Mucinous Adenocarcinoma Of Prostate Research Articles

Metastatic Mucinous Adenocarcinoma of the Prostate: Case Report and a Review of the Literature

We report the case of a 47 years old man with a first-degree familial history of prostate cancer in the father and breast cancer in the sister. Our patient presented an irritative urinary syndrome for 7 months; the clinical examination revealed a stony prostate on rectal examination, initial PSA was 1ng /ml, pelvic MRI showed an enlarged prostate measuring 65*60*45mm, with irregular contours and a median lobe protruding into the bladder lumen. The tumor was globally responsible for a capsular effraction with infiltration of the posterior bladder wall in front and at the base of the seminal vesicles behind. The patient underwent a transurethral resection of the prostate (TURP) with anatomopathological and immuno-histochemical studies showing a profile in favor of a mucinous prostatic adenocarcinoma. The tumor markers angiotensin converting enzyme (ACE) and cancer antigen 19-9 (CA19.9) were normal at 9.71 ng/ml and 22.96 IU/ml respectively. The extension workup showed metastatic lesions in the lung and skin (positive skin biopsy). The total colonoscopy was normal. Clinically, the patient presented with a WHO performance status at 3 and could not receive chemotherapy. He was put under symptomatic treatment and passed away one month later. The series reported in the literature are few; nevertheless, it seems that the prognosis of mucinous adenocarcinoma is considered to be comparable if not favorable to conventional adenocarcinoma even though it has been believed to be more aggressive in the past.

Single Cutaneous Metastasis from Mucinous Adenocarcinoma of Prostate with Bladder Invasion: An Unusual Localization

Mucinous adenocarcinoma of the prostate is an extremely rare histological variant of prostate cancer. The malignancy potential, tumor grading, clinical course and prognosis of affected patients remain controversial. There are no data on the evolution of metastatic mucinous adenocarcinoma of the prostate. Our case describes the rapid and unfortunate evolution of a prostatic mucinous adenocarcinoma invading bladder with skin metastasis in a 47-year-old patient, who was hospitalized because of intermittent gross hematuria accompanied by bulky and dark red clots for more than two months. The diagnosis was confirmed after a prostatic Magnetic resonance imaging (MRI) and a transurethral resection of the prostate and bladder with anatomopathological study and immunohistochemical complement. The evolution was marked initially by the appearance cutaneous metastasis during his hospitalization and hepatic and splenic metastases 3 months after his initial extension workup which was negative; our patient is currently on his 2nd cycle of chemotherapy for palliative purposes. The aim of our article is to highlight the most important diagnostic features and specific aspects in the primary diagnosis of this tumor, which every urologist should keep in mind, and we will focus on the prognosis and the interest of an early and especially multidisciplinary management.

Mucinous adenocarcinoma of Prostate (MAOP), a rare variant of prostate adenocarcinoma: a case report and literature review

A prostatectomy specimen was received from a 72-year-old male with a previous needle core biopsy diagnosis of prostatic adenocarcinoma, Gleason score 3+4=7. Microscopic examination of the prostatectomy specimen demonstrated single and fused neoplastic glands floating in copious amounts of extracellular mucin representing >50% of the tumour volume. There was a minor component of non-mucinous conventional adenocarcinoma in the background. Immunhistochemistry NKX 3.1 and PSA showed positive staining of tumour cells. Clinical, radiological or serological evidence of carcinoma of another site was not revealed. A diagnosis of MAOP, Gleason score 4+3 =7 (WHO/ISUP Grade Group 3) with a tertiary component of Gleason pattern 5 comprising <1% of total tumour volume was made. MAOP is a rare variant, comprising 0.38–0.43% of prostatic carcinoma. It is characterised by tumour cells floating in >25% of extracellular mucin excluding any intraluminal mucin. The diagnosis should only be made in resection specimens, and following exclusion of secondary deposits of extra-prostatic origin of mucinous adenocarcinoma by clinical-radiological correlation and with confirmatory immunohistochemistry. Grading and scoring for MAOP should be performed according to the growth pattern similar to conventional adenocarcinoma. The prognosis appears to be similar to non-mucinous prostatic adenocarcinoma.

