{"id":4447,"date":"2022-04-19T07:10:35","date_gmt":"2022-04-19T07:10:35","guid":{"rendered":"https:\/\/iboblr.in\/gupathsociety\/?page_id=4447"},"modified":"2022-06-03T09:57:50","modified_gmt":"2022-06-03T09:57:50","slug":"cow-2020-20","status":"publish","type":"page","link":"https:\/\/iboblr.in\/gupathsociety\/cow-2020-20\/","title":{"rendered":"COW-2020-20"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"4447\" class=\"elementor elementor-4447\" data-elementor-settings=\"[]\">\n\t\t\t\t\t\t\t<div class=\"elementor-section-wrap\">\n\t\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-be4762d elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"be4762d\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-c63c3a4\" data-id=\"c63c3a4\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-8b33c7e elementor-widget elementor-widget-heading\" data-id=\"8b33c7e\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.5.6 - 28-02-2022 *\/\n.elementor-heading-title{padding:0;margin:0;line-height:1}.elementor-widget-heading .elementor-heading-title[class*=elementor-size-]>a{color:inherit;font-size:inherit;line-height:inherit}.elementor-widget-heading .elementor-heading-title.elementor-size-small{font-size:15px}.elementor-widget-heading .elementor-heading-title.elementor-size-medium{font-size:19px}.elementor-widget-heading .elementor-heading-title.elementor-size-large{font-size:29px}.elementor-widget-heading .elementor-heading-title.elementor-size-xl{font-size:39px}.elementor-widget-heading .elementor-heading-title.elementor-size-xxl{font-size:59px}<\/style><h2 class=\"elementor-heading-title elementor-size-default\">CASE OF THE WEEK<\/h2>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-0828588 elementor-widget elementor-widget-text-editor\" data-id=\"0828588\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.5.6 - 28-02-2022 *\/\n.elementor-widget-text-editor.elementor-drop-cap-view-stacked .elementor-drop-cap{background-color:#818a91;color:#fff}.elementor-widget-text-editor.elementor-drop-cap-view-framed .elementor-drop-cap{color:#818a91;border:3px solid;background-color:transparent}.elementor-widget-text-editor:not(.elementor-drop-cap-view-default) .elementor-drop-cap{margin-top:8px}.elementor-widget-text-editor:not(.elementor-drop-cap-view-default) .elementor-drop-cap-letter{width:1em;height:1em}.elementor-widget-text-editor .elementor-drop-cap{float:left;text-align:center;line-height:1;font-size:50px}.elementor-widget-text-editor .elementor-drop-cap-letter{display:inline-block}<\/style>\t\t\t\t<p><strong>2020-20 \/ May 18 <\/strong><br \/><strong>(Contributors: Daniel H. Russell and Salvatore E. Mignano)<\/strong><\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-61734dc elementor-widget elementor-widget-text-editor\" data-id=\"61734dc\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<p>A 64 year-old-male presented with hematuria and a mass in the fossa navicularis of the anterior urethra. Past history was notable for Grade Group 5 (Gleason score 4+5=9) pT3b pN0 acinar adenocarcinoma of the prostate. His PSA had an interval increase to 0.569 ng\/mL. PSA immunohistochemistry on the tumor showed scattered patchy expression.<\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-7437663 elementor-arrows-position-inside elementor-pagination-position-outside elementor-widget elementor-widget-image-carousel\" data-id=\"7437663\" data-element_type=\"widget\" data-settings=\"{&quot;navigation&quot;:&quot;both&quot;,&quot;autoplay&quot;:&quot;yes&quot;,&quot;pause_on_hover&quot;:&quot;yes&quot;,&quot;pause_on_interaction&quot;:&quot;yes&quot;,&quot;autoplay_speed&quot;:5000,&quot;infinite&quot;:&quot;yes&quot;,&quot;speed&quot;:500}\" data-widget_type=\"image-carousel.