Aquesta Pathology

Toowong, Australia

Aquesta Pathology

Toowong, Australia
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Perry-Keene J.,Aquesta Pathology | Perry-Keene J.,Royal Brisbane Hospital | Ferguson P.,Malaghan Institute of Medical Research | Ferguson P.,University of Otago | And 3 more authors.
Histopathology | Year: 2014

Aims: The detection of lymph node metastases has prognostic and therapeutic implications for patients undergoing radical prostatectomy for prostate cancer. Macroscopic identification of pelvic lymph nodes in surgical lymphadenectomy specimens can be difficult, with a potential for incomplete submission of lymph nodes for microscopic examination. This study was undertaken to determine whether complete sampling of lymphadenectomy specimens would improve the detection of metastatic disease in patients undergoing radical prostatectomy. Methods and results: We examined 109 pelvic lymphadenectomies accompanying radical prostatectomy specimens to assess the benefit of complete submission of the lymph node packets to detect extra lymph nodes and metastatic disease. We found that blocking the residual tissue, after all palpable lymph nodes had been identified, increased the mean number of lymph nodes from 3.8 to 10.8, with an average of 0.84 macroscopically undetectable nodes being recovered per block submitted. Metastatic prostate cancer was identified in eight cases, one of which had cancer in an impalpable lymph node only. Conclusions: Submission of all pelvic lymphadenectomy tissue for histological examination improves the yield of lymph nodes and the detection of metastatic prostate cancer. © 2013 John Wiley & Sons Ltd.


Comperat E.,University Pierre and Marie Curie | Roupret M.,University Pierre and Marie Curie | Yaxley J.,Brisbane Private Hospital | Reynolds J.,Brisbane Private Hospital | And 5 more authors.
Pathology | Year: 2010

Aim: Micropapillary carcinoma (MPC) of the bladder is an aggressive variant of urothelial carcinoma (UC). It is unknown if any amount of a micropapillary component justifies the diagnosis of MPC. It is also unknown if surface MPC also has aggressive potential. Methods: We studied 72 patients with UC with a micropapillary component in transurethral resections of bladder (TURB) diagnosed between 1998 and 2008. Fifty-seven patients were treated with radical cystectomy. Tumours were classified according to pathological (pT) stage and percentage of MPC (≤10%, 10-49%, 50-100%). This was correlated with clinical data and follow up. Significant factors in univariate analysis were entered into a multivariate analysis. Results: In the TURB specimens, 12 had pTa, 33 pT1 and 27 pT2 tumours with 23 also displaying urothelial carcinoma in situ (CIS). On cystectomy, the MPC component was upstaged in 79 of cases. Twenty-five (35) patients had metastases at presentation or nodal metastases at cystectomy and 27 patients (38) died of disease. Mean survival was 17.8 months. Of 12 pTa MPC cases, eight were treated with cystectomy, all displaying invasive carcinoma including five (62) with pT2pT4 disease. Three (25) of these patients died of disease. Seven patients had a MPC component of <10 all of whom had cystectomy. Six of these had invasive carcinoma including two (33) with pT2pT4 disease. One (15) of these patients died of disease. On univariate analysis, the proportion of the MPC component on TURB and pathological stage predicted disease specific survival (p=0.01 and 0.004, respectively), while presence of CIS predicted recurrence (p=0.03). On multivariate analysis, CIS predicted recurrence (p=0.003); however, the proportion of MPC in TURB did not remain significant in predicting disease specific survival. The pathological stage of MPC remained significant in predicting disease specific survival (p=0.04). Conclusions: Any amount of MPC, even <10 is significant in urothelial carcinoma and should be reported. Surface MPC is associated with invasive carcinoma in most cases which can be high stage. Adequate sampling to include detrusor muscle is crucial in these cases. Associated CIS is important to be recognised and reported as this also impacts on clinical outcome. © 2010 The Royal College of Pathologists of Australasia.


