Prostatic Acinar Adenocarcinoma Research Articles

Pelvic Gossypiboma Diagnosed at the Time of Radical Prostatectomy 30 Years after Inguinal Hernioplasty

Study Background: The term “Gossypiboma” is used to define a mass inside the body consisting of cotton matrix with surrounding foreign body reaction. Gossypibomas may be clinically silent or present in the postoperative period with a broad range of symptoms, mimicking a mass or abscess both clinically and radiologically. Although extremely rare, their precise incidence is unknown and probably underestimated. Methods: Herein we describe the case of a 71-year-old man with a large pelvic Gossypiboma diagnosed at the time of radical prostatectomy (RP) 30 years after inguinal hernioplasty. Results: Clinical stage of prostate cancer was cT2N1M0. Preoperative CT scan showed a 3.0 cm × 5.0 cm mass of unknown nature with inhomogeneous uptake of contrast medium close to the right iliac vessels suspected for lymph node metastasis. For this reason, an open approach was chosen for RP and extended lymph node dissection. A solid mass, firmly adherent to the surrounding tissues, was carefully dissected from the iliac vessels and removed en-block. The intraoperative examination revealed a left-behind surgical sponge. No surgical complications were recorded. At definitive histopathological analysis, a Gleason 4+4 pT3b N0 (n=28) prostatic acinar adenocarcinoma was found and a retained surgical sponge with a peripheral fibrous pseudocapsule, resulting from an inflammatory foreign-body reaction, were found. Surgical margins were negative for malignancy. Conclusion: Although more infrequent with the advent of standardized surgical counting, gossypibomas can still occur in surgical practice, being either asymptomatic occasional findings or, if not promptly diagnosed, lifethreatening causes of acute abdomen. In our case, the radiological appearance of the pelvic gossypiboma simulated a malignant lymphadenopathy and changed our surgical strategy from the robotic to the open approach. Overall, our case highlights how prevention represents the key aspect to ensure the maximal safety of surgical patients.

RELATIONSHIP BETWEEN THE EXPRESSION OF ERG/ PBOV1 PROTEINS AND LYMPH NODE METASTASIS AND MORPHOLOGICAL CHARACTERISTICS OF ACINAR ADENOCARCINOMA OF THE PROSTATE

When examining prostate cancer, a great attention is currently paid to the study of specific molecular characteristics of the tumor. It has been found that TMPRSS2-ERG is the most common fusion gene in prostate cancer. The fusion between TMPRSS2 and ERG/ ETV1 transcription factor genes participating in the processes of growth, differentiation and transformation of cells has been described in prostate cancer. During carcinogenesis, TMPRSS2 allele loses its promoter, and one of the ERG alleles gains that promoter leading to its overexpression in these tumor cells. Prostate and breast cancer overexpressed 1 (PBOV1) promotes proliferation of tumor cells by inhibiting the cell cycle and increasing the level of cyclin D1. It has been shown that the PBOV1 gene expression is regulated by androgens through FOXA-1 and FOXA-2 transcription factors and participates in the organogenesis in the embryo, as well as it controls the division of stem cells in adults, and plays a role in the development of certain types of malignant tumors. The purpose of the study was to analyze the expression of ERG and PBOV1 genes in acinar prostatic adenocarcinoma and evaluate their relationship with morphological characteristics and lymph node metastases. Material and methods. Surgical specimens from 85 patients with stage T1–3N0–3M0 prostate cancer were morphologically studied using standard techniques. All patients underwent radical prostatectomy. Histological type of the tumor was evaluated according to the 2016 WHO classification of tumors, and the tumor grade was assessed using the Gleason scoring system. Immunohistochemical examination was performed according to the standard technique. The expression of ERG (Clone, EP 111) and PBOV1 (Polyclonal) was assessed using histological scoring system. Proliferative activity was analyzed using Ki67 nuclear staining (Clone, SP6). Data analysis was performed using Statistica 10.0. Results. The high expression level of ERG and PBOV1 proteins was associated with tumor grading (Gleason score > 6) and lymph node metastasis. Inflammatory cell infiltration of the tumor was not associated with the frequency of lymph node dissemination. However, the presence of stromal retraction in acinar tumors was found to be associated with more frequent involvement of regional lymph nodes. The level of PBOV1 expression in tumor cells correlated with proliferative activity and associated with tumor invasion into seminal vesicles. Conclusion. The study showed the relationship between ERG /PBOV1 proteins and morphological characteristics of acinar adenocarcinoma of the prostate as well as the frequency of lymph node metastasis, thus indicating prognostic significance of these markers.

