The Significance of the “KGS Practice” in Pathology and Oncology Part 11
PART 11: KGS PATHOLOGY REPORT (Article PART 2)
Part 2: KGS PATHOLOGY REPORT
KGS Diagnostic Profile: The comprehensive KGS Pathology Report routinely provides the detailed KGS Diagnostic Profile of the examined tissue with specific clinical, morphological and molecular data. The instructive KGS terminology and coding used in the report makes the case details and description neat, clear and punctual, and easy to view, share and record.
KGS Cellular Profile: Although not used as a routine primary part in the KGS Report, the KGS Cellular Profile has a highly important role of diagnostic and prognostic guidance (Figures 1-3). It displays the proportions of the tumor cells of various grades in the examined tumor tissue. Data are based on the mean proportional cellular percentages in 10 HPFs; the tumor tissue’s parenchymal cell groups are listed in the profile by their grades with their proportional volumes which directly reflect their individual contributions to the tumor. The KGS Cellular Profile is issued and added to the KGS Pathology Report as required, not necessarily routinely.
At a recent oncology meeting, I astoundedly witnessed a discussion about a displayed histopathologic image of a prostate tumor whose case was actually presented at the meeting as a benign prostatic hyperplasia (BPH). Four of the people in the discussion turned the case into a big argument which centered on the histopathological status of the displayed tissue and its cells. The specimen was from a surgically removed part of a BPH prostate. The four participants, who had the knowledge of the case in detail, had various opinions which they insisted on. One of them, the presenter of the case, said that it was a typical BPH tissue which turned out to be a prostate cancer. One of the other three opposed and said that it was nothing more than a BPH and a few neoplastic-looking cells would not qualify it as cancer. The third one called it a low-grade PIN (prostatic intraepithelial neoplasia) and the fourth one diagnosed it as a high-grade PIN. As the argument reached a point of impasse, I stood up and told them that all four of them were right, and I gave them a brief and brisk explanation why all of them were right upon which they were all content. So, the tissue of that transforming prostate tumor was indeed composed of the cells of various morphology: The Grade III hyperplastic cells which, in both subgroups (Grade IIIA and Grade IIIB), are becoming minority; the outnumbering metaplastic Grade IV (Grade IVA and Grade IVB) cells, the cells of low-grade PIN (LGPIN); the flourishing Grade V (Grade VA,Grade VB and Grade VC) cells, the cells of high-grade (dysplastic) PIN (HGPIN) which is carcinoma in situ; and the newly emerging higher-class tumor cells, the brand new Grade VIA prostate cancer cells. They may appear in the KGS Pathology Report of the case as below (Figures 1 and 2):
KGS Pathology Report
Sample Case
KGS Diagnostic Profile:
Biopsy: Prostate Tumor
Date of Collection: 22.05.2014
Date of Report: 30.05.2014
Clinical Diagnosis: Prostatic carcinoma
Microscopic Description: The Grade V tumor’s obvious fresh transformation toGrade VIA. Although not dominant, holding around 10% of the tumor tissue, theGrade VIA cells straightly qualify the tumor as a new “Grade VIA Prostatic Carcinoma”. Among the dominating Grade IV cells, significantly flourishing Grade V (C>B>A) cells and newly emerging clusters of Grade VIA cells are seen. There are 21 mitotic cells in 10 HPFs (Grade VC: 13/10PHF, Grade VIA: 8/10PHF).
Original KGS Grade: IIIB
Overall KGS Grade: VC
Diagnostic KGS Grade: VIA
KGS Index: 21.25
First KGS Index: 6.53 [Report Date: 11.03.2014]
KGS Prognostic Range: H
Pathologic Diagnosis: “Grade VIA Prostatic Carcinoma”
KGS Cellular Profile:
………………..11/03/14 22/04/14 30/05/14 16/06/14 25/07/14 18/08/14
GRADE
VIIB……………0%…………..0%…………..0%………….0%…………0%……………0%…..
VIIA……………0%…………..0%…………..0%………….0%…………0%……………5%…..
VIB…………….0%…………..0%…………..0%………….0%………..20%………….60%…
VIA…………….0%…………..0%………….10%………..20%………..65%…………35%…
VA-C…………..0%………….10%…………25%………..65%………..15%…………..0%….
IVA-B……10%(A>B)…45%(A>B)……55%(A=B)..10(B)………0%……………0%….
IIIA-B…….90%(A<B)…45%(A=B)…..10(A>B)……..0%……….0%……………0%…
KGS Index..6.53…………13.70………..18.60………21.25…….26.40……..29.20… ________________________________________________________
Figure 1: KGS Cellular Profile. The “KGS Cellular Profile” has a highly important role of prognostic guidance. In this example of KGS Cellular Profile table of a Grade VIA Prostatic Carcinoma displays the proportions of the tumor cell groups of various grades in the tumor tissue as documented in the sample pathology report above. Data are based on the mean proportional cellular percentages in 10 HPFs. The tumor tissue’s parenchymal cell groups of various KGS grades directly reflect their individual contributions to the tumor with their proportional volumes in a pattern of progressive interposing cascade within a period of five months during which an unpromising oncotherapy program was carried out (see also Figure 2). The corresponding monthlyKGS Index values through the five-month profile straightly reflects the prognostic progression. The KGS Cellular Profile is importantly issued and added to the KGS Pathology report as required, not necessarily routinely.
