Pathological evaluation of prostate needle biopsies is labor-intensive and often requires ancillary immunohistochemistry (IHC), increasing cost and diagnostic turnaround time (TAT). Artificial intelligence (AI)-based decision-support tools may improve efficiency, but clinical deployment requires institutional validation and assessment of real-world impact. Within a fully digital pathology practice, we performed institutional validation of an AI-assisted prostate biopsy decision-support tool using routine clinical cases, with pathologist-rendered diagnoses as ground truth. Following validation, the tool was implemented into the routine sign-out. A retrospective pre–post analysis compared prostate biopsy cases signed out during 3-month periods before and after implementation, excluding a transition month. Diagnostic TAT was defined as the interval from whole-slide image scan completion to final sign-out. IHC utilization was recorded. Weighted median TATs and IHC use were compared using standard statistical methods. The validation cohort met all predefined acceptance criteria, demonstrating high AI performance (sensitivity 91–100%, specificity 99%, positive-predictive value 98%, negative-predictive value 96%, area under the curve 0.97). Following clinical implementation, diagnostic TAT decreased by 30% and IHC utilization decreased by 38%. Institutional validation and clinical implementation of an AI-assisted prostate biopsy decision-support tool were associated with significant reductions in diagnostic TAT and IHC utilization. When deployed as an adjunct within a digital workflow, AI assistance may enhance efficiency while preserving pathologist responsibility for final diagnosis.

Mesonephric-like adenocarcinoma is a rare uterine neoplasm recognized in the fifth edition of the World Health Organization Classification of Female Genital Tumors and poses diagnostic challenges due to its morphologic and immunophenotypic overlap with other endometrial carcinomas. We retrospectively reviewed three cases diagnosed at our institution, evaluating clinical presentation, histologic features, immunohistochemical profile, and available molecular findings, and performed a literature review of approximately 200 reported cases with emphasis on comorbidities and potential predisposing factors. All three patients presented with abnormal uterine bleeding and had hypothyroidism, and one patient had Down syndrome, representing the first reported case in this population. Tumors consistently expressed thyroid transcription factor 1, showed variable GATA3 expression, and demonstrated limited or absent hormone receptor expression. Literature review revealed frequent association with Müllerian-type lesions and recurrent KRAS mutations, while thyroid disease was not identified as a consistent comorbidity. These findings support a Müllerian origin for mesonephric-like adenocarcinoma and suggest that hypothyroidism is unlikely to represent a defining association. The occurrence in a patient with Down syndrome raises the possibility of an underlying genetic susceptibility that warrants further investigation.