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Rijstenberg LL, Harikumar H, Verhoef EI, van den Bosch TPP, Choiniere R, van Royen ME, van Leenders GJLH. Identification of intraductal-to-invasive spatial transitions in prostate cancer: proposal for a new unifying model on intraductal carcinogenesis. Histopathology 2025; 86:1091-1100. [PMID: 39888049 PMCID: PMC12045775 DOI: 10.1111/his.15414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2024] [Revised: 12/30/2024] [Accepted: 01/11/2025] [Indexed: 02/01/2025]
Abstract
AIMS Intraductal carcinoma (IDC) is an independent pathological parameter for adverse prostate cancer (PCa) outcome. Although most IDC are believed to originate from retrograde spread of established PCa, rare IDC cases may represent precursor lesions. The actual transition areas between intraductal and invasive cancer, however, have not yet been identified. Our objective was to identify intraductal-invasive PCa transitions using 2- and 3-dimensional microscopy. METHODS AND RESULTS Seventy-five samples from 46 radical prostatectomies with PCa were immunohistochemically stained for basal cell keratins. In 35 samples, atypical glands that were indistinguishable from invasive adenocarcinoma (IAC) had focal 34BE12-positive basal cells. These IAC-like glands were present adjacent to IDC and prostatic intra-epithelial neoplasia (PIN) in 21 of 45 (46.7%) and 16 of 58 (27.6%) cases, respectively. Whole-mount confocal imaging of immunofluorescent Ker5/18 double-stained and cleared 1-mm-thick intact tissues revealed spatial continuity between IDC, IAC-like glands and IAC with a gradual loss of basal cells. In 24 of 35 (68.6%) samples more than one IAC-like focus (median 3.0) was present. CONCLUSIONS We identified areas of spatial transition between PIN, IDC and IAC, characterised by remnant basal cells in IAC-like glands. Based on the coexistence of IDC and PIN, the gradual loss of basal cells in IAC-like glands and IAC-like glands' multifocality, we propose a novel hypothesis on intraductal carcinogenesis, which we term 'repetitive invasion, precursor progression' (RIPP).
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Affiliation(s)
- Lucia L Rijstenberg
- Department of Pathology, Erasmus MC Cancer InstituteUniversity Medical CentreRotterdamThe Netherlands
| | - Hridya Harikumar
- Department of Pathology, Erasmus MC Cancer InstituteUniversity Medical CentreRotterdamThe Netherlands
| | - Esther I Verhoef
- Department of Pathology, Erasmus MC Cancer InstituteUniversity Medical CentreRotterdamThe Netherlands
| | - Thierry P P van den Bosch
- Department of Pathology, Erasmus MC Cancer InstituteUniversity Medical CentreRotterdamThe Netherlands
| | - Roselyne Choiniere
- Department of Pathology, Erasmus MC Cancer InstituteUniversity Medical CentreRotterdamThe Netherlands
| | - Martin E van Royen
- Department of Pathology, Erasmus MC Cancer InstituteUniversity Medical CentreRotterdamThe Netherlands
| | - Geert J L H van Leenders
- Department of Pathology, Erasmus MC Cancer InstituteUniversity Medical CentreRotterdamThe Netherlands
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2
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Artamonova N, Galleé L, Neuwirt H, Heimdörfer D, Ladurner M, Giannini G, Steiner E, Puhr M, Bektic J, Horninger W, Heidegger I. The Clinical Trajectory of Prostate Cancer Patients Harboring Rare Histological Subtypes-A Retrospective Cohort Trial. Clin Genitourin Cancer 2025; 23:102350. [PMID: 40344715 DOI: 10.1016/j.clgc.2025.102350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2024] [Revised: 04/07/2025] [Accepted: 04/07/2025] [Indexed: 05/11/2025]
Abstract
BACKGROUND Acinar adenocarcinoma is the most common histological subtype of prostate cancer (PCa). However, 5% of cases present with unconventional histological subtypes (UHs), which have inconsistent clinical characteristics. PATIENTS AND METHODS 600 patients underwent a radical prostatectomy (RP) at our institution between 2003 and 2023. 50% had UHs, while other 50% age-matched patients (median age 63 years), with pure acinar adenocarcinoma served as comparison group. Collected parameters included age at diagnosis, PSA levels, imaging results, ISUP (International Society of Urological Pathology) Grade Group at biopsy and RP, TNM-stage and biochemical recurrence rates (BCR). Statistical analysis was conducted using SPSS and Excel, applying Mann-Whitney-U, Chi-Square tests, and Cox proportional hazards models to assess associations with recurrence-free survival. RESULTS All patients with UHs presented mixed histological forms (P < .001). Importantly, UHs were previously identified only in 9% of biopsy specimens (P < .001). Patients with UHs had more aggressive disease reflected by higher ISUP Grade Group (P < .001), higher prevalence of ≥pT3a tumors as well as higher rates of positive resection margins (P < .001) although fewer nerve-sparing procedures were performed (P < .001). Patients with UH had a higher risk of PSA persistence after RP (P = .04) and higher BCR rates (P < .001) after a median follow-up of 54.8 months. Notably, multivariate Cox regression analysis indicated that the presence of UHs is the most significant risk factor for BCR (HR 1.972, 95% CI 1.210-3.312). CONCLUSION Patients with UH exhibit more aggressive disease and have an increased risk of disease relapse following curative therapy.
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Affiliation(s)
| | - Leon Galleé
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
| | - Hannes Neuwirt
- Department of Internal Medicine IV-Nephrology and Hypertension, Medical University Innsbruck, Innsbruck, Austria
| | - David Heimdörfer
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
| | - Michael Ladurner
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
| | - Giulia Giannini
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
| | - Eberhard Steiner
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
| | - Martin Puhr
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
| | - Jasmin Bektic
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
| | | | - Isabel Heidegger
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria.
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3
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Harikumar H, van Royen ME, van Leenders GJLH. 4D pathology: translating dynamic epithelial tubulogenesis to prostate cancer pathology. Histopathology 2025; 86:681-693. [PMID: 39428716 PMCID: PMC11903113 DOI: 10.1111/his.15354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2024]
Abstract
The Gleason score is the gold standard for grading of prostate cancer (PCa) and is assessed by assigning specific grades to different microscopical growth patterns. Aside from the Gleason grades, individual growth patterns such as cribriform architecture were recently shown to have independent prognostic value for disease outcome. PCa grading is performed on static tissue samples collected at one point in time, whereas in vivo epithelial tumour structures are dynamically invading, branching and expanding into the surrounding stroma. Due to the lack of models that are able to track human PCa microscopical developments over time, our understanding of underlying tissue dynamics is sparse. We postulate that human PCa expansion utilizes embryonic and developmental tubulogenetic pathways. The aim of this study is to provide a comprehensive overview of developmental pathways of normal epithelial tubule formation, elongation, and branching, and relate those to the static microscopical PCa growth patterns observed in daily clinical practise. This study could provide a rationale for the discerned pathological interobserver variability and the clinical outcome differences between PCa growth patterns.
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Affiliation(s)
- Hridya Harikumar
- Department of Pathology, Erasmus MC Cancer InstituteUniversity Medical CentreRotterdamthe Netherlands
| | - Martin E van Royen
- Department of Pathology, Erasmus MC Cancer InstituteUniversity Medical CentreRotterdamthe Netherlands
| | - Geert JLH van Leenders
- Department of Pathology, Erasmus MC Cancer InstituteUniversity Medical CentreRotterdamthe Netherlands
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4
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Ding CKC, Greenland NY, Sirohi D, Lotan TL. Molecular Landscape of Aggressive Histologic Subtypes of Localized Prostate Cancer. Surg Pathol Clin 2025; 18:1-12. [PMID: 39890297 DOI: 10.1016/j.path.2024.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2025]
Abstract
Despite incredible progress in describing the molecular underpinnings of prostate cancer over the last decades, pathologic examination remains indispensable for predicting aggressive behavior in the localized setting. Beyond pathologic grade, specific histologic findings have emerged as critical prognostic or predictive indicators. Here, the authors review molecular correlates of aggressive histologic subtypes of prostate cancer in the localized setting, demonstrating that many of the signature molecular alterations found in metastatic disease-such as tumor suppressor gene loss and DNA repair defects-are enriched in primary disease with adverse histologic features, presaging aggressive behavior, and presenting opportunities for earlier germline screening or targeted therapies.
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Affiliation(s)
- Chien-Kuang C Ding
- Department of Pathology, University of California, San Francisco (UCSF), 1825 4th Street, M2370, San Francisco, CA 94158, USA
| | - Nancy Y Greenland
- Department of Pathology, University of California, San Francisco (UCSF), 1825 4th Street, M2370, San Francisco, CA 94158, USA
| | - Deepika Sirohi
- Department of Pathology, University of California, San Francisco (UCSF), 1825 4th Street, M2370, San Francisco, CA 94158, USA
| | - Tamara L Lotan
- Department of Pathology, Johns Hopkins University, Baltimore, MD, USA.
