Papers by Jennifer Gordetsky
The American Journal of Surgical Pathology, 2016
Recent studies have suggested that multiparametric magnetic resonance imaging (MRI)/ultrasound (U... more Recent studies have suggested that multiparametric magnetic resonance imaging (MRI)/ultrasound (US) fusion-guided prostate biopsy can detect more clinically significant prostate cancers, which could impact patient management. As many of the studies evaluating MRI/US fusion-guided prostate biopsy were conducted in specialized quaternary care centers, the question remains whether this technology is transferable to general practice. Our study assesses the diagnostic ability of MRI/US fusion-guided prostate biopsy compared with standard biopsy in the new era of prostate cancer Grade Grouping. We reviewed our prostate biopsy database evaluating men who underwent MRI/US fusion-guided prostate biopsy with concurrent standard 12-core extended-sextant biopsy. Patient demographics and pathologic findings were reviewed. All patient biopsies were performed by 1 of 2 urologic oncologists. Tumors were given a Grade Group for each biopsy based on the core with the highest grade in each case. A total of 191 patients underwent MRI/US fusion-guided biopsy with concurrent 12-core extended sextant biopsy, with a cancer detection rate of 56%. The average number of biopsy cores obtained via the targeted approach was significantly less than those obtained by standard biopsy, 4.8 cores versus 12 cores, respectively, P<0.001. There was no difference in cancer detection between targeted and standard biopsy, 41.4% and 49.2%, respectively, P=0.15. However, when comparing the 2 techniques, the degree of detection of ≥Grade Group 3 tumors significantly favored targeted biopsy over standard biopsy (P=0.009). MRI/US fusion-guided prostate biopsy is equivalent to the standard-of-care 12-core biopsy in terms of cancer detection and superior in detecting higher grade disease.
Urology, 2016
To identify risk factors for urologic reconstruction during surgery for endometriosis PATIENTS AN... more To identify risk factors for urologic reconstruction during surgery for endometriosis PATIENTS AND METHODS: We retrospectively identified patients in a surgical pathology database undergoing surgery for endometriosis at our institution from 2010-2015 and subsequently identified those patients with ureteral involvement. Patients were categorized as requiring minimal urologic surgery (e.g. ureterolysis only) or more extensive urologic surgery (e.g. ureteral reimplant). All patients were undergoing surgery for endometriosis, and preoperative risk factors were then identified to predict the need for intraoperative extensive urologic surgery. Of 386 women undergoing surgery for endometriosis, 82 (21%) women required a surgical procedure on the ureter. 15 of these 82 patients (18.3%) with ureteral involvement required urologic surgical expertise in the form of either ureteral reimplantation with or without psoas hitch, or ureterolysis with ureteral stenting or omental wrap. The remaining 67 underwent ureterolysis alone or no intervention. The presence of flank pain, any urinary symptom, or hydronephrosis on preoperative imaging was a significant predictor of the need for major urologic intervention. In patients with endometriosis undergoing surgery who complain of flank pain, any urinary symptom, or have hydronephrosis on preoperative imaging, one should have a high suspicion for needing to perform urologic reconstruction during surgery. Planning for this additional operation can afford the opportunity for appropriate urologic consultation and patient counseling.
J Urol, 2009
INTRODUCTION AND OBJECTIVE: FSH is important in the regulation of sertoli cell function and ultim... more INTRODUCTION AND OBJECTIVE: FSH is important in the regulation of sertoli cell function and ultimately spermatogenesis. The normal range for FSH in the post-pubescent male is commonly defined as 1.4-18.1 mIU/ml, which is uninformative in determining the etiology of male factor infertility since nearly all patients would be considered to have "normal" FSH levels. We examined the correlation of FSH and testosterone/FSH level with semen analysis parameters to evaluate whether the range for judging normal FSH levels should be reconsidered.