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.5.6 - 28-02-2022 *\/\n.elementor-widget-image-carousel .swiper-container{position:static}.elementor-widget-image-carousel .swiper-container .swiper-slide figure{line-height:inherit}.elementor-widget-image-carousel .swiper-slide{text-align:center}.elementor-image-carousel-wrapper:not(.swiper-container-initialized) .swiper-slide{max-width:calc(100% \/ var(--e-image-carousel-slides-to-show, 3))}<\/style>\t\t<div class=\"elementor-image-carousel-wrapper swiper-container\" dir=\"ltr\">\n\t\t\t<div class=\"elementor-image-carousel swiper-wrapper\">\n\t\t\t\t\t\t\t\t<div class=\"swiper-slide\"><a data-elementor-open-lightbox=\"yes\" data-elementor-lightbox-slideshow=\"7437663\" data-elementor-lightbox-title=\"image1 PCANF F.1 GUPS300\" e-action-hash=\"#elementor-action%3Aaction%3Dlightbox%26settings%3DeyJpZCI6NTg2MCwidXJsIjoiaHR0cHM6XC9cL2lib2Jsci5pblwvZ3VwYXRoc29jaWV0eVwvd3AtY29udGVudFwvdXBsb2Fkc1wvMjAyMlwvMDRcL2ltYWdlMS1QQ0FORi1GLjEtR1VQUzMwMC5qcGciLCJzbGlkZXNob3ciOiI3NDM3NjYzIn0%3D\" href=\"https:\/\/iboblr.in\/gupathsociety\/wp-content\/uploads\/2022\/04\/image1-PCANF-F.1-GUPS300.jpg\"><figure class=\"swiper-slide-inner\"><img decoding=\"async\" class=\"swiper-slide-image\" src=\"https:\/\/iboblr.in\/gupathsociety\/wp-content\/uploads\/2022\/04\/image1-PCANF-F.1-GUPS300.jpg\" alt=\"image1 PCANF F.1 GUPS300\" \/><\/figure><\/a><\/div><div class=\"swiper-slide\"><a data-elementor-open-lightbox=\"yes\" data-elementor-lightbox-slideshow=\"7437663\" data-elementor-lightbox-title=\"image2 PCANF composite F.3 GUPS300\" e-action-hash=\"#elementor-action%3Aaction%3Dlightbox%26settings%3DeyJpZCI6NTg2MSwidXJsIjoiaHR0cHM6XC9cL2lib2Jsci5pblwvZ3VwYXRoc29jaWV0eVwvd3AtY29udGVudFwvdXBsb2Fkc1wvMjAyMlwvMDRcL2ltYWdlMi1QQ0FORi1jb21wb3NpdGUtRi4zLUdVUFMzMDAuanBnIiwic2xpZGVzaG93IjoiNzQzNzY2MyJ9\" href=\"https:\/\/iboblr.in\/gupathsociety\/wp-content\/uploads\/2022\/04\/image2-PCANF-composite-F.3-GUPS300.jpg\"><figure class=\"swiper-slide-inner\"><img decoding=\"async\" class=\"swiper-slide-image\" src=\"https:\/\/iboblr.in\/gupathsociety\/wp-content\/uploads\/2022\/04\/image2-PCANF-composite-F.3-GUPS300.jpg\" alt=\"image2 PCANF composite F.3 GUPS300\" \/><\/figure><\/a><\/div><div class=\"swiper-slide\"><a data-elementor-open-lightbox=\"yes\" data-elementor-lightbox-slideshow=\"7437663\" data-elementor-lightbox-title=\"image3 SYN F.2 GUPS300\" e-action-hash=\"#elementor-action%3Aaction%3Dlightbox%26settings%3DeyJpZCI6NTg2MiwidXJsIjoiaHR0cHM6XC9cL2lib2Jsci5pblwvZ3VwYXRoc29jaWV0eVwvd3AtY29udGVudFwvdXBsb2Fkc1wvMjAyMlwvMDRcL2ltYWdlMy1TWU4tRi4yLUdVUFMzMDAuanBnIiwic2xpZGVzaG93IjoiNzQzNzY2MyJ9\" href=\"https:\/\/iboblr.in\/gupathsociety\/wp-content\/uploads\/2022\/04\/image3-SYN-F.2-GUPS300.jpg\"><figure class=\"swiper-slide-inner\"><img decoding=\"async\" class=\"swiper-slide-image\" src=\"https:\/\/iboblr.in\/gupathsociety\/wp-content\/uploads\/2022\/04\/image3-SYN-F.2-GUPS300.jpg\" alt=\"image3 SYN F.2 GUPS300\" \/><\/figure><\/a><\/div>\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"swiper-pagination\"><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"elementor-swiper-button elementor-swiper-button-prev\">\n\t\t\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-chevron-left\"><\/i>\t\t\t\t\t\t<span class=\"elementor-screen-only\">Previous<\/span>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"elementor-swiper-button elementor-swiper-button-next\">\n\t\t\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-chevron-right\"><\/i>\t\t\t\t\t\t<span class=\"elementor-screen-only\">Next<\/span>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-87c9892 elementor-widget elementor-widget-heading\" data-id=\"87c9892\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Quiz<\/h2>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-fc8b781 elementor-widget elementor-widget-text-editor\" data-id=\"fc8b781\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<p><strong>1. What is the diagnosis?<\/strong><\/p><p>a. Invasive high grade urothelial carcinoma<\/p><p>b. Metastatic prostatic adenocarcinoma (acinar adenocarcinoma; usual-type)<\/p><p>c. Metastatic prostatic adenocarcinoma with neuroendocrine features<\/p><p>d. Metastatic large cell neuroendocrine carcinoma of prostatic origin<\/p><p>e. Primary urothelial large cell neuroendocrine carcinoma<\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-43390c7 elementor-widget elementor-widget-accordion\" data-id=\"43390c7\" data-element_type=\"widget\" data-widget_type=\"accordion.