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5
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Kawahara M, Tanaka A, Akahane K, Endo M, Fukuda Y, Okada K, Ogawa K, Takahashi S, Nakamura M, Konishi T, Saito K, Washino S, Miyagawa T, Hiruta M, Oshiro H, Oyama-Manabe N, Shirai K. Cribriform Pattern Is a Predictive Factor of PSA Recurrence in Patients Receiving Radiotherapy After Prostatectomy. CANCER DIAGNOSIS & PROGNOSIS 2024; 4:715-721. [PMID: 39502616 PMCID: PMC11534056 DOI: 10.21873/cdp.10386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 07/30/2024] [Accepted: 08/20/2024] [Indexed: 11/08/2024]
Abstract
Background/Aim In prostate cancer, robotic total prostatectomy is a popular treatment modality. However, prostate-specific antigen (PSA) recurrence after prostate cancer surgery remains a concern. Salvage radiotherapy is commonly used to treat PSA recurrence, but the recurrence rate after salvage radiotherapy is high, highlighting the need for better predictive markers. This study aimed to retrospectively evaluate the association between cribriform pattern and PSA recurrence in patients receiving radiotherapy after radical prostatectomy. Patients and Methods Data of 50 patients who underwent radiotherapy after total prostatectomy between January 2010 and May 2020 were retrospectively evaluated. The median age was 67 years. Among these patients, two cases involved postoperative irradiation, while 48 cases involved salvage irradiation after postoperative PSA recurrence. The median time from surgery to PSA recurrence was 38.3 months. The median radiation dose was 64 Gy in 32 fractions. Three-dimensional conformal radiation therapy was administered in 38 cases and intensity-modulated radiation therapy was used in 12 cases. Combined hormone therapy was administered in 21 cases. PSA levels were measured every 3 months after treatment. Statistical analysis between groups was performed by a t-test. Results The median follow-up period after radiotherapy was 31 months. No local recurrences were observed at the prostate bed, and no deaths related to prostate cancer were recorded during follow-up. However, 18 patients (36.0%) had PSA recurrence. The PSA recurrence rate based on the cribriform pattern was 17.6% in the none to moderate group (34 patients) and 75.0% in the severe cribriform pattern group (16 patients). The PSA recurrence rate was significantly higher in patients with a severe invasive cribriform pattern (p=0.001). No significant differences were observed in other histopathological characteristics. Conclusion The cribriform pattern in surgical pathology specimens was found to be a useful predictor of PSA recurrence after postoperative radiotherapy.
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Affiliation(s)
- Masahiro Kawahara
- Department of Radiology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Akira Tanaka
- Department of Pathology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Keiko Akahane
- Department of Radiology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Masashi Endo
- Department of Radiology, Jichi Medical University Hospital, Tochigi, Japan
| | - Yukiko Fukuda
- Department of Radiology, Jichi Medical University Hospital, Tochigi, Japan
| | - Kohei Okada
- Department of Radiology, Jichi Medical University Hospital, Tochigi, Japan
| | - Kazunari Ogawa
- Department of Radiology, Jichi Medical University Hospital, Tochigi, Japan
| | - Satoru Takahashi
- Department of Radiology, Jichi Medical University Hospital, Tochigi, Japan
| | - Michiko Nakamura
- Department of Radiology, Jichi Medical University Hospital, Tochigi, Japan
| | - Tsuzumi Konishi
- Department of Urology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Kimitoshi Saito
- Department of Urology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Satoshi Washino
- Department of Urology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Tomoaki Miyagawa
- Department of Urology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Masahiro Hiruta
- Department of Pathology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Hisashi Oshiro
- Department of Pathology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Noriko Oyama-Manabe
- Department of Radiology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Katsuyuki Shirai
- Department of Radiology, Jichi Medical University Saitama Medical Center, Saitama, Japan
- Department of Radiology, Jichi Medical University Hospital, Tochigi, Japan
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6
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Ci X, Chen S, Zhu R, Zarif M, Jain R, Guo W, Ramotar M, Gong L, Xu W, Singh O, Mansouri S, Zadeh G, Wei GH, Xu W, Bristow R, Berlin A, Koritzinsky M, van der Kwast T, He HH. Oral pimonidazole unveils clinicopathologic and epigenetic features of hypoxic tumour aggressiveness in localized prostate cancer. BMC Cancer 2024; 24:744. [PMID: 38890593 PMCID: PMC11186205 DOI: 10.1186/s12885-024-12505-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 06/11/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Tumor hypoxia is associated with prostate cancer (PCa) treatment resistance and poor prognosis. Pimonidazole (PIMO) is an investigational hypoxia probe used in clinical trials. A better understanding of the clinical significance and molecular alterations underpinning PIMO-labeled tumor hypoxia is needed for future clinical application. Here, we investigated the clinical significance and molecular alterations underpinning PIMO-labeled tumor hypoxia in patients with localized PCa, in order to apply PIMO as a prognostic tool and to identify potential biomarkers for future clinical translation. METHODS A total of 39 patients with localized PCa were recruited and administered oral PIMO before undergoing radical prostatectomy (RadP). Immunohistochemical staining for PIMO was performed on 37 prostatectomy specimens with staining patterns evaluated and clinical association analyzed. Whole genome bisulfite sequencing was performed using laser-capture of microdissected specimen sections comparing PIMO positive and negative tumor areas. A hypoxia related methylation molecular signature was generated by integrating the differentially methylated regions with previously established RNA-seq datasets. RESULTS Three PIMO staining patterns were distinguished: diffuse, focal, and comedo-like. The comedo-like staining pattern was more commonly associated with adverse pathology. PIMO-defined hypoxia intensity was positively correlated with advanced pathologic stage, tumor invasion, and cribriform and intraductal carcinoma morphology. The generated DNA methylation signature was found to be a robust hypoxia biomarker, which could risk-stratify PCa patients across multiple clinical datasets, as well as be applicable in other cancer types. CONCLUSIONS Oral PIMO unveiled clinicopathologic features of disease aggressiveness in localized PCa. The generated DNA methylation signature is a novel and robust hypoxia biomarker that has the potential for future clinical translation.
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Affiliation(s)
- Xinpei Ci
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Sujun Chen
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Present Address: West China School of Public Health, West China Fourth Hospital, and State Key Laboratory of Biotherapy, Sichuan University, Chengdu, Sichuan, China
| | - Rui Zhu
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Mojgan Zarif
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Rahi Jain
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Wangyuan Guo
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Matthew Ramotar
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Linsey Gong
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Wenjie Xu
- MOE Key Laboratory of Metabolism and Molecular Medicine and Department of Biochemistry and Molecular Biology of School of Basic Medical Sciences, and Fudan University Shanghai Cancer Center, Shanghai Medical College of Fudan University, Shanghai, China
| | - Olivia Singh
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Sheila Mansouri
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Gelareh Zadeh
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Gong-Hong Wei
- MOE Key Laboratory of Metabolism and Molecular Medicine and Department of Biochemistry and Molecular Biology of School of Basic Medical Sciences, and Fudan University Shanghai Cancer Center, Shanghai Medical College of Fudan University, Shanghai, China
| | - Wei Xu
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Robert Bristow
- Division of Cancer Sciences, University of Manchester, Manchester, UK
- Christie NHS Trust and CRUK Manchester Institute and Cancer Centre, Manchester, UK
| | - Alejandro Berlin
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
| | - Marianne Koritzinsky
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada.
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada.
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
| | - Theodorus van der Kwast
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
- Division of Anatomic Pathology, Laboratory Medicine Program, University Health Network, Toronto, ON, Canada.
| | - Housheng Hansen He
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada.
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7
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Park WY, Yun J, Shin J, Oh BH, Yoon G, Hong SM, Kim KH. Open-top Bessel beam two-photon light sheet microscopy for three-dimensional pathology. eLife 2024; 12:RP92614. [PMID: 38488831 PMCID: PMC10942781 DOI: 10.7554/elife.92614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024] Open
Abstract
Nondestructive pathology based on three-dimensional (3D) optical microscopy holds promise as a complement to traditional destructive hematoxylin and eosin (H&E) stained slide-based pathology by providing cellular information in high throughput manner. However, conventional techniques provided superficial information only due to shallow imaging depths. Herein, we developed open-top two-photon light sheet microscopy (OT-TP-LSM) for intraoperative 3D pathology. An extended depth of field two-photon excitation light sheet was generated by scanning a nondiffractive Bessel beam, and selective planar imaging was conducted with cameras at 400 frames/s max during the lateral translation of tissue specimens. Intrinsic second harmonic generation was collected for additional extracellular matrix (ECM) visualization. OT-TP-LSM was tested in various human cancer specimens including skin, pancreas, and prostate. High imaging depths were achieved owing to long excitation wavelengths and long wavelength fluorophores. 3D visualization of both cells and ECM enhanced the ability of cancer detection. Furthermore, an unsupervised deep learning network was employed for the style transfer of OT-TP-LSM images to virtual H&E images. The virtual H&E images exhibited comparable histological characteristics to real ones. OT-TP-LSM may have the potential for histopathological examination in surgical and biopsy applications by rapidly providing 3D information.
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Affiliation(s)
- Won Yeong Park
- Department of Mechanical Engineering, Pohang University of Science and TechnologyPohangRepublic of Korea
| | - Jieun Yun
- Department of Mechanical Engineering, Pohang University of Science and TechnologyPohangRepublic of Korea
| | - Jinho Shin
- Department of Medicine, University of Ulsan College of Medicine, SeoulSeoulRepublic of Korea
| | - Byung Ho Oh
- Department of Dermatology, College of Medicine, Yonsei UniversitySeoulRepublic of Korea
| | - Gilsuk Yoon
- Department of Pathology, School of Medicine, Kyungpook National UniversityDaeguRepublic of Korea
| | - Seung-Mo Hong
- Department of Pathology, Asan Medical Center, University of Ulsan College of MedicineSeoulRepublic of Korea
| | - Ki Hean Kim
- Department of Mechanical Engineering, Pohang University of Science and TechnologyPohangRepublic of Korea
- Medical Science and Engineering Program, School of Convergence Science and Technology, Pohang University of Science and TechnologyPohangRepublic of Korea
- Institute for Convergence Research and Education in Advanced Technology, Yonsei UniversitySeoulRepublic of Korea
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8
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Aiyer KTS, Kroon LJ, van Leenders GJLH. Impact of comedonecrosis on prostate cancer outcome: a systematic review. Histopathology 2023; 83:339-347. [PMID: 37195595 DOI: 10.1111/his.14945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/13/2023] [Accepted: 04/30/2023] [Indexed: 05/18/2023]
Abstract
Cribriform architecture has been recognised as an independent parameter for prostate cancer outcome. Little is yet known on the added value of individual Gleason 5 growth patterns. Comedonecrosis is assigned Gleason pattern 5 and can occur in both invasive and intraductal carcinoma. The aim of this study is to systematically review the literature for the prognostic value of comedonecrosis in prostate cancer. A systematic literature search of Medline, Web of Science, Cochrane library and Google scholar was performed according to the Preferred reporting items for systematic reviews and meta-analysis (PRISMA)guidelines. After identification and screening of all relevant studies published up to July 2022, 12 manuscripts were included. Clinicopathological data were extracted and the presence of comedonecrosis in either invasive, intraductal or ductal carcinoma was associated with at least one clinical outcome measure. No meta-analysis was performed. Eight of 11 studies showed that comedonecrosis was significantly associated with biochemical recurrence and two studies with metastasis or death. The only studies using metastasis-free and disease specific-free survival as an endpoint both found comedonecrosis to be an independent prognostic parameter in multivariate analysis. The studies were all retrospective and demonstrated considerable heterogeneity with regard to clinical specimen, tumour type, grade group, correction for confounding factors and endpoints. This systematic review demonstrates weak evidence for comedonecrosis to be associated with adverse prostate cancer outcome. Study heterogeneity and lack of correction for confounding factors prohibit drawing of definitive conclusions.
