Utility of Alpha-Methyl Acyl-CoA Racemase Marker in Prostatic Adenocarcinomas

Abstract

Introduction: Prostatic adenocarcinoma is the second leading cause of cancer related death in men in the western world and its incidence is increasing in Asian countries. Hence, it is of diagnostic challenge for pathologists to report in tissue biopsies especially in small focus of suspicious glands in radical prostatectomies and needle biopsies. Aim: To evaluate the role of Alpha-Methyl Acyl CoA Racemase (AMACR) immunohistochemical marker in diagnosing prostatic adenocarcinomas and in benign conditions of prostate. Materials and Methods: This was a cross-sectional study of 26 cases of prostatic adenocarcinomas, two cases of High Grade Prostatic Intraepithelial Neoplasias (HGPIN), 139 cases of Benign Prostatic Hyperplasia (BPH) and two cases of atypical adenomatous diagnosed on routine Haemotoxylin and Eosin (H&E) stained sections during a period of four years from January 2016 to December 2019 at ASRAM Medical College, Eluru. Immunohistochemistry with AMACR marker was done in all cases. Membranous staining pattern was accepted for prostatic adenocarcinomas. Semiquantitative scoring method was employed and tissue sections were examined at high power magnification (X400) by Olympus light microscope to evaluate AMACR expression. Results: Out of the 26 cases of prostatic adenocarcinomas in the study, majority were Grade group IV according to Gleason scoring system. Majority of the prostatic carcinomas showed strong and diffuse AMACR positivity. All BPH and Atypical Adenomatous Hyperplasia (AAH) were negative to AMACR immunohistochemical marker. Conclusion: The AMACR was found to be important diagnostic immune marker in prostatic adenocarcinomas especially in problematic situations where quantity and quality of tissue is limited.