Intraductal Carcinoma of the Prostate

The histologic differential diagnosis of IDC-P on prostate needle biopsy includes high-grade prostatic intraepithelial neoplasia (HGPIN), invasive cribriform prostatic adenocarcinoma, prostatic ductal adenocarcinoma, and urothelial carcinoma extending into prostatic ducts. Diagnostic reproducibility is low in the category of intraductal lesions of the prostate (4) whereas, accurate diagnosis is crucial for patient management. When IDC-P is accompanied by invasive carcinoma, it is associated with higher grade and higher stage cancer. Isolated IDC-P (IDC-P unaccompanied by invasive cancer) on needle biopsy is generally associated with highgrade invasive prostatic adenocarcinoma on subsequent radical prostatectomy (2,4). IDC-P requires either definitive therapy or prompt rebiopsy. In contrast, HGPIN is considered a preneoplastic lesion; its presence does not require definitive therapy and in limited quantities, does not require rebiopsy. If urothelial carcinoma extending into prostatic ducts is identified on needle biopsy, radical cystoprostatectomy is recommended. Usual (acinar) prostatic adenocarcinoma and prostatic ductal adenocarcinoma are treated in the same manner and require definitive treatment.

Beyond Prostate Adenocarcinoma: Expanding the Differential Diagnosis in Prostate Pathologic Conditions.

Recent advances in magnetic resonance (MR) imaging of the prostate gland have dramatically improved the ability to detect and stage adenocarcinoma of the prostate, one of the most frequently diagnosed cancers in men and one of the most frequently diagnosed pathologic conditions of the prostate gland. A wide variety of nonadenocarcinoma diseases can also be seen with MR imaging, ranging from benign to malignant diseases, as well as infectious and inflammatory manifestations. Many of these diseases have distinctive imaging features that allow differentiation from prostate acinar adenocarcinoma. Early recognition of these entities produces a more accurate differential diagnosis and may enable more expeditious clinical workup. Benign neoplasms of the prostate include plexiform neurofibroma and cystadenoma, both of which demonstrate distinctive imaging features. Stromal neoplasms of uncertain malignant potential are rare tumors of uncertain malignant potential that are often difficult to distinguish at imaging from more-malignant prostate sarcomas. Other malignant neoplasms of the prostate include urothelial carcinoma, primary prostatic carcinoid, carcinosarcoma, endometrioid or ductal adenocarcinoma, and mucinous adenocarcinoma. Prostatic infections can lead to abscesses of pyogenic, tuberculous, or fungal origins. Finally, miscellaneous idiopathic disorders of the prostate include amyloidosis, exophytic benign prostatic hyperplasia, and various congenital cysts. Considerable overlap can exist in the clinical history and imaging findings associated with these prostate pathologic conditions, and biopsy is often required for ultimate confirmation of the diagnosis. However, many diagnoses, including cystadenoma, mucinous adenocarcinoma, sarcoma, and abscesses, have distinct imaging features, which can enable the informed radiologist to identify the diagnosis and recommend appropriate clinical workup and management. (©)RSNA, 2016.

The pathology of unusual subtypes of prostate cancer.

There are some current literatures describing the morphologic change of prostate carcinoma variants. Some subtypes do not respond to hormone deprivation therapy, for example adenosquamous and squamous cell carcinoma (SQCC), basaloid and adenoid cystic carcinoma (ACC), small cell carcinoma (SmCC), sarcomatoid carcinoma, urothelial carcinoma; some are defined in special Gleason grade, some develop different prognosis. So, it is very important to identify these rare subtypes to avoid misdiagnosis. In this review, we aim to describe the typical clinicopathological features of the rare variants of prostate cancer, including prostate acinar adenocarcinoma morphologic variants.

