Here’s a #pathquiz on the #CAPProtocol of #prostate #tumors
#pathology #GUPath

1. For a TURP specimen measuring 22gm, approximately how many cassettes will you submit?

8-10
First 12gm in 6-8 cassettes
For every additional 5gm - 1 cassette

So for 22gm
6-8 (12gm) + 2 (10gm) = 8-10 cassettes

2. In a partially submitted TURP specimen, I find a carcinoma in<5% of the examined tissue, what should I do with the rest of the specimen in the container?

A. Nothing. Just report it as <5% tumor
B. Submit the entire tissue in the container

B. Submit everything
All the tissue bits need to be examined to make sure you can accurately assess the amount of tumor, tumor type and grade

3. If the patient has received prior androgen deprivation (AD)/radiation treatment, I should still assign a Gleason grade

Depends.
If treatment-related changes (cytoplasmic swelling/ microvesicular change/ nuclear enlargement/ chromatin smudging) are pronounced, then you should NOT assign a grade.

If there aren’t any changes, some suggest that you can grade it.

4. Which carcinoma should be assigned a Gleason grade?

Pseudohyperplastic adenocarcinoma

Usually Gleason score 6 (3+3) / 10
Others aren’t graded
Intraductal carcinoma is graded ONLY IF it’s associated with an invasive component

5. The TURP specimen shows an adenocarcinoma with
95% pattern 3
& 5% pattern 4.
The correct Gleason score will be

7 (3+4)
In TURP/needle core biopsies, even if there is a minor secondary component of a HIGHER grade, it should be reported

6. The TURP specimen shows an adenocarcinoma with
70% pattern 3,
25% pattern 4 and
5% pattern 5.
The correct Gleason score will be

8 (3+5)

In a TURP specimen/needle core biopsy, when there are 3 patterns, the most predominant + the highest grade should be reported

7. Radical prostatectomy specimen shows an adenocarcinoma with
70% pattern 3,
27% pattern 4 and
3% pattern 5.
The correct Gleason score will be

7 (3+4) AND a comment about tertiary Gleason pattern 5

(explanation after the next question)

8. Radical prostatectomy specimen shows an adenocarcinoma with
70% pattern 3,
20% pattern 4 and
10% pattern 5.
The correct Gleason score will be

8 (3+5)
When there are 3 patterns (3, 4 & 5) & pattern 5 is >5%, it is considered as the secondary pattern (rather than tertiary) & should be included in the score.

However, if it is <5%, it should NOT be included in a RADICAL prostatectomy (BUT it is included in a biopsy/TURP).

9. If the tumor is entirely confined to the prostate, the correct T stage would be

pT2

pT1 doesn’t exist in prostate staging (yeah!)

10. Intraprostatic seminal vesicle involvement is a pT3

False

Only EXTRAprostatic seminal vesicle involvement in a pT3

It’s difficult to differentiate intraprostatic seminal vesicles from the ejaculatory duct and so infiltration of the muscle of the extraprostatic seminal vesicle is considered pT3

And here's a quick recap as well as the 2019 ISUP consensus conference highlights on grading of prostatic carcinoma (PMID:32459716)