them was an expert uropathologist with experience of 18 years. Among 7 general pathologists 4 had surgical pathology experience for over 5 years whilst 3 had under 5 years. The Fleiss' kappa was found as 0.54 for primary Gleason pattern, and 0.44 for total Gleason score (moderate agreement). The Fleiss' kappa was 0.45 for grade grouping system. CONCLUSION: Assigning a Gleason score for a patient can be problematic because of different interobserver agreement rates among pathologists even though the patterns were accepted as well-defined.

Clinicopathologic features of the mixed epithelial and mesenchymal type metaplastic breast carcinoma with myoepithelial differentiation in a subset of six cases.

Metaplastic carcinoma (MC) of the breast, consisting of epithelial and mixed epithelial-mesenchymal tumors, are extremely rare human neoplasms. They are mostly detected between the 5th and 7th decade and have an unfavorable prognosis. Therefore, it is of utmost important to find out the behavior and also the immunohistochemical (IHC) profile of these tumors. In the current study, the aim was to examine 6 cases of MC with detailed clinico-pathological variables of cancer, follow-up and IHC profile of several antigens. The following immunohistochemical markers were used: MNF116, vimentin, CD10, smooth muscle actin (SMA), estrogen/progesterone receptors and HER-2/neu. The mean age was 39.1 the mean size was 3.3 cm. 83% of the cases had spindle cell sarcoma-like areas. Two of six cases also had a chondrosarcoma-like component. The epithelial component was invasive ductal carcinoma in all. MNF116, vimentin, CD10, and SMA expressions were as follows: mesenchymal cells: 33%, 100%, 50%, 83%, epithelial cells: 100%, 50%, 33%, 0%. All were triple negative. 66.6% presented with the axillary lymph node metastases. The mean follow-up period was 51 months, 50% died of the disease. Two had distant metastases to the lung. Our series which only included mixed epithelial-mesenchymal type metaplastic carcinoma of the breast showed myoepithelial differentiation with a worse prognosis.

The enigmatic role of nucleophosmin in malignant melanoma: does it have an effect?

BACKGROUND: Melanoma is quite a heterogeneous group of diseases of the skin. Prognostic markers of tumor behavior are important to precisely assign individual patients for appropriate treatment protocols. AIM: The aim of our first study was to investigate nucleophosmin expression in melanoma patients and to determine its relationship with the tumor characteristics and patient prognosis. MATERIALS AND METHODS: We analyzed the immunohistochemical expression of nucleophosmin in 55 melanoma patients. The immunostaining pattern was classified into two groups: Diffuse nuclear and nucleolar relocalization. We also investigated the relationship between the expression of nucleophosmin and the clinicopathological parameters such as Clark level, tumor thickness, stage, histological type, location, and survey. RESULTS: In all cases the neoplastic cells were strongly positive for nucleophosmin (14 cases diffuse nuclear, 41 cases nucleolar relocalization). No correlation was demonstrated between the expression pattern of nucleophosmin and the clinicopathological parameters and survey. CONCLUSIONS: The implications of our results, nevertheless, are that the immunohistochemical detection of nucleophosmin is not a valuable tool for predicting the outcome of patients with melanoma or identifying subgroups of patients who may be at a higher risk.

Sarcomatoid chromophobe renal cell carcinoma with osteosarcoma-like differentiation which presented as a retroperitoneal mass: a case report.

Sarcomatoid component can occur in all histological subtypes of renal cell carcinoma but most commonly accompanies chromophobe renal cell carcinoma. The majority of the sarcomatoid components consist of malignant fibrous histiocytoma, fibrosarcoma or undifferentiated sarcoma areas. Heterologous differentiation in the form of osteosarcoma or rhabdomyosarcoma is very rarely encountered. We report a very rare case of a chromophobe renal cell carcinoma with osteosarcomatous differentiation that presented as a retroperitoneal mass. Renal cell carcinoma with sarcomatoid change should be always kept in mind when a retroperitoneal mass with sarcomatoid differentiation is encountered.

Papillary cystadenocarcinoma originating from a minor salivary gland with lymph node metastases.

Papillary cystadenocarcinoma is a rare malignant neoplasm of the salivary glands. This tumor most commonly arises in the major salivary glands, mainly in the parotid gland, and rarely metastasizes to regional lymph nodes. We report here a case of papillary cystadenocarcinoma originating from a minor salivary gland, localized in the lateral portion of the tongue and with neck metastases, in a 57-year old woman. We discuss histopathologic and clinical features of this lesion and review the literature.

Papillary renal cell carcinoma with lipocyte-like cells: a rare morphological variant or an indication of aggressiveness?

Papillary renal cell carcinoma (PRCC) is the second most common carcinoma of the kidney, which is classified into two types. Type 1 displays single layer of cells with scanty pale cytoplasm and type 2 has pseudostratified high-grade nuclei with eosinophilic cytoplasm. Recently, apart from these two types, oncocytic PRCC and clear-cell PRCC have been described. To the best of our knowledge, lipocyte-like cells have not yet been reported to accompany any subtypes of renal cell carcinoma. Herein, we report a case of PRCC with lipocyte-like cells and sarcomatoid features. Lipocyte-like cells might represent a special type of PRCC or this feature may be an indication of poor prognosis regarding its association with sarcomatoid change.