The Expression Frequency of Androgen Receptor, c-erbB2 and CD117 in Acinar Adenocarcinoma of Prostate and Normal Prostate Tissue and It’s Clinical Importance

The Expression Frequency of Androgen Receptor, c-erbB2 and CD117 in Acinar Adenocarcinoma of Prostate and Normal Prostate Tissue and It’s Clinical Importance

Foamy Gland Variant of Prostatic Carcinoma

The foamy gland variant (FGV) of prostatic acinar adenocarcinoma was first described by Nelson and Epstein (1) in 1996. Abundant xanthomatous cytoplasm with picnotic nuclei is characteristic for this variant. The FGV is uncommon but its incidence is not clear on transurethral resection materials (2). The age range of affected patients with foamy gland carcinoma does not differ from that of those with the usual prostatic adenocarcinoma.

Role of tumor-associated macrophages in the Hexim1 and TGFβ/SMAD pathway, and their influence on progression of prostatic adenocarcinoma

BackgroundHexamethylene bisacetamide-inducible protein 1 (Hexim1) regulates transforming growth factor-β (TGFβ) activity and turnover of SMAD proteins in a cyclin-dependent kinase 9-dependent way. It does so specifically through inhibiting function of this enzyme and by inhibiting the transcriptional activity of positive transcription elongation factor b (P-TEFb). Tumor-associated macrophages (TAMs) play a role in the progression of prostate adenocarcinomas. We investigated the clinicopathological significance of Hexim1, TGFβ, SMAD2, and SMAD7 expression in prostate adenocarcinoma cells, and assessed associations between TAMs density and these proteins. MethodsThe cases of 100 patients diagnosed with prostate acinar adenocarcinoma who had undergone radical prostatectomy were retrospectively examined. Each was reviewed for Gleason score, cancer stage, and specific histopathological features. Original slides were re-examined, and new slides were prepared and immunostained with Hexim1, TGFβ, SMAD2, SMAD7 and CD68. ResultsHexim1 expression was positively correlated with Gleason score, cancer stage, lymphovascular invasion, perineural invasion, extracapsular extension, and positive surgical margin. TAMs density was positively correlated with Gleason score, cancer stage, perineural invasion, extracapsular extension, and positive surgical margin. TAMs density was positively correlated with Hexim1 expression and TGFβ expression. More advanced cancer stage, lymphovascular invasion, perineural invasion, and extracapsular extension were correlated with strong Hexim1 expression, strong SMAD2 expression, and mild SMAD7 expression, respectively. Strong Hexim1 expression, strong TGFβ expression, and mild SMAD7 expression were associated with higher Gleason score. Strong Hexim1 expression was correlated with strong TGFβ expression and mild SMAD7 expression. Strong Hexim1 expression, strong SMAD2 expression, and mild expression of SMAD7 were associated with disease progression. Strong SMAD2 expression was associated with shorter disease-free survival. ConclusionThe results suggest that greater TAMs density, strong Hexim1 expression, strong SMAD2 expression, and mild SMAD7 expression play important roles in the progression of prostate adenocarcinoma. Further investigation of these proteins will help facilitate the definitive prognosis of prostate adenocarcinomas. Ultimately, these proteins may be therapeutic targets for patients with prostate cancer.

Prostatic ductal adenocarcinoma: An aggressive variant that is underdiagnosed and undersampled on transrectal ultrasound (TRUS)-guided needle biopsy.

We sought to determine if prostatic ductal adenocarcinoma is undersampled and/or underdiagnosed at transrectal ultrasound (TRUS)-guided biopsy. With institutional review board approval, we searched our pathology database between 2008 and 2014 for patients with a diagnosis of ≥10% ductal adenocarcinoma on radical prostatectomy and available TRUS-guided needle biopsy specimens. Three blinded genitourinary pathologists independently examined the biopsy slides. The presence or absence of ductal adenocarcinoma was determined. Diagnostic accuracy was calculated using consensus diagnosis as the reference standard. Inter-observer agreement was assessed using Cohen's kappa coefficient. Based on consensus review, 66.7% (12/18) biopsy specimens demonstrated ductal adenocarcinoma and 33.3% (6/18) demonstrated conventional acinar prostatic adenocarcinoma. The sensitivity/specificity for each reader (R) was: 83/100% (R1), 100/83% (R2) and 58/83% (R3) and the inter-observer agreement was only fair (K=0.32). Only two of the original needle-biopsy reports correctly identified ductal adenocarcinoma (sensitivity = 17%). The main limitations of the study are the relatively small sample size and the potential for selection bias since we could only examine patients who underwent radical prostatectomy. Prostatic ductal adenocarcinoma may be undersampled at TRUS-guided biopsy and in this study was under-reported in routine clinical practice. This highlights the importance of increased awareness of ductal adeoncarcinoma and the need for clear diagnostic criteria. These findings have significant clinical impact especially when determining candidacy for active surveillance protocols.

