The significance of intraluminal crystalloids in benign prostatic glands on needle biopsy.
ABSTRACT Based on data from autopsy, radical prostatectomy, and cystoprostatectomy specimens, it has been suggested that the finding of intraluminal crystalloids in benign glands on needle biopsy may indicate a concurrent carcinoma; therefore, repeat biopsy is recommended. We studied data from 56 consecutive needle biopsies from the Johns Hopkins Hospital and Dianon Systems in which the diagnosis of intraluminal crystalloids in benign glands was rendered and follow-up data were subsequently obtained. Cases in which crystalloids were present in glands suspicious for cancer, in glands of high-grade prostatic intraepithelial neoplasia, or in adenosis were excluded from the study. Follow-up data included repeat biopsy results and serum prostatic specific antigen levels. Of the 56 men, 31 (55%) had repeat biopsy (two underwent transurethral resection of the prostate [TURP]); the remaining men were either noncompliant or had medical conditions precluding subsequent biopsy. Of the 31 men who underwent repeat biopsies, 23 (74%) had benign diagnoses, one (3%) had high-grade prostatic intraepithelial neoplasia, and seven (23%) had adenocarcinoma. There was no difference in serum prostate-specific antigen values between those with and without cancer on repeat biopsy. In a control population of men with a benign first biopsy not showing crystalloids, the incidence of cancer on repeat biopsy was 16.2%, which was not statistically significantly different from the incidence found in our study group. We conclude that men with prostate biopsy results showing benign glands with crystalloids are at no significantly higher risk of having cancer on repeat biopsy than if crystalloids were not present.
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ABSTRACT: One of the major diagnostic challenges in prostate needle biopsy interpretation is definitive establishment of a malignant diagnosis based on a minimal or limited amount of carcinoma in needle biopsy tissue. Major and minor diagnostic criteria should be used for interpretation of small foci of carcinoma. The constellation of findings and a combination of the major and minor diagnostic criteria permit a definitive diagnosis of focal adenocarcinoma. The differential diagnosis of minimal prostatic adenocarcinoma in needle biopsy tissue is broad and includes many benign lesions. The benign entities most likelty to be misdiagnosed as minimal prostatic adenocarcinoma are atypical adenomatous hyperplasia (adenosis) and atrophy. High-grade prostatic intraepithelial neoplasia and a descriptive diagnosis of focal glandular atypia or atypical small acinar proliferation also should be considered before diagnosing minimal adenocarcinoma. The most valuable adjunctive study for the diagnosis of minimal adenocarcinoma is immunohistochemistry using antibody 34 beta E12, reactive against basal cell-specific high-molecular-weight cytokeratins. Most cases can be diagnosed based on H&E-stained sections without this immunostain. Most minimal carcinomas in prostate needle biopsy tissue are of intermediate histologic grade, and most are indicative of pathologically significant carcinoma in the whole prostate gland.American Journal of Clinical Pathology 01/2001; 114(6):896-909. · 2.60 Impact Factor
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ABSTRACT: The vast majority of prostatic tumors developing in adult males are adenocarcinomas (ACP). Histological diagnosis of prostate cancer relies on the infiltrative growth pattern, presence of macronucleoli, and absence of basal cell layer. In the last few years a special attention has been focused on investigation of cancerous glands lumen content. The aim of the study was to determine the presence of intraluminal (crystaloids, blue-tanged mucinous secretions and distension of glands) and extracellular markers of pathological secretions in ACP, as well as the type of intraluminal and extracellular mucinous secretions. Micromorphological and hystochemical (PAS, HID-AB pH 2.5) analysis was done in 96 patients to detemine differentiation by Gleason and markers of secretory activity. In ACP neoplastic gland's distension (53.12%), crystalloids (30.2%), basophilic secretions (26.04%) and presence of extracellular mucins (8.3%) were found. All morphological signs were detected in carcinoma of Gleason grade 1-4A. There was significant presence of crystalloids ((G1+G2)/G4 p < 0.05; G3/G4A p < 0.05), basophilic secretions (G3/G2 p < 0.05; G3/G4A p < 0.05) and extracellular mucins (G3/G4A p < 0.001). The association of these morphological features with neutral and acidic mucins secretion was statisticaly significant (p < 0.0001). This study showed that intraluminal and extracellular markers of secretory activity in ACP were significantly more often associated by mixed type of mucin secretion with predominace of sialomucins.Vojnosanitetski pregled. Military-medical and pharmaceutical review 09/2007; 64(9):617-22. · 0.18 Impact Factor
Article: Discovery and clinical application of a novel prostate cancer marker: alpha-methylacyl CoA racemase (P504S).[show abstract] [hide abstract]
ABSTRACT: The recent discovery of the overexpression of P504S/alpha-methylacyl coenzyme A racemase (AMACR) in prostate cancer is a successful example of translating an advanced molecular finding into clinical practice. AMACR (P504S) has been proven to be one of the few biomarkers that can help distinguish cancer from benign cells, with high sensitivity and specificity for prostate carcinoma. It is the first gene identified by the analysis of complementary DNA microarray profiles from prostate tissue to be used as a tissue tumor marker in clinical practice and to improve the diagnosis of prostate cancer. This review focuses on the study of AMACR (P504S) expression in prostate cancer, premalignant lesions, benign prostate tissues, and other normal and malignant tissues and a discussion of its clinical usefulness. We emphasize the interpretation of the AMACR immunohistochemical results in routine surgical pathology practice and also discuss the potential future applications of this marker and the possible role of AMACR in the pathogenesis of cancer development.American Journal of Clinical Pathology 09/2004; 122(2):275-89. · 2.60 Impact Factor