This special section includes 4 articles as the proceedings of the Fifth Princeton Integrated Pathology Symposium (PIPS): Genitourinary Pathology, and an update on neuroendocrine tumor of the prostate. The symposium took place at the Princeton Medical Center, Plainsboro, New Jersey, on Sunday April 15, 2018. We hope again that this collection of outstanding reviews will serve as a handy reference for your daily practice.
Molecular pathology is playing an increasingly important role in almost every subspecialty of anatomic pathology. But its availability and clinical usefulness vary by subspecialty. Magers and Cheng provide a review on the practical use of molecular testing in genitourinary pathology. The organ-based summary table and several sample photomicrographs will help readers better understand and use these molecular tests. The table in our view is particularly useful for listing targeted genes/molecules, test methods, and suitable specimen types. Tumor mutation burden is an emerging biomarker for guiding immunotherapy, and is also discussed.
Immunohistochemistry is now a critical part of handling morphologically challenging cases. Ross, Li, and Yang share their institutional experiences in using various immunohistochemical markers for genitourinary pathology. The pitfalls of commonly used markers are very concerning and in our opinion worth serious consideration in your daily practice. For example, ETS-related gene (ERG) could be false negative in high-grade prostate carcinomas, yet false positive in endothelial cells including vascular tumors. Many similar examples are described in the text and illustrated by photomicrographs. This comprehensive review on the diagnostic pitfalls of immunohistochemical markers covers the tumors of prostate, bladder, testis, and kidney. Summary tables are presented for each of these organs.
The false-negative rate of diagnosing prostate carcinoma on biopsy ranged from 2% to 10%. The consequence of missing a cancer could be devastating and painful for both pathologists and patients. It is therefore critical to avoid or reduce false-negative diagnoses on prostate biopsy. Yang and Humphrey thus present their experiences in identifying the morphologically deceptive prostate acinar carcinomas. They classify the contributing factors into 5 categories, namely, tissue artifacts, minimal adenocarcinoma, deceptively benign histologic variants of prostatic adenocarcinoma, single cell adenocarcinoma, and treatment effects. One should always look out for these diagnostic pitfalls when interpreting prostate biopsies.
The 8th edition of the American Joint Committee on Cancer (AJCC) Cancer Staging Manual became effective for diagnosing and treating cancers on January 1, 2018. The differences between the 8th and the 7th AJCC staging manuals appear subtle in some areas of genitourinary pathology. To better illustrate the subtle, yet important, differences, Cornejo, Rice-Stitt, and Wu compare and contrast the staging criteria of these 2 editions with numerous tables and photomicrographs. They also review the literature with a focus on the changes adopted by the 8th edition manual. Given the nearly 2 years of experience in adopting the 8th AJCC Cancer Staging Manual, this update article is timely, practical, and clinically relevant.
Tumor grading is also an important prognostic factor for cancers. The grading schemes of genitourinary tumors have changed in recent years as new data became available. Most of these grading schemes are straightforward, despite some still being difficult to adopt, while some are less clear than others. We therefore may need a detailed discussion on the practical use or misuse of these grading schemes. However, few articles to our knowledge were exclusively focused on the changes of grading schemes. The review by Rice-Stitt et al appears to fill in such a gap. It not only provides a practical guide on adopting the new grading scheme, but also serves as a good source for the history of evolving grading schemes in genitourinary pathology.
Complementary to the symposium, Hu, Han, and Huang provide an update on the morphologic and histochemical features of prostate neuroendocrine tumors. They describe the different clinical outcomes of various prostate tumors with neuroendocrine component. Conventional neuroendocrine differentiation in prostate adenocarcinoma is not linked to any survival difference. But Paneth cell–like neuroendocrine differentiation is linked to better survival, despite its morphologic similarity to high-grade carcinoma. The rare types of neuroendocrine tumor in prostate, namely, small cell neuroendocrine carcinoma and large cell neuroendocrine carcinoma, are also discussed in depth. Finally, they offer practicing pathologists some insightful comments on how to identify/confirm the origin of neuroendocrine carcinoma, as well as how to best convey the diagnosis of neuroendocrine tumor to clinicians.
