Abstract
BackgroundTo evaluate the diagnostic utility of alpha-methylacyl CoA racemase (P504S) & HMWCK (34beta E12) in morphologically difficult prostate cancer.MethodsA total of 1034 cases were reviewed and divided into benign (585) malignant (399) and suspicious (50). Immunohistochemistry with HMWCK and AMACR was done on the 50 suspicious cases along with controls.ResultsForty nine suspicious cases were resolved by using both markers where as 1 case was resolved by further support with CD68. The original diagnosis was changed in 15 of 50 (30%) suspicious cases from benign to malignant, one case from benign to high grade PIN and in one case from malignant to benign. Change of diagnosis was seen in 17 of 50 (34%) suspicious cases with a significant p value of 0.002. The overall diagnosis was changed in 17 of 1034 cases (1.64%) of prostatic disease (p < 0.001).ConclusionsA combination of HMWCK and AMACR is of great value in combating the morphologically suspicious cases and significantly increasing the diagnostic accuracy in prostate cancer. Although, in this study the sensitivity and specificity of HMWCK and AMACR were high, yet it should be used with caution, keeping in mind all their pitfalls and limitations.
Highlights
The diagnosis of prostatic cancer (PC) is based on a combination of architectural, cytological and ancillary features rather than any single diagnostic feature none of which is absolutely sensitive and specific
Expression of high molecular weight cytokeratin (HMWCK)/amethylacyl CoA racemase (AMACR) in controls Benign controls In all the 16 benign controls (Table 1), HMWCK highlighted the presence of basal cells in the form of moderate to strong cytoplasmic continuous positivity
In this study we concluded that AMACR has a sensitivity of 92% and a specificity of 100% whereas HMWCK has a sensitivity of 100% and a specificity of 84%
Summary
The diagnosis of prostatic cancer (PC) is based on a combination of architectural, cytological and ancillary features rather than any single diagnostic feature none of which is absolutely sensitive and specific. Accurate tissue diagnosis can be very challenging due to the presence of either a small focus of cancer or due to the presence of many benign mimickers of malignancy like adenosis, sclerosing adenosis, atrophy, partial atrophy, basal cell hyperplasia, clear cell cribriform hyperplasia, post atrophic hyperplasia, nephrogenic adenoma, mesonephric hyperplasia, radiation atypia, seminal vesicle and cowpers glands [1,2,3]. Due to the widespread use of serum PSA as a mass screening test for prostate cancer there has been an ever increasing number of prostate needle biopsies and the need to give an accurate. To evaluate the diagnostic utility of alpha-methylacyl CoA racemase (P504S) & HMWCK (34beta E12) in morphologically difficult prostate cancer
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