Case ID: 146

Publication date: 29 May, 2015

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) Typical

there is 4, there is 3, really borderline between both 3+4 and 4+3

Pathologist 4 GS 3+4=7 (ISUP 2) Borderline higher
Pathologist 5 GS 3+3=6 (ISUP 1) Borderline higher

Classic Gleason pattern is 3+3 (cribriform glands are collapsible, not rigid, and would thus be pattern 3 rather than pattern 4; for ISUP in which all cribriform pattern is pattern 4 (unproven hypothesis), this would probably best be graded as 3 + 4

Pathologist 6 GS 3+4=7 (ISUP 2) Typical
Pathologist 7 GS 3+4=7 (ISUP 2) Typical
Pathologist 8 GS 3+4=7 (ISUP 2) Typical
Pathologist 9 GS 3+4=7 (ISUP 2) Typical
Pathologist 10 GS 3+4=7 (ISUP 2) Typical
Pathologist 11 GS 3+4=7 (ISUP 2) Typical
Pathologist 12 GS 3+4=7 (ISUP 2) Borderline higher
Pathologist 13 GS 3+4=7 (ISUP 2) Typical
Pathologist 14 GS 3+4=7 (ISUP 2) Typical
Pathologist 15 GS 3+4=7 (ISUP 2) Typical
Pathologist 16 GS 3+4=7 (ISUP 2) Typical
Pathologist 17 GS 3+4=7 (ISUP 2) Typical

Definite pattern 4 and definite pattern 3, so just a question of estimating the relative percentage of each.

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

Mainly well-formed separate glands with a second component of cribriform and poorly-formed glands

Pathologist 19 GS 4+3=7 (ISUP 3) Typical
Pathologist 20 GS 4+3=7 (ISUP 3) Borderline lower
Pathologist 21 GS 3+4=7 (ISUP 2) Typical
Pathologist 22 GS 3+4=7 (ISUP 2) Typical
Pathologist 23 GS 3+4=7 (ISUP 2) Typical
Pathologist 24 GS 4+4=8 (ISUP 4) Borderline lower
Pathologist 25 GS 3+4=7 (ISUP 2) Borderline lower


Case description (by case creator):

There is a focal cribriform gland that looks invasive. Occasional glands of cribriform cancer is enough for diagnosing GP4 and this case is then 3+4=7.