We very much appreciate the support of Archives of Pathology & Laboratory Medicine Editor-in-Chief Philip T. Cagle, MD, the other advisory committee members of the PIPS, the authors, and the reviewers. We also wish to thank Patrick Kearns, Katie Giesen, and Hilary Price at the editorial office of the Archives of Pathology & Laboratory Medicine, James Demetriades, BS, MBA, and Elliot A. Krauss, MD, at Princeton Medical Center, and F. Michael Walsh, MD, MBA, at Aurora Diagnostics.
Jiaoti Huang, MD, PhD, is Distinguished University Professor of Pathology, Pharmacology and Cancer Biology, Johnston and West endowed chair, and chairman of the Department of Pathology, Duke University School of Medicine, Durham, North Carolina. Dr Huang earned his medical degree from Anhui Medical University, Hefei, China, and obtained a master's degree in pharmacology from Beijing Institute of Radiation Medicine, Beijing, China. He came to the United States in 1987 and earned his PhD in molecular and cellular biology from New York University (NYU) School of Medicine, New York, in 1991. He was a Leukemia Society of America postdoctoral fellow at NYU and Yale University, New Haven, Connecticut. He did his residency in anatomic and clinical pathology at NYU and fellowship in oncologic surgical pathology at Memorial Sloan Kettering Cancer Center, New York, New York. He became an assistant professor at the University of Rochester, Rochester, New York, in July 2000 and rose to the rank of professor in 2007. Dr Huang moved to University of California, Los Angeles, in 2008 to be a professor of Pathology and later director of Surgical Pathology. He arrived at Duke University at the beginning of 2016 to be chairman of the Department of Pathology.
Dr Huang is an internationally renowned surgical pathologist and prostate cancer researcher. His clinical expertise is in the pathologic diagnosis of genitourinary tumors. His research laboratory investigates the molecular mechanisms, biomarkers, and novel therapies for advanced prostate cancer. Dr Huang has more than 200 publications including those in high impact journals such as Cell, Science, and New England Journal of Medicine. His research laboratory has been continuously funded by federal agencies and private foundations including National Cancer Institute, Department of Defense, American Cancer Society, Prostate Cancer Foundation, and Stand Up To Cancer.
Jiaoti Huang, MD, PhD, is Distinguished University Professor of Pathology, Pharmacology and Cancer Biology, Johnston and West endowed chair, and chairman of the Department of Pathology, Duke University School of Medicine, Durham, North Carolina. Dr Huang earned his medical degree from Anhui Medical University, Hefei, China, and obtained a master's degree in pharmacology from Beijing Institute of Radiation Medicine, Beijing, China. He came to the United States in 1987 and earned his PhD in molecular and cellular biology from New York University (NYU) School of Medicine, New York, in 1991. He was a Leukemia Society of America postdoctoral fellow at NYU and Yale University, New Haven, Connecticut. He did his residency in anatomic and clinical pathology at NYU and fellowship in oncologic surgical pathology at Memorial Sloan Kettering Cancer Center, New York, New York. He became an assistant professor at the University of Rochester, Rochester, New York, in July 2000 and rose to the rank of professor in 2007. Dr Huang moved to University of California, Los Angeles, in 2008 to be a professor of Pathology and later director of Surgical Pathology. He arrived at Duke University at the beginning of 2016 to be chairman of the Department of Pathology.