Clinical characteristics and treatment strategies of prostate mucinous adenocarcinoma: the multi-center summary of 36 cases

Objective To review the clinical characteristics of prostate mucinous adenocarcinoma cases and update literatures , and recommend the corresponding clinical treatment strategy. Methods From October 2010 to March 2018, 36 cases of prostate mucinous adenocarcinoma were involved from 5 urinary centers in China, including 9 cases from Shanghai Changhai Hospital, 4 cases from Wuhan Tongji Hospital, 13 cases from Shanghai Renji Hospitals, 8 cases from the First Affiliated Hospital of Nanjing Medical University, and 2 cases from Sichuan West China Hospitals. The patients′ age were (66.8±7.2) years (53-83 years) and the median PSA was 22.89 ng / ml (2.67-1786 ng / ml). Prostate biopsy confirmed Gleason score 3+ 3 points in 6 cases, 3+ 4 points in 9 cases, 4+ 3 points in 5 cases, 8 points in 11 cases, and 9 to 10 points in 5 cases. According to D′Amico risk stratification, 2 patients were in the low-risk group, 9 in the intermediate-risk group, and 25 in the high-risk group. Eight cases underwent radical retroperitoneal prostatectomy, 13 cases underwent laparoscopic radical prostatectomy, and 12 cases underwent robotic laparoscopic radical prostatectomy. Twenty-three cases underwent pelvic lymphadenectomy, including 12 cases of bilateral obturator lymph node dissection, and 11 cases of bilateral obturator+ intraorbital+ para-vascular para-aortic lymphadenectomy. Results All 36 operations were completed successfully.Twenty-three cases underwent pelvic lymphadenectomy, including 12 of bilateral obturator lymph node dissection, and 11 of bilateral obturator, intraorbital, and para-aortic lymphadenectomy. Pathological examination showed 9 cases of prostate mucinous adenocarcinoma, 26 cases of mucinous adenocarcinoma with acinar adenocarcinoma, and 1 case of mucinous adenocarcinoma with neuroendocrine and immunohistochemical positive of MUC2(+ ). Among 33 cases undergoing radical surgery, the pathological stage of ≤T2b in 12 cases (36.3%), T2c in 7 cases (21.2%), T3a in 7 cases (21.2%), T3b in 6 cases (18.2%), and T4 in 1 case (3.0%). Four cases had positive pelvic lymph nodes and 9 cases had positive margin. The median follow-up period was 26 months (6-48 months). The biochemical recurrence occurred in 6 patients one year after surgery, including 3 cases in the intermediate-risk group and 3 cases in the high-risk group. Six cases with postoperative biochemical recurrence and 19 cases with PSA>0.2 ng/ml after radical or palliative resection underwent adjuvant androgen deprivation therapy(ADT), no postoperative adjuvant radiotherapy or chemotherapy was administered, and 4 cases progressed to castration-resistant prostate cancer. Four cases with CRPC were in the high-risk group and had underwent radical surgery, and the median period progressed to CRPC was 26 months(3-37months)with 2 cases of death. However, there was no significant difference in the rate of biochemical recurrence and the incidence of CRPC in the low-risk group, the intermediate-risk group and the high-risk group. In addition, 2 cases had metastases, with pelvic MRI presenting pelvic multiple nodular mass in one case which was consistent with recurrence and metastasis at the 5th month after radical surgery, and pathological examination presenting the mucinous adenocarcinoma being neurosecretory in another case and mestastasis being detected on glans at the 3rd months after radical surgery. The recovery rate of urinary continience at 6 and 12 months after radical surgery was 86.2%(31/36) and 89.7%(32/36) respectively. Conclusions Prostate mucinous adenocarcinoma is a variant of acinar adenocarcinoma. This study clarifies prostate mucinous adenocarcinoma of Chinese patients with high Gleason scores, advanced pathological stage, variant in prognosis, and prone to recurrence and metastasis. For treatment strategy, the low-risk and intermediate-risk mucinous adenocarcinoma is recommended undergoing radical surgery, and the prognosis maybe good. High-risk mucinous adenocarcinoma could treated with radical surgery or palliative surgery with adjuvant ADT, and most high-risk patients can benefite, with a small number of poor prognosis. Key words: Prostatic neoplasms; Mucinous adenocarcinoma; Biochemical recurrence; Castration-resistant

Magnetic Resonance Imaging Features of Prostate Mucinous Adenocarcinoma

Magnetic Resonance Imaging Features of Prostate Mucinous Adenocarcinoma

Mucinous adenocarcinoma of the prostate: case report and review of the literature