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Affiliation(s)
- Kaveri T S Aiyer
- Department of Pathology, Erasmus MC Cancer Institute, University Medical Centre, Rotterdam, the Netherlands
| | - Lisa J Kroon
- Department of Pathology, Erasmus MC Cancer Institute, University Medical Centre, Rotterdam, the Netherlands
| | - Geert J L H van Leenders
- Department of Pathology, Erasmus MC Cancer Institute, University Medical Centre, Rotterdam, the Netherlands
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9
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Wong HY, Sheng Q, Hesterberg AB, Croessmann S, Rios BL, Giri K, Jackson J, Miranda AX, Watkins E, Schaffer KR, Donahue M, Winkler E, Penson DF, Smith JA, Herrell SD, Luckenbaugh AN, Barocas DA, Kim YJ, Graves D, Giannico GA, Rathmell JC, Park BH, Gordetsky JB, Hurley PJ. Single cell analysis of cribriform prostate cancer reveals cell intrinsic and tumor microenvironmental pathways of aggressive disease. Nat Commun 2022; 13:6036. [PMID: 36229464 PMCID: PMC9562361 DOI: 10.1038/s41467-022-33780-1] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 10/03/2022] [Indexed: 12/03/2022] Open
Abstract
Cribriform prostate cancer, found in both invasive cribriform carcinoma (ICC) and intraductal carcinoma (IDC), is an aggressive histological subtype that is associated with progression to lethal disease. To delineate the molecular and cellular underpinnings of ICC/IDC aggressiveness, this study examines paired ICC/IDC and benign prostate surgical samples by single-cell RNA-sequencing, TCR sequencing, and histology. ICC/IDC cancer cells express genes associated with metastasis and targets with potential for therapeutic intervention. Pathway analyses and ligand/receptor status model cellular interactions among ICC/IDC and the tumor microenvironment (TME) including JAG1/NOTCH. The ICC/IDC TME is hallmarked by increased angiogenesis and immunosuppressive fibroblasts (CTHRC1+ASPN+FAP+ENG+) along with fewer T cells, elevated T cell dysfunction, and increased C1QB+TREM2+APOE+-M2 macrophages. These findings support that cancer cell intrinsic pathways and a complex immunosuppressive TME contribute to the aggressive phenotype of ICC/IDC. These data highlight potential therapeutic opportunities to restore immune signaling in patients with ICC/IDC that may afford better outcomes.
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Affiliation(s)
- Hong Yuen Wong
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Quanhu Sheng
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Amanda B Hesterberg
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sarah Croessmann
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Brenda L Rios
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Khem Giri
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jorgen Jackson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Adam X Miranda
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Evan Watkins
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kerry R Schaffer
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | - Meredith Donahue
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Elizabeth Winkler
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - David F Penson
- Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Joseph A Smith
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - S Duke Herrell
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Amy N Luckenbaugh
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Daniel A Barocas
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Young J Kim
- Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
- Regeneron Pharmaceuticals, Tarrytown, New York, USA
| | - Diana Graves
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Giovanna A Giannico
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jeffrey C Rathmell
- Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Center for Immunobiology, Nashville, TN, USA
| | - Ben H Park
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | - Jennifer B Gordetsky
- Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Paula J Hurley
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
- Vanderbilt-Ingram Cancer Center, Nashville, TN, USA.
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA.
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10
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Iczkowski KA, Molina M, Egevad L, Bostwick DG, van Leenders GJLH, La Rosa FG, van der Kwast T, Berney DM, Evans AJ, Wheeler TM, Leite KRM, Samaratunga H, Srigley J, Varma M, Tsuzuki T, Lucia MS, Crawford ED, Harris RG, Stricker P, Lawrentschuk N, Woo HH, Fleshner NE, Shore ND, Yaxley J, Bratt O, Wiklund P, Roberts M, Cheng L, Delahunt B. Low-Grade Prostate Cancer Should Still be Labeled Cancer. BJU Int 2022; 130:741-743. [PMID: 36083240 DOI: 10.1111/bju.15886] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - Mariel Molina
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI
| | - Lars Egevad
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - David G Bostwick
- Bostwick Laboratories, a division of Poplar Healthcare, Orlando, FL
| | | | - Francisco G La Rosa
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Theodorus van der Kwast
- Laboratory Medicine Program, University Health Network and Princess Margaret Cancer Center, Toronto, Canada
| | - Daniel M Berney
- Department of Pathology, Barts Health NHS TRUST, London, United Kingdom
| | - Andrew J Evans
- Department of Pathology, Mackenzie Health, Richmond Hill, Ontario, Canada
| | - Thomas M Wheeler
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX
| | - Katia R M Leite
- Urology Department, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Hemamali Samaratunga
- Department of Pathology, University of Queensland School of Medicine, and Aquesta Uropathology, Queensland, Australia
| | - John Srigley
- Dept. of Laboratory Medicine and Pathobiology, University of Toronto, Ontario, Canada
| | - Murali Varma
- Department of Cellular Pathology, University Hospital of Wales, Cardiff, Wales, United Kingdom
| | - Toyonori Tsuzuki
- Department of Surgical Pathology, Aichi Medical University Hospital, Japan
| | - M Scott Lucia
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - E David Crawford
- Department of Urology, University of California San Diego, San Diego, CA
| | | | - Philip Stricker
- Department of Urology, St. Vincent's Private Hospital and Clinic, Melbourne, Australia
| | - Nathan Lawrentschuk
- Urology Department of the Royal Melbourne Hospital and University of Melbourne, Australia
| | - Henry H Woo
- College of Health and Medicine, Australian National University and SAN Prostate Centre of Excellence, Sydney Adventist Hospital, Sydney, Australia
| | - Neil E Fleshner
- Division of Urology, University of Toronto, Toronto, Ontario, Canada
| | | | - John Yaxley
- Wesley Medical Center, Auchenflower, Australia
| | - Ola Bratt
- Department of Urology and Clinical Cancer Epidemiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenberg, Sweden
| | - Peter Wiklund
- Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institutet.,Department of Urology, Icahn School of Medicine, Mount Sinai, New York, USA
| | - Matthew Roberts
- Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Liang Cheng
- Department of Pathology and Laboratory Medicine, Indiana University, Indianapolis, IN
| | - Brett Delahunt
- Pathology and Molecular Medicine, University of Otago, Wellington, New Zealand
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11
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Peng YC, Lin YC, Hung YL, Fu CC, Chang MDT, Lin YY, Chou TY. Rapid Histological Assessment of Prostate Specimens in the Three-dimensional Space by Hydrophilic Tissue Clearing and Confocal Microscopy. J Histochem Cytochem 2022; 70:597-608. [PMID: 35912522 PMCID: PMC9393508 DOI: 10.1369/00221554221116936] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Microscopic examination of biopsied and resected prostatic specimens is the mainstay in the diagnosis of prostate cancer. However, conventional analysis of hematoxylin and eosin (H&E)-stained tissue is time-consuming and offers limited two-dimensional (2D) information. In the current study, we devised a method-termed Prostate Rapid Optical examination for cancer STATus (proSTAT)-for rapid screening of prostate cancer using high-resolution 2D and three-dimensional (3D) confocal images obtained after hydrophilic tissue clearing of 100-µm-thick tissue slices. The results of the proSTAT method were compared with those of traditional H&E stains for the analysis of cores (n=15) obtained from radical prostatectomy specimens (n=5). Gland lumen formation, consistent with Gleason pattern 3, was evident following tracking of multiple optical imaging sections. In addition, 3D rendering allowed visualizing a tubular network of interconnecting branches. Rapid 3D fluorescent labeling of tumor protein p63 accurately distinguished prostate adenocarcinoma from normal tissue and benign lesions. Compared with conventional stains, the 3D spatial and molecular information extracted from proSTAT may significantly increase the amount of available data for pathological assessment of prostate specimens. Our approach is amenable to automation and-subject to independent validation-can find a wide spectrum of clinical and research applications.
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Affiliation(s)
- Yu-Ching Peng
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yu-Chieh Lin
- JelloX Biotech Inc., Zhubei City, Taiwan.,Department of Power Engineering, National Tsing Hua University, Hsinchu, Taiwan.,Brain Research Center, National Tsing Hua University, Hsinchu, Taiwan
| | | | - Chien-Chung Fu
- Department of Power Engineering, National Tsing Hua University, Hsinchu, Taiwan.,Brain Research Center, National Tsing Hua University, Hsinchu, Taiwan
| | | | | | - Teh-Ying Chou
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Brain Research Center, National Tsing Hua University, Hsinchu, Taiwan.,Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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12
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Destouni M, Lazaris AC, Tzelepi V. Cribriform Patterned Lesions in the Prostate Gland with Emphasis on Differential Diagnosis and Clinical Significance. Cancers (Basel) 2022; 14:cancers14133041. [PMID: 35804812 PMCID: PMC9264941 DOI: 10.3390/cancers14133041] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 06/14/2022] [Accepted: 06/20/2022] [Indexed: 02/05/2023] Open
Abstract
Simple Summary A cribriform structure is defined as a continuous proliferation of cells with intermingled lumina. Various entities may have a cribriform morphology within the prostate gland, ranging from normal, to benign, to borderline and even to malignant lesions. This review summarizes the morphologic features of entities that have a cribriform morphology within the prostate gland, with an emphasis on their differential diagnosis, molecular profile and clinical significance. The basic aim is to assist the pathologist with challenging and controversial cases and inform the clinician on the clinical implications of cribriform morphology. Abstract Cribriform glandular formations are characterized by a continuous proliferation of cells with intermingled lumina and can constitute a major or minor part of physiologic (normal central zone glands), benign (clear cell cribriform hyperplasia and basal cell hyperplasia), premalignant (high-grade prostatic intraepithelial neoplasia), borderline (atypical intraductal cribriform proliferation) or clearly malignant (intraductal, acinar, ductal and basal cell carcinoma) lesions. Each displays a different clinical course and variability in clinical management and prognosis. The aim of this review is to summarize the current knowledge regarding the morphological features, differential diagnosis, molecular profile and clinical significance of the cribriform-patterned entities of the prostate gland. Areas of controversy regarding their management, i.e., the grading of Intaductal Carcinoma, will also be discussed. Understanding the distinct nature of each cribriform lesion leads to the correct diagnosis and ensures accuracy in clinical decision-making, prognosis prediction and personalized risk stratification of patients.
