Questions in Daily Urologic Practice

1. Front Matter

   Pages I-X

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2. Prostate

   1. Front Matter

      Pages 1-1

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   2. Does a prostatic capsule exist? Pathologists and urologists use the word “capsule” when evaluating the extent of prostatic cancer in prostatectomy specimens

      Pages 3-6

   3. What is the anatomic structure of the prostate? Where is the transition zone? Where does carcinoma develop? Where does benign prostatic hyperplasia occur?

      Pages 7-11

   4. What is the clinical significance of perineural invasion reported on prostate needle core biopsy?

      Pages 12-15

   5. What is the difference between a positive surgical margin and extraprostatic extension in pathology reports of radical prostatectomy? What is the clinical relevance of these findings?

      Pages 16-20

   6. What is the clinical significance of prostate cancer incidentally discovered in tissue removed to relieve urinary tract obstruction mostly by transurethral resection (stage T1a and T1b cancers)?

      Pages 21-24

   7. What are the characteristics of transition zone cancer? Is it less aggressive than the non-transition-zone cancer?

      Pages 25-28

   8. Is there a significant difference in prognosis between Gleason score 3 + 4 and 4 + 3 prostate cancers in radical prostatectomy specimens? What is the prognostic implication of Gleason score 3 + 4 versus 4 + 3 prostate cancer assigned to prostate needle core biopsy specimens?

      Pages 29-33

   9. A positive surgical margin associated with an extraprostatic extension of prostate carcinoma is a significant risk for disease progression. What, then, is the risk of a positive margin created by an inadvertent surgical incision into cancerous prostate parenchyma?

      Pages 34-38

   10. What are the neuroendocrine cells in prostate cancer? From where are these cells derived? What is the clinical implication of neuroendocrine differentiation in prostate cancer?

       Pages 39-48

   11. What is prostatic ductal adenocarcinoma? How is it clinically and pathologically different from the conventional (acinar) adenocarcinoma?

       Pages 49-54

   12. What immunohistochemical markers are useful for the diagnosis of prostate cancer?

       Pages 55-61

   13. When a basal cell-specific marker (34βE12 or p63) is negative in an atypical focus, can the diagnosis of adenocarcinoma be rendered? By the same token, if 34βE12- or p63-positive cells are present, can carcinoma be ruled out?

       Pages 62-63

   14. How often is cancer detected when serum PSA is elevated? What factors affect the prostate cancer detection rate?

       Pages 64-67

   15. What is the clinical significance of isolated high-grade prostatic intraepithelial neoplasia discovered on a prostate needle core biopsy? How often does it occur? Does its presence predict cancer on a subsequent biopsy? Are there any specific clinical or pathologic findings that favorably predict cancer on a subsequent biopsy?

       Pages 68-76

   16. What is the clinical significance of a Gleason pattern 4 or 5 tumor found on a prostate needle core biopsy? What impact does a Gleason pattern 4 or 5 tumor have on the prognosis after radical prostatectomy?

       Pages 77-81

   17. What clinically useful information should be included in the pathology report on a prostate needle core biopsy? Are there specific microscopic findings useful when assessing cancer staging?

       Pages 82-83

   18. What is the meaning of “atypical glands suspicious but not diagnostic of adenocarcinoma” in a pathology diagnosis? Is “atypical small acinar proliferation” a pathologic entity?

       Pages 84-85

3. Kidney

   1. Front Matter

      Pages 87-87

      PDF

The principal role of the diagnostic surgical pathologist is to serve a patient by assisting the clinician in charge of the patient's care. In that capacity,the pathologist provides the vital informationthat should be directly and indirectly useful in guiding the clinician toward the most appropriate therapy. The material pathologists receive most commonly is a biopsy or a part of an organ removed after a definitive pro- dure. To extract useful information, pathological evaluation proceeds according to a set of guidelines. Simply reporting a diagnosis of cancer is inadequate. Detailed additional information is needed so that the clinician can go on to establish a the- peutic plan as needed. To best serve the patient, close interaction between the cli- cian and the pathologist is vital. In the field of urological pathology, there are problems specific to this system. Typically, in the prostate, because of its location, there is little room for a surgeon to work to obtain adequate resection margins, unlike with many other organs. As a result, questions arise such as "What constitutes an adequate surgical margin?" "What is the significance of extraprostatic extension of neoplasm that is still inside the resection margin?" and "What is the significance of neoplastic glands found on the resection margin marked with the ink?" It has been shown that a prostate needle core biopsy can generate much information that is immediately useful in predicting the extent of cancer in the prostate and, consequently, the outcome for the patient.

• Grading
• Staging
• biopsy
• cancer
• carcinoma
• cell
• differential diagnosis
• kidney
• pathogenesis
• prostate cancer
• prostatectomy
• renal cell carcinoma
• tissue
• tumor
• urology

From the reviews:

"The book is authored by 2 pathologists and 1 urologist and contains 5 parts spanning 287 pages. … the book is user-friendly and an easy read. It contains detailed and high-quality photographs. This book will prove useful to resident physicians in pathology and urology, as well as have pragmatic value to general pathologists." (Navin C. Shah and Isabell Sesterhenn, Journal of the American Medical Association, December, 2008)

"This book focuses on important questions about malignant diseases of the prostate, kidney, bladder, testes, and adrenal glands faced by urologists. … The book is written for the benefit of both clinical urologists and diagnostic surgical pathologists. Residents also will benefit from the broad array of relevant questions … . By focusing on the questions asked by practicing urologists, this book offers a source of easily referenced, valuable information for physicians managing patients with urologic malignancies." (Nicholas T Leone, Doody’s Review Service, May, 2009)

"This book attempts to answer various questions in the practice of Uro-Oncology. … The questions and answers format is very interesting, with detailed comments and references. … I conclude by saying that this book is a must read for all exam preparing post graduates. Lot of information they get by wide search are concentrated in single hand book. This is a good reference book for practicing urologists … . Well updated book for all pathologists, practicing Uro-Pathology." (Urology, Vol. 74 (3), September, 2009)

• Northwestern University Feinberg School of Medicine, Chicago, USA

  Ryoichi Oyasu

• Surgical Pathology, Northwestern Memorial Hospital, Northwestern University, Chicago, USA

  Ximing J. Yang

• Nara Medical University, Japan

  Osamu Yoshida

• Kyoto University Postgraduate School of Medicine, Nara, Japan

  Osamu Yoshida

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