Background: Mucinous adenocarcinoma of the prostate (MACP) is a rare variant of prostatic carcinoma that is characterized by pools of extra-acinar mucin. Precise diagnosis is important due to nonspecific findings on imaging tests, its aggressive behaviour and poor response to radiotherapy. The essential point in the diagnosis of MACP is to rule out the extraprostatic malignancies, originating from the bladder or colorectum. Case Report: A 57-year-old man presented in our clinic with urinary frequency, nocturia and voiding difficulties. Digital rectal examination revealed a slightly enlarged prostate, without palpable nodules. Patient PSA was 18.0 ng/mL. Twelve-core transrectal ultrasound-guided biopsy confirmed prostate cancer with Gleason score 8 (3+4). Up to 50% of the tumor lesion consisted of neoplastic glands with isolated cells, floating in mucinous material. The metastatic work-up, including CT scan and bone scintigraphy was negative and radical retropubic prostatectomy with lymph node dissection has been performed. Periodic Acid Schiff staining confirmed the presence of mucinous prostatic adenocarcinoma. Morphological examination was negative for lymph nodes metastases. The extraprostatic extension and surgical margins were negative. Three years after surgery, patient’s serum PSA remained undetectable, without recurrence. Conclusion: We report this case due to the rarity of primary MACP and its challenging diagnosis. Although MACP may be associated with poor outcome, its proper diagnosis and treatment significantly contribute to favorable prognosis and patient survival.

Mucinous adenocarcinoma of prostate and prostatic adenocarcinoma with mucinous components: a clinicopathological analysis of 143 cases.

The clinical significance of mucinous prostatic adenocarcinoma (PCa) remains uncertain. From 6440 cases of PCa treated by radical prostatectomy from 2009 to 2014, mucinous components of 5-100% were found in 143 (2.2%) cases. The mean age was 61.4years, mean pre-operative serum prostate-specific antigen (PSA) was 7.8ng/ml and clinical stage category was cT1 in 81% and cT2 in 19% of cases. Cases were graded using the 2014 International Society of Urological Pathology recommendation of grading underlying architecture, and Gleason scores (GS) were 3+4 in 13.3%, 4+3 in 54.5%, 4+4 in 2.1%, 3+4 or 4+3 with tertiary 5 in 11.9% and 9-10 in 18.2%. The mucinous component invariably had a high-grade component. Extraprostatic extension was found in 46.8% of cases. In 21.6%, tumour volume was ≥3cm³ and 9.7% had surgical margin positivity. Seminal vesicle involvement was found in 6.9%. In 73 cases the mucinous component was >25%, and when cases were divided on the basis of the area of mucin present (≤25 versus >25%) there was no significant difference between clinical or pathological features. Similar findings were achieved when cases were compared with grade-matched non-mucinous carcinoma controls. The 5-year biochemical recurrence rates for mucinous versus non-mucinous cancer were 12.5 versus 17% (P=0.15). PCa with mucinous components is often high grade; however, the prognosis appears to be similar to non-mucinous cancers of similar GS.

Mucinous Adenocarcinoma of Prostate: A Case Report and Review of Literature

Mucinous adenocarcinoma(MC) of prostate is extremely rare, with an incidence of approximately 0.2% Mucinous adenocarcinoma of the prostate usually has no obvious symptoms, its usual clinical symptom are frequency, dysuria, difficulty in voding which are similar to benign prostate hypertension, the diagnosis of mucinous adenocarcinoma is made only when extraluminal pools of mucin involve at least 25% of the tumor volume at prostatectomy, the different with the prostate acinar cell carcinoma is that MC is more likely to occur in skeletal and visceral metastases. Some studies suggest that 77.8% of MC patients’ PSA will be increased, and there is no significant difference in the degree of increase compare with the prostate acinar cell carcinoma. This case report describes the excellent clinical course of a 74-year-old patient with mucinous adenocarcinoma of the prostate, treated by trans-urethral resection of prostate (TURP). In our case, mucinous adenocarcinoma of the prostate does not appear to behave differently than acinar prostate cancer, and with a review of the current literature.

PTEN Expression in Mucinous Prostatic Adenocarcinoma, Prostatic Adenocarcinoma With Mucinous Features, and Adjacent Conventional Prostatic Adenocarcinoma: A Multi-institutional Study of 92 Cases.