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Affiliation(s)
- Maria Destouni
- Department of Cytopathology, Hippokrateion General Hospital of Athens, 11527 Athens, Greece;
| | - Andreas C. Lazaris
- First Department of Pathology, School of Medicine, The National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Vasiliki Tzelepi
- Department of Pathology, School of Medicine, University of Patras, 26504 Patras, Greece
- Correspondence:
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13
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van Ineveld RL, van Vliet EJ, Wehrens EJ, Alieva M, Rios AC. 3D imaging for driving cancer discovery. EMBO J 2022; 41:e109675. [PMID: 35403737 PMCID: PMC9108604 DOI: 10.15252/embj.2021109675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 03/09/2022] [Accepted: 03/09/2022] [Indexed: 11/09/2022] Open
Abstract
Our understanding of the cellular composition and architecture of cancer has primarily advanced using 2D models and thin slice samples. This has granted spatial information on fundamental cancer biology and treatment response. However, tissues contain a variety of interconnected cells with different functional states and shapes, and this complex organization is impossible to capture in a single plane. Furthermore, tumours have been shown to be highly heterogenous, requiring large-scale spatial analysis to reliably profile their cellular and structural composition. Volumetric imaging permits the visualization of intact biological samples, thereby revealing the spatio-phenotypic and dynamic traits of cancer. This review focuses on new insights into cancer biology uniquely brought to light by 3D imaging and concomitant progress in cancer modelling and quantitative analysis. 3D imaging has the potential to generate broad knowledge advance from major mechanisms of tumour progression to new strategies for cancer treatment and patient diagnosis. We discuss the expected future contributions of the newest imaging trends towards these goals and the challenges faced for reaching their full application in cancer research.
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Affiliation(s)
- Ravian L van Ineveld
- Princess Máxima Center for Pediatric OncologyUtrechtThe Netherlands
- Oncode InstituteUtrechtThe Netherlands
| | - Esmée J van Vliet
- Princess Máxima Center for Pediatric OncologyUtrechtThe Netherlands
- Oncode InstituteUtrechtThe Netherlands
| | - Ellen J Wehrens
- Princess Máxima Center for Pediatric OncologyUtrechtThe Netherlands
- Oncode InstituteUtrechtThe Netherlands
| | - Maria Alieva
- Princess Máxima Center for Pediatric OncologyUtrechtThe Netherlands
- Oncode InstituteUtrechtThe Netherlands
| | - Anne C Rios
- Princess Máxima Center for Pediatric OncologyUtrechtThe Netherlands
- Oncode InstituteUtrechtThe Netherlands
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14
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Wyvekens N, Tsai HK, Sholl LM, Tucci J, Giannico GA, Gordetsky JB, Hirsch MS, Barletta JA, Acosta AM. Histopathologic and Genetic Features of Mismatch Repair-Deficient High-Grade Prostate Cancer. Histopathology 2022; 80:1050-1060. [PMID: 35395112 DOI: 10.1111/his.14645] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/01/2022] [Accepted: 03/14/2022] [Indexed: 11/30/2022]
Abstract
AIMS Mismatch repair (MMR) deficiency is commonly caused by functional inactivation of MLH1, PMS2, MSH2 or MSH6. The morphologic and molecular correlates of MMR deficiency have been extensively characterized in certain tumor types such as colorectal and endometrial adenocarcinoma. In contrast, the histologic and molecular features of MMR-deficient prostate cancer remain incompletely described. In this study, we evaluated 19 MMR-deficient prostate cancers, including 11 cases without prior systemic treatment. METHODS AND RESULTS All treatment-naïve cases (11/11, 100%) were Grade Group 4-5 and had predominant cribriform and/or solid growth patterns. Solid components (any amount) and tumor infiltrating lymphocytes were seen in 7/11 (64%) of these cases each. In 68 MMR-proficient Grade Group 5 prostate cancers, predominant cribriform or solid growth patterns, solid components (any amount) and tumor infiltrating lymphocytes were seen at significantly lower frequencies (31/68, 46%; 9/68, 13% and 6/62, 9%, respectively; p<0.001 for all comparisons). Molecular evaluation of 19 cases demonstrated that MMR-deficiency was secondary to functional loss of MSH2/MSH6 and MLH1/PMS2 in 15 cases (79%) and 4 cases (21%), respectively. Definite or likely germline mutations were present in 4 cases (4/19, 21%). TMPRSS2::ERG rearrangements were identified in 2 cases (2/19, 11%). Recurrent cancer-relevant somatic mutations included (but were not limited to) ATM, TP53, FOXA1, RB1, BRCA2 and PTEN. CONCLUSIONS MMR deficiency was most commonly secondary to inactivation of MSH2/MSH6 in this study. Importantly, MMR-deficient high-grade prostatic adenocarcinomas had morphologic features that might be useful to identify selected cases for MMR IHC.
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Affiliation(s)
- Nicolas Wyvekens
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Harrison K Tsai
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Lynette M Sholl
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Jonathan Tucci
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Giovanna A Giannico
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jennifer B Gordetsky
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michelle S Hirsch
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Justine A Barletta
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Andres M Acosta
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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15
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Cahill LC, Rosen S, Yoshitake T, Wu Y, York L, Tsai LL, Gershman B, Fujimoto JG, Sun Y. Real-time diagnosis and Gleason grading of prostate core needle biopsies using nonlinear microscopy. Mod Pathol 2022; 35:539-548. [PMID: 34725447 PMCID: PMC8560363 DOI: 10.1038/s41379-021-00960-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 11/09/2022]
Abstract
Rapid histologic assessment of fresh prostate biopsies may reduce patient anxiety, aid in biopsy sampling, and enable specimen triaging for molecular/genomic analyses and research that could benefit from fresh tissue analysis. Nonlinear microscopy (NLM) is a fluorescence microscopy technique that can produce high-resolution images of freshly excised tissue resembling formalin-fixed paraffin-embedded (FFPE) H&E. NLM enables evaluation of tissue up to ~100 µm below the surface, analogous to serial sectioning, but without requiring microtome sectioning. One hundred and seventy biopsies were collected from 63 patients who underwent in-bore MRI or MRI/ultrasound fusion biopsy procedures. Biopsies were stained in acridine orange and sulforhodamine 101, a nuclear and cytoplasmic/stromal fluorescent dye, for 45 s. Genitourinary pathologists evaluated the biopsies using NLM by translating the biopsies in real time to areas of interest and NLM images were recorded. After NLM evaluation, the biopsies were processed for standard FFPE H&E and similarities and differences between NLM and FFPE H&E were investigated. Accuracies of NLM diagnoses and Gleason scores were calculated using FFPE histology as the gold standard. Pathologists achieved a 92.4% sensitivity (85.0-96.9%, 95% confidence intervals) and 100.0% specificity (94.3-100.0%) for detecting carcinoma compared to FFPE histology. The agreement between the Grade Group determined by NLM versus FFPE histology had an unweighted Cohen's Kappa of 0.588. The average NLM evaluation time was 2.10 min per biopsy (3.08 min for the first 20 patients, decreasing to 1.54 min in subsequent patients). Further studies with larger patient populations, larger number of pathologists, and multiple institutions are warranted. NLM is a promising method for future rapid evaluation of prostate needle core biopsies.
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Affiliation(s)
- Lucas C Cahill
- Harvard-MIT Division of Health Sciences and Technology, Harvard Medical School and Massachusetts Institute of Technology, Cambridge, MA, USA.,Department of Electrical Engineering and Computer Science and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Seymour Rosen
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Tadayuki Yoshitake
- Department of Electrical Engineering and Computer Science and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Yubo Wu
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Linda York
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Leo L Tsai
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Boris Gershman
- Division of Urologic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - James G Fujimoto
- Department of Electrical Engineering and Computer Science and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Yue Sun
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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16
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Brenna C, Simioni C, Varano G, Conti I, Costanzi E, Melloni M, Neri LM. Optical tissue clearing associated with 3D imaging: application in preclinical and clinical studies. Histochem Cell Biol 2022; 157:497-511. [PMID: 35235045 PMCID: PMC9114043 DOI: 10.1007/s00418-022-02081-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2022] [Indexed: 12/23/2022]
Abstract
Understanding the inner morphology of intact tissues is one of the most competitive challenges in modern biology. Since the beginning of the twentieth century, optical tissue clearing (OTC) has provided solutions for volumetric imaging, allowing the microscopic visualization of thick sections of tissue, organoids, up to whole organs and organisms (for example, mouse or rat). Recently, tissue clearing has also been introduced in clinical settings to achieve a more accurate diagnosis with the support of 3D imaging. This review aims to give an overview of the most recent developments in OTC and 3D imaging and to illustrate their role in the field of medical diagnosis, with a specific focus on clinical applications.
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Affiliation(s)
- Cinzia Brenna
- Department of Translational Medicine, University of Ferrara, 44121, Ferrara, Italy.,Medical Research Center, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Carolina Simioni
- Department of Life Sciences and Biotechnology, University of Ferrara, 44121, Ferrara, Italy.,LTTA - Electron Microscopy Center, University of Ferrara, 44121, Ferrara, Italy
| | - Gabriele Varano
- Department of Translational Medicine, University of Ferrara, 44121, Ferrara, Italy
| | - Ilaria Conti
- Department of Translational Medicine, University of Ferrara, 44121, Ferrara, Italy
| | - Eva Costanzi
- Department of Translational Medicine, University of Ferrara, 44121, Ferrara, Italy
| | - Mattia Melloni
- Department of Translational Medicine, University of Ferrara, 44121, Ferrara, Italy
| | - Luca Maria Neri
- Department of Translational Medicine, University of Ferrara, 44121, Ferrara, Italy. .,LTTA - Electron Microscopy Center, University of Ferrara, 44121, Ferrara, Italy.
