Transurethral Resection Of Prostate Specimens Research Articles

HISTOMORPHOLOGICAL STUDY OF TRANSURETHRAL RESECTION OF PROSTATE SPECIMENS

Objectives: (The objectives of the study are as follows: 1) To study various histomorphological patterns of transurethral resection of prostate specimens. (2) To classify malignant lesions with Gleason’s grading and to do Prostate-specific antigen (PSA) level and immunohistochemistry as required. Methods: It was a cross-sectional study conducted from January 2022 to June 2023 in a tertiary care hospital. Fifty-seven patients study who underwent transurethral resection of the prostate (TURP) surgery with hypertrophied prostate during the study period were included in the study on the basis of a predefined inclusion and exclusion criteria. Demographic characteristics of all the cases were analyzed. Clinical features, presenting complaints, histopathological findings, and the final diagnosis were studied. For statistical purposes, p value < 0.05 was taken as statistically significant. Results: The majority of the participants were in the age group of 60–69 years (42.11%) followed by people in the age group of 70–79 years (35.09%). Benign disease of prostrate was common than the malignant disease. BHP was the most common disease encountered and was seen in 37 (64.91%) cases. Among 37 patients with BHP, 70.27% (26) patients had increased PSA levels. Among 10 patients of BHP with CP 8 (80%) patients had increased levels of PSA. Serum PSA levels were increased in all the cases of malignancy, Adenocarcinoma prostate and PIN. Conclusion: In patients undergoing TURP modified Gleason scoring patterns and prognostic grade grouping should be done in conjunction for assessing prognosis and management. Immunohistochemistry and molecular genetic analysis are valuable adjuncts to the diagnosis in these cases.

Evaluation of expression of immunohistochemical markers high molecular weight cytokeratin (HMWCK) and alpha-methylacyl coa racemose (AMACR) in prostatic needle biopsies and transurethral resection of prostate (TURP) specimen – A one year observational study

In view of increasing incidence of Prostate cancer with age, its early detection and management is of utmost importance. Digital rectal examination, clinical picture and USG findings are non-specific. In prostatic lesions having a suspicious morphology, IHC staining (HMWCK and AMACR) is done to distinguish benign from malignant lesions. Absence of myoepithelial layer (HMWCK negative) along with cytoplasmic granular staining in glands (AMACR positive) is consistent with malignant diagnosis.To evaluate the utility of IHC markers HMWCK and AMACR in resolving morphologically suspicious foci on Prostatic needle core biopsies and TURP specimens.Observational StudyA total of 30 cases of prostatic lesions were studied. The specimens were fixed in 10% formalin and routinely processed. Haematoxylin-Eosin (H&E) and IHC staining (HMWCK and AMACR) was done in all 30 cases.Data collected was analyzed using appropriate statistical test.A total of 30 cases including 19 cases prostatic needle core biopsies and 11 cases of TURP specimens were included in our study. Histopathological diagnosis included 1 case each of Adenosis, Atypical adenomatous hyperplasia and Transitional cell metaplasia; 9 cases of BPH with suspicious foci, 4 cases of LGPIN, 3 cases of HGPIN and 11 cases Prostatic adenocarcinoma. In 5 cases including 3 cases of BPH with suspicious foci and 1 case each of adenosis and AAH, the diagnosis was changed to Prostatic Adenocarcinoma after IHC analysis. We conclude that IHC staining should be done in cases where routine H&E sections have an ambiguous morphology. HMWCK along with AMACR is a good marker combination to differentiate Benign from Malignant lesions.

