Granulomatous prostatitis (GP) frequently mimics prostatic adenocarcinoma on multiparametric MRI (mpMRI), producing elevated PI-RADS scores and diagnostic challenges. We retrospectively analyzed 63 patients with biopsy-proven GP (without concurrent prostate cancer) and paired mpMRI (2019–2025) to correlate radiologic and histopathologic findings. Median age was 66 years (range 41–80), median PSA 6.2 ng/mL (range 0.1–26.4), and median percentage of biopsy parts involved (PPI) was 36

Introduction: pediatric urinary tract infection (UTI) should be diagnosed based on compatible symptoms and a positive urine culture obtained using an appropriate technique, although diagnostic errors are common. Objective: to analyze diagnostic inadequacy in UTI according to the recommendations of the 2019 Spanish guideline. Material and methods: a prospective, multicenter observational study was conducted in Spain between October 2019 and December 2020. A total of 206 primary care pediatricians recorded episodes of suspected UTI in their assigned patients. Results: of the 1506 recorded episodes, 1402 were valid: 1212 (86.4%) were adequately diagnosed and 190 (13.6%) were inadequate (p<0.001). Causes of inadequacy included urine culture from an inappropriate sample (37.4%), diagnosis without urine culture (31.6%), incorrect interpretation of CFU/ml (26.8%), and underdiagnosis (4.2%). The use of urine collection bags in children under two years, particularly in primary care compared with hospital emergency departments (66.7% vs 21.7%; p=0.005), and the absence of urine culture in children aged six years or older compared with those aged two to five years (33.9% vs 66.1%; p=0.015) were associated with higher inadequacy. Hematuria (4.7% vs 11.1%; p=0.001), weight loss (2.4% vs 5.8%; p=0.016), and leukocyte esterase (42.8% vs 53.6%; p=0.009) were also associated with greater diagnostic error. Follow-up urine cultures were more frequent in inadequately diagnosed cases (39.0% vs 26.5%; p=0.002), and 23.6% of antibiotic treatments were unnecessarily maintained. Conclusions: a total of 13.6% of suspected UTI did not meet diagnostic recommendations, resulting in 23.6% of unnecessary antibiotic treatments. These findings underscore the need to strengthen evidence-based practices, particularly regarding urine sample collection, microbiological confirmation, and interpretation of culture results.

Sox9 is a transcription factor with multiple roles during development and in adult organ homeostasis. In the adult eye, Sox9 expression persists in several cell types, including the retinal pigmented epithelium cells and the Müller glial (MG) cells, as well as in the limbal and corneal basal epithelia. To uncover the role of Sox9 in these cell types, we induced the deletion of the gene in adult mice. We found that, after Sox9 ablation, mutant mice undergo a severe process of retinal degeneration characterized by the loss of MG cells and complete depletion of the photoreceptors layer. Moreover, by combining single-cell RNA sequencing and Sox9 lineage tracing, we found that Sox9 is expressed in a basal limbal stem cell population with the ability to form two types of long-lived cell clones involved in stem cell maintenance and homeostasis. Mosaic analysis of Sox9 positive and negative cells confirmed that the gene is essential for limbal stem cell differentiation. Our results show that Sox9 is required for the maintenance of retinal integrity and for limbal stem cell differentiation in the adult mouse eye.

AIMS:Compared to lymphovascular invasion (LVI), hilar soft tissue invasion (HSTI) is a relatively novel pT2 staging parameter in testicular germ cell tumours (GCT), associated with metastasis at the time of diagnosis and a risk factor for disease relapse. Given diagnostic variability in how pathologists interpret HSTI, herein we explore interobserver reproducibility among genitourinary (GU) pathologists. METHODS:Twenty haematoxylin and eosin-stained digitized slides from testicular GCTs were distributed to 30 GU pathologists to classify each as HSTI or not HSTI based on their respective clinical practices; slides with concomitant LVI were excluded. Slides were then evaluated for the following morphologic features: tumour invasion beyond prominent hilar vessels, tumour invasion beyond the rete, tumour invasion beyond the level parallel to hilar adipose tissue and tumour within (directly touching) hilar adipose tissue. Interobserver reproducibility was assessed, and the morphological features were correlated with HSTI. Relationships between pathologists' interpretations, morphological features and HSTI were evaluated using hierarchical clustering. RESULTS:Although the diagnosis of HSTI was relatively uniform with a majority agreement (>67%) reached in 17/20 slides, overall interobserver reproducibility was only moderate (kappa = 0.50). Morphological features such as invasion beyond the level parallel to hilar adipose tissue and invasion into fat were more sensitive and specific for HSTI, while features such as invasion beyond hilar vessels and invasion beyond rete were less useful. CONCLUSIONS:These findings suggest that more specific defined diagnostic criteria for testicular GCT HSTI are needed.