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17
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Haddad TS, Friedl P, Farahani N, Treanor D, Zlobec I, Nagtegaal I. Tutorial: methods for three-dimensional visualization of archival tissue material. Nat Protoc 2021; 16:4945-4962. [PMID: 34716449 DOI: 10.1038/s41596-021-00611-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 08/05/2021] [Indexed: 02/08/2023]
Abstract
Analysis of three-dimensional patient specimens is gaining increasing relevance for understanding the principles of tissue structure as well as the biology and mechanisms underlying disease. New technologies are improving our ability to visualize large volume of tissues with subcellular resolution. One resource often overlooked is archival tissue maintained for decades in hospitals and research archives around the world. Accessing the wealth of information stored within these samples requires the use of appropriate methods. This tutorial introduces the range of sample preparation and microscopy approaches available for three-dimensional visualization of archival tissue. We summarize key aspects of the relevant techniques and common issues encountered when using archival tissue, including registration and antibody penetration. We also discuss analysis pipelines required to process, visualize and analyze the data and criteria to guide decision-making. The methods outlined in this tutorial provide an important and sustainable avenue for validating three-dimensional tissue organization and mechanisms of disease.
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Affiliation(s)
- Tariq Sami Haddad
- Department of Pathology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Peter Friedl
- Department of Cell Biology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
- David H. Koch Center for Applied Research of Genitourinary Cancers, Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Cancer GenomiCs.nl (CGC.nl), http://cancergenomics.nl, Utrecht, the Netherlands
| | | | - Darren Treanor
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
- University of Leeds, Leeds, UK
- Department of Clinical Pathology, and Department of Clinical and Experimental Medicine, Linkoping University, Linköping, Sweden
- Center for Medical Imaging Science and Visualization (CMIV), Linköping, Sweden
| | - Inti Zlobec
- Institute of Pathology, University of Bern, Bern, Switzerland
| | - Iris Nagtegaal
- Department of Pathology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
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18
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Santamaría L, Ingelmo I, Teba F. Dimensional study of prostate cancer using stereological tools. J Anat 2021; 240:145-154. [PMID: 34355401 PMCID: PMC8655212 DOI: 10.1111/joa.13524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/05/2021] [Accepted: 07/20/2021] [Indexed: 11/26/2022] Open
Abstract
This study analyzes the dimensional changes of the glands from prostate cancer by applying stereology to estimate the variations in volume, length, surface, and cellular densities of tumor acini. Normal and tumor acini were visualized using immunohistochemistry for cytokeratin18. On immunostained sections, parameters related to the dimensions and cell population of prostate acini were measured. The immunohistochemical expression of proliferative cell nuclear antigen was also measured to correlate the quantitative changes estimated with the proliferative activity of the epithelium. The average cell volume in normal and tumor epithelium was estimated using the method of the nucleator. The relative size of the acini was similar in the carcinoma compared with the normal prostate. Within the acini, the fraction of acinar volume occupied by the epithelium was significantly higher in cancer than in the nontumor prostate. Conversely, the glandular lumen of the cancer acini is lower than in the normal acini. The significant increase of acinar length density in the carcinoma indicates that the glandular tree's growth in the carcinoma is higher and with more branches than in the case of nonneoplastic glands. The basal surface density is higher in the carcinoma than in the controls. The number of epithelial cells per unit length of acini was significantly decreased in the neoplastic glands. This "dilution" of the cell population along the cancer acinus can be explained by the significant increase in the tumor cell's mean cell volume.
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Affiliation(s)
- Luis Santamaría
- Department of Anatomy, Histology, and Neuroscience, School of Medicine, Autonomous University of Madrid, Madrid, Spain
| | | | - Fernando Teba
- Department of Surgery (Urology), Hospital de La Princesa, School of Medicine, Autonomous University of Madrid, Madrid, Spain
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19
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van der Kwast TH, van Leenders GJ, Berney DM, Delahunt B, Evans AJ, Iczkowski KA, McKenney JK, Ro JY, Samaratunga H, Srigley JR, Tsuzuki T, Varma M, Wheeler TM, Egevad L. ISUP Consensus Definition of Cribriform Pattern Prostate Cancer. Am J Surg Pathol 2021; 45:1118-1126. [PMID: 33999555 DOI: 10.1097/pas.0000000000001728] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The presence of a cribriform pattern is now recognized as a clinically important, independent adverse prognostic indicator for prostate cancer. For this reason the International Society of Urological Pathology (ISUP) recently recommended its inclusion in standard reporting. In order to improve interobserver agreement as to the diagnosis of cribriform patterns, the ISUP assembled an international panel of 12 expert urogenital pathologists for the purpose of drafting a consensus definition of cribriform pattern in prostate cancer, and provide their opinions on a set of 32 images and on potential diagnostic criteria. These images were selected by the 2 nonvoting convenors of the study and included the main categories where disagreement was anticipated. The Delphi method was applied to promote consensus among the 12 panelists in their review of the images during 2 initial rounds of the study. Following a virtual meeting, convened to discuss selected images and diagnostic criteria, the following definition for cribriform pattern in prostate cancer was approved: "A confluent sheet of contiguous malignant epithelial cells with multiple glandular lumina that are easily visible at low power (objective magnification ×10). There should be no intervening stroma or mucin separating individual or fused glandular structures" together with a set of explanatory notes. We believe this consensus definition to be practical and that it will facilitate reproducible recognition and reporting of this clinically important pattern commonly seen in prostate cancer. The images and the results of the final Delphi round are available at the ISUP website as an educational slide set (https://isupweb.org/isup/blog/slideshow/cribriform-slide-deck/).
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Affiliation(s)
| | - Geert J van Leenders
- Department of Pathology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | | | - Brett Delahunt
- Department of Pathology and Molecular Medicine, Wellington School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand
| | - Andrew J Evans
- Department of Pathology, Princess Margaret Cancer Center, University Health Network
| | | | | | - Jae Y Ro
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI
| | - Hemamali Samaratunga
- Department of Pathology, University of Queensland School of Medicine, and Aquesta Uropathology, Queensland, Australia
| | - John R Srigley
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Toyo Tsuzuki
- Department of Pathology and Surgical Pathology, Aichi Medical University, Japanese Red Cross Nagoya Daini Hospital, Japan
| | | | - Thomas M Wheeler
- Department of Pathology, Baylor College of Medicine, Houston, TX
| | - Lars Egevad
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
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20
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Epstein JI, Amin MB, Fine SW, Algaba F, Aron M, Baydar DE, Beltran AL, Brimo F, Cheville JC, Colecchia M, Comperat E, da Cunha IW, Delprado W, DeMarzo AM, Giannico GA, Gordetsky JB, Guo CC, Hansel DE, Hirsch MS, Huang J, Humphrey PA, Jimenez RE, Khani F, Kong Q, Kryvenko ON, Kunju LP, Lal P, Latour M, Lotan T, Maclean F, Magi-Galluzzi C, Mehra R, Menon S, Miyamoto H, Montironi R, Netto GJ, Nguyen JK, Osunkoya AO, Parwani A, Robinson BD, Rubin MA, Shah RB, So JS, Takahashi H, Tavora F, Tretiakova MS, True L, Wobker SE, Yang XJ, Zhou M, Zynger DL, Trpkov K. The 2019 Genitourinary Pathology Society (GUPS) White Paper on Contemporary Grading of Prostate Cancer. Arch Pathol Lab Med 2021; 145:461-493. [PMID: 32589068 DOI: 10.5858/arpa.2020-0015-ra] [Citation(s) in RCA: 159] [Impact Index Per Article: 39.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Controversies and uncertainty persist in prostate cancer grading. OBJECTIVE.— To update grading recommendations. DATA SOURCES.— Critical review of the literature along with pathology and clinician surveys. CONCLUSIONS.— Percent Gleason pattern 4 (%GP4) is as follows: (1) report %GP4 in needle biopsy with Grade Groups (GrGp) 2 and 3, and in needle biopsy on other parts (jars) of lower grade in cases with at least 1 part showing Gleason score (GS) 4 + 4 = 8; and (2) report %GP4: less than 5% or less than 10% and 10% increments thereafter. Tertiary grade patterns are as follows: (1) replace "tertiary grade pattern" in radical prostatectomy (RP) with "minor tertiary pattern 5 (TP5)," and only use in RP with GrGp 2 or 3 with less than 5% Gleason pattern 5; and (2) minor TP5 is noted along with the GS, with the GrGp based on the GS. Global score and magnetic resonance imaging (MRI)-targeted biopsies are as follows: (1) when multiple undesignated cores are taken from a single MRI-targeted lesion, an overall grade for that lesion is given as if all the involved cores were one long core; and (2) if providing a global score, when different scores are found in the standard and the MRI-targeted biopsy, give a single global score (factoring both the systematic standard and the MRI-targeted positive cores). Grade Groups are as follows: (1) Grade Groups (GrGp) is the terminology adopted by major world organizations; and (2) retain GS 3 + 5 = 8 in GrGp 4. Cribriform carcinoma is as follows: (1) report the presence or absence of cribriform glands in biopsy and RP with Gleason pattern 4 carcinoma. Intraductal carcinoma (IDC-P) is as follows: (1) report IDC-P in biopsy and RP; (2) use criteria based on dense cribriform glands (>50% of the gland is composed of epithelium relative to luminal spaces) and/or solid nests and/or marked pleomorphism/necrosis; (3) it is not necessary to perform basal cell immunostains on biopsy and RP to identify IDC-P if the results would not change the overall (highest) GS/GrGp part per case; (4) do not include IDC-P in determining the final GS/GrGp on biopsy and/or RP; and (5) "atypical intraductal proliferation (AIP)" is preferred for an intraductal proliferation of prostatic secretory cells which shows a greater degree of architectural complexity and/or cytological atypia than typical high-grade prostatic intraepithelial neoplasia, yet falling short of the strict diagnostic threshold for IDC-P. Molecular testing is as follows: (1) Ki67 is not ready for routine clinical use; (2) additional studies of active surveillance cohorts are needed to establish the utility of PTEN in this setting; and (3) dedicated studies of RNA-based assays in active surveillance populations are needed to substantiate the utility of these expensive tests in this setting. Artificial intelligence and novel grading schema are as follows: (1) incorporating reactive stromal grade, percent GP4, minor tertiary GP5, and cribriform/intraductal carcinoma are not ready for adoption in current practice.