Ductal and Acinar Adenocarcinoma of Prostate: Morphological and Immunohistochemical Characterization.

We sought to characterize the ductal and acinar subtype of prostate adenocarcinoma using hematoxylin and eosin (H&E) staining and an immunohistochemical antibody cocktail. We also investigated the clinical features, prostate-specific antigen (PSA) levels, and biological aggressiveness of these tumors. We utilized tumor bearing prostate biopsies, obtained between 2010 and 2014 from Dow Diagnostic Research and Reference Laboratory, to identify cases of prostatic ductal and acinar adenocarcinoma using routine H&E and immunohistochemical staining. The immunohistochemical antibody cocktail 34βE12/p63/AMACR was used for staining. The association of clinicopathological variables including patient's age at diagnosis, Gleason score, and PSA levels before surgery was retrospectively analyzed. A total of 10 ductal and 140 non-ductal cases were identified. Ductal cases were predominantly high grade with advanced histopathological features (90%; p=0.030). Marked elevation in PSA level was also reported in most cases. No other significant statistical difference was observed. Pathological and immunohistochemical examination could be used to characterize ductal and acinar adenocarcinoma of the prostate. Ductal adenocarcinoma of the prostate is a rare subtype of prostate carcinoma and is be more likely to present with advanced grade cancer suggesting that timely detection of the disease is vital.

Black pleural effusion

A 56-year-old man undergoing treatment for a prostatic acinar adenocarcinoma was referred to us in May, 2014, for assessment of a massive right pleural eff usion (fi gure). Although the eff usion was large, he had only mild shortness of breath and was admitted originally for urinary incontinence. A pleural aspiration showed black pleural fl uid (fi gure). This fl uid was determined to be an exudate with very high concentrations of protein (85 g/L; serum protein 56 g/L), lactate dehydrogenase, and amylase. We drained about 3 L of this black pleural fl uid from the patient over the following 24 h. Fibreoptic bronchoscopy was normal. However, a thoracoscopy showed nodularity of the visceral and parietal pleura with signifi cant pleural thickening. Pleural fl uid cytology showed groups of neoplastic cells arranged in balls, gland, and papillioid confi guration in a haemorrhagic background with mesothelial cells and mixed population of infl ammatory cells. Immunohistochemistry studies favoured a diagnosis of an adenocarcinoma of pulmonary origin. Percutaneous and thoracoscopic pleural biopsies also confi rmed this diagnosis. The patient is receiving treatment for lung and prostate cancer and at last follow-up in February, 2015, he had poor performance status and the pleural eff usion was persisting. Black pleural eff usions are extremely rare and have been reported previously in patients with pleural infections caused by Aspergillus niger and Rhizopus oryzae, metastatic melanoma, adenocarcinoma of the lung, pancreaticopleural fi stula, oesophageal perforation during activated charcoal treatment for a drug overdose, and in patients actively using crack cocaine. The black pleural fl uid in our patient was most likely due to haemolysis and the presence of haemosiderinladen macrophages after a massive bleed into the pleura. The absence of clinically signifi cant symptoms in spite of the massive eff usion and the fact that the fl uid was black and not red suggest that the fl uid collected over a prolonged period of time and that the bleeding would have occurred a long time before presentation. Increased concentrations of amylase in the pleural fl uid, as noted in our patient, are commonly seen in patients with lung cancer—most frequently in those with adenocarcinomas.

