Abstract Embryonal rhabdomyosarcoma (ERMS) is a primitive and aggressive soft tissue tumor that arises from premature mesenchymal cells and accounts for less than 1% of prostate malignancies. We present the case of a 26-year-old Filipino male who initially sought consultation and work-up for acute urinary retention. Although his prostate-specific antigen (PSA) level was normal, a kidney-ureter-bladder (KUB) ultrasound revealed an incidental finding of an enlarged prostate gland. Subsequent imaging tests (MRI and CT) identified a large, partially exophytic mass on the prostate with intravesical extension. The patient underwent a biopsy via transurethral resection at another institution, which yielded findings of a poorly differentiated carcinoma, primarily suggesting prostatic adenocarcinoma with a Gleason score of 10 (5+5). A request for slide review was submitted to our institution, and subsequent immunohistochemistry (IHC) studies—highlighting the tumor's immunoreactivity to myogenin and desmin—confirmed the diagnosis of ERMS. In this report, we discuss the clinical features, pathogenesis, treatment, diagnosis, and prognosis of this rare prostate tumor.
Embryonal rhabdomyosarcoma ; Immunohistochemistry ; Prostate ; Young adult

Angiomyolipoma with epithelial cysts (AMLEC) is a rare subtype of angiomyolipoma that may closely mimic both malignant and benign neoplasms. We report a case of AMLEC in an 18-year-old female presenting with acute flank pain and radiologic suspicion for malignancy. This case highlights the diagnostic challenges posed by AMLEC, emphasizes its characteristic histopathologic and immunohistochemical features, and reviews current concepts regarding its pathogenesis. This case represents the first documented case of AMLEC in the Philippines.

Background: The effectiveness of intravenous tissue plasminogen activator (IV tPA) in patients with large-vessel occlusion (LVO) receiving endovascular treatment (EVT) for acute ischemic stroke (AIS) has been questioned. We investigated IV tPA effectiveness in real-world AIS patients, including those with intracranial LVO receiving EVT. Methods: We identified patients with AIS who presented to hospital with National Institutes of Health Stroke Scale ≥4 within 8 hours of symptom onset from the institutional stroke registry. The association of IV tPA use with effectiveness and safety outcomes was analyzed in overall enrolled AIS patients; LVO patients; and patients treated with EVT. The effect of IV tPA was assessed using multiple logistic regression. Results: Among the 654 patients meeting study entry criteria, 238 (36.4%) received IV tPA and 416 (63.6%) did not. Multiple logistic regression analysis and shift analysis revealed IV tPA was associated with improved outcomes in overall enrolled AIS population, LVO, and EVT-treated subgroups. Among EVT-treated patients, IV tPA was associated with higher likelihood of ambulatory or better outcome (modified Rankin Scale 0–3) with odds ratio of 1.95 (P=0.03). Conclusions In this real-world study, IV tPA use was associated with improved outcomes for patients with AIS, including among LVO patients treated and not treated with EVT, in the contemporary mechanical thrombectomy era.

Leydig cell tumor is a rare testicular neoplasm that can present as a non-palpable small testicular nodule. Here we present a case of a 36-year-old Filipino male who initially came in for fertility work-up. Semen analysis showed azoospermia. However, an incidental finding on ultrasound showed a well-circumscribed round tumor. The patient underwent radical orchiectomy. On histopathologic examination, a Leydig cell tumor was identified and supported by immunohistochemical staining. We discuss the clinical features pathogenesis, treatment, diagnosis and prognosis of this uncommon entity.
Leydig Cells ; Testis ; Orchiectomy ; Infertility

Lower incidence and mortality rates from prostate cancer (PCa) have been shown in Asian men in general compared to Westerners. This is the first study detailing the clinicopathologic features of resected prostate cancer in Filipino men living in the Philippines (PH). This study investigated the supposed "lower risk" Filipino and "higher risk" American PCa patients from the PH and the United States of America (USA), respectively. We examined 348 (176 from PH, 172 from USA) radical prostatectomy cases. The clinicopathologic features of both groups (age at time of diagnosis, preoperative prostate-specific antigen [pre-op PSA] level, Gleason score [GS], Grade groups [GG], margin involvement, extraprostatic extension [EPE], seminal vesicle invasion [SVI], and regional lymph node [RLN] metastasis) were compared. Six of seven prognosticators examined were more strongly associated with Filipinos than with Americans. Filipinos were older at diagnosis (PH: 64.32 ± 6.56 years vs USA: 58.98 ± 8.08 years) and had higher pre-op PSA levels (PH: 21.39 ± 46.40 ng ml

Neuroendocrine carcinoma (NEC) of the endometrium is a rare, aggressive subtype of endometrial cancer. We report a 61-year-old female with a history of breast cancer, s/p modified radical mastectomy, chemotherapy, radiotherapy and hormonal (tamoxifen) therapy, who presented with post-menopausal bleeding. Patient underwent TAH-BSO with lymph node dissection, and was diagnosed with a mixed small cell neuroendocrine carcinoma (SCNEC) and large cell neuroendocrine carcinoma (LCNEC), confirmed by positive immunohistochemical staining for neuroendocrine markers. No other lesions were identified on PET-CT, making a primary endometrial NEC the most likely diagnosis. We review the clinical and pathologic characteristics of endometrial neuroendocrine carcinomas.
Endometrial Neoplasms ; Carcinoma, Neuroendocrine ; Carcinoma, Large Cell ; Carcinoma, Small Cell