ROLE OF EXPRESSION OF P63 AND CALPONIN IN PROSTATIC BIOPSIES

Background: An increased number of mortality and morbidity in elderly men is caused due to prostatic diseases all over the world. An increase in mass screening programmes conducted with the help of Prostate Specic Antigen (PSA) blood test along with Digital rectal examination (DRE) and imaging studies has resulted in an upsurge in the diagnosis of prostatic cancer which is markedly noted in the recent decades. Material And Methods: A total 100 cases of formalin xed parafn embedded histological sections of various prostatic lesions including benign prostatic hyperplasia, prostatic intraepithelial lesion and prostate carcinoma were studied. Out of 100 cases, 55 cases were benign prostatic hyperplasia, 10 cases of prostatic intraepithelial lesion and 35 cases were of prostate adenocarcinoma. All the sections were stained with Hematoxylin and Eosin stain and then immunohistochemical staining of p63 and Calponin was performed on all the cases (gure 6- 12). The parameters used to analyse the expression of both p63 and calponin were - Pattern of staining, Percentage of stained cell, Intensity of staining reaction. Total 100 cases i Results: ncluded in this study, out of which 55 (55%) cases were benign prostatic hyperplasia, 10 (10%) cases of prostatic intraepithelial neoplasia, and 35 (35%) cases were prostatic adenocarcinoma, majority of specimens (78%) were TURP followed by trucut biopsy (20%), Suprapubic prostatectomy (2%). The proportion of Transurethral resection of prostate (TURP) was signicantly higher as compared to the proportion of Trucut biopsy and supra pubic prostatectomy (SPP) (p<.001). Expression of calponin in various prostatic lesion. On analysing expression of proliferation marker calponin, in BPH it was expressed in only 52 cases out of 5 cases (94.5%) and 3 cases (8.6%) were negative. Our study concluded that the proportion of Benign prostatic Conclusion: hyperplasia was signicantly higher as compared to the Prostatic intraepithelial neoplasia and Prostatic adenocarcinoma. Immunohistochemical staining by p63 is diagnostically reliable in identifying basal cells in prostatic needle biopsies and TURP specimens. p63 is a valuable tool with high sensitivity in differentiating BPH from prostatic carcinoma. The decreased or absent stromal staining of calponin which indicates a reactive stroma in malignancy can be used alone or in conjunction with p63 for conrmation of diagnosis of prostatic carcinoma

Does benign prostate hyperplasia histopathological variation impact disease-specific clinical outcomes after transurethral resection?

The impact of histopathological variants in stromal and glandular tissue on clinical outcomes following transurethral resection of prostate (TURP) is unexplored. We sought to evaluate the relationship between histopathological variations in TURP specimen and postoperative clinical outcomes. We performed a retrospective analysis of men undergoing initial TURP at our institution from 2017 to 2019. All pathology slides were re-reviewed by one specialized genitourinary pathologist who was blinded to all clinical data. Types of BPH were defined as: glandular-predominant (gland:stroma ratio >50%), mixed (gland:stroma ratio 25%-50%), and stromal-predominant (gland:stromal ratio <25%). Primary clinical outcomes were ∆ post-void residual and ∆ American Urological Society Symptom Score (AUASS) at 3, 6, and 12 months post-operatively. We also evaluated for a temporal relationship between time since surgery and ∆AUASS amongst different histopathological subgroups. One hundred and five patients were included in the final analysis. 61/105 (58.1%) had glandular-predominant histopathology, 21/105 (20%) had stromal-predominant histopathology, and 23/105 (21.9%) were classified as mixed histopathology. On univariate and multivariate analysis, histopathological subtype was not a significant predictor of any of the clinical post-operative endpoints of interest at any time points. Disease-specific outcomes after TURP appear to be consistent across these different histopathologic subtypes.