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.5.6 - 28-02-2022 *\/\n.elementor-accordion{text-align:left}.elementor-accordion .elementor-accordion-item{border:1px solid #d4d4d4}.elementor-accordion .elementor-accordion-item+.elementor-accordion-item{border-top:none}.elementor-accordion .elementor-tab-title{margin:0;padding:15px 20px;font-weight:700;line-height:1;cursor:pointer;outline:none}.elementor-accordion .elementor-tab-title .elementor-accordion-icon{display:inline-block;width:1.5em}.elementor-accordion .elementor-tab-title .elementor-accordion-icon svg{width:1em;height:1em}.elementor-accordion .elementor-tab-title .elementor-accordion-icon.elementor-accordion-icon-right{float:right;text-align:right}.elementor-accordion .elementor-tab-title .elementor-accordion-icon.elementor-accordion-icon-left{float:left;text-align:left}.elementor-accordion .elementor-tab-title .elementor-accordion-icon .elementor-accordion-icon-closed{display:block}.elementor-accordion .elementor-tab-title .elementor-accordion-icon .elementor-accordion-icon-opened,.elementor-accordion .elementor-tab-title.elementor-active .elementor-accordion-icon-closed{display:none}.elementor-accordion .elementor-tab-title.elementor-active .elementor-accordion-icon-opened{display:block}.elementor-accordion .elementor-tab-content{display:none;padding:15px 20px;border-top:1px solid #d4d4d4}@media (max-width:767px){.elementor-accordion .elementor-tab-title{padding:12px 15px}.elementor-accordion .elementor-tab-title .elementor-accordion-icon{width:1.2em}.elementor-accordion .elementor-tab-content{padding:7px 15px}}<\/style>\t\t<div class=\"elementor-accordion\" role=\"tablist\">\n\t\t\t\t\t\t\t<div class=\"elementor-accordion-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-7041\" class=\"elementor-tab-title\" data-tab=\"1\" role=\"tab\" aria-controls=\"elementor-tab-content-7041\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-accordion-icon elementor-accordion-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-accordion-icon-closed\"><i class=\"fas fa-plus\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-accordion-icon-opened\"><i class=\"fas fa-minus\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-accordion-title\" href=\"\">Quiz Answers<\/a>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div id=\"elementor-tab-content-7041\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"1\" role=\"tabpanel\" aria-labelledby=\"elementor-tab-title-7041\"><p>1. c<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-accordion-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-7042\" class=\"elementor-tab-title\" data-tab=\"2\" role=\"tab\" aria-controls=\"elementor-tab-content-7042\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-accordion-icon elementor-accordion-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-accordion-icon-closed\"><i class=\"fas fa-plus\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-accordion-icon-opened\"><i class=\"fas fa-minus\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-accordion-title\" href=\"\">Diagnosis<\/a>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div id=\"elementor-tab-content-7042\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"2\" role=\"tabpanel\" aria-labelledby=\"elementor-tab-title-7042\"><p>1. Metastatic prostatic adenocarcinoma with neuroendocrine features<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-accordion-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-7043\" class=\"elementor-tab-title\" data-tab=\"3\" role=\"tab\" aria-controls=\"elementor-tab-content-7043\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-accordion-icon elementor-accordion-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-accordion-icon-closed\"><i class=\"fas fa-plus\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-accordion-icon-opened\"><i class=\"fas fa-minus\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-accordion-title\" href=\"\">Discussion<\/a>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div id=\"elementor-tab-content-7043\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"3\" role=\"tabpanel\" aria-labelledby=\"elementor-tab-title-7043\"><p>The