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Affiliation(s)
- Jonathan I Epstein
- From the Departments of Pathology (Epstein, DeMarzo, Lotan), McGill University Health Center, Montréal, Quebec, Canada.,Urology (Epstein), David Geffen School of Medicine at UCLA, Los Angeles, California (Huang).,and Oncology (Epstein), The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Mahul B Amin
- Department of Pathology and Laboratory Medicine and Urology, University of Tennessee Health Science, Memphis (Amin)
| | - Samson W Fine
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York (Fine)
| | - Ferran Algaba
- Department of Pathology, Fundacio Puigvert, Barcelona, Spain (Algaba)
| | - Manju Aron
- Department of Pathology, University of Southern California, Los Angeles (Aron)
| | - Dilek E Baydar
- Department of Pathology, Faculty of Medicine, Koç University, İstanbul, Turkey (Baydar)
| | - Antonio Lopez Beltran
- Department of Pathology, Champalimaud Centre for the Unknown, Lisbon, Portugal (Beltran)
| | - Fadi Brimo
- Department of Pathology, McGill University Health Center, Montréal, Quebec, Canada (Brimo)
| | - John C Cheville
- Department of Pathology, Mayo Clinic, Rochester, Minnesota (Cheville, Jimenez)
| | - Maurizio Colecchia
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy (Colecchia)
| | - Eva Comperat
- Department of Pathology, Hôpital Tenon, Sorbonne University, Paris, France (Comperat)
| | | | | | - Angelo M DeMarzo
- From the Departments of Pathology (Epstein, DeMarzo, Lotan), McGill University Health Center, Montréal, Quebec, Canada
| | - Giovanna A Giannico
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Giannico, Gordetsky)
| | - Jennifer B Gordetsky
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Giannico, Gordetsky)
| | - Charles C Guo
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston (Guo)
| | - Donna E Hansel
- Department of Pathology, Oregon Health and Science University, Portland (Hansel)
| | - Michelle S Hirsch
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (Hirsch)
| | - Jiaoti Huang
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California (Huang)
| | - Peter A Humphrey
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut (Humphrey)
| | - Rafael E Jimenez
- Department of Pathology, Mayo Clinic, Rochester, Minnesota (Cheville, Jimenez)
| | - Francesca Khani
- Department of Pathology and Laboratory Medicine and Urology, Weill Cornell Medicine, New York, New York (Khani, Robinson)
| | - Qingnuan Kong
- Department of Pathology, Qingdao Municipal Hospital, Qingdao, Shandong, China (Kong).,Kong is currently located at Kaiser Permanente Sacramento Medical Center, Sacramento, California
| | - Oleksandr N Kryvenko
- Departments of Pathology and Laboratory Medicine and Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida (Kryvenko)
| | - L Priya Kunju
- Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan (Kunju, Mehra)
| | - Priti Lal
- Perelman School of Medicine, University of Pennsylvania, Philadelphia (Lal)
| | - Mathieu Latour
- Department of Pathology, CHUM, Université de Montréal, Montréal, Quebec, Canada (Latour)
| | - Tamara Lotan
- From the Departments of Pathology (Epstein, DeMarzo, Lotan), McGill University Health Center, Montréal, Quebec, Canada
| | - Fiona Maclean
- Douglass Hanly Moir Pathology, Faculty of Medicine and Health Sciences Macquarie University, North Ryde, Australia (Maclean)
| | - Cristina Magi-Galluzzi
- Department of Pathology, The University of Alabama at Birmingham, Birmingham (Magi-Galluzzi, Netto)
| | - Rohit Mehra
- Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan (Kunju, Mehra)
| | - Santosh Menon
- Department of Surgical Pathology, Tata Memorial Hospital, Parel, Mumbai, India (Menon)
| | - Hiroshi Miyamoto
- Departments of Pathology and Laboratory Medicine and Urology, University of Rochester Medical Center, Rochester, New York (Miyamoto)
| | - Rodolfo Montironi
- Section of Pathological Anatomy, School of Medicine, Polytechnic University of the Marche Region, United Hospitals, Ancona, Italy (Montironi)
| | - George J Netto
- Department of Pathology, The University of Alabama at Birmingham, Birmingham (Magi-Galluzzi, Netto)
| | - Jane K Nguyen
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio (Nguyen)
| | - Adeboye O Osunkoya
- Department of Pathology, Emory University School of Medicine, Atlanta, Georgia (Osunkoya)
| | - Anil Parwani
- Department of Pathology, Ohio State University, Columbus (Parwani, Zynger)
| | - Brian D Robinson
- Department of Pathology and Laboratory Medicine and Urology, Weill Cornell Medicine, New York, New York (Khani, Robinson)
| | - Mark A Rubin
- Department for BioMedical Research, University of Bern, Bern, Switzerland (Rubin)
| | - Rajal B Shah
- Department of Pathology, The University of Texas Southwestern Medical Center, Dallas (Shah)
| | - Jeffrey S So
- Institute of Pathology, St Luke's Medical Center, Quezon City and Global City, Philippines (So)
| | - Hiroyuki Takahashi
- Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan (Takahashi)
| | - Fabio Tavora
- Argos Laboratory, Federal University of Ceara, Fortaleza, Brazil (Tavora)
| | - Maria S Tretiakova
- Department of Pathology, University of Washington School of Medicine, Seattle (Tretiakova, True)
| | - Lawrence True
- Department of Pathology, University of Washington School of Medicine, Seattle (Tretiakova, True)
| | - Sara E Wobker
- Departments of Pathology and Laboratory Medicine and Urology, University of North Carolina, Chapel Hill (Wobker)
| | - Ximing J Yang
- Department of Pathology, Northwestern University, Chicago, Illinois (Yang)
| | - Ming Zhou
- Department of Pathology, Tufts Medical Center, Boston, Massachusetts (Zhou)
| | - Debra L Zynger
- Department of Pathology, Ohio State University, Columbus (Parwani, Zynger)
| | - Kiril Trpkov
- and Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada (Trpkov)
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21
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Hesterberg AB, Gordetsky JB, Hurley PJ. Cribriform Prostate Cancer: Clinical Pathologic and Molecular Considerations. Urology 2021; 155:47-54. [PMID: 34058243 DOI: 10.1016/j.urology.2021.05.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 05/11/2021] [Indexed: 02/07/2023]
Abstract
Intraductal cribriform (IDC) and invasive cribriform morphologies are associated with worse prostate cancer outcomes. Limited retrospective studies have associated IDC and cribriform morphology with germline mutations in DNA repair genes, particularly BRCA2. These findings, which prompted the National Comprehensive Cancer Network (NCCN) Guidelines for Prostate Cancer and Genetic/Familial High- Risk Assessment to consider germline testing for individuals with IDC/cribriform histology, have been questioned in a recent prospective study. A deepened understanding of the molecular mechanisms driving disease aggressiveness in cribriform morphology is critical to provide more clarity in clinical decision making. This review summarizes the current understanding of IDC and cribriform prostate cancer, with an emphasis on clinical outcomes and molecular alterations.
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Affiliation(s)
| | - Jennifer B Gordetsky
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN; Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | - Paula J Hurley
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; Department of Urology, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt-Ingram Cancer Center, Nashville, TN.
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22
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Liu JTC, Glaser AK, Bera K, True LD, Reder NP, Eliceiri KW, Madabhushi A. Harnessing non-destructive 3D pathology. Nat Biomed Eng 2021; 5:203-218. [PMID: 33589781 PMCID: PMC8118147 DOI: 10.1038/s41551-020-00681-x] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 12/17/2020] [Indexed: 02/08/2023]
Abstract
High-throughput methods for slide-free three-dimensional (3D) pathological analyses of whole biopsies and surgical specimens offer the promise of modernizing traditional histology workflows and delivering improvements in diagnostic performance. Advanced optical methods now enable the interrogation of orders of magnitude more tissue than previously possible, where volumetric imaging allows for enhanced quantitative analyses of cell distributions and tissue structures that are prognostic and predictive. Non-destructive imaging processes can simplify laboratory workflows, potentially reducing costs, and can ensure that samples are available for subsequent molecular assays. However, the large size of the feature-rich datasets that they generate poses challenges for data management and computer-aided analysis. In this Perspective, we provide an overview of the imaging technologies that enable 3D pathology, and the computational tools-machine learning, in particular-for image processing and interpretation. We also discuss the integration of various other diagnostic modalities with 3D pathology, along with the challenges and opportunities for clinical adoption and regulatory approval.
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Affiliation(s)
- Jonathan T C Liu
- Department of Mechanical Engineering, University of Washington, Seattle, WA, USA.
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA.
- Department of Bioengineering, University of Washington, Seattle, WA, USA.
| | - Adam K Glaser
- Department of Mechanical Engineering, University of Washington, Seattle, WA, USA
| | - Kaustav Bera
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Lawrence D True
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - Nicholas P Reder
- Department of Mechanical Engineering, University of Washington, Seattle, WA, USA
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - Kevin W Eliceiri
- Department of Medical Physics, University of Wisconsin, Madison, WI, USA.
- Department of Biomedical Engineering, University of Wisconsin, Madison, WI, USA.
- Morgridge Institute for Research, Madison, WI, USA.
| | - Anant Madabhushi
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA.
- Louis Stokes Cleveland Veterans Administration Medical Center, Cleveland, OH, USA.