Evaluation of TURP specimen with special reference to prostatic intraepithelial neoplasia and prostatic cancer using light microscopy and immunohistochemical markers of P63, CK5/6, AMACR (p504s), and PSA

Background: Prostate cancer is the world’s leading cause of cancer and the second cause of cancer-related death in men after lung cancer. The incidence of prostatic carcinoma is increasing with age. Prostate intraepithelial neoplasia can only be diagnosed by histopathological examination of prostate tissue. In practice, small foci of cancer and several morphological mimickers of different Gleason Grades were encountered leading to diagnosing difficulty. To overcome this pitfall, the use of HMW Cytokeratin’s 5 and 6 (CK5/6) or p63 or combination of these two with alpha-methyl acyl- COA-racemase (AMACR) is triple cocktail which is recommended. Aims and Objectives: The objectives of this study were to analyze the histomorphology of various non-neoplastic and neoplastic lesions of the prostate and to know the incidence of prostatic intraepithelial neoplasia in transurethral resection of prostate (TURP) specimen, to assess the usefulness of immunohistochemical analysis with a panel of markers (p63, CK5/6, AMACR [p504s], and prostate-specific antigen [PSA]) to confirm the diagnosis of prostatic intraepithelial neoplasia and prostate cancer, and to differentiate several benign mimickers of prostatic adenocarcinoma. Materials and Methods: It is a prospective study performed for 18 month from January 2020 to June 2021. Thirty TURP specimens were collected in 10% formalin and processed in the department of pathology, MCH, Kolkata. Results: In the present study, benign prostatic hyperplasia formed majority of cases (80%). The presence of AMACR and absence of basal cell specific marker p63 and CK5/6 confirm the presence of prostate cancer. Conclusion: High degree of association of HGPIN with prostatic Carcinoma, it is suggested that these HGPIN patients need close follow-up, observation, and investigation to rule out existence of carcinoma, especially in the peripheral zone.

Poster 11 - A 10 Year Retrospective Analysis of Transurethral Resection of Prostate specimens at an Irish Academic Centre 2012–2021

Poster 11 - A 10 Year Retrospective Analysis of Transurethral Resection of Prostate specimens at an Irish Academic Centre 2012–2021

Incidence of incidental cancer in transurethral resection of prostate specimens: a 10-year retrospective analysis

BackgroundProstate cancer can be detected incidentally in patients undergoing transurethral resection of the prostate for benign prostatic hyperplasia. Therefore, it is very important that the transurethral resection of the prostate specimen is evaluated carefully for accurate grading and staging. The aim of this study was to investigate the frequency of incidental prostate cancer and its relationship with clinicopathological findings.MethodsThe study included a total of 900 patients, who underwent transurethral resection of the prostate for benign prostatic hyperplasia treatment between June 2010 and June 2020. Patient age, prostate-specific antigen (PSA) levels and resected prostate weight were assessed, and the tumor stage, Gleason grade group, lymphovascular and perineural invasion status were also evaluated in the incidental prostate cancer group. The association between these parameters and prostate cancer detection was analyzed.ResultsIncidental detection of prostate cancer was determined at the rate of 13.3%. The incidental prostate cancer group had a significantly higher mean age and PSA levels compared to the benign prostatic hyperplasia group. The weight of the resected specimen had no impact on the incidence of incidental prostate cancer. Of the total 120 incidental prostate cancer cases, 59 (49.2%) were stage T1a and 61 (50.8%) were stage T1b. No significant difference was determined between the T1 stages and age distribution, but a statistically significant difference was determined in the other clinicopathological parameters.ConclusionsThe results of this study demonstrated that the incidence of incidental prostate cancer detection was related to age and PSA levels and increased, especially in those aged ≥ 60 years and/or PSA level ≥ 4 ng/mL. To avoid overlooking incidental prostate cancer in these patients, it can be recommended that material is sufficiently sampled and carefully evaluated, and when necessary, all resected specimens are examined. Although no significant correlation was determined between specimen weight and the incidence of incidental prostate cancer, as a significant difference was determined in T1 stages, this suggests that the amount of material evaluated could change the sub-stage.