Samaratunga H.,Aquesta Pathology | Samaratunga H.,University of Queensland | Martignoni G.,University of Verona | Egevad L.,Karolinska Institutet | Delahunt B.,University of Otago
Pathology | Year: 2013

Although most carcinomas of the bladder occur de novo, some vesical lesions progress to malignancy over time. These lesions appear morphologically benign, but often harbour genetic changes that signify their malignant potential. Despite their benign appearance, accurate identification is important given that these patients will require close followup. In addition to this some lesions may mimic carcinoma, and as a consequence, misdiagnosis could result in serious over-treatment. In this review, we discuss the clinical and histological features as well as the differential diagnosis of lesions of the bladder that have the potential to progress to cancer. Specifically, we present the features of flat, papillary and atypical urothelial hyperplasia, urothelial papilloma, urothelial dysplasia, intestinal metaplasia, keratinising squamous metaplasia, verrucous squamous hyperplasia and condyloma acuminatum and examine the molecular and clinical evidence relating to their malignant potential. © 2013 Royal College of Pathologists of Australasia.


Seipel A.H.,Karolinska Institutet | Samaratunga H.,Aquesta Pathology | Delahunt B.,University of Otago | Wiklund P.,Karolinska Institutet | And 2 more authors.
APMIS | Year: 2016

Ductal adenocarcinoma of the prostate (DAC) has morphological similarities to adenocarcinomas of other organs. DAC behaves in an aggressive manner and may present with metastases. These metastases may occur at unusual sites, which itself may cause diagnostic difficulties. It is important for therapeutic decisions that a prostatic origin of these metastases be established. Our aim was to compare the protein expression of DAC and adenocarcinomas of colon, endometrium, lung, pancreas, stomach and urinary bladder. A tissue microarray was constructed using 60 DAC, 6 colonic, 7 endometrial, 7 lung, 5 pancreatic, 5 gastric, and 9 urinary bladder adenocarcinomas. Slides were stained for estrogen, progesterone and androgen receptor, prolactin, PSA, prostein, PSMA, PSAP, CDX2, lysozyme, villin, monoclonal CEA, CK7, CK20, HMWCK, p63, p504s, c-Myc, EGFR, Ki-67, p16, p21, p27, p53, PTEN, ERG, and PAX-8. Androgen receptor, prostein, PSA, and PSAP were almost invariably expressed in DAC. Ki-67-labeling index was lower in DAC than in other adenocarcinomas. The expression patterns of intestinal markers and cytokeratins in DAC were less specific and may lead to diagnostic errors if not combined with prostate-specific markers. © 2016 APMIS Published by John Wiley & Sons Ltd.


Samaratunga H.,Aquesta Pathology | Montironi R.,Marche Polytechnic University | True L.,University of Washington | Epstein J.I.,Johns Hopkins Hospital | And 7 more authors.
Modern Pathology | Year: 2011

The 2009 International Society of Urological Pathology Consensus Conference in Boston made recommendations regarding the standardization of pathology reporting of radical prostatectomy specimens. Issues relating to the handling and processing of radical prostatectomy specimens were coordinated by working group 1. Most uropathologists followed similar procedures for fixation of radical prostatectomy specimens, with 51% of respondents transporting tissue in formalin. There was also consensus that the prostate weight without the seminal vesicles should be recorded. There was consensus that the surface of the prostate should be painted. It was agreed that both the prostate apex and base should be examined by the cone method with sagittal sectioning of the tissue sample. There was consensus that the gland should be fully fixed before sectioning. Both partial and complete embedding of prostates was considered to be acceptable as long as the method of partial embedding is stated. No consensus was determined regarding the necessity of weighing and measuring the length of the seminal vesicles, the preparation of whole mounts rather than standardized blocks and the methodology for sampling of fresh tissue for research purposes, and it was agreed that these should be left to the discretion of the working pathologist. © 2011 USCAP, Inc. All rights reserved.


Delahunt B.,University of Otago | Delahunt B.,Victoria University of Wellington | Sika-Paotonu D.,Victoria University of Wellington | Bethwaite P.B.,University of Otago | And 6 more authors.
American Journal of Surgical Pathology | Year: 2011