GRADE
VIIB..0%……0%…….0%…….0%……0%…..0%……0%….0%……0%…..0%….0%….0%
VIIA..0%……0%…….0%…….0%……0%…..5%…..60%..45%….30%..15%…5%…..0%
VIB…0%……0%…….0%…….0%…..20%…60%…..40%…0%…..0%….0%….0%…..0%
VIA…0%……0%…..10%…..20%…..65%…35%…..0%….0%……0%….0%…..0%….0% V……0%…..10%…..25%…..65%…..15%…..0%…..0%….0%…..0%….0%…..0%….0%
IV….10%….45%…..55%…..10%……0%…..0%……0%….0%……0%….0%…..0%….0%
III…..90%…45%….10%……..0%……0%…..0%……0%….0%……0%….0%…..0%….0%
KI…6.53…13.70..18.60….21.25…26.40..29.20..37.00..30.55..18.25..9.05..3.11…0..
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Figure 2: KGS Cellular Profile. In this continuation of the clinical management of the case profiled in Figure 1 above, the oncotherapy shows a dramatic turn after its sixth month (18.08.2014) from which a post-therapy regressive period begins and the Grade VIIA cells, the only remaining cell group in the tissue, show a significant decrease in the proportion of their contribution to the tumor. At their last stand, where they occupy only 5% of the tumor tissue, the remaining part of the mass (%95) consists of fibrosis and low (regressive) necrosis. The following (final) KGS Pathology Report shows the full regression of the tumor with %0 Grade VIIA cells which have no chance to upgrade to Grade VIIB and get outpowered by the fibrosis which now conquers the tissue. KI: KGS Index (Karindas Index)
Benign prostatic hyperplasia (BPH) is also frequently called benign prostatic hypertrophy which is a bold misnomer. The term prostatic intraepithelial neoplasia (PIN)[43-56,70,71,73-75], meanwhile, has long been either replacing or linked to or associated with the multitude of terms (including intraductal hyperplasia, intraductal dysplasia, atypical glandular hyperplasia, intraglandular dysplasia, hyperplasia with malignant change, large acinar atypical hyperplasia, atypical adenomatous hyperplasia, atypical epithelial hyperplasia and ductal-acinar dysplasia, etc.) that were previously used to describe or associated with the lesion [45,46,52,56,61,69,71-75]. Its two grades, however, high-grade (HGPIN) and low-grade (LGPIN), and the wider terms related or near to them, namely hyperplasia, metaplasia and dysplasia have often been used interchangeably, and sometimes they still are. This and other similar examples of confusion result, as we see in some otherwise impressive case studies and reviews, from the unavailability of established integral grading systems and classifications to refer to, or limited availability and/or usability of the established ones which are not comprehensively wide enough to provide determinate boundaries for dedicated individual definitions of tumor cells and their tissues in terms of ranks, nomenclature and entitlement [41,46,48-60].
Along the multi-step and multi-generational process of oncogenesis [20], we see overlapping grades of tumor cell groups whose proportions of contribution to the tumor alter manifestly through the whole period of oncogenetic progression. It is a wonder that this entity of measureless diagnostic and prognostic importance has not been worked on, so far, in order to grace it in a method of cellular profiling. For this reason, I have created an integral universal paradigm of cellular profiling for all tumors and incorporated it into the KGS.
30.04.14………..24.05.14……..20.06.14…….29.07.14…..26.08.14….22.09.14
GRADE
VII..17.5%.(A>B)…..78%.(A=B)…..85%.(B>A)…87%.(B>A)…99%.(B)…,100%.(B)..
VI….75%.(A=B)…..18.5%.(B>A)….15%.(B)………3%.(B)……..1%.(B)……..0%……….
V…..5%.(C>B>A)….3%.(A>B>C)…..0%……………..0%……………0%………..0%……….
IV…1.5%.(B>A)………0.5%.(A)………0%……………..0%……………0%………..0%……….
III…..1%.(B>A)………….0%…………….0%……………..0%……………0%………..0%………
KI……22.25……………..36.55………..40.30…………..41.10………..44.90…….47.30……..
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Figure 3: KGS Cellular Profile. This “KGS Cellular Profile” table of an aggressive Basal Cell Carcinoma displays, during a six-month period of unsuccessful oncotherapy, the proportions of the tumor cells of various grades in the examined tumor tissue as documented in the pathology report above. Data are based on the mean proportional cellular percentages in 10 HPFs. Excluding the normal (Grade I) cells, the tissue’s parenchymal cell groups are listed in the profile by their grades with their proportional volumes which directly reflect their individual contributions to the tumor. Within the KGS Grading, KGS Cellular Profile has a highly important prognostic guidance role. KI: KGS Index (Karindas Index)
Copyright © 2010-2015 M. M. Karindas, MD