Recent studies have demonstrated that most patients with mucinous prostatic adenocarcinoma may have a better prognosis than those with conventional prostatic adenocarcinoma; however, the mechanism remains unclear. Loss of phosphatase and tensin homolog (PTEN) expression is known to occur in aggressive high-grade prostatic adenocarcinoma, but expression in mucinous prostatic adenocarcinoma has not been well characterized. In this study, we sought to analyze PTEN expression in mucinous prostatic adenocarcinoma, prostatic adenocarcinoma with mucinous features, and the adjacent conventional prostatic adenocarcinoma. Cases were obtained from the Urologic Pathology files of 3 major academic institutions. Ninety-two cases were identified. PTEN expression was positive in the mucinous component of 79/92 (86%) cases. Concordant positive expression of PTEN between mucinous prostatic adenocarcinoma, prostatic adenocarcinoma with mucinous features, and the adjacent conventional prostatic adenocarcinoma was present in 60/79 (76%) cases. The fact that 86% of cases of mucinous prostatic adenocarcinoma and prostatic adenocarcinoma with mucinous features were positive for PTEN despite relatively high Gleason scores is in keeping with the fact that these tumors may be less aggressive than conventional prostatic adenocarcinoma without associated extraluminal mucinous components. In 76% of cases, the expression profiles (PTEN positive or negative) of mucinous prostatic adenocarcinoma and prostatic adenocarcinoma with mucinous features were similar to those of the adjacent conventional prostatic adenocarcinoma, implying that they may likely be clonal from a molecular standpoint. In addition, it is highly conceivable that the subset of PTEN-negative mucinous tumors may still have a relatively good prognosis due to a different/PTEN-independent protective pathway or mechanism.

Solitäre PSA-negative Spätmetastase eines Prostatakarzinoms in der Glans penis

Metastatic involvement of the penis is rare. Secondary lesions generally originate from pelvic tumours. Bladder and prostate are the most common primary tumours. Commonly, penile metastases occur in cases of disseminated cancer disease. We present the case of a prostatic mucinous adenocarcinoma with a solitary, PSA-negative, asymptomatic metastasis to the glans 6 years after radical prostatectomy, which was successfully treated by local excision.

Penile metastasis from prostate cancer: a case report.

Metastatic involvement of the penis is rare. About 80% of secondary lesions originate from pelvic primary tumors, mainly bladder and prostate. We present a case of prostatic mucinous adenocarcinoma with penile metastasis symptomatic for pain, which was treated with external-beam radiation (35 Gy/14 fractions; 2.5 Gy daily) combined with androgen deprivation, resulting in complete pain relief and objective response after treatment.

ERG expression in mucinous prostatic adenocarcinoma and prostatic adenocarcinoma with mucinous features: comparison with conventional prostatic adenocarcinoma

TMPRSS2-ERG is the most common gene fusion in conventional prostatic adenocarcinoma (PCa), identified in about 40% to 70% of cases. Mucinous PCa and PCa with mucinous features are rare subtypes of prostate cancer, and ERG expression in these subtypes has not been well characterized in a large series. A search was made through the surgical pathology and expert consultation files of 2 major academic institutions for cases of mucinous PCa and PCa with mucinous features. The former were obtained from radical prostatectomy cases and the latter from radical prostatectomy cases, transurethral resection of the prostate, and prostate needle core biopsies. A tissue microarray composed of additional cases of mucinous PCa was also included in the study. Immunohistochemical stains for ERG were performed on all the cases. A total of 51 cases of mucinous PCa and PCa with mucinous features were identified. Twenty-five of 51 (47%) cases were positive for ERG expression, including 10/24 (42%) radical prostatectomy specimens, 7/14 (50%) biopsies, 2/4 (50%) transurethral resection of the prostate specimens, 6/9 (67%) from a tissue microarray. This is the largest study to date specifically characterizing ERG expression in mucinous PCa and PCa with mucinous features, with emphasis on comparison with adjacent conventional PCa. ERG is expressed in almost 50% of cases of mucinous PCa and PCa with mucinous features, similar to rates of expression in conventional PCa. This study strongly suggests that these rare subtypes of PCa are clonally related to conventional PCa.