Signet Ring Cell Carcinoma of the Prostate Gland: A Review and Update

Signet-ring cell carcinoma of the prostate gland (SRCCP) an uncommon and aggressive malignant tumour of the prostate gland which is characterized by histopathology examination features of compression of the nucleus into the form of a crescent by a large cytoplasmic vacuole. SRCCPs that have so far been reported have been either (a) primary tumours, metastatic tumours with the primary tumour elsewhere with the gastro-intestinal tract being the site of the primary tumour but the primary tumour could originate elsewhere, and additionally some reported SRCCPs have been classified as carcinoma of unknown primary. SRCCP could be a pure tumour or a tumour that is contemporaneously associated with other types of tumour including various variants of adenocarcinoma. SRCCP can manifest in various ways including: Incidental finding following prostatectomy that has been undertaken for a presumed benign prostatic hyperplasia, lower urinary tract symptoms, visible and non-visible haematuria, raised levels of serum PSA but some SRCCPs have been diagnosed with normal / low levels of serum PSA, there may be a history of dyspepsia in cases of metastatic signet-ring cell carcinoma in association with contemporaneous primary signet-ring cell carcinoma of the stomach or there may be a past history of surgical treatment for signet-ring cell carcinoma of the gastrointestinal tract, or bleeding from the gastrointestinal tract in cases of upper gastrointestinal tract and rectal bleeding as well as change in bowel habit for primary tumours of the anorectal region, retention of urine, and rarely a rectal mass in the case of SRCCP with an anorectal primary tumour. In order to exclude a primary signet ring cell carcinoma elsewhere, a detailed past medical history is required as well as radiology imaging including contrast – enhanced computed tomography (CECT) scan and contrast-enhanced magnetic resonance imaging (CEMRI) scan as well as upper gastrointestinal endoscopy and colonoscopy to exclude a primary lesion within the gastrointestinal tract. Diagnosis of SRCCP requires utilization of the histopathology and immunohistochemistry examination features of prostate biopsy, prostatic chips obtained from trans-urethral resection of prostate specimen or radical prostatectomy specimen. SRCCPs upon immunohistochemistry staining studies tend to show tumour that tend to exhibit positive staining for the following tumour markers as follows: PSA – positive staining for PSA has been variable in some studies, AE1/AE3, CAM 5.2, Ki-67 with a mean of 8%, PAS-diastase, Mucicarmine (50%), Alcian blue (60%), Alpha-methyl-acyl coenzyme A racemase (P504S), and Cytokeratin 5/6. SRCCPs also tend to exhibit negative staining for: Bcl2 (rare positive), and CEA (80%). Traditionally the treatment of Primary Signet-Ring Cell Carcinoma of the Prostate Gland has tended to be similar to the treatment of the traditional adenocarcinoma of the prostate gland which does include: hormonal treatment, radiotherapy, and surgery. Nevertheless, considering that primary SRCCPs and metastatic SRCCPs that have been reported in the literature have generally tended to be associated with an aggressive biological behaviour, even though there is no consensus opinion on the treatment of the disease it would be strongly recommended that these tumours that tend to be associated with rapid progress of the disease and poor survival there is an urgent need to treat all these tumours with aggressive surgery including radical prostatectomy plus adjuvant therapies including: radical radiotherapy, combination chemotherapy, selective prostatic angiography and super-selective embolization of the artery feeding the tumour including intra-arterial infusion of chemotherapy agents directly to the tumour, radiofrequency ablation of the tumour as well as irreversible electroporation of the tumour which should form part of a global multicentre study of various treatment options. With regard to metastatic signet-ring cell carcinomas of the prostate gland with a contemporaneous primary tumour elsewhere the primary tumour should also be treated by radical and complete excision of the primary tumour plus radical surgery and aggressive adjuvant therapy. Considering that SRCCPs have tendered not to respond well to available chemotherapy agents, there is need for urologists, oncologists, and pharmacotherapy research workers to identify new chemotherapy medicaments that would more effectively and safely destroy signet-ring cell tumours in order to improve upon the prognosis.

Incidental finding of prostate cancer in Transurethral Resection of Prostate (TURP) specimens: a retrospective analysis from a Tertiary Care Hospital in Pakistan.