Urology, Jan 13, 2016
To identify occult metastases within LNs reported as negative by routine histologic evaluation. I... more To identify occult metastases within LNs reported as negative by routine histologic evaluation. In patients with high-grade, muscle-invasive urothelial carcinoma(UC) of the bladder, pelvic lymphadenectomy during radical cystectomy demonstrates a survival advantage, increasing with the number of lymph nodes (LNs) removed, even if negative for metastatic disease. This finding may potentially be explained by the presence of occult metastases. Radical cystectomy specimens with high-grade UC invading the perivesical tissue and negative LNs (pT3N0) between 2000-2014 were reviewed. Five levels were cut for each LN block. Two sections were cut per level: one stained for H&E and one for AE1/AE3. Micrometastases were defined as tumor deposits >0.2mm but <2mm. ITCs were defined as ≤0.2mm. Medical records and survival data were reviewed. We identified 21 cases, consisting of 370 lymph nodes. 6/21(29%) patients had occult metastases, including 5 occult metastatic UC and 1 occult metastatic...
Urology, 2016
To review the diagnosis and management of Nephrogenic adenoma (NA), an uncommon benign lesion fou... more To review the diagnosis and management of Nephrogenic adenoma (NA), an uncommon benign lesion found in the urinary tract. This lesion arises from a proliferation of implanted renal tubular cells, and although more common in adults, it can occur at all ages. NAs can recur and cause significant morbidity in patients. These tumors are also a potential diagnostic pitfall as they can clinically and histologically mimic malignancy in the urinary tract. We performed an Institutional Board Review approved search of our surgical pathology database from 2005-2015 for cases of NA. A retrospective chart review was performed with a focus on the clinical, pathologic, and radiographic findings in these patients. We identified 32 cases of NA in 31 patients. Lesions were most common in Caucasian males (male-to-female ratio of 2:1) with an average age at diagnosis of 55 years (range 25-77). Bladder was the most common site of occurrence (81.2%), followed by ureter (9.4%), urethra (6.3%), and intrarenal collecting system (3.1%). Most patients (72%) were symptomatic and presented with hematuria (41%), lower urinary tract symptoms (28%), pelvic or flank pain (6%), hydronephrosis (19%), or urinary incontinence (13%). NA was asymptomatic and identified incidentally in 9 (28%) patients. One patient (3%) had a renal transplant and 8 (26%) patients had diabetes mellitus. Twenty-six (84%) patients were managed with endoscopic resection of their tumors. NAs are benign lesions that can be a cause of significant morbidity and mimic malignant tumors. There should be increased suspicion in patients with predisposing factors.
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, Jan 10, 2016
The Oncology Grand Rounds series is designed to place original reports published in the Journal i... more The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors' suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice.A 64-year-old man with a history of cigarette smoking but no significant comorbidities presented with hematuria and dysuria. Computed tomography scans demonstrated a mass and thickening of the bladder wall and no evidence of metastasis. His laboratory evaluation showed normal blood cell counts and comprehensive metabolic panel with a calculated creatinine clearance of more than 60 mL per minute. A transurethral resection of the bladder tumor and biopsy identified transit...
Case Reports in Urology, 2015
The increased use of axial imaging in various fields of medicine has led to an increased frequenc... more The increased use of axial imaging in various fields of medicine has led to an increased frequency of incidental findings, specifically incidental cancer lesions. Hence, as the use of multiparametric magnetic resonance imaging (MP-MRI) for prostate cancer detection, staging, and management becomes more widespread, the potential for additional incidental findings in the pelvis increases. Herein, we report the case of a man on active surveillance for low-grade, early-staged prostate cancer who underwent MP-MRI and was incidentally found to have a high-grade bladder cancer lesion.
