1/ Here's my train of thought regarding the case below...first, it is important to recognize that w/o the provided #IHC this may be a straightforward diagnosis of GS 3+3=6/Grade group 1 w/associated high grade PIN #gupath #prostatecancer https://twitter.com/rovingatuscap/status/1252300579596054530

2/ the crowded nature of the glands with nuclear stratification raised the possibility that they too were a component of this #prostatecancer and hence #IHC was performed #gupath

3/ With #IHC - the larger glands w/luminal infolding/tufting/micropapillae, lined by cells w/stratified nuclei = #prostatecancer originally termed 'cancer with stratified epithelium' or "PIN-like" cancer by Drs. Hameed & Humphrey here: https://pubmed.ncbi.nlm.nih.gov/16607376/  #gupath

4/ later work by Drs. Tavora & Epstein expanded this spectrum & introduced the term "High-grade PIN-like Ductal Adenocarcinoma of the Prostate" due to the shared feature of nuclear (pseudo)stratification: https://pubmed.ncbi.nlm.nih.gov/18496142/  #prostatecancer #gupath

5/ while they reported "PIN-like (ductal)" features are typically associated w/GS 3+3=6 - incorporation of the term"ductal" understandably raises clinical concerns, as majority of “ductal” #prostatecancer (as seen in pics) is assoc. w/aggressive behavior (~ to GS 4+4=8) #gupath

6/ for some, that's sufficient to NOT use "PIN-like ductal" - HOWEVER, if oneat definitions of #prostatecancer : “ductal”=lined by (pseudo)stratified columnar vs. “acinar”=lined by cuboidal/low simple columnar epithelium, then ‘PIN-like ductal’ may seem reasonable #gupath

7/ using that distinction may also help distinguish “PIN-like (ductal)” from pseudohyperplastic #prostatecancer - which also has dilated glands and papillary infoldings, yet is typically lined by cuboidal or low simple columnar epithelium typical of acinar carcinoma #gupath

8/ recent and more comprehensive work on "PIN-like" #prostatecancer from Drs. Paulk, Giannico & Epstein extends previous findings: https://pubmed.ncbi.nlm.nih.gov/30138215/  - BUT, with a note of caution #gupath

9/ as in previous studies, most "PIN-like" #prostatecancer is associated w/GS 3+3=6, HOWEVER, a small % (see pics from paper) showed thin papillary projections into cystic dilated PIN-like CA glands ( @rovingatuscap note: ?ductal), which may b assoc. w/higher grade & stage #gupath

10/ with these findings + recognition & evolution in terminology, reports that assign GS 3+3=6 +/- 'PIN-like' or 'PIN-like ductal' to OUR case may be considered correct; HOWEVER, if one uses "PIN-like ductal" terminology, a NOTE is required... #prostatecancer #gupath

11/ the note should make clear that PIN-like (ductal) adenocarcinomas generally have a favorable prognosis & are typically graded as GS 3+3=6, so as to avoid clinical confusion with ductal adenocarcinoma #prostatecancer #gupath

12/fin - in our case, given predominance of usual pattern 3 acinar #prostatecancer - my preferred diagnosis = "Prostatic adenocarcinoma, Gleason score 3+3=6/Grade group 1, with PIN-like features" - hope you found this 'stream of consciousness' helpful #gupath