Introductionincidental prostate cancer findings reflect the great burden of prostatic cancer across the globe. Our 10 year retrospective analysis aimed to identify the incidence and clinic-pathologic features of prostate cancer incidentally detected in patients undergoing transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH), and to estimate the clinical value of pathologic review of all TURP specimens.Methodsafter excluding patients with a known diagnosis of prostate cancer prior to TURP a total of 2,386 men (ages 25-98) were identified by pathology (TURP) specimens. Yearly incidences, Gleason score, grade, pathologic stage were recorded for all incidental prostate cancer patients.Resultsa total of 256 (10.7%) patients were found to have prostate cancer. Mean Age was 68.51±9.22 years. T1a and T1b stage prostatic carcinoma was found in 9.9% and 90.1% of these patients respectively. Forty-nine percent (49%) patients had higher Gleason scores (>7). After subtracting average incidences between 5-year intervals, a statistical rise of almost 4% was found.Conclusionour analysis concludes that a large proportion (10.7%) of patients had incidental prostate cancer and the incidence was increasing in recent years in Pakistan and in comparison, to Asian countries. In Pakistan there is a scarcity of updated national cancer registries. The growing incidence of high Gleason scores requires keen and prompt attention. The diverse ethnic and socioeconomic background of patients propels their propensity towards loss of follow up with already limited tertiary healthcare institutes in Pakistan. This pathologic review of TURP specimens is valuable for Asiatic and non-Asiatic populations.

HISTOPATHOLOGICALANALYSIS OF INCIDENTAL PROSTATE CARCINOMA IN TRANSURETHRAL RESECTION OF PROSTATE SPECIMENS: A FIVE-YEAR RETROSPECTIVE STUDY

Aim: To identify the rate of incidental prostate cancer in patients undergone Transurethral resection of prostate(TURP) over a period of 5 years in our center. Methods: A Retrospective review was conducted using Histopathological department database on all TURP specimens over a period of 5 years from January 2015 to December 2019. Results: Out of 570 cases of TURP during our study period, 1.9% had incidental prostate cancer. Most of these positive cases had a Gleasons score of 10, which represent poorly differentiated Adenocarcinoma. Conclusion: The value of pathologic review of TURP specimens is limited but a detailed review helps to reduce under detection of prostate cancer.

Relation of Age and Serum Prostatic-Specific Antigen level with Histopathological diagnosis in Transurethral Resection of Prostate specimen, an Experience from Eastern Tertiary Hospital

Background: Prostatic Specific Antigen (PSA) is a protease secreted by epithelial cells of prostate. Serum PSA level is increased when the normal structure of gland is destroyed by benign or malignant tumor or inflammation. Though there is established relation between PSA plasma level and age among the two most common prostate diseases (Benign prostatic hyperplasia and Carcinoma Prostate) in the literature, relation has not been explored in our part of the world, therefore, this study was done to see the relation between age and PSA amount with Prostate diseases.&#x0D; Material and Methods: This was a Cross-sectional study conducted in a tertiary hospital, Nobel Medical College Teaching Hospital from January 2017 to December 2018. Ethical clearance was obtained from Institutional Review Committee (IRC). All the cases of prostate diseases presenting to urology department undergoing transurethral resection of the prostate (TURP) were included. Histopathology report of TURP specimen were collected from department of pathology and the relationship between diagnosis, PSA level and age were established.&#x0D; Results: BPH was the most common diagnosis (72.41%). Age of BPH patients ranged from 48-78 years and mean age with SD was 60.56±7.32. Median age with interquartile range was 61.00. Similarly, in the BPH group, PSA value ranged between 0.80-15.40 ng/ml with mean PSA value along with SD being 5.64±4.16 ng/ml. Similarly, Median PSA value with interquartile range was 4.20ng/ml. Carcinoma Prostate (27.59%) was the second most common diagnosis. Histological type of all cases diagnosed as cancer was adenocarcinoma. Their age ranged between 54-83. Their mean age with SD was 67.67±7.68. Similarly, Median age with interquartile range was 68.00. PSA value in this group ranged between 8.50-147.30 ng/ml. Again, the mean PSA value with SD is 55.72±33.40 ng/ml. Similarly, Median PSA value with interquartile range is 54.30 ng/ml.&#x0D; Conclusion: PSA level in the blood of men over 40years is highly correlated with a Age, irrespective of diagnosis. In above 40 age group, with advancing age, Carcinoma Prostate becomes more and more common diagnosis than BPH. Similarly, average PSA level is higher in Carcinoma Prostate than BPH.