Fuhrman grading of renal cell carcinoma focuses on features of nuclear size, nuclear shape, and nucleolar prominence. Despite the reported widespread usage of Fuhrman grading in clinical studies, there is debate as to the prognostic significance and reproducibility of its criteria. It has been noted that many pathologists rely on assessment of nucleolar prominence alone when grading renal cell carcinoma; however, the validity of this remains unconfirmed. This study was undertaken to determine the relationship of the 3 morphologic components of the Fuhrman grading system with one another and to determine which, if any of these, can be correlated with outcome for clear cell renal cell carcinoma. One hundred twenty-one organ-confined clear cell renal cell carcinomas were examined in this study. Parameters of nuclear size (area, major axis, perimeter) and nuclear shape (shape factor, nuclear compactness) were assessed by image analysis, whereas nucleolar prominence was assigned (grades 1 to 3) using the criteria of Fuhrman. On the basis of the predominant grade present, there were 17 nucleolar grade 1, 90 nucleolar grade 2, and 14 nucleolar grade 3 tumors. When the high-power field in each tumor with the worst nucleolar grade was assessed, there was 1 nucleolar grade 1, 68 nucleolar grade 2, and 52 nucleolar grade 3 tumors. Predominant and worst nucleolar grade correlated with all measures of nuclear size, but not nuclear shape. Worst nucleolar grade and all parameters of nuclear size were significantly associated with outcome. On multivariate analysis, worst nucleolar grade retained a significant association with survival when modeled with nuclear area. Neither worst nucleolar grade nor major nuclear axis/nuclear perimeter was significantly associated with survival when modeled together. In this study, we have shown that worst nucleolar grade and nuclear size are of prognostic significance for clear cell renal cell carcinoma. We have further shown the association of worst nucleolar grade with outcome to be independent of nuclear area, whereas it is a dependent variable when tested against other parameters of nuclear size. These findings indicate that worst nucleolar grading alone is a valid grading parameter for clear cell renal cell carcinoma. Copyright © 2011 by Lippincott Williams & Wilkins.


Samaratunga H.,Aquesta Pathology | Duffy D.,Queensland Institute of Medical Research | Yaxley J.,Royal Brisbane Hospital | Delahunt B.,University of Otago
Human Pathology | Year: 2010

Ductal adenocarcinoma of the prostate is an aggressive malignancy, often presenting at an advanced stage. In mixed ductal and acinar adenocarcinomas, the relationship between the proportion of the ductal component of the tumor and the pathologic stage and whether or not aggressive behavior is simply a function of grade remains undetermined. From 268 consecutive radical prostatectomies undertaken as a curative procedure for clinical localized prostate cancer, we identified 34 cases (12.7%) with ductal adenocarcinoma of the prostate comprising 5% to 100% of the total tumor volume. For cases with a ductal adenocarcinoma of the prostate component, the mean age at diagnosis of 60 years (range 49-69 years), mean serum prostate-specific antigen of 8.4 ng/mL (range, 0.8-21 ng/mL) and positive surgical margin rate of 17.6% did not differ significantly from that of the pure adenocarcinoma group. All 34 patients with ductal adenocarcinoma of the prostate had peripheral zone involvement while 16 (46%) also had transition zone involvement. Twenty-five (73%) cases with ductal adenocarcinoma of the prostate had extraprostatic extension (pT3), which compared to 32.9% with acinar adenocarcinoma. The presence of ductal adenocarcinoma of the prostate (P < .0001), high tumor volume (P = .001) and Gleason score >7 (P = .04) significantly predicted pT3 staging category, and the presence of ductal adenocarcinoma of the prostate remained a significant predictor for pT3, after adjusting for tumor volume and Gleason score >7. The proportion of ductal adenocarcinoma of the prostate did not significantly modify the strength of the observed association with pathological stage. In view of the significant association with extraprostatic extension we would recommend that in both core biopsies and radical prostatectomy specimens any proportion of ductal adenocarcinoma of the prostate should be reported. © 2010 Elsevier Inc.


Bennett N.C.,University of Queensland | Hooper J.D.,Materials Medical Research Institute | Lambie D.,Princess Alexandra Hospital | Lee C.S.,University of Western Sydney | And 8 more authors.
American Journal of Pathology | Year: 2012