Prostatic Ductal Adenocarcinoma: Case Report and Literature Review

Prostatic Duct Adenocarcinoma (PDA), not a unique disease but with nearly 5% of the prostate carcinoma, clinically deviated from common Prostatic Acinar Adenocarcinoma (PAA) in recent years and was deemed the exact existence even with its long-standing origin debates. Addedly, it was usually more aggressive than PAA in most studies. As for our daily urologic practice, the 2 PDA cases (with obstruction symptoms; with gross hematuria) progressed to imaging-indicated bone metastases and were probably historically in the large primary periurethral prostatic ducts or the peripheral prostatic ducts and extending exophytically into the urethra and most commonly in and around the verumontanum before retrospective chart reviews. Convincingly, though the early diagnosis and aggressive treatment failed, long term follow-up for disease outcomes stayed serious. Indeed, the rate of the gene fusion in the pure PDA was significantly lower genetically and biologically than that in the PAA and will be likewise examined.

Bone marrow metastasis of prostatic adenocarcinoma with post-treatment foamy-like changes: A diagnostic pitfall

Prostatic acinar adenocarcinoma (PAA) is the most common malignant tumour of the male genital system. Hormonal therapy and radiotherapy are widely-used treatment modalities in advanced stage disease. However, with hormonal therapy, the morphology of the neoplastic cells can be altered with a shift towards benign-appearing cells with inconspicuous nucleoli and abundant cytoplasm. When the tumour spreads to the bone marrow, these neoplastic cells can mimic foamy histiocytes, which may lead to a misdiagnosis. This becomes more challenging if a concurrent bone marrow malignancy is identified. Attention should be paid if foamy cells are detected in bone marrow, particularly if the patient has a history of PAA. To the best of our knowledge, this is the first report of simultaneous bone marrow involvement by metastatic PAA with mimicking foamy histiocytes and lymphoplasmacytic lymphoma.

Models of neuroendocrine prostate cancer.

Prostate cancer remains the second leading cause of cancer death in men in the USA and most western countries. Prostatic acinar adenocarcinoma is the most commonly diagnosed form of prostate cancer. Small-cell neuroendocrine carcinoma is less frequently identified at the time of initial diagnosis, but this highly aggressive form of prostate cancer is increasingly observed in patients who have failed first- and second-line hormone therapy. Thus, developing and exploring models of neuroendocrine prostate cancer (NePC) are of increasing importance. This review examines the relevant xenograft tumor and genetically engineered mouse models of NePC, with the aim of addressing salient features and clinical relevance.

Does prostate acinar adenocarcinoma with Gleason Score 3 + 3 = 6 have the potential to metastasize?

BackgroundThere is a worldwide debate involving clinicians, uropathologists as well as patients and their families on whether Gleason score 6 adenocarcinoma should be labelled as cancer.Case descriptionWe report a case of man diagnosed with biopsy Gleason score 6 acinar adenocarcinoma and classified as low risk (based on a PSA of 5 ng/mL and stage cT2a) whose radical prostatectomy specimen initially showed organ confined Gleason score 3 + 3 = 6, WHO nuclear grade 3, acinar adenocarcinoma with lymphovascular invasion and secondary deposit in a periprostatic lymph node. When deeper sections were cut to the point that almost all the slice present in the paraffin block was sectioned, a small tumor area (<5% of the whole tumor) of Gleason pattern 4 (poorly formed glands) was found in an extraprostatic position.ConclusionThe epilogue was that the additional finding changed the final Gleason score to 3 + 3 = 6 with tertiary pattern 4 and the stage to pT3a.Virtual SlidesThe virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/13000_2014_190

Pseudopapillary Features in Prostatic Adenocarcinoma Mimicking Urothelial Carcinoma