Mucin-producing Tumors and Tumor-like Lesions Involving the Prostate

Mucin-producing tumors of the prostate include both primary and secondary tumors with mucinous differentiation or features involving the prostate gland. These tumors are relatively rare and have variable prognostic and therapeutic implications. Primary mucinous (colloid) adenocarcinoma of the prostate is defined as prostatic adenocarcinoma with mucinous differentiation involving 25% or more of the entire tumor. Another primary tumor of the prostate that may have mucinous features is primary mucin-producing urothelial-type adenocarcinoma of the prostate (mucinous prostatic urethral adenocarcinoma). Primary mucin-producing urothelial-type adenocarcinoma of the prostate is a distinct entity that typically arises from the prostatic urethra possibly from urethritis glandularis or glandular metaplasia with malignant transformation, and it is analogous to adenocarcinoma with mucinous differentiation arising from the urinary bladder. Signet ring cell tumors of the prostate, though rare, may also have mucinous features. Secondary tumors with mucinous differentiation that may involve the prostate include adenocarcinomas of the urinary bladder and colorectum. Pathologists should also be aware of mucin-producing tumor-like lesions involving the prostate, including mucinous metaplasia, and benign Cowper glands that may mimic malignancy. Herein we present an updated and comprehensive review of the clinicopathologic, immunohistochemical, molecular, and prognostic features of mucinous tumors and tumor-like lesions involving the prostate gland, with emphasis on mucinous prostatic adenocarcinoma and its mimickers, including potential diagnostic pitfalls.

Mucinous adenocarcinoma of urinary bladder type, arising from prostatic urethra in a patient treated with radiotherapy for acinar type prostatic adenocarcinoma: a case report

We present here a case of mucinous adenocarcinoma of urinary bladder type, arising from the prostatic urethra in a 78-year-old man who also had a previous history of prostatic adenocarcinoma of acinar type treated with radiotherapy. The patient presented to the clinic with haematuria. A biopsy from the prostatic urethra showed poorly differentiated mucinous adenocarcinoma favouring primary mucinous urothelial adenocarcinoma. The subsequent transurethral resection of prostate revealed poorly differentiated (signet-ring) malignant cells floating in pools of extracellular mucin within the prostatic stroma. The overlying urothelium exhibited intestinal metaplasia and glandular dysplasia. The tumour was positive for cytokeratin 20, villin, CEA and CDX2 but was negative for prostate specific antigen (PSA), Alpha methylacyl co-A racemase (AMACR) and cytokeratin 7. Beta catenin showed positive membrane staining. Mucinous adenocar-cinoma arising from the prostatic urethra is a rare and aggressive tumour which must be differentiated from prostatic mucinous adenocarcinoma, metastatic colonic adenocarcinoma and meta-static adenocarcinoma from urinary bladder. These tumours share morphological and immunohistochemical features with enteric adenocarcinoma, and the presence of surface intestinal metaplasia and glandular dysplasia in this case favours a urothelial origin.

Radical exenteration surgery is curative in locally advance mucinous prostatic adenocarcinoma involving bladder and rectum.

The management of mucinous prostatic adenocarcinoma include hormonal treatment, radiotherapy and radical prostatectomy with variable long-term outcome. We report a 59 year old man with advanced mucinous prostatic adenocarcinoma involving almost the entire bladder and had failed treatment with hormonal and radiotherapy, but subsequently underwent radical pelvic exenteration surgery that resulted in long-term cure. He remains alive, his PSA remains undetectable and his surveillance CT scans did not show any evidence of recurrence after 11 years post-surgery. The favourable outcome of radical surgery suggests that radical surgery should be considered, especially in cases with failed initial treatments.

Rare histological patterns of prostatic ductal adenocarcinoma

Prostatic ductal adenocarcinomas account for 1% of prostate cancers. Most commonly, these lesions grow in large cribriform and/or papillary patterns or, as recently described, in a manner resembling prostatic intraepithelial neoplasia (i.e., 'PIN-like' prostatic ductal adenocarcinoma). This study aims to report rare variants of ductal adenocarcinoma. Ten cases of rare patterns of prostatic ductal adenocarcinoma that have not been formally investigated prior to this study, primarily from one author's consultation service (1987-2009), were selected. Two (n = 2) cases were prostatic ductal adenocarcinoma with mucinous and goblet cell features. Three (n = 3) cases are the first described cases of foamy gland prostatic ductal adenocarcinoma. Other unique cases were prostatic duct adenocarcinomas with associated Paneth cell-like neuroendocrine (n = 2), micropapillary (n = 2), and cystic papillary features (n = 1). Prostatic origin was confirmed with immunohistochemical studies for prostate specific antigen (PSA), P501S, and prostate specific membrane antigen (PSMA). High-grade PIN was ruled out with negative stains for high molecular weight cytokeratin (HMWCK) and p63. Four prostatic ductal adenocarcinomas had no evidence of disease at 2-8 years follow-up: foamy gland, Paneth cell-like, and micropapillary (two cases). One mucinous prostatic ductal adenocarcinoma resulted in the patient's death and the other mucinous case was alive at 7 years and 2 months, yet with no information as to status of disease. The remaining four cases were lost to follow-up, died of other causes, or were recent. In summary, we report several rare and unique histological patterns of prostatic ductal adenocarcinoma. The practical importance of recognising these histological variations is that in some cases they may be misdiagnosed as non-prostatic tumours. These unusual cases also provide further support for the relationship between acinar and ductal adenocarcinoma.

