Pulmonary hamartoma:a clinic-pathologic study of 206 consecutive cases focusing on different histologic variants

Background:Pulmonary hamartoma(PH)is the most common benign pulmonary tumor usually presenting as a solitary,well-demarcated nodule composed of mature cartilage and adipose tissue.Some unusual histologic variants are challenging on clinic-radiologic and pathologic examination.Methods:We collected a multicentric,retrospective,consecutive series of 206 PH with clinical characteristics and histologic variants.Results:Clinical data were in line with the literature demonstrating a male prevalence(2:1)and a median age of 61.6 years.The median size of the nodule was 17.8 mm.When performed,SUVmax>2.5 at FDC-PET was evidenced in 4%of cases(5 out of 119)and was significantly associated with undifferentiated/myxoid histology.Conventional histology showing chondroid or chondro-lipomatous PH was quoted in 186 cases(90%),while leiomyomatous and undifferentiated/myxoid variants were recorded in 20 cases(10%).The high rate of unusual variants on pathology is possibly related to a selection bias due to external consultations or surgical excision of the lesions lacking classic features at imaging studies.Conclusions:About 10% of PH may show unusual histology and SUVmax>2.5 at FDC-PET in 4%.These uncommon findings may challenge the correct recognition,raising some concerns in terms of differential diagnosis with several other mesenchymal tumors in the lung.These features should be kept in mind to achieve a correct diagnosis and avoid unnecessary invasive treatments.

Ductal prostate cancer:Clinical features and outcomes from a multicenter retrospective analysis and overview of the current literature

Objective:The aim of the study is to evaluate clinical features and outcomes after different therapeutic strategies for ductal prostate adenocarcinoma(DPC),a rare but aggressive subtype of invasive prostate cancer(PCa)accounting for,in the pure and mixed form,1%or less and 5%or less,respectively,of all the newly diagnosed PCa.Materials and methods:Patients with a proven diagnosis of DPC undergoing surgery,radiotherapy,and androgen deprivation therapy,alone or in combination,were considered for this multicenter,retrospective study.The study assessed overall survival(OS),disease-free survival(DFS),and age-related disease-specific survival.Results:Eighty-one patients met the study inclusion criteria.Pure DPC was found in 29 patients(36%)and mixed ductal-acinar-PCa in 52 patients(64%).After a median follow-up of 63 months(range,3-206 months),3-and 5-year OS rates were 84%and 67%,respectively,and 3-and 5-year DFS rates were 54%and 34%,respectively.There were no significant differences in OS or DFS between the pure and mixed DPC groups.Pure DPC was associated with a higher rate of metastatic disease at onset.Patients 74 years or younger had better disease-specific survival(p=0.0019).A subgroup analysis favored radiotherapy as the primary treatment for nonmetastatic,organ-confined DPC(3-and 5-year DFS of 80%and 50%,respectively,compared with 5-year DFS of 35%for surgical patients;p=0.023).Conclusions:Our study found DPC to be rarer,more aggressive,more likely to metastasize,and have a worse prognosis than the common acinar variant,especially in its pure form.Multicenter series are encouraged to obtain large data sets,or propensity score matching analyses with patients with conventional PCa are desirable to understand the best therapeutic approach and improve outcomes.