Three Sample Cases in the KGS Solid Tumor Grading
Case 1
The First KGS REPORT
KGS Pathology Report and Diagnostic Profile
Biopsy: Breast Tumor
Date of Collection: 14.03.2014
Date of Report: 20.03.2014
Diagnosis: Invasive Lobular Carcinoma of the Breast
KGS Grade: VIIA
Microscopic Description: In a deeply infiltrative growth pattern, across abortive tubular structures, dominating clusters of Grade VIIA cells along with sporadic groups of Grade VIIAn (necrotic) cells; 22 Grade VIIAm (mitotic) cells in 10 HPFs (High-power fields) (22/10PHF); sporadic areas of ductal carcinoma in situ (Grade VC) next to the Grade VII area.
KGS Grade: VIIA
Overall KGS Grade: VII
KGS Index: 40.02
KGS Prognostic Range: E
Pathologic Diagnosis: “Grade VIIA Invasive Lobular Carcinoma of the Breast”
Case 2
The Final KGS REPORT
KGS Pathology Report and Diagnostic Profile
Biopsy: Post-therapy Pancreatic Tumor
Date of Collection: 07.08.2014
Date of Report: 15.08.2014
Diagnosis: Regressed Pancreatic Ductal Adenocarcinoma
KGS Grade: VIR (Regressed Grade VI Tumor)
Microscopic Description: The Grade VIB tumor’s substantial regression to Grade VIR0 with a zero PTR (Post-Therapy Regression) score (KGS 0); dominating necrosis and fibrosis; no visible/viable tumor cells; rare dying Grade VIB cells among overwhelming groups of Grade VIRn (necrotic) cells; no mitotic (Grade VIBm) cells in 10 HPFs (0/10PHF); 7 Grade VIBo (apoptotic) cells in 10 HPFs (7/10PHF).
Original KGS Grade: VIB
Overall KGS Grade: VIR (VIR0)
KGS Index: -0.50
First KGS Index: 38.72 [Report Date: 16.02.2013]
PTR (Post-Therapy Regression) Score: 0 (KGS 0)
KGS Prognostic Range: N
Pathologic Diagnosis: “Regressed Grade VIB Pancreatic Ductal Adenocarcinoma”
Case 3
The First KGS REPORT
KGS Pathology Report and Diagnostic Profile
Biopsy: Pituitary Tumor
Date of Collection: 11.10.2013
Date of Report: 19.10.2013
Diagnosis: Corticotroph Pituitary Adenoma
KGS Grade: IIIA
Microscopic Description: Clustered ACTH-positive adenohypophyseal Grade IIItumor cells are settled throughout the tumor tissue in a sinusoidal pattern varying fromGrade IIIA to Grade IIIB with distinct cellular borders and oval to round nuclei. While the Grade IIIA cells dominate, the Grade IIIB cells occupy 30% of the Grade III area. Mitotic (Grade IIIm) cells in 10 HPFs: 16 (16/10PHF: 7 Grade IIIAm, 9Grade IIIBm). Adjacent to the Grade III area are clearly seen groups of Grade IIcells and neat locations of Grade I cells.
KGS Grade: IIIA
Overall KGS Grade: III
KGS Index: 6.48
KGS Prognostic Range: L
Pathologic Diagnosis: “ Grade IIIA Corticotroph Pituitary Adenoma”.
The KGS’s PTR (Post-Therapy Regression) Grading
PTR Score: 0 (KGS 0)
KGS Range: VIR0-VIIR0
PTR Criteria: Fully credible neoplastic regression. No trace of residual tumor, no viable tumor cells
PTR Score: 1 (KGS 1)
KGS Range: VIR1-VIIR1
PTR Criteria: Substantial neoplastic regression. Rare (<5%) residual tumor cells
PTR Score: 2 (KGS 2)
KGS Range: VIR2-VIIR2
PTR Criteria: Significant neoplastic regression. 5-15% residual tumor cells
PTR Score: 3 (KGS 3)
KGS Range: VIR3-VIIR3
PTR Criteria: Considerable neoplastic regression. 15-35% residual tumor cells
PTR Score: 4 (KGS 4)
KGS Range: VIR4-VIIR4
PTR Criteria: Limited neoplastic regression. 35-50% residual tumor cells
PTR Score: 5 (KGS 5)
KGS Range: VIR5-VIIR5
PTR Criteria: Insignificant neoplastic regression. >50% residual tumor cells
Table 4: The KGS’s PTR Grading. The KGS’s PTR Grading, a five-tier-scale system, is based on the existing tumor cells’ proportional value in relation to the proportions of necrosis and fibrosis in regressing solid tumors. In pathologic examination reports, tumors’ PTR scores, which are designated as KGS 0, KGS 1, KGS 2, KGS 3, KGS 4, and KGS 5, also indicate the five levels of the grading where the corresponding KGS ranges take place synchronously (e.g. KGS 3 : VIR3-VIIR3)
KGS Prognostic Ranges
KGS Index: <1
Prognostic KGS Range: Normal (N)
NORMAL RANGE: This is the range where a totally normal tissue and cells are seen. Examples: 1. A normal tissue with no status or history of neoplastic activity, 2. Fully regressed neoplastic tissue.
KGS Index: 1-7
Prognostic KGS Range: Low (L)
LOW RANGE: The range of tumoral activity with no considerable neoplastic weight. Examples: 1. Grade III-IV tumors, 2. Almost fully regressed neoplastic tissue.
KGS Index: 8-18
Prognostic KGS Range: Medium (M)
MEDIUM RANGE: This is the range of emerging neoplastic activity, with considerable neoplastic potential and significance. Examples: 1. Grade VB-VC tumors, 2. Fairly regressed neoplastic tissue.
KGS Index: 19-29
Prognostic KGS Range: High (H)
HIGH RANGE: The high range is the range of established neoplasia where a qualified malignant tumor tissue takes place with all the features of neoplasia: Fully developed cancer (e.g. Grade VIA-VIB tumors).
KGS Index: 30-40
Prognostic KGS Range: Extreme (E)
EXTREME RANGE: This is the range of neoplasia where tumors with full neoplastic features and complications, including necrosis (high necrosis) and metastasis, take place: Full-blown cancer (e.g. Grade VIB-VIIA tumors).
KGS Index: >40
Prognostic KGS Range: Ultimate (U)
ULTIMATE RANGE: The range of the most advanced malignancy with highly malignant anaplastic cells with maximum mitotic, necrotic and metastatic activity: Full-scale anaplasia (e.g. Grade VIIA-VIIB tumors).
Table 5: The KGS Prognostic Ranges. The prognostic KGS ranges, highly important and crucial to use in the prognostic follow-up in clinical oncology, are used for both malignant and benign tumors. Range levels are determined by the ranges of the “KGS Index” whose variable limits of numerical values directly make up the levels. The “Normal” range level with the KGS Index of “<1” covers normal tissues and regressive tumors that have fully regressed to normality.
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