30. Mucin-producing urothelial-type adenocarcinoma of the prostate – discussion of a case and its differential diagnosis

<h3>Introduction</h3> The most common malignancy of the prostate gland is acinar-type adenocarcinoma. The less common types of carcinoma are large duct carcinoma, mucinous carcinoma, urothelial adenocarcinoma and squa-mous neoplasms. Mucin-producing urothelial-type adenocar-cinoma of the prostate is extremely rare. Only two studies have been reported in the recent years. It is considered to be of prostatic urethral origin and equivalent to non-urachal adenocarcinoma of the urinary bladder. The diagnosis is difficult. In this report, we present a rare mucin-producing urothelial-type adenocarcinoma of the prostate. <h3>Case report</h3> A 60-year-old man presented with haematuria and haematospermia. A TURP prostate specimen showed mucinous adenocarcinoma. Serum PSA value was 50.1ng/mL. A radical retropubic prostatectomy was performed. Macroscopically, the prostate parenchyma was widely replaced by a mucinous neoplasm, filling the left posterior quadrant, and much of the right posterior and left anterior quadrants. Microscopically, there was extensive infiltration by mucin-producing adenocarcinoma of intestinal type with extensive mucus pooling. A papillary growth pattern was focally noted and there was a poorly differentiated component. Tumour was present in the prostatic urethra and invaded the left seminal vesicle. The presence of mucin was confirmed by diastatse-resistant positive PAS staining. On immunohistochemistry, tumour cells were positive for CEA, CK20 and CK7 and negative for PSA and PAP. The CK7 positive and CK20 positive profile is more in keeping with urothelial-type carcinoma. <h3>Conclusion</h3> Mucin-producing urothelial-type adenocarcinoma of the prostate is a rare aggressive tumour. Diagnosis is a challenge due to similarity to prostatic mucinous adenocarci-noma and secondary carcinoma, such as that from colorectal or bladder origin. Immunohistochemistry and clinical findings as to probable site of the primary tumour are helpful in making the correct diagnosis.

Immunohistochemical Expression of Prostatic Antigens in Adenocarcinoma and Villous Adenoma of the Urinary Bladder

Adenocarcinomas of the bladder are rare, with the diagnosis dependent on exclusion of secondary involvement by direct extension or metastatic spread from other sites. The recent description of an unusual form of urothelial-type mucinous prostatic adenocarcinoma raises a novel differential diagnosis between adenocarcinomas of the prostate and bladder, and investigation into the utility of classic prostatic immunohistochemical antigens in bladder adenocarcinoma is warranted. We identified 37 primary infiltrating adenocarcinomas of the bladder, which included signet ring cell carcinomas (n=11), urachal adenocarcinomas (n=5), and enteric adenocarcinoma (n=21). Also included for comparison were 3 cases, each of bladder villous adenomas and bladder adenocarcinoma in situ. Tissue microarrays were constructed from each case, with each specimen represented by multiple 1.0-mm cores to assess for tumor protein heterogeneity. Immunohistochemistry for prostate-specific antigen (PSA), prostate specific acid phosphatase (PSAP), P501S (prostein), and prostate specific membrane antigen (PSMA) was performed, and moderate to strong immunoreactivity was considered a positive result. Of the 37 adenocarcinomas, all were negative for PSA and PSAP (0/37; 0%). In contrast, a minority of bladder adenocarcinomas was labeled with the prostate antigens P501S and PSMA. P501S showed moderate diffuse cytoplasmic staining in 4/37 cases (11%), including 3 enteric-type adenocarcinomas and 1 mucinous adenocarcinoma. Additionally, 1 case of adenocarcinoma in situ demonstrated diffuse cytoplasmic staining for P501S. The granular perinuclear staining pattern of P501S typically seen in prostatic adenocarcinoma was absent in all cases of bladder adenocarcinoma. PSMA showed diffuse cytoplasmic staining in 4/37 (11%) infiltrating adenocarcinomas (including 1 signet ring carcinoma and 3 enteric-type adenocarcinomas), and in 1 case of adenocarcinoma in situ. Membranous PSMA staining was evident in an additional 3 tumors, 1 urachal mucinous adenocarcinoma, 1 nonurachal mucinous and signet ring cell adenocarcinoma, and 1 nonurachal villous adenoma. In conclusion, although all cases of bladder adenocarcinoma examined were negative for PSA and PSAP, the surprising finding that a subset of invasive and in situ adenocarcinomas of the bladder demonstrated immunoreactivity for P501S and PSMA should warrant caution when using these markers in differentiating prostatic from bladder adenocarcinomas. The lack of granular perinuclear staining for P501S and the absence of membranous PSMA staining both favor a bladder adenocarcinoma, although rare cases of villous adenoma and adenocarcinoma did show PSMA membranous staining indistinguishable from that seen in prostate cancer. Although the novel antigens P501S and PSMA are fairly specific and more sensitive in the differential diagnosis of prostate and urothelial carcinoma, care must be taken when adenocarcinomas of the bladder are considered within this differential diagnosis.