Yolk sac tumor is the second most common subtype of ovarian germ cell tumors and is rare in postmenopausal women. The few cases in literature have found that in this age group, yolk sac tumors more commonly present as a mixed component, combined with epithelial tumors. We report a case of a 60-year-old female who presented with an enlarging abdominopelvic mass. Imaging pointed to an ovarian new growth. Total abdominal hysterectomy with bilateral salpingo-oophorectomy revealed a tumor with three populations composed of carcinomatous, sarcomatous, and germ cell components, which was ultimately diagnosed as an ovarian carcinosarcoma with concurrent yolk sac tumor based on histomorphology and immunohistochemical staining. This report also discusses the proposed pathogenesis, treatment, and prognosis of this uncommon entity.
Carcinosarcoma ; Endodermal Sinus Tumor ; Ovary

OBJECTIVE: This study aims to evaluate the effects on biochemical recurrence (BCR) of the followingproposed prognostic factors after radical prostatectomy (RP): patients' clinical T stage, Gleason gradegroup (GG) of RP specimen, technique of operation used (open RP vs. robot-assisted laparoscopicRP), presence of positive surgical margin (PSM), length of PSM, GG at PSM, extraprostatic extension(EPE) at PSM, and presence of detectable PSA at 4-6 weeks after RP. It also aims to identify whichamong the aforementioned variables are independent predictors of risk for BCR. PATIENTS AND METHODS: This is a retrospective study. Included in the study were patients who underwentRP (Open and Robot-assisted Laparoscopic technique) at two tertiary hospital branches of an academicmedical center from April 2009 to December 2015 with histopathology reports read by a singleurologic pathologist and with complete follow- up for at least one year. Excluded were those whounderwent RP but without complete follow- up. Using Pearson chi-square and z-test with level ofsignificance set at 0.05, the clinicopathologic variables including: patients clinical stage, GG of RPspecimen, length of PSM, GG at positive margins, presence of EPE at positive margins, and presenceof detectable PSA after the surgery were assessed in order to know which among these factors werepredictive of BCR. Multinomial regression analysis was also used to identify which among the variableswere independent predictors of risk for BCR. RESULTS: A total of 165 patients underwent RP from April 2009 to December 2015, among which 72patients were eligible for inclusion in the final analysis. Clinical T2 stage was found to be a predictorof BCR with odds ratio of 13.000 (95%CI: 3.705 - 45.620; p < 0.001) as compared to stage T1. GGof final histopathology report of prostatectomy specimen was found to be a predictor of BCR, asthose with grade groups 4 and 5 had significantly increased risk of BCR with odds ratio of 70.778(95%CI: 8.207 - 610.426; p < 0.001) as compared to those with grade groups 1 to 3. Patients withpositive margins had increased risk of BCR, with odds ratio of 13.458 (95%CI: 13.472 - 52.171; p <0.001) compared to those with negative margins. GG at the PSM was found to be a predictor of BCR,with a grade grouping of 4 or 5 at the positive margin predicting BCR with odds ratio of 20.625(95%CI: 2.241 - 189.847; p = 0.008) as compared to grade grouping of 1 or 2 at the margin. DetectablePSA after RP was found to be a predictor of BCR, with odds ratio of 115.000 (95%CI: 19.457 -679.712; p < 0.001) as compared to undetectable PSA after RP. Technique of RP (p = 0.177), measuredlength of PSM (p = 0.713), and EPE at PSM (p = 0.146) were not found to predict BCR. Furthermore,clinical T stage (p = 0.007) and detectable PSA after RP (p < 0.001) were found to be independentpredictors of BCR among the risk factors examined. CONCLUSION Of the independent variables examined, clinical T stage, GG of RP specimen, presenceof PSM, GG at positive margins, and detectable PSA were found to be significant predictors of BCR. Technique of RP, measured length of PSM, and EPE at PSM were not found to predict BCR.Furthermore, multivariate analysis showed that only clinical T stage and detectable PSA after RPwere independent predictors of BCR. Attentive assessment of these predictors in the preoperativeperiod should aid the urologist in clinical decision-making and in advising patients regarding theirprognosis.

OBJECTIVE: Image-guided targeted biopsy techniques have been proposed to address problems ofsystematic transrectal ultrasound guided prostate biopsies that lead to the suboptimal cancer detectionrate as well as inaccurate grading of the disease. This study aims to provide local data on the diagnosticaccuracy of multiparametric MRI (MP-MRI) and MP-MRI ultrasound cognitive fusion biopsy inidentifying areas of clinically significant malignancy of the prostate. MATERIALS AND METHODS: This is a validity study involving patients who underwent MP-MRI and MP-MRI ultrasound cognitive fusion biopsy, who eventually underwent robot-assisted laparoscopic radicalprostatectomy (RALRP). Outcome measures included sensitivity, specificity, positive and negativepredictive values of MP-MRI and MP-MRI ultrasound cognitive fusion biopsy. Reference standardused was the final histopathologic report obtained after RALRP. RESULTS: MP-MRI has a sensitivity of 35.5%, specificity of 95.2%, positive predictive value of 97.1%,and negative predictive value of 25%. MP-MRI ultrasound fusion biopsy had similar results, withsensitivity of 34.4%, specificity of 81.0%, positive predictive value of 88.9%, and negative predictivevalue of 21.8%. CONCLUSION The high specificity and positive predictive value of MP-MRI (95.2% and 97.1%respectively) indicates the necessity for a prostate biopsy and supports the utility of a targeted MP-MRI guided ultrasound cognitive fusion biopsy. However, the low sensitivity and negative predictivevalue (25% and 35% respectively) of 35.5% indicates that MP-MRI guidance does not limit thenumber of biopsy samples only to visible MP-MRI lesions, since negative areas on MP-MRI stillcontains tumors in 75% of cases.