Dr Huang is an internationally renowned surgical pathologist and prostate cancer researcher. His clinical expertise is in the pathologic diagnosis of genitourinary tumors. His research laboratory investigates the molecular mechanisms, biomarkers, and novel therapies for advanced prostate cancer. Dr Huang has more than 200 publications including those in high impact journals such as Cell, Science, and New England Journal of Medicine. His research laboratory has been continuously funded by federal agencies and private foundations including National Cancer Institute, Department of Defense, American Cancer Society, Prostate Cancer Foundation, and Stand Up To Cancer.
Lanjing “L. J.” Zhang, MD, FACG, FRCPath, is the vice chair, and director of Gastrointestinal and Liver Pathology at the Department of Pathology, Princeton Medical Center, Plainsboro, New Jersey, an associate member of Rutgers Cancer Institute of New Jersey, and a visiting professor in Biological Sciences at Rutgers Faculty of Arts and Sciences, Newark, New Jersey. He also regularly teaches cancer molecular biology at Princeton University, Princeton, New Jersey, and mentors graduate students at Rutgers School of Public Health, Piscataway, New Jersey. His research and clinical interest is focused on gastrointestinal and breast pathology, biomarkers, applied statistics, and clinical epidemiology. His recent work also concerns methodology of trend analysis and the US health disparities. Dr Zhang has published more than 70 peer-reviewed articles with nearly half as a lead author, has mentored more than 10 undergraduate and graduate students, and is a coprincipal investigator of 2 intramural grants. He was a recipient of a resident subspecialty grant from the American Society of Clinical Pathology and several unrestricted educational grants. His editorial experiences include serving as executive editor-in-chief of American Journal of Digestive Disease, co–editor-in-chief of Exploratory Research and Hypothesis in Medicine, associate editor of Journal of Clinical and Translational Hepatology, section editor of Stem Cell Investigation and Medicine, and editorial board member of several peer-reviewed scientific journals. He chairs the Steering Committee of the Cancer Epidemiology Services at New Jersey Department of Health, Trenton, New Jersey, and serves on the Hematology-Pathology Devices Panel, Medical Devices Advisory Committee of the US Food and Drug Administration, Silver Spring, Maryland. He regularly reviews grant proposals for US and international funding agencies. Dr Zhang serves as an associate editor for the Archives of Pathology & Laboratory Medicine.
Lanjing “L. J.” Zhang, MD, FACG, FRCPath, is the vice chair, and director of Gastrointestinal and Liver Pathology at the Department of Pathology, Princeton Medical Center, Plainsboro, New Jersey, an associate member of Rutgers Cancer Institute of New Jersey, and a visiting professor in Biological Sciences at Rutgers Faculty of Arts and Sciences, Newark, New Jersey. He also regularly teaches cancer molecular biology at Princeton University, Princeton, New Jersey, and mentors graduate students at Rutgers School of Public Health, Piscataway, New Jersey. His research and clinical interest is focused on gastrointestinal and breast pathology, biomarkers, applied statistics, and clinical epidemiology. His recent work also concerns methodology of trend analysis and the US health disparities. Dr Zhang has published more than 70 peer-reviewed articles with nearly half as a lead author, has mentored more than 10 undergraduate and graduate students, and is a coprincipal investigator of 2 intramural grants. He was a recipient of a resident subspecialty grant from the American Society of Clinical Pathology and several unrestricted educational grants. His editorial experiences include serving as executive editor-in-chief of American Journal of Digestive Disease, co–editor-in-chief of Exploratory Research and Hypothesis in Medicine, associate editor of Journal of Clinical and Translational Hepatology, section editor of Stem Cell Investigation and Medicine, and editorial board member of several peer-reviewed scientific journals. He chairs the Steering Committee of the Cancer Epidemiology Services at New Jersey Department of Health, Trenton, New Jersey, and serves on the Hematology-Pathology Devices Panel, Medical Devices Advisory Committee of the US Food and Drug Administration, Silver Spring, Maryland. He regularly reviews grant proposals for US and international funding agencies. Dr Zhang serves as an associate editor for the Archives of Pathology & Laboratory Medicine.