Supplementary Figure S1-S8; Supplementary Table S1-S3

The staging for pT2/pT3 penile squamous cell carcinoma (pSCC) has undergone major changes. Some authors proposed criteria wherein the distinction between pT2/pT3 was made using the same histopathological variables that are currently utilized to differentiate pT1a/pT1b. In this single-institution, North American study, we focused on (HPV-negative) pT2/3 pSCCs (i.e., tumors invading corpus spongiosum/corpus cavernosum), and compared the prognostic ability of the following systems: (i) AJCC (8th edition) criteria; (ii) modified staging criteria proposed by Sali et al (Am J Surg Pathol. 2020;44:1112-7). In the proposed system, pT2 tumors were defined as those devoid of lymphovascular invasion (LVI) or perineural invasion (PNI), and were not poorly differentiated; whereas pT3 showed one or more of the following: LVI, PNI, and/or grade 3. 48 pT2/pT3 cases were included (AJCC, pT2: 27 and pT3: 21; Proposed, pT2: 22 and pT3: 26). The disease-free survival (DFS) and progression-free survival (PFS) did not differ between pT2 and pT3, following the current AJCC definitions (p=0.19 and p=0.10, respectively). When the pT2/3 stages were reconstructed using the modified criteria, however, a statistically significant difference was present in both DFS and PFS between pT2 and pT3 (p=0.004 and p=0.003, respectively). The proposed staging system has the potential to improve the prognostication of pT2/pT3 tumors in pSCC. Each of these histopathologic variables has been shown to have a significant association with outcomes in pSCC, which is an advantage. Further studies are needed to demonstrate the utility of this modified staging system in patient populations from other geographic regions.

In this case report, we describe an unusual presentation of gout, manifesting as a fluorodeoxyglucose-avid anterior mediastinal mass mimicking a malignant neoplasm on positron emission tomography/computed tomography. The unusual observation of tophaceous gout in the anterior mediastinum is of relevance to chest physicians and surgeons as well as to radiologists and pathologists evaluating patients with lesions in the mediastinum.

In mammals, sex determination is controlled by antagonistic gene cascades operating in embryonic undifferentiated gonads12. The expression of the Y-linked geneSRYis sufficient to trigger the testicular pathway, whereas its absence in XX embryos leads to ovarian differentiation345. Despite this strong genetic component, the involvement of non-coding regulation in determining mammalian sex remains unclear6. Here we show that the deletion of a single microRNA cluster,miR-17∼92, induces complete primary male-to-female sex reversal in XY mice. Time-course analyses revealed thatSryis heterochronically expressed, showing a delay in XYmiR-17∼92knockout gonads, which subsequently activate the ovarian genetic program. Bulk and single cell RNA-seq analyses showed that Sertoli cell differentiation is reduced, delayed and unable to sustain the testicular fate. This disrupted differentiation results from a transient state of sex ambiguity in pre-supporting cells, which is later resolved towards the ovarian fate. Consistent with known mechanisms of miRNA-mediated gene regulation, the expression ofmiR-17∼92target genes is not stabilized in undifferentiated XY mutant gonads, affecting concomitantly the fine regulation of gene networks with critical roles in developing gonads. Our results demonstrate that microRNAs are key components for mammalian sex determination, controlling the timing ofSryexpression and Sertoli cell differentiation.