The American Journal of Surgical Pathology, 2015
Multiparametric magnetic resonance imaging (MP-MRI) incorporates high-resolution imaging to aid i... more Multiparametric magnetic resonance imaging (MP-MRI) incorporates high-resolution imaging to aid in the detection of lesions suspicious for prostate cancer (PCa). MP-MRI and MRI/ultrasound (US) fusion-guided prostate biopsy has been shown to detect more clinically significant PCa. However, to date there have been no studies in fusion-guided biopsies evaluating the detection of perineural invasion. We assessed whether MRI/US fusion-guided prostate biopsies diagnosed more perineural invasion compared with standard techniques. We reviewed our prospectively maintained prostate biopsy database evaluating men who underwent MP-MRI and MRI/US fusion-guided prostate biopsy between January 2014 and June 2015. Patients underwent MP-MRI followed by 12-core standard biopsy and fusion-guided biopsies of MRI-identified lesions. Patients&amp;amp;amp;amp;amp;amp;amp;amp;#39; clinical, radiologic, and pathologic findings were reviewed. A total of 114 patients underwent both 12-core standard biopsy and MRI/US fusion-guided prostate biopsy. The mean age and prebiopsy prostate-specific antigen of our patient cohort was 64.5 years and 10.7 ng/mL, respectively. Sixty-four of 114 (56%) patients were found to have PCa. Perineural invasion was identified in 19/64 (30%) patients. Of the patients with perineural invasion, 9 were diagnosed on the fusion biopsy only, 2 were diagnosed on standard biopsy only, and 8 were diagnosed on both standard and fusion biopsies. Perineural invasion was significantly associated with higher prostate-specific antigen and with a higher number of cores involved by cancer (P&amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05). Compared with standard biopsy, MRI/US fusion-guided prostate biopsy improves detection of perineural invasion in PCa. As perineural invasion has only been studied on standard biopsies to date, it is unclear whether this finding has the same clinical significance for MP-MRI targeted lesions.
Pediatric Urology, 2010
Boys of any age may develop acute scrotal pathology. Due to the potential for testicular loss, to... more Boys of any age may develop acute scrotal pathology. Due to the potential for testicular loss, torsion of the spermatic cord is always a diagnostic consideration. The goals of this chapter are to review the causes of the acute scrotum, define the appropriate diagnostic evaluation, advise criteria for referral, and outline reasoned management.
Human pathology, 2012
To investigate the role of frozen section assessment in sparing unnecessary orchiectomy for suspe... more To investigate the role of frozen section assessment in sparing unnecessary orchiectomy for suspected lesions, we retrospectively reviewed intraoperative testicular and paratesticular frozen section assessments performed at our institution between the years 1993 and 2010. Frozen section assessments were performed on 45 testicular lesions (age, 5-60 [mean, 32.2] years; lesion size, 0.5-9.7 [mean, 2.1] cm) and 20 paratesticular lesions (age, 26-76 [mean, 43.5] years; lesion size, 0.4-11.0 [mean, 2.8] cm) before the decision to complete radical orchiectomy. Benign/malignant frozen section assessment diagnoses were reported in 26/19 testicular cases and 17/3 paratesticular cases, respectively. Of the 26 benign testicular frozen section assessments, 5 cases resulted in orchiectomy, where permanent diagnoses included epidermoid cyst, large cell calcifying Sertoli cell tumor, fibrous pseudotumor, abscesses, and sarcoidosis, caused by a concern for potential malignancy or questionable viabi...
