Fig. 5

Patient with ISUP grade group 4 prostate adenocarcinoma. H&E illustrates a primary grade of Gleason pattern 4 with a majority of poorly-formed glands and a minor grade of Gleason pattern 3 with well-formed glands giving rise to an ISUP grade group of 3. Reassessment with the biomarkers highlighted the presence of nests, cords and single cells throughout the poorly-formed regions to increase the Gleason pattern identified from 4 to 5 in the primary region of the tumour. Syndecan-1 labelling is strong and highlights nests, cords and single cells (indicated by the red arrow) while Sortilin has lost polarity and has minimal labelling (<1+ intensity) as illustrated in the higher power micrographs. This sample was regraded to ISUP 4 (Gleason grade 5 + 3) from the original ISUP 3 by H&E.