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23
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Hollemans E, Verhoef EI, Bangma CH, Rietbergen J, Osanto S, Pelger RCM, van Wezel T, van der Poel H, Bekers E, Helleman J, Roobol MJ, van Leenders GJLH. Cribriform architecture in radical prostatectomies predicts oncological outcome in Gleason score 8 prostate cancer patients. Mod Pathol 2021; 34:184-193. [PMID: 32686748 PMCID: PMC7806505 DOI: 10.1038/s41379-020-0625-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/02/2020] [Accepted: 07/02/2020] [Indexed: 11/09/2022]
Abstract
The Gleason score is an important parameter for clinical outcome in prostate cancer patients. Gleason score 8 is a heterogeneous disease including Gleason score 3 + 5, 4 + 4, and 5 + 3 tumors, and encompasses a broad range of tumor growth patterns. Our objective was to characterize individual growth patterns and identify prognostic parameters in Gleason score 8 prostate cancer patients. We reviewed 1064 radical prostatectomy specimens, recorded individual Gleason 4 and 5 growth patterns as well as presence of intraductal carcinoma, and evaluated biochemical recurrence- and metastasis-free survival. Gleason score 8 disease was identified in 140 (13%) patients, of whom 76 (54%) had Gleason score 3 + 5, 46 (33%) 4 + 4, and 18 (13%) 5 + 3 disease. Invasive cribriform and/or intraductal carcinoma (n = 87, 62%) was observed more frequently in Gleason score 4 + 4 (93%) than 3 + 5 (47%; P < 0.001) and 5 + 3 (44%; P < 0.001) patients. Gleason pattern 5 was present in 110 (79%) men: as single cells and/or cords in 99 (90%) and solid fields in 32 (29%) cases. Solid field pattern 5 coexisted with cribriform architecture (23/32, 72%) more frequently than nonsolid pattern 5 cases (36/78, 46%, P = 0.02). In multivariable analysis including age, prostate-specific antigen, pT-stage, surgical margin status, and lymph node metastases, presence of cribriform architecture was an independent parameter for biochemical recurrence-free (hazard ratio (HR) 2.0, 95% confidence interval (CI) 1.0-3.7; P = 0.04) and metastasis-free (HR 3.5, 95% CI 1.0-12.3; P = 0.05) survival. In conclusion, invasive cribriform and/or intraductal carcinoma occurs more frequently in Gleason score 4 + 4 prostate cancer patients than in Gleason score 3 + 5 and 5 + 3, and is an independent parameter for biochemical recurrence and metastasis. Therefore, cribriform architecture has added value in risk stratification of Gleason score 8 prostate cancer patients.
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Affiliation(s)
- Eva Hollemans
- Department of Pathology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
| | - Esther I. Verhoef
- grid.5645.2000000040459992XDepartment of Pathology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Chris H. Bangma
- grid.5645.2000000040459992XDepartment of Urology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - John Rietbergen
- grid.461048.f0000 0004 0459 9858Department of Urology, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Susanne Osanto
- grid.10419.3d0000000089452978Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Rob C. M. Pelger
- grid.10419.3d0000000089452978Department of Urology, Leiden University Medical Center, Leiden, The Netherlands
| | - Tom van Wezel
- grid.10419.3d0000000089452978Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Henk van der Poel
- grid.430814.aDepartment of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Elise Bekers
- grid.430814.aDepartment of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jozien Helleman
- grid.5645.2000000040459992XDepartment of Urology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Monique J. Roobol
- grid.5645.2000000040459992XDepartment of Urology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Geert J. L. H. van Leenders
- grid.5645.2000000040459992XDepartment of Pathology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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24
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Comedonecrosis Gleason pattern 5 is associated with worse clinical outcome in operated prostate cancer patients. Mod Pathol 2021; 34:2064-2070. [PMID: 34175896 PMCID: PMC8514328 DOI: 10.1038/s41379-021-00860-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 06/07/2021] [Accepted: 06/11/2021] [Indexed: 01/04/2023]
Abstract
Individual growth patterns and cribriform architecture are increasingly considered in risk stratification and clinical decision-making in men with prostate cancer. Our objective was to establish the prognostic value of individual Gleason 5 patterns in a radical prostatectomy (RP) cohort. We reviewed 1064 RPs and recorded Grade Group (GG), pT-stage, surgical margin status, Gleason 4 and 5 growth patterns as well as intraductal carcinoma. The clinical endpoints were biochemical recurrence and post-operative distant metastasis. Gleason pattern 5 was present in 339 (31.9%) RPs, of which 47 (4.4%) presented as primary, 166 (15.6%) as secondary, and 126 (11.8%) as tertiary pattern. Single cells/cords were present in 321 (94.7%) tumors with Gleason pattern 5, solid fields in 90 (26.5%), and comedonecrosis in invasive carcinoma in 32 (9.4%) tumors. Solid fields demonstrated either a small nested morphology (n = 50, 14.7%) or medium to large solid fields (n = 61, 18.0%). Cribriform architecture was present in 568 (53.4%) RPs. Medium to large solid fields and comedonecrosis coincided with cribriform architecture in all specimens, and were not observed in cribriform-negative cases. In multivariable analysis adjusted for Prostate-Specific Antigen, pT-stage, GG, surgical margin status and lymph node metastases, cribriform architecture (Hazard Ratio (HR) 9.9; 95% Confidence Interval (CI) 3.9-25.5, P < 0.001) and comedonecrosis (HR 2.1, 95% CI 1.2-3.7, P = 0.01) were independent predictors for metastasis-free survival, while single cells/cords (HR 1.2; 95% CI 0.7-1.8, P = 0.55) and medium to large solid fields (HR 1.6, 95% CI 0.9-2.7, P = 0.09) were not. In conclusion, comedonecrosis in invasive carcinoma is an independent prognostic Gleason 5 pattern for metastasis-free survival after RP. These data support the current recommendations to routinely include cribriform pattern in pathology reports and indicate that comedonecrosis should also be commented on.
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25
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Atallah C, Toi A, van der Kwast TH. Gleason grade 5 prostate cancer: sub-patterns and prognosis. Pathology 2020; 53:3-11. [PMID: 33143905 DOI: 10.1016/j.pathol.2020.09.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 09/24/2020] [Indexed: 10/24/2022]
Abstract
Since the conception of the Gleason grading system, several modifications have been made, including the definition of Gleason pattern 5 (GP5) and its reporting in biopsies and prostatectomy specimens. This includes the addition of a few GP5 sub-patterns over time such as single file, solid cylinders and pseudorosetting. Comedonecrosis was also adopted as a GP5 pattern, but in 2014 the International Society of Urological Pathology (ISUP) excluded intraductal carcinoma with comedonecrosis from the GP5 sub-patterns, although the vast majority of cases with comedonecrosis actually represent intraductal carcinoma. The 2019 conference on prostate cancer grading re-adopted comedonecrosis as GP5, also if found in intraductal carcinoma. It is well-established that presence of GP5 conveys an unfavourable prognosis for the patient with regards to risk of lymph node and distant metastasis as well as death of disease. However, there is a paucity of data on the prognostic impact of individual GP5 sub-patterns. In biopsies the frequency of diagnosis of GP5 is about 1-5% in most published series and the most common GP5 sub-pattern is single files and single cells. In an institutional biopsy review study we noted an increase in GP5 diagnosis over time which could not be attributed to the adoption of new GP5 sub-patterns or to overdiagnosis, but might be associated with changing biopsy indications. Further studies on the prognostic impact of GP5 sub-patterns and their molecular genetic profile are indicated.
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Affiliation(s)
- Chantal Atallah
- Département de médecine de laboratoire, Service clinique d'anatomopathologie, Université Laval, Québec, Canada
| | - Ants Toi
- Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, ON, Canada
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26
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Boamfa MI, Asselman MJA, Vulders RCM, Verhoef EI, van Royen ME, van der Zaag PJ. Combined transmission, dark field and fluorescence microscopy for intact, 3D tissue analysis of biopsies. JOURNAL OF BIOMEDICAL OPTICS 2020; 25:JBO-200131R. [PMID: 33215476 PMCID: PMC7676494 DOI: 10.1117/1.jbo.25.11.116503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 10/28/2020] [Indexed: 05/03/2023]
Abstract
SIGNIFICANCE Currently, tissue biopsies are sectioned into 3- to 5-μm-thick slices that are used for conventional pathology analysis. Previous work by confocal microscopy and light-sheet microscopy has shown that analyzing biopsies intact in three-dimensions (3D) is possible and may lead to a better understanding of cancer growth patterns. Although accurate, these methods require fluorescent staining of the tissue, in addition to tissue clearing. If the 3D biopsy analysis could be done sufficiently swiftly, this approach may be used for on-site assessment of the adequacy of a biopsy taken. AIM We aim to show that, by transmission microscopy of optically cleared tissue punches, the tissue architecture can be determined without the need for fluorescent staining. APPROACH Transmission microscopy is used by combining bright field microscopy with dark field and epifluorescent microscopy to compare samples that have also been analyzed by fluorescent confocal microscopy. RESULTS With increasing distance to the focal plane, the higher-frequency part of the spatial frequency spectrum of transmitted light is attenuated increasingly. This property is exploited for tissue segmentation, detecting whether tissue is present at a certain position in the focal plane image. Using this approach, we show that a 3D rendering of the internal cavity or tubules structure of punch biopsies, which are up to 1-mm thick, can be acquired in ≈1 min scan time per imaging modality. The images of the overall tissue architecture that are obtained are similar to those from the confocal microscopy benchmark, without requiring fluorescent staining. CONCLUSIONS Images of the overall tissue architecture can be obtained from transmission microcopy; they are similar to those from the confocal microscopy benchmark without requiring fluorescent staining. Tissue clearing is still needed. The total scan time of the present method is significantly shorter at a fraction of the device costs.
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Affiliation(s)
| | | | | | | | - Martin E. van Royen
- Erasmus MC, Department of Pathology, Rotterdam, The Netherlands
- Erasmus MC, Erasmus Optical Imaging Centre, Rotterdam, The Netherlands
| | - Pieter J. van der Zaag
- Philips Research Laboratories, Eindhoven, The Netherlands
- Address all correspondence to Pieter J. van der Zaag,
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27
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van Leenders GJLH, Verhoef EI, Hollemans E. Prostate cancer growth patterns beyond the Gleason score: entering a new era of comprehensive tumour grading. Histopathology 2020; 77:850-861. [PMID: 32683729 PMCID: PMC7756302 DOI: 10.1111/his.14214] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/13/2020] [Accepted: 07/15/2020] [Indexed: 12/18/2022]
Abstract
The Gleason grading system is one of the most important factors in clinical decision‐making for prostate cancer patients, and is entirely based on the classification of tumour growth patterns. In recent years it has become clear that some individual growth patterns themselves have independent prognostic value, and could be used for better personalised risk stratification. In this review we summarise recent literature on the clinicopathological value and molecular characteristics of individual prostate cancer growth patterns, and show how these, most particularly cribriform architecture, could alter treatment decisions for prostate cancer patients.