Schistosomiasis on prostate biopsy, adenocarcinoma on transurethral resection of prostate specimens

In bilharzia-endemic areas, schistosomiasis is a common infection. Prostate cancer is also a common urological condition affecting people in both bilharzia and non-bilharzia-endemic areas. The association of these familiar conditions is infrequent and the relationship between these entities still controversial. We are adding to the literature a rare case of prostatic bilharzia on needle biopsy, and the subsequent finding of prostatic adenocarcinoma on transurethral resection of prostate specimens. Level of evidence: 4

Histopathologic False-positive Diagnoses of Prostate Cancer in the Age of Immunohistochemistry.

There are few studies into the rate and causes of histopathologic false-positive diagnosis of prostate cancer. Only 2 of these, including a previous one from our group, incorporate survival data. In addition, in none of the previous studies had immunohistochemistry (IHC) been originally requested on any of the misdiagnosed cases. Diagnostic biopsies (n=1080) and transurethral resection of prostate specimens (n=314) from 1394 men with clinically localized prostate cancer diagnosed in the United Kingdom but treated conservatively between 1990 and 2003 were reviewed by a panel of 3 genitourinary pathologists. Thirty-five cases were excluded for being potentially incomplete. Of the remaining 1359, 30 (2.2%) were reassigned to a nonmalignant category (26 benign and 4 suspicious for malignancy). IHC had been originally performed on 7 of these. The reasons for the errors were recorded on each case: adenosis (19), partial atrophy (3), prostatic intraepithelial neoplasia (2), seminal vesicle epithelium (1), and hyperplasia (1). Follow-up of these men revealed only one prostate cancer-related death, possibly due to unsampled tumor. In conclusion, a relatively small number of prostate cancer mimics were responsible for a large proportion of the false-positive prostate cancer diagnoses and the use of IHC did not prevent the overcall of benign entities as cancer in approximately a quarter of these cases. Targeting these mimics at educational events and raising awareness of the pitfalls in the interpretation of IHC in prostate cancer diagnosis, emphasizing that glands within a suspicious focus should be treated as a whole rather than individually, may be beneficial in lowering the rate of false-positive diagnosis.

Incidentally Detected Adenocarcinoma Prostate in Transurethral Resection of Prostate Specimens: a Hospital Based Study from India.

Awareness about prostate cancer has increased in the community, and prostate cancer screening examinations, including prostate specific antigen (PSA) assays, are now widely available. Prior to the PSA era, up to 27% of prostate cancers were detected incidentally at the time of transurethral resection of prostate (TURP). After PSA testing became widely available, the incidence of incidentally detected carcinoma prostate in TURP specimens without prior diagnosis reduced to 5-13%. However, the incidence of incidentally detected carcinoma prostate has been reported to vary across the globe since various factors can influence the identification of this malignancy in TURP specimens. In this paper, we focus on rates of incidentally detected prostate cancer in TURP specimens in our hospital and correlate it with various parameters. This retrospective study of histopathological findings of biopsy specimens was conducted for patients undergoing TURP during a period of 5 years from April 2010. The inclusion criteria were patients diagnosed with benign prostatic hyperplasia (BPH) (digital rectal examination (DRE) not showing any abnormally hard areas and normal age adjusted PSA values). Patients with elevated PSA, abnormal DRE, documented urinary tract infection and proved adenocarcinoma prostate (CaP) were excluded from the study. The total weight of prostatectomy specimen, occurrence of carcinoma prostate in the chips, percentage of total tissue resected showing malignancy and Gleason's scores were recorded. A total of 597 patients belonging to the inclusion criteria were studied. The incidence of occult CaP in the study group was 5.2 % (31/597). Out of these, 8 belonged to T1a and 23 belonged to T1b stages. The age group 70 - 79 years had the maximum incidence of occult CaP. It was observed that the clinical grading of prostate did not have a bearing on the incidence of occult CaP whereas the weight of resected specimen correlated with the incidence of CaP. The incidence of occult CaP was greater with low volume prostates (<20 g). (P=0.15). The rate of incidentally detected adenocarcinoma prostate in patients undergoing TURP for clinically diagnosed BPH was found to be only 5.2 % in our study which is low when compared with similar studies done elsewhere. The age of the patient and weight of the resected specimen correlated with incidence of occult prostate cancer. The clinical grading of prostate by DRE however, demonstrated no correlation.