High-grade prostate adenocarcinoma can have overlapping morphologic features with high-grade urothelial carcinoma, a critical distinction as treatments differ substantially. Pseudopapillary features have not previously been described in high-grade acinar prostate adenocarcinoma. We reviewed our consult cases (2006 to 2013) for cases of high-grade prostate adenocarcinoma, in which the Gleason score was equal to 5+4=9 or 5+5=10, and the differential diagnosis included high-grade urothelial carcinoma. We identified 7 consult cases of high-grade prostate adenocarcinoma with pseudopapillary features, mimicking urothelial carcinoma. Three cases were originally misdiagnosed as urothelial carcinoma. In 3 cases, the outside diagnosis was urothelial carcinoma versus prostate adenocarcinoma, and 1 case had no submitting diagnosis. All cases were transurethral resections, with tumor involving the prostatic urethra in 5 cases and 6 with bladder involvement. Three patients had a known history of prostate adenocarcinoma. The tumors grew in nests and sheets, 1 with microacinar differentiation and another with focal, rare glands. In places, tumors formed papillary-appearing structures with central blood vessels. In most cases, the nuclei were uniform with prominent nucleoli. One case had pleomorphic giant cell features, and another had sarcomatoid features. Necrosis was present in 2 cases. One case had a separate focus of low-grade noninvasive urothelial carcinoma present in the bladder and a better-differentiated prostate adenocarcinoma (Gleason score 4+3=7) involving the prostate on needle biopsy. In all cases, the pseudopapillary areas showed negative immunohistochemical staining for bladder markers including GATA3 (5 cases), p63 (5 cases), CK903 (4 cases), and thrombomodulin (3 cases). All cases showed positivity for prostatic markers including PSA (5 cases), p501s (6 cases), PSMA (4 cases), and NKX3.1 (5 cases). One case showed focal, nonspecific staining for p63, and another showed focal staining for p63 and CK903 in an area with squamous differentiation, contributing to the diagnostic difficulty. In summary, high-grade prostate adenocarcinoma can present in the urinary bladder and prostatic urethra, clinically mimicking urothelial carcinoma. Although high-grade prostate adenocarcinoma typically has relatively uniform cytology, it can have pleomorphic giant cell features overlapping with urothelial carcinoma. The presence of pseudopapillary features in high-grade prostate adenocarcinoma is a newly recognized morphologic overlap that can lead to further diagnostic difficulty in distinguishing the 2 entities. For high-grade tumors involving the prostatic urethra without typical admixed lower-grade prostate adenocarcinoma, immunohistochemical studies for bladder and prostate markers should be carried out.

Increased androgen receptor gene copy number is associated with TMPRSS2-ERG rearrangement in prostatic small cell carcinoma.

Small cell carcinoma of the prostate (PSCC) is a highly aggressive malignancy that often develops in patients previously treated with hormonal therapy for metastatic prostatic acinar adenocarcinoma. The TMPRSS2-ERG gene rearrangement is highly specific for prostate cancer and shared by PSCC; however, the role of androgen receptor (AR) gene alterations and interaction with TMPRSS2-ERG rearrangement are incompletely understood in PSCC. Sixty-one cases of PSCC were examined for AR gene copy number and TMPRSS2-ERG rearrangement by fluorescence in situ hybridization (FISH) and AR protein expression by immunohistochemistry. Of 61 cases of PSCC, 51% (31/61) demonstrated increased AR gene copy number (FISH+), 54% (33/61) were positive for TMPRSS2-ERG gene fusion, and 38% (23/61) showed AR protein expression. Of the 31 AR FISH+ cases, 23 also showed TMPRSS2-ERG gene fusion, and 16 expressed AR protein. Of the 33 cases with TMPRSS2-ERG fusion, 28 were AR FISH+ or expressed AR protein. Statistically significant correlations were observed between AR gene copy number or AR protein expression and TMPRSS2-ERG gene fusion (P = 0.001 and P = 0.03, respectively). In summary, high AR gene copy number emerges during the development of PSCC, often in association with TMPRSS2-ERG rearrangement. This potential mechanism warrants further study. Improvement will come from understanding the biology of the disease and integrating new therapies into the treatment of this rare and aggressive tumor.

