Reporting trends, practices, and resource utilization in neuroendocrine tumors of the prostate gland: a survey among thirty-nine genitourinary pathologists

Background: Neuroendocrine differentiation in the prostate gland ranges from clinically insignificant neuroendocrine differentiation detected with markers in an otherwise conventional prostatic adenocarcinoma to a lethal high-grade small/large cell neuroendocrine carcinoma. The concept of neuroendocrine differentiation in prostatic adenocarcinoma has gained considerable importance due to its prognostic and therapeutic ramifications and pathologists play a pivotal role in its recognition. However, its awareness, reporting, and resource utilization practice patterns among pathologists are largely unknown. Methods: Representative examples of different spectrums of neuroendocrine differentiation along with a detailed questionnaire were shared among 39 urologic pathologists using the survey monkey software. Participants were specifically questioned about the use and awareness of the 2016 WHO classification of neuroendocrine tumors of the prostate, understanding of the clinical significance of each entity, and use of different immunohistochemical (IHC) markers. De-identified respondent data were analyzed. Results: A vast majority (90%) of the participants utilize IHC markers to confirm the diagnosis of small cell neuroendocrine carcinoma. A majority (87%) of the respondents were in agreement regarding the utilization of type of IHC markers for small cell neuroendocrine carcinoma for which 85% of the pathologists agreed that determination of the site of origin of a high-grade neuroendocrine carcinoma is not critical, as these are treated similarly. In the setting of mixed carcinomas, 62% of respondents indicated that they provide quantification and grading of the acinar component. There were varied responses regarding the prognostic implication of focal neuroendocrine cells in an otherwise conventional acinar adenocarcinoma and for Paneth cell-like differentiation. The classification of large cell neuroendocrine carcinoma was highly varied, with only 38% agreement in the illustrated case. Finally, despite the recommendation not to perform neuroendocrine markers in the absence of morphologic evidence of neuroendocrine differentiation, 62% would routinely utilize IHC in the work-up of a Gleason score 5 + 5 = 10 acinar adenocarcinoma and its differentiation from high-grade neuroendocrine carcinoma. Conclusion: There is a disparity in the practice utilization patterns among the urologic pathologists with regard to diagnosing high-grade neuroendocrine carcinoma and in understanding the clinical significance of focal neuroendocrine cells in an otherwise conventional acinar adenocarcinoma and Paneth cell-like neuroendocrine differentiation. There seems to have a trend towards overutilization of IHC to determine neuroendocrine differentiation in the absence of neuroendocrine features on morphology. The survey results suggest a need for further refinement and development of standardized guidelines for the classification and reporting of neuroendocrine differentiation in the prostate gland

Clinicopathological and immunohistochemistry profile of 100 cases of lung cancer in a tertiary care occupational centre in north India

Background:According to estimates, the global cancer burden increased to 18.1 million new cases and 9.6 million deaths in 2018..Lung cancer is the most common cancer-related cause of death in both men and women. In most Western and Asian countries, adenocarcinoma has now surpassed squamous cell carcinoma. In India, however, the clinical and pathological picture of lung cancer varies greatly.Aim: The goal of this study is to look at the clinicopathological and immunohistochemical profiles of 100 patients of lung cancer in a North Indian tertiary care occupational centre.Material and methods:This is a retrospective study of lung carcinoma patients who were diagnosed with biopsy-proven lung cancer in the previous four years (between May 2016 and May 2020). Patients were diagnosed using the WHO classification of lung malignancies 2015as nonsmall cell lung carcinoma (SCC), adenocarcinoma, nonsmall cell lungcarcinoma not otherwise defined [NSCLCNOS]), small cell lung carcinoma, and others based on morphology in H&E stained sections. In all cases, immunohistochemistry (IHC) was used to help the sub-classification. In some cases, IHC was used to detect EGFR and ALK rearrangements.Result:The average age of the patients in our study was 61.04 years old (12 percent were under 50 years old and 6% were under/equal to 45 years old). Smokers made up 54 percent of all lung cancer patients. COPD was seen in 43.8 percent of lung cancer patients, and it was often linked to smoking. 4.5 percent of the patients had a history of ATT ingestion, while 36.6 percent of the patients had no relevant medical history. Cough (26%) was the most common symptom, followed by chest pain (23%), and shortness of breath (28%) in almost equal percentages and were most frequently occurring together.Squamous cell carcinoma (38 percent), adenocarcinoma (27 percent), non-small cell carcinoma-not otherwise specified(NOS) (5 percent), adenosquamous carcinoma (3 percent), and small cell carcinoma (17 percent) were the subtypes with the highest percentages histologically, with immunohistochemical confirmation.Conclusion:Along with age, radon exposure, environmental pollution, occupational exposures, gender, race, pre-existing lung disease, and genetic factors, cigarette smoking is the leading cause of lung cancer and lung cancer in the occupational category