Human Pathology, 2013
It remains unanswered whether and how intraoperative frozen section analysis contributes to the s... more It remains unanswered whether and how intraoperative frozen section analysis contributes to the surgical margin status on radical prostatectomy specimens. We aimed to determine whether frozen section analysis during radical prostatectomy reduces the incidence of positive surgical margins. We retrospectively analyzed a consecutive series of patients undergoing robot-assisted laparoscopic radical prostatectomy performed at our institution between 2004 and 2011. We identified 2608 cases, including 1128 (43.3%) where intraoperative frozen section analysis was performed to assess surgical margins. Of the cases with positive (n = 60; 5.3%)/negative (n = 1029; 91.2%)/atypical or indeterminate (n = 39; 3.5%) frozen section analyses, 22 (36.7%)/83 (8.1%)/4 (10.3%) were found to have positive surgical margins on radical prostatectomy specimens, respectively. Thus, 109 (9.7%) of 1128 cases with frozen section analysis had positive surgical margins, compared with 163 (11.0%) of 1480 cases with no frozen section analysis (P = .264). When the patients were subgrouped by histopathologic characteristics, frozen section analysis led to a considerable reduction in the rate of positive surgical margins in cases with biopsy Gleason score 7 (12.4% → 8.7%; P = .087)/8 (28.6% → 16.3%; P = .048)/≥7 (15.3% → 10.1%; P = .012) tumor or pT3b (36.6% → 23.2%; P = .075)/≥pT3b (38.1% → 25.4%; P = .091) disease. Multivariate analysis further revealed that performing frozen section analysis in biopsy Gleason score 7 or higher tumors was an independent predictor of negative surgical margins (odds ratio, 0.61; P = .018). In addition, frozen section analysis of the distal urethra or apex of the prostate (7.5%, P = .035) as well as multiple negative frozen section analyses (≥2: 6.2%, P = .001; ≥4: 2.2%, P = .007) correlated with significantly lower rates of positive surgical margin, compared with no frozen section analysis. Overall, intraoperative frozen section analysis did not dramatically change surgical margin status of radical prostatectomy. Nonetheless, it could be useful in preventing incomplete tumor resection, especially in men with high-grade (Gleason score ≥7) tumor at the apex.
Urologia Internationalis, 2012
Dear Editor, Mixed epithelial and stromal tumor (MEST) is a relatively new entity of rare renal n... more Dear Editor, Mixed epithelial and stromal tumor (MEST) is a relatively new entity of rare renal neoplasm composed of a mixture of cystic and solid areas. To the best of our knowledge, this is the first report describing a MEST in adolescent males. A previously healthy 14-year ...
Histopathology, 2015
Intestinal metaplasia (IM) of the bladder is a benign glandular proliferation, where the urotheli... more Intestinal metaplasia (IM) of the bladder is a benign glandular proliferation, where the urothelium becomes lined by intestinal-type epithelium. There is no association between IM and an increased risk for the development of adenocarcinoma. However, in rare cases IM shows dysplasia, similar to that of the gastrointestinal tract. We evaluated the significance of urothelial IM with dysplasia. Consultation cases were searched for IM of the bladder with dysplasia. We identified 20 cases, including 17 males and females, aged 31-85 years (mean 60 years). Twelve (60%) patients had low-grade dysplasia and eight (40%) patients had high-grade dysplasia. Focal dysplasia was found in eight (40%) patients and non-focal dysplasia in 12 (60%) patients. IM with dysplasia was found with concurrent adenocarcinoma in eight (40%) cases. Five of these patients (63%) had disease recurrence and three (38%) patients died from their disease. IM with dysplasia was found with concurrent urothelial carcinoma in one case. Eleven patients had IM with dysplasia without evidence of malignancy. Of these, one went on to develop non-invasive, high-grade papillary urothelial carcinoma. Clinical follow-up is recommended in cases of IM with dysplasia, as a significant number of these cases are associated with concurrent carcinoma.
Human Pathology, 2014
This study focused on 11 cases of prostatic adenocarcinoma with Paneth cell-like change, which ha... more This study focused on 11 cases of prostatic adenocarcinoma with Paneth cell-like change, which had sparse to no Paneth cell-like granules; grading the tumor conventionally would have resulted in assigning a Gleason pattern 5 for the primary or secondary pattern. Ten cases were entirely composed of the Paneth cell-like component. Architectural patterns included the following: nest and cord-like architecture (n = 4; 36.4%), nests only (n = 6; 54.5%), and cords only (n = 1; 9.1%). All 11 cases had amphophilic cytoplasm. Among the 11 cases, 7 had rare granules, 1 had 10% of the cells with granules, and 3 had no granules. Within the Paneth cell-like feature component, rare nucleolar prominence was seen in only 4 (36.4%) of 11 cases. Eight cases were diffusely positive for chromogranin and synaptophysin, 2 for chromogranin only, and 1 for synaptophysin only. In the 3 cases where performed, Ki-67 showed a very low rate of less than 5%. The keys to recognizing these cases are as follows: (1) nests and cords in a small focus, (2) deeply amphophilic cytoplasm with careful search in most cases revealing rare Paneth cell-like eosinophilic granules, (3) indistinct nucleoli, and (4) immunohistochemical staining for neuroendocrine markers. Based on follow-up from prior studies and the current work, these tumors appear to have a favorable prognosis. The importance of recognizing this variant of adenocarcinoma with Paneth cell-like differentiation is that if these tumors were graded conventionally, 9 of the 11 cases would have been assigned a misleading Gleason score of 5 + 5 = 10 or 5 + 4 = 9.