Malignant prostate cancer (PCa) is usually treated with androgen deprivation therapies (ADTs). Recurrent PCa is resistant to ADT. This research investigated whether PCa can potentially produce androgens de novo, making them androgen self-sufficient. Steroidogenic enzymes required for androgen synthesis from cholesterol (CYP11A1, CYP17A1, HSD3β, HSD17β3) were investigated in human primary PCa (n = 90), lymph node metastases (LNMs; n = 8), and benign prostatic hyperplasia (BPH; n = 6) with the use of IHC. Six prostate cell lines were investigated for mRNA and protein for steroidogenic enzymes and for endogenous synthesis of testosterone and 5α-dihydrotestosterone. All enzymes were identified in PCa, LNMs, BPH, and cell lines. CYP11A1 (rate-limiting enzyme) was expressed in cancerous and noncancerous prostate glands. CYP11A1, CYP17A1, HSD3β, and HSD17β3 were identified, respectively, in 78%, 52%, 16%, and 82% of human BPH and PCa samples. Approximately 10% of primary PCa, LNMs, and BPH expressed all four enzymes simultaneously. CYP11A1 expression was stable, CYP17A1 increased, and HSD3β and HSD17β3 decreased with disease progression. CYP17A1 expression was significantly correlated with CYP11A1 (P = 0.0009), HSD3β (P = 0.0297), and HSD17β3 (P = 0.0090) in vivo, suggesting CYP17A1 has a key role in prostatic steroidogenesis similar to testis and adrenal roles. In vitro, all cell lines expressed mRNA for all enzymes. Protein was not always detectable; however, all cell lines synthesized androgen from cholesterol. The results indicate that monitoring steroidogenic metabolites in patients with PCa may provide useful information for therapy intervention. © 2012 American Society for Investigative Pathology.


Samaratunga H.,Aquesta Pathology | Samaratunga H.,University of Queensland | Delahunt B.,University of Otago
Pathology | Year: 2012

Urothelial carcinoma (UC) of the urinary bladder has a great propensity to undergo divergent differentiation. The resulting subtypes are morphologically unique and have significant prognostic and therapeutic differences. While squamous and glandular subtypes are the most common, a number of other well characterised morphological subtypes were described in the 2004 World Health Organization Classification. More recently additional variants of UC have been described, while others have been more fully characterised. In this review we report the details of recently described and selected unusual variants of UC. Specifically, the pathological and clinical details are discussed, relating to large nested and nested variant of UC, large cell undifferentiated carcinoma, lymphoepithelioma-like carcinoma, osteoclast rich undifferentiated carcinoma, pleomorphic giant cell carcinoma, UC with syncytiotrophoblastic giant cells, lipid cell variant of UC, micropapillary UC, UC with abundant myxoid stroma and plasmacytoid UC. © 2012 Royal College of Pathologists of Australasia.


Klopfer K.,Aquesta Pathology | Delahunt B.,Aquesta Pathology | Delahunt B.,University of Otago | Adamson M.,Aquesta Pathology | And 2 more authors.
Anticancer Research | Year: 2014

Background: Urothelial carcinoma (UC) variants can be difficult to differentiate from carcinoma metastatic to the bladder. Materials and Methods: We examined immunostaining for uroplakin III in 43 cases of primary bladder UC variants including micropapillary UC (n=19), nested variant of UC (n=2), pleomorphic giant-cell carcinoma (n=8), plasmacytoid UC (n=4), lymphoepithelioma-like carcinoma (n=2), large cell undifferentiated carcinoma (n=2), UC with abundant myxoid stroma (n=3) and lipid cell variant (n=3) and in 11 tumors from other organs metastatic to the bladder. These tumors included invasive ductal carcinoma of the breast (n=2), colorectal adenocarcinoma (n=4), endometrioid adenocarcinoma (n=1) and serous papillary carcinoma of the uterus (n=1) melanoma (n=1), embryonal carcinoma of the testis (n=1), and renal clear cell carcinoma (n=1). Results: Out of the 43 UC variants, 35 (81%) were positive for uroplakin III, including micropapillary, lipid cell variant and UC with abundant myxoid stroma. Pleomorphic giant cell carcinoma, plasmacytoid UC and nested variant of UC were less commonly positive. Of the 11 metastatic tumors, six were found to be positive for uropIakin III: metastatic colorectal adenocarcinoma, clear cell carcinoma of the kidney and embryonal carcinoma of testis. Conclusion: UP III Positivity for uroplakin III is not found only in primary bladder UC variants, but in some tumors that have metastatized to the bladder. Staining for uroplakin III alone should not be taken as evidence of UC. © 2014, International Institute of Anticancer Research. All rights reserved.

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