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Affiliation(s)
| | - Esther I Verhoef
- Department of Pathology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Eva Hollemans
- Department of Pathology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
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28
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Somatic Mitochondrial DNA Point Mutations Used as Biomarkers to Demonstrate Genomic Heterogeneity in Primary Prostate Cancer. Prostate Cancer 2020; 2020:7673684. [PMID: 32908706 PMCID: PMC7474793 DOI: 10.1155/2020/7673684] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 08/03/2020] [Accepted: 08/13/2020] [Indexed: 12/23/2022] Open
Abstract
Primary prostate tumor heterogeneity is poorly understood, leaving research efforts with challenges regarding the initiation and advancement of the disease. The growth of tumor cells is accompanied by mutations in nuclear and in mitochondrial genomes. Thus, mitochondrial DNA mutations may be used as tumor cell markers. By the use of laser capture microdissection coupled with assays for mitochondrial point mutation detection, mtDNA mutations were used to trace mutated cells at a histological level. Point mutations in mtDNA were determined in 12 primary prostate cancers. The tumors represent different pathology-prognostic grade groups. Known mutational hotspots of the mtDNA were scanned for heteroplasmy. All specimens with mtDNA heteroplasmy were subsequently subsampled by laser capture microdissection. From a total number of 1728 microsamples, mitochondrial DNA target sequences were amplified and base substitutions detected by cycling temperature capillary electrophoresis. Real-time PCR was used as a quantitative assay to determine the relative mtDNA copy number of 12 tumors studied, represented by two samples from each (N = 24); a high degree (75%) demonstrated tumor specimen heterogeneity. A grid of 96 spots isolated by laser capture microdissection demonstrated interfocal sample heterogeneity and increased the limit of detection. The spots demonstrated a wide range of mutant fractions from 0 to 100% mutant copies. The mitochondrial DNA copy number in the samples was determined by real-time PCR. No correlation between copy number and pathology-prognostic grade groups was observed. Somatic mitochondrial DNA point mutations represent traceable biomarkers demonstrating heterogeneity in primary prostate cancer. Mutations can be detected in areas before changes in tissue histopathology are evident to the pathologist.
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van Santvoort BWH, van Leenders GJLH, Kiemeney LA, van Oort IM, Wieringa SE, Jansen H, Vernooij RWM, Hulsbergen-van de Kaa CA, Aben KKH. Histopathological re-evaluations of biopsies in prostate cancer: a nationwide observational study. Scand J Urol 2020; 54:463-469. [PMID: 32845207 DOI: 10.1080/21681805.2020.1806354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Grading prostate biopsies has an important role in determining treatment strategy. Histopathological evaluations suffer from interobserver variability and therefore biopsies may be re-evaluated. OBJECTIVE To provide insight into the extent of, characteristics associated with and clinical implications of prostate biopsy re-evaluations in daily clinical practice. METHODS Patients diagnosed with prostate cancer (PCa) by biopsy between October 2015 and April 2016 identified through the Netherlands Cancer Registry were included. The proportion of re-evaluations was assessed and characteristics were compared between patients with and without biopsy re-evaluation. Interobserver concordance of ISUP grade and EAU prognostic risk classification was determined by calculating Cohen's kappa. RESULTS Biopsy re-evaluation was performed in 172 (3.3%) of 5214 patients. Primary reason for re-evaluation in patients treated with curative intent was referral to another hospital. Most referred patients treated with curative intent (n = 1856) had no re-evaluation (93.0%, n = 1727). Patients with biopsy re-evaluation were younger and underwent more often prostatectomy compared to patients without re-evaluation. The disagreement rate for ISUP grade was 26.1% and interobserver concordance was substantial (κ-weighted = 0.74). Re-evaluation resulted in 21.1% (n = 14) of patients with localised PCa in a different prognostic risk group. More tumours were downgraded (57.1%) than upgraded (42.9%). Interobserver concordance was very good (κ weighted = 0.85). CONCLUSION Pathology review of prostate biopsies is infrequently requested by clinicians in the Netherlands but in a non-negligible minority of patients with localised PCa the pathology review led to a change in prognostic risk group which might impact their treatment.
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Affiliation(s)
- B W H van Santvoort
- Research & Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
| | - G J L H van Leenders
- Department of Pathology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - L A Kiemeney
- Department for Health Evidence, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.,Department of Urology, Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Nijmegen, the Netherlands
| | - I M van Oort
- Department of Urology, Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Nijmegen, the Netherlands
| | - S E Wieringa
- Research & Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
| | - H Jansen
- Research & Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
| | - R W M Vernooij
- Research & Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
| | | | - K K H Aben
- Research & Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands.,Department for Health Evidence, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
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Clinicopathological characteristics of glomeruloid architecture in prostate cancer. Mod Pathol 2020; 33:1618-1625. [PMID: 32080350 DOI: 10.1038/s41379-020-0507-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 01/30/2020] [Accepted: 02/06/2020] [Indexed: 01/04/2023]
Abstract
Glomeruloid architecture is the least common Gleason 4 growth pattern in prostate adenocarcinoma. Its clinicopathological features and relation with cribriform architecture, which has been recognized as an adverse feature, remains to be established. Our objective was to investigate clinicopathological features of glomeruloid architecture in radical prostatectomies. We reviewed 1064 radical prostatectomy specimens and recorded Grade Group, pT-stage, margin status, Gleason pattern percentages, and growth patterns. Simple and complex glomerulations were distinguished by gland size and intraluminal cribriform protrusions. Clinical endpoint was biochemical recurrence-free survival. Glomerulations were identified in 365 (34%) specimens. In 472 Grade Group 2 patients, 210 (44%) had simple and 92 (19%) complex glomerulations. Complex glomerulations coincided with cribriform architecture more often than simple glomerulations (67% versus 52%; P = 0.01). Men with simple glomerulations had significantly lower prostate specific antigen (PSA) levels (9.7 versus 12.1 ng/ml; P = 0.03), percentage Gleason pattern 4 (19% versus 25%; P = 0.001), extra-prostatic extension (34% versus 50%; P = 0.01), and positive surgical margins (25% versus 39%; P = 0.04) than those with cribriform architecture. Extra-prostatic extension (37%) and positive surgical margins (30%) in men with complex glomerulations resembled those with simple glomeruloid rather than those with cribriform architecture. In multivariate Cox regression analysis adjusted for PSA, pT-stage, margin status, and lymph node metastases, cribriform architecture had independent predictive value for biochemical recurrence-free survival (hazard ratio (HR)) 1.9; 95% confidence interval (CI) 1.2-2.9; P = 0.004), while simple (HR 0.8; 95% CI 0.5-1.2; P = 0.26) and complex (HR 0.9; 95% CI 0.5-1.6; P = 0.67) glomerulations did not. Both simple and complex glomeruloid architecture are associated with better outcome than cribriform architecture in Grade Group 2 prostate cancer patients. Therefore, glomeruloid pattern and particularly complex glomerulations should not be classified as a cribriform growth pattern variant in radical prostatectomy specimens.
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Verhoef EI, van Cappellen WA, Slotman JA, Kremers GJ, Ewing-Graham PC, Houtsmuller AB, van Royen ME, van Leenders GJLH. Three-dimensional architecture of common benign and precancerous prostate epithelial lesions. Histopathology 2019; 74:1036-1044. [PMID: 30815904 PMCID: PMC6849837 DOI: 10.1111/his.13848] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 02/25/2019] [Indexed: 12/12/2022]
Abstract
Aims Many glandular lesions can mimic prostate cancer microscopically, including atrophic glands, adenosis and prostatic intraepithelial neoplasia. While the characteristic histopathological and immunohistochemical features of these lesions have been well established, little is known about their three‐dimensional architecture. Our objective was to evaluate the three‐dimensional organisation of common prostate epithelial lesions. Methods and results 500 μm‐thick punches (n = 42) were taken from radical prostatectomy specimens, and stained with antibodies targeting keratin 8–18 and keratin 5 for identification of luminal and basal cells, respectively. Tissue samples were optically cleared in benzyl alcohol:benzyl benzoate and imaged using a confocal laser scanning microscope. The three‐dimensional architecture of peripheral and transition zone glands was acinar, composed of interconnecting and blind‐ending saccular tubules. In simple atrophy, partial atrophy and post‐atrophic hyperplasia, the acinar structure was attenuated with branching blind‐ending tubules from parental tubular structures. Three‐dimensional imaging revealed a novel variant of prostate atrophy characterised by large Golgi‐like atrophic spaces parallel to the prostate surface, which were represented by thin, elongated tubular structures on haematoxylin and eosin (H&E) slides. Conversely, adenosis lacked acinar organisation, so that it closely mimicked low‐grade prostate cancer. High‐grade prostatic intraepithelial neoplasia displayed prominent papillary intraluminal protrusions but retained an acinar organisation, whereas intraductal carcinoma predominantly consisted of cribriform proliferations with either spheroid, ellipsoid or complex interconnecting lumens. Conclusions While various prostate epithelial lesions might mimic malignancy on H&E slides, their three‐dimensional architecture is acinar and clearly different from the tubular structure of prostate cancer, with adenosis as an exception.
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Affiliation(s)
- Esther I Verhoef
- Department of Pathology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Wiggert A van Cappellen
- Department of Pathology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.,Department of Optical Imaging Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Johan A Slotman
- Department of Pathology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.,Department of Optical Imaging Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Gert-Jan Kremers
- Department of Pathology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.,Department of Optical Imaging Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Patricia C Ewing-Graham
- Department of Pathology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Adriaan B Houtsmuller
- Department of Pathology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.,Department of Optical Imaging Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Martin E van Royen
- Department of Pathology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.,Department of Optical Imaging Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Geert J L H van Leenders
- Department of Pathology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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