Incidental prostate cancer in transurethral resection of prostate specimens in men aged up to 65 years.

BackgroundThe identification of prostate cancer (PC) is important in men aged ≤ 65 years. We examined complete transurethral resection of prostate (TURP) specimens to quantify the incidence and nature of PC in men aged ≤ 65 years.MethodsA prospective multi-institutional database included TURP specimens. The cohort was stratified into two groups according to age. For men aged ≤ 65 years, the entire specimen was submitted for histological analysis, while the TURP specimens from men aged > 65 years were sampled following standard guidelines.ResultsA total of 923 men were included, with 224 in the younger group. PC was identified in 13.4% in men aged ≤ 65 years, compared with 28.7% the older group. The younger group had a lower proportion of Gleason score ≥ 7 (30% compared with 40%) and higher rates of pT1a (57% compared with 43%). In men aged ≤ 65 years with cancer, tumor was identified in one block in 15 of 30 cases (50%). Following diagnosis, 4/30 underwent radical prostatectomy, 5/30 underwent curative radiotherapy, 10/30 androgen deprivation, and 1/30 received palliative radiotherapy.ConclusionIncidental PC in men aged ≤ 65 years is not uncommon. Our results suggest that TURP specimens in men aged ≤ 65 years should be completely assessed. Underidentification of cancer may occur as a result of increasing use of laser prostatectomy and the consequent loss of tissue for pathological examination.

Diagnostic utility of p63 and α-methyl acyl Co A racemase in resolving suspicious foci in prostatic needle biopsy and transurethral resection of prostate specimens.

The objective is to assess the utility of the p63 and α-methylacyl CoA racemase (AMACR) in resolving suspicious foci in prostatic needle biopsy and transurethral resection of prostate (TURP) specimens. A total of 470 cases are selected. These included 310 TURP specimens, 157 needle biopsies and 03 radical prostatectomy specimens. All the cases are reviewed and divided into three categories. Benign (370), cases with suspicious foci (40 cases) and malignant (60 cases). Immunohistochemistry (IHC) was carried out using monoclonal AMACR and p63 antibodies in the 40 suspicious cases along with positive and negative controls. This study showed AMACR had a sensitivity of 95%, specificity of 92.5%, whereas p63 had a sensitivity of 90%, specificity of 100%. All the 40 suspicious cases were resolved using a combination of morphology and IHC expression p63 and AMACR. In 13 (32.5%), of the 40 suspicious cases there was change of diagnosis based of morphology, clinical details and staining with p63 and AMACR, In the 11 cases (11/40), diagnosis was changed from the benign to malignant. In one case benign to high grade prostatic intraepithelial neoplasia (1/40) and in one case from malignant to benign (1/40). This change was statistically significant with P value of 0.013. Combination of p63 and AMACR is of great additional value in combating the morphologically suspicious cases and should be used on case to case basis especially in prostatic needle biopsies and small foci lesions.

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.