The Prostate, 2011
Little is known about the role of semenogelins, seminal plasma proteins that play critical roles ... more Little is known about the role of semenogelins, seminal plasma proteins that play critical roles in semen clotting and subsequent liquefaction in the presence of zinc and prostate-specific antigen, in human malignancies. METHODS. We investigated the expression of semenogelins in four human prostate cancer lines by RT-PCR and Western blotting as well as in 70 radical prostatectomy specimens by immunohistochemistry. Effects of semenogelin overexpression on prostate cancer cell proliferation were also assessed. RESULTS. mRNA/protein signals for semenogelins I (SgI) and II (SgII) were detected only in androgen-sensitive LNCaP cells cultured with zinc. Transfection of SgI/SgII increased/ decreased cell growth of androgen receptor (AR)-positive/semenogelin-negative CWR22Rv1 in the presence of zinc, whereas it showed marginal effects in AR-negative/semenogelinnegative PC-3 and DU145. Immunohistochemical studies showed that SgI and SgII stain positively in 55 (79%) and 31 (44%) cancer tissues, respectively, which was significantly higher than in corresponding benign tissues [SgI-positive in 13 (19%) cases (P < 0.0001) and SgIIpositive in 15 (21%) cases (P ¼ 0.0066)]. Among the histopathological parameters available for our patient cohort, there was an inverse association only between Gleason score (GS) and SgII expression (GS 7 vs. GS ! 8: P ¼ 0.0150; GS7 vs. GS ! 8: P ¼ 0.0111). Kaplan-Meier and logrank tests further revealed that patients with SgI-positive/SgII-negative tumor have the highest risk for biochemical recurrence (P ¼ 0.0242). CONCLUSIONS. These results suggest the involvement of semenogelins in prostate cancer and their prognostic values in predicting cancer progression after radical prostatectomy. Additional functional analyses of semenogelins are necessary to determine their biological significance in prostate cancer.
Modern Pathology, 2012
Lymph node count has prognostic implications in bladder cancer patients who are treated with radi... more Lymph node count has prognostic implications in bladder cancer patients who are treated with radical cystectomy. Lymph nodes that are too small to identify grossly can easily be missed, potentially leading to missed nodal metastases and inaccurate nodal counts, resulting in inaccurate prognoses. We investigated whether there is a benefit to submitting the entire lymph node packet for histological examination to identify additional lymph nodes. We prospectively assessed 61 pelvic lymphadenectomy specimens in 14 consecutive patients undergoing radical cystectomy. The specimens were placed in Carnoy&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s solution overnight, then analyzed for lymph nodes. The residual tissue was entirely submitted to assess for additional lymph nodes. In 61 specimens, we identified 391 lymph nodes, ranging from 4-44 nodes per patient. We identified 238 (61%) lymph nodes with standard techniques and 153 (39%) lymph nodes in submitted residual tissue. The number of additional lymph nodes found in the residual tissue ranged from 0 to 26 (0-75%) per patient. These lymph nodes ranged in size from 0.05 to 1 cm. All additional lymph nodes were negative for metastatic disease. Submitting the entire specimen for histological examination allowed for identification of more lymph nodes in radical cystectomy pelvic lymphadenectomy specimens. However, as none of the additional lymph nodes contained metastatic disease, it is unclear if there is a clinical benefit in evaluating lymph nodes that are neither visible nor palpable in lymphadenectomy specimens.
The Journal of Urology, 2011
The Journal of Urology, 2011
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Papers by Jennifer Gordetsky