histology shows a poorly-differentiated tumor with prominent nucleoli and moderate amphophilic cytoplasm growing in sheets, with focal acinar formation. The tumor co-expresses synaptophysin and PSA. In conjunction with the patient\u2019s history, the findings are compatible with prostatic adenocarcinoma with neuroendocrine features (PCANF). Current primary prostatic neuroendocrine tumors recognized by the WHO include PCANF, prostatic adenocarcinoma with Paneth cell-like change, well differentiated neuroendocrine tumor (carcinoid tumor), small cell carcinoma, and large cell neuroendocrine carcinoma (LCNEC). By definition, PCANF is a morphologically typical usual-type (acinar) adenocarcinoma (usually high grade), which co-expresses both acinar and neuroendocrine markers via immunohistochemistry (IHC). The utility of identifying PCANF with the use of IHC is of unconvincing clinical benefit, and as such, the routine use of IHC to evaluate neuroendocrine phenotype is not recommended, and scattered tumor cells expressing a neuroendocrine phenotype in usual prostate cancer is normal. In light of this, the presence of neuroendocrine cells in usual-type prostate cancer often increases with castration resistance, and thus it is unsurprising that a majority of prostatic neuroendocrine cancers arise in previously treated patients, a process termed \u201ctransdifferentiation&#8221;. The value in recognition of PCANF is its distinction from neuroendocrine carcinomas, usually LCNEC, given that men with PCANF remain eligible for androgen deprivation therapy, whereas the diagnosis of \u201cneuroendocrine carcinoma\u201d may exclude patients from this potential benefit. The diagnosis of LCNEC of the prostate is contentious. To be considered, all of the classic morphologic findings must be present, including peripheral palisading and expansile nests of high grade classic tumor cells with central comedonecrosis and expression of at least 1 neuroendocrine marker without co-expression of acinar markers. There have been a handful of reported cases of morphologically pure LCNEC that co-express acinar markers, typically in a reduced fashion, which have arisen both de novo and post-therapy. The significance of these observations is currently unsettled, while some data, albeit sparse, indicates that clinical benefit may still be derived from traditional androgen deprivation therapy in these patients.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-accordion-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-7044\" class=\"elementor-tab-title\" data-tab=\"4\" role=\"tab\" aria-controls=\"elementor-tab-content-7044\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-accordion-icon elementor-accordion-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-accordion-icon-closed\"><i class=\"fas fa-plus\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-accordion-icon-opened\"><i class=\"fas fa-minus\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-accordion-title\" href=\"\">References<\/a>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div id=\"elementor-tab-content-7044\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"4\" role=\"tabpanel\" aria-labelledby=\"elementor-tab-title-7044\"><p>1. Humphrey PA, Amin MB, Berney DM. In: Molch H, Humphrey PA, Ulbright TM, Reuter VM eds. WHO Classification of Tumours of the Urinary System and Male Genital Organs. 4th ed. Geneva, Switzerland. WHO Press\/World Health Organization; 2016.<br \/><br \/>2. Epstein JI, Amin MB, Beltran H, Lotan TL, Mosquera JM, Reuter VE, Robinson BD, Tronosco P, Rubin MA. Proposed morphologic classification of prostate cancer with neuroendocrine differentiation. Am J Surg Pathol. 2014 Jun;38(6):756-767.<br \/><br \/>3. Bellur S, Van der Kwast T, Mete O. Evolving concepts in prostatic neuroendocrine manifestations: from focal divergent differentiation to amphicrine carcinoma. Hum Pathol. 2019 Mar;85:313-327.