Utility of racemase and other immunomarkers in the detection of adenocarcinoma in prostatic tissue damaged by high intensity focused ultrasound therapy

High intensity focused ultrasound (HIFU) is an emerging alternative for the treatment of prostate adenocarcinoma. Alpha-methylacyl-CoA racemase (AMACR) has been shown to be a sensitive immunomarker for prostate cancer, however, there is no information available concerning its utility and that of other immunomarkers for the detection of malignancy after HIFU therapy. AMACR expression was examined in 11 cases of prostatic carcinoma treated by HIFU, with histological evidence of residual carcinoma. In seven cases tumour was examined from thin core biopsies and in four cases from tissue fragments obtained by transurethral resection of prostate (TURP). In addition to AMACR, immunostaining was also undertaken for p63, cytokeratin 34betaE12, cytokeratin 5, cytokeratin 8-18, prostate specific alkaline phosphatase (PSAP), prostate specific antigen (PSA), chromogranin and CD56. In two of the cases foci of tumour were cut out in serial sections. AMACR was expressed in eight of nine evaluable cases (4/5 biopsies and 4/4 TURP specimens). Cytokeratin 8-18 and PSAP were positive in all cases, whereas PSA was positive in five of nine cases. Cytokeratin 34betaE12, cytokeratin 5, and p63 marked the basal layer in normal prostatic glands, but were negative in neoplastic glands. In four cases we found tumour cells with positive staining for CD56 and chromogranin. A panel with positive markers for AMACR, and negative markers for p63/cytokeratin 5/cytokeratin 34betaE12 confirms the neoplastic nature of the residual glands on biopsies or TURP fragments sampled after HIFU therapy.

Signet ring cells of stromal derivation in the uterine cervix secondary to cauterisation: report of a previously undescribed phenomenon

Aims:To describe the occurrence of signet ring cells of stromal origin within the uterine cervix.Methods:Following the identification of prominent signet ring cells in the stroma in a large loop excision...

Mucin-producing urothelial-type adenocarcinoma of prostate: report of two cases of a rare and diagnostically challenging entity

The differential diagnosis of mucin-producing adenocarcinoma of the prostate includes conventional prostatic adenocarcinoma with mucin production, secondary adenocarcinoma usually of colorectal origin and, very rarely, urothelial-type adenocarcinoma arising from either the prostatic urethra or proximal ducts. Conventional prostatic adenocarcinoma with mucin production is readily identified by routine microscopy and immunohistochemistry. The distinction between secondary adenocarcinoma and urothelial-type adenocarcinoma, however, can present a significant diagnostic challenge. In addition, documented examples of the latter in the prostate are exceptionally rare. A transurethral resection of prostate specimen and prostatic needle biopsies from two patients showing urothelial-type adenocarcinoma of the prostate were identified in our consultation files. One of the patients subsequently underwent a radical prostatectomy. Both patients had negative gastrointestinal endoscopic workups. Transurethral resection of prostate material from two patients with clinically confirmed secondary adenocarcinoma of colonic origin involving the prostate and a prostatectomy specimen with mucinous conventional prostatic adenocarcinoma were also identified for comparison purposes. Formalin-fixed, paraffin-embedded sections were stained for prostate-specific antigen (PSA), prostatic acid phosphatase, carcinoembryonic antigen, cytokeratin 7, cytokeratin 20 and high molecular weight cytokeratin 34βE12. The urothelial-type adenocarcinoma cases were diffusely positive for cytokeratin 7 and focally positive for 34βE12 and cytokeratin 20, consistent with an origin from the urothelium of the prostatic urethra or proximal prostatic ducts. In contrast, the secondary adenocarcinoma of colonic origin cases were diffusely cytokeratin 20 positive and either negative or focally positive for cytokeratin 7 and negative for 34βE12. The mucinous conventional prostatic adenocarcinoma was positive for PSA and prostatic acid phosphatase and negative for cytokeratin 7, cytokeratin 20 and 34βE12. All tumors were positive for carcinoembryonic antigen.