Foamy Gland Carcinoma of the Prostate in Needle Biopsy

Foamy gland carcinoma is a variant of prostatic acinar adenocarcinoma characterized by abundant, foamy cytoplasm, frequently showing small, pyknotic nuclei. The incidence and Gleason grade of foamy gland carcinoma in a large prostate needle biopsy series have not been established. Foamy gland carcinoma may be deceptively benign appearing and missed on needle biopsy. Immunohistochemical staining for basal cells and α-methylacyl-CoA racemase (AMACR) can support a diagnosis of foamy gland carcinoma, but the sensitivity of AMACR for foamy gland carcinoma has been reported to be lower than that for usual acinar carcinoma. The utility of ERG immunohistochemistry in the diagnosis of foamy gland carcinoma has not been explored. The aim of this study was to characterize the incidence and Gleason grade of foamy gland carcinoma in a large consecutive series of prostate needle biopsy cases. We also assessed ERG expression in foamy gland carcinoma, in comparison with AMACR expression, to determine whether ERG expression provides added diagnostic value beyond AMACR expression. We evaluated a consecutive series of 476 prostatic adenocarcinoma needle core biopsy cases for presence, linear extent, and Gleason grade of foamy gland carcinoma. A selected block from each case containing foamy gland carcinoma was evaluated for AMACR and ERG expression by immunohistochemistry. Of the 476 cases, 17% contained a foamy gland carcinoma component, with 2% of the cases showing pure foamy gland carcinoma. Two cases of pure foamy gland carcinoma had a total linear extent of <3 mm. The majority (80%) of cases had a Gleason score 3+3=score of 6. Sensitivity of AMACR for foamy gland carcinoma was 92%, and sensitivity of ERG was 42%. No AMACR-negative case was ERG positive. Low AMACR expression was detected in 24 of 72 cases (33%), and of these cases ERG was positive in 5 (21%). In summary, foamy gland carcinoma features are relatively common in prostate needle core biopsies, the foamy gland carcinoma is admixed with usual acinar carcinoma in the majority of cases, and is usually not of high Gleason grade, although 20% are Gleason score 7 or greater. ERG immunohistochemistry did not provide added value beyond AMACR expression in most cases, suggesting that it need not be initially utilized in addition to basal cell markers and AMACR when immunohistochemistry is needed to substantiate a diagnosis of foamy gland malignancy. This is an important consideration in this era of cost-consciousness in application of immunohistochemistry. Sensitivity of AMACR for foamy gland carcinoma was comparable to that seen in studies of usual acinar carcinoma and is an excellent marker for foamy gland carcinoma of the prostate. ERG immunohistochemistry could be considered in a second round of immunostaining of select difficult cases of foamy gland carcinoma with low AMACR expression.

The prognostic role of ERG immunopositivity in prostatic acinar adenocarcinoma: a study including 454 cases and review of the literature

TMPRSS2/ERG fusion is among the most frequent genetic anomalies in prostate adenocarcinomas. Although positive immunostaining for ERG has been shown to tightly correlate with ERG fusion status, the clinical and prognostic significance of a positive ERG stain remains undetermined. The significance of ERG immunostaining in 454 consecutive prostate adenocarcinomas from radical prostatectomies (RPs) using tissue microarrays, herein, is evaluated. A separate set of 59 cases of incidental prostate adenocarcinoma detected on transurethral resection of prostate with a Gleason score of 6 was also included. ERG translocation was significantly more common in peripheral zone cancer in comparison with cancer of the transitional zone (33% in RP versus 5% in transurethral resection of prostate specimens). In the RP cohort, although ERG positivity was significantly associated with younger age at presentation and lower prostate-specific antigen values, it showed no association with Gleason score or with pathologic stage. In multivariate analysis, biochemical recurrence was only associated with the final RP Gleason score and elevated prostate-specific antigen levels and was unrelated to neither ERG positivity or to its staining intensity. In our hands, ERG positivity was unrelated to either aggressive local tumor characteristics or a worse outcome. Our results, as well as an extensive review of the related literature showing conflicting findings, seem to indicate that ERG immunopositivity cannot be considered as an important prognostic factor in prostate cancer.

Biopsy-proven brain metastases from prostate cancer: a series of four cases with review of the literature

Prostate cancer is very common and is the second most common cause of cancer death in males in Australia; however, brain metastases are exceedingly rare. We review four cases of biopsy-proven brain metastases from prostate cancer and review the relevant literature. Three of four patients had acinar adenocarcinoma of prostate with one patient having ductal adenocarcinoma variant on histopathology. Three patients had the brain as the only site of metastatic disease. All patients underwent surgery, and three of four patients underwent adjuvant palliative radiotherapy to the brain. Brain metastases from prostate cancer are rare, but brain metastases without other sites of metastatic disease are exceedingly rare and may be more common with ductal adenocarcinoma variant.