Case ID: 298

Publication date: 22 Dec, 2024

Consensus grade: GS 3+4=7 (ISUP 2)

User Diagnosis Difficulty Comment
Pathologist 1 GS 3+4=7 (ISUP 2) Typical
Pathologist 2 GS 3+4=7 (ISUP 2) Typical
Pathologist 3 GS 3+4=7 (ISUP 2) Borderline higher

Either ductal or IDC component

Pathologist 4 GS 3+4=7 (ISUP 2) Typical

Find it difficult distinguishing 3+4 from 4+3 on separate images as some same area at different magnification.
Some of the cribriform glands may be intraductal cancer.

Pathologist 5 GS 3+4=7 (ISUP 2) Borderline higher

need better low power image
? is some IDC-P

Pathologist 6 GS 3+4=7 (ISUP 2) Typical

difficult to say whether "+4 or 4+3, because I cannot estimate which part is predominant on the pics. But 4 has to be in as well as 3

Pathologist 7 GS 4+3=7 (ISUP 3) Typical

Nice classic histologic patterns, but hard to tell relative percentage of each component

Pathologist 8 GS 3+4=7 (ISUP 2) Typical

Should be straightformard but close to 50:50 3:4.

Pathologist 9 GS 3+4=7 (ISUP 2) Typical
Pathologist 10 GS 3+4=7 (ISUP 2) Borderline higher

Depends on the overall amount of 4 - low power overview image of the entire core would likely create greater agreement on 4+3 vs 3+4

Pathologist 11 GS 3+4=7 (ISUP 2) Typical
Pathologist 12 GS 4+3=7 (ISUP 3) Typical
Pathologist 13 GS 3+4=7 (ISUP 2) Typical
Pathologist 14 GS 3+4=7 (ISUP 2) Borderline higher

difficult to estimate the amount of 3 and 4 by images; could be 4+3

Pathologist 15 GS 3+4=7 (ISUP 2) Typical
Pathologist 16 GS 4+3=7 (ISUP 3) Borderline lower

Since photo 1 is the same as 6 iand the others are different, is difficult to gauge the amounts of 3 and 4. If all are considered different fields of 1 slide them cribriform 4 predominates

Pathologist 17 GS 3+4=7 (ISUP 2) Borderline lower

is that cribriform area intraductal - does that make it 3+3 then!!

Pathologist 18 GS 4+3=7 (ISUP 3) Typical
Pathologist 19 GS 3+4=7 (ISUP 2) Borderline higher

Definitely both patterns 4 and 3 but it's tricky to estimate the relative percentages off the screen. I thinks it's about 40% pattern 4 and have graded it accordingly but can see others estimating the pattern 4 slightly higher. Also considered IDC-P and HGPIN focally and might have done a 34betaE12/p63 stain, depending on what the rest of the case looked like. Not convinced that there is a ductal adenocarcinoma component.

Pathologist 20 GS 3+4=7 (ISUP 2) Typical
Pathologist 21 GS 3+4=7 (ISUP 2) Typical
Pathologist 22 GS 3+4=7 (ISUP 2) Typical
Pathologist 23 GS 4+3=7 (ISUP 3) Typical
Pathologist 24 GS 3+4=7 (ISUP 2) Typical


Case description (by case creator):

A lot of the tumor is GP3 but there are also a couple of cribriform glands. The epithelium is tall columnar, sometimes with elongated nuclei but the tumor does not have other features of ductal adenocarcinoma and should probably be considered a variant of acinar adenocarcinoma of the prostate.