Primary Mucin-producing Urothelial-type Adenocarcinoma of Prostate: Report of 15 Cases

Prostatic urothelial-type adenocarcinoma arises through a process of glandular metaplasia of the prostatic urethral urothelium and subsequent in situ adenocarcinoma sometimes associated with villous adenoma. These prostatic adenocarcinomas are analogous to nonurachal adenocarcinomas arising in the bladder from cystitis glandularis. Only 2 cases of urothelial-type adenocarcinoma from an institution other than our own have been previously described. The distinction between adenocarcinoma from another organ secondarily involving the prostate, usual adenocarcinoma of the prostate, and prostatic urothelial-type adenocarcinoma can present a significant diagnostic challenge and has significant therapeutic implications. Fifteen cases of prostatic urothelial-type adenocarcinoma were retrieved from the consult files of one of the authors. Mean patient age at diagnosis was 72 years (range 58 to 93 y). All men had negative colonoscopies, clinically excluding a colonic primary. Bladder primaries were ruled out clinically or pathologically in radical resection specimens. Follow-up was available on all men with a mean of 50.3 months (range 2 to 161 mo). All men presented with urinary obstruction symptoms with 3 (20%) also having mucusuria and 2 (13.3%) also having hematuria. Four men (26.7%) developed metastatic disease and 8 (53.3%) died of disease. In 8/15 (53%) cases, glandular metaplasia of the prostatic urethra and contiguous transition to adenocarcinoma were identified. Multiple histologic patterns were observed including dissection of the stroma by mucin pools 15/15 (100%), villous features 7/15 (47%), necrosis 2/15 (13.3%), signet ring cells 3/15 (20%), perineural invasion 1/15 (6.7%), focal squamous differentiation 1/15 (6.7%), and a granulomatous inflammatory response 1/15 (6.7%). Immunohistochemical stains were negative for prostate specific antigen, prostate specific acid phosphatase, CDX2, and beta-catenin in all cases. Stains were positive for high molecular weight cytokeratin in 12/12 cases (100%), and CK7 and CK20 in 10/12 cases (83.3%). Prostatic urothelial-type adenocarcinoma is a rare aggressive cancer arising in the prostate. The differential diagnosis includes conventional prostatic mucinous adenocarcinoma and secondary infiltration from a colonic or bladder adenocarcinoma. Immunohistochemistry for prostate specific antigen, prostate specific acid phosphatase, and high molecular weight cytokeratin along with morphology can help rule out conventional prostate carcinoma. beta-catenin, CDX2, and clinical studies are needed to rule out colonic adenocarcinoma. As prostatic urothelial-type adenocarcinoma is entirely analogous to bladder adenocarcinoma in both, its morphology and immunophenotype, only clinical studies or in some cases pathologic examination of the cystoprostatectomy specimen can exclude infiltration from a primary bladder adenocarcinoma.

Prostate mucinous adenocarcinoma with signet ring cells: a case report and literature review

Prostate mucinous adenocarcinoma with signet ring cells: a case report and literature review