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-accordion-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-7045\" class=\"elementor-tab-title\" data-tab=\"5\" role=\"tab\" aria-controls=\"elementor-tab-content-7045\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-accordion-icon elementor-accordion-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-accordion-icon-closed\"><i class=\"fas fa-plus\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-accordion-icon-opened\"><i class=\"fas fa-minus\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-accordion-title\" href=\"\">Contributors<\/a>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div id=\"elementor-tab-content-7045\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"5\" role=\"tabpanel\" aria-labelledby=\"elementor-tab-title-7045\"><p>Daniel H. Russell and Salvatore E. Mignano<br \/>Tripler Army Medical Center<br \/><br \/>russdanny22@gmail.com<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-accordion-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-7046\" class=\"elementor-tab-title\" data-tab=\"6\" role=\"tab\" aria-controls=\"elementor-tab-content-7046\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-accordion-icon elementor-accordion-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-accordion-icon-closed\"><i class=\"fas fa-plus\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-accordion-icon-opened\"><i class=\"fas fa-minus\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-accordion-title\" href=\"\">Organ Site<\/a>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div id=\"elementor-tab-content-7046\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"6\" role=\"tabpanel\" aria-labelledby=\"elementor-tab-title-7046\"><p>Urethra<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-accordion-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-7047\" class=\"elementor-tab-title\" data-tab=\"7\" role=\"tab\" aria-controls=\"elementor-tab-content-7047\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-accordion-icon elementor-accordion-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-accordion-icon-closed\"><i class=\"fas fa-plus\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-accordion-icon-opened\"><i class=\"fas fa-minus\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-accordion-title\" href=\"\">Keywords<\/a>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div id=\"elementor-tab-content-7047\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"7\" role=\"tabpanel\" aria-labelledby=\"elementor-tab-title-7047\"><p>Prostatic Adenocarcinoma with Neuroendocrine Features; Castration Resistance; Transdifferentiation of Prostate Cancer;<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>CASE OF THE WEEK 2020-20 \/ May 18 (Contributors: Daniel H. Russell and Salvatore E. Mignano) A 64 year-old-male presented with hematuria and a mass in the fossa navicularis of the anterior urethra. Past history was notable for Grade Group 5 (Gleason score 4+5=9) pT3b pN0 acinar adenocarcinoma of the prostate. His PSA had an<br \/><a class=\"moretag\" href=\"https:\/\/iboblr.in\/gupathsociety\/cow-2020-20\/\">+ Read More<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"templates\/page-fullwidth_template.php","meta":{"pmpro_default_level":0,"footnotes":""},"class_list":["post-4447","page","type-page","status-publish","hentry","pmpro-has-access"],"_links":{"self":[{"href":"https:\/\/iboblr.in\/gupathsociety\/wp-json\/wp\/v2\/pages\/4447","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/iboblr.in\/gupathsociety\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/iboblr.in\/gupathsociety\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/iboblr.in\/gupathsociety\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/iboblr.in\/gupathsociety\/wp-json\/wp\/v2\/comments?post=4447"}],"version-history":[{"count":7,"href":"https:\/\/iboblr.in\/gupathsociety\/wp-json\/wp\/v2\/pages\/4447\/revisions"}],"predecessor-version":[{"id":6760,"href":"https:\/\/iboblr.in\/gupathsociety\/wp-json\/wp\/v2\/pages\/4447\/revisions\/6760"}],"wp:attachment":[{"href":"https:\/\/iboblr.in\/gupathsociety\/wp-json\/wp\/v2\/media?parent=4447"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}