Distinguishing prostatic from colorectal adenocarcinoma on biopsy samples: The role of morphology and immunohistochemistry

Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD, USA.
Archives of pathology & laboratory medicine (Impact Factor: 2.84). 04/2007; 131(4):599-603. DOI: 10.1043/1543-2165(2007)131[599:DPFCAO]2.0.CO;2
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Poorly differentiated carcinoma on prostate or colorectal biopsy can occasionally present a diagnostic challenge in determining tumor source especially in locally advanced colorectal carcinoma (CRCa) or prostate carcinoma (PCa). Such determination can affect prognosis and therapy.
To evaluate the role of morphology and immunohistochemistry in the previously mentioned setting.
Surgical pathology and consultation records. Hematoxylin-eosin sections were reviewed in 16 cases (11 PCa, 5 CRCa). Immunohistochemistry for 9 markers was performed in 15 cases.
Dirty necrosis, seen in 5 (100%) of 5 CRCa and 2 (18%) of 11 PCa cases, and the presence of columnar cells with basal nuclei, seen in 5 (100%) of 5 CRCa and 1 (9%) of 11 PCa cases, appear to be the most useful morphologic parameters. Immunohistochemistry confirmed the value of prostate-specific antigen (PSA), CDX2, cytokeratin (CK) 20, and beta-catenin in the differential of CRCa (0% PSA+, 60% CDX2+, 80% CK20+, and 100% beta-catenin+) versus PCa (80% PSA+, 0% CDX2+, 10% CK20+, and 0% beta-catenin+). P501S had a similar sensitivity as PSA in detecting PCa (80%). Two (20%) of 10 PCa cases were positive for 1 of the 2 markers but not the other. P501S was negative in all 5 cases of CRCa.
P501S is a useful marker in this setting when included together with PSA, CDX2, CK20, and beta-catenin. P501S labels a subset of PCa cases that are negative for PSA. Dirty necrosis and/or columnar cells with basal nuclei could also be of help.

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    • "When a definitive diagnosis cannot be established on the basis of morphological characteristics, immunohistochemical studies can be helpful. Rectal adenocarcinoma, unlike prostatic adenocarcinoma, shows positive staining for b-catenin, caudal-related homeobox 2 (CDX2) and carcinoembryonic antigen(CEA) but negative staining for PSA, PSAP, P501S [40,41]. "
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    ABSTRACT: Prostate cancer patients with rectal involvement are rare, and the factors associated with the survival of these patients are yet to be elucidated.Patients and methods: We collected data on patients who were admitted to our hospital for prostate cancer in the last thirteen years and of those in studies in the literature. The associations of clinical characteristics with survival were evaluated using Cox regression models. This study included 94 patients (5 admitted to our hospital and 89 from studies in the literature) of prostate cancer with rectal involvement. 11 patients in the group of synchronous rectal involvement at first cancer diagnosis (n = 58) and 23 patients in the group of metachronous diagnosis of rectal involvement (n = 29) died at the latest follow up. The estimated overall survival rate (% +/- SE) at 1, 3, and 5 years were 68.3 +/- 5.3%, 54.4 +/- 7.2%, and 38.1 +/- 11.1%, respectively. In the Cox univariate analysis, Asian prostate cancer (p = 0.001) was associated with better survival, while rectal bleeding (p = 0.043), metachronous presentation of development of rectal involvement (p = 0.000), prior hormonal therapy (p = 0.000) and extrarectal metastases (p = 0.054) were associated with poor survival. In multivariate analysis, prior hormone therapy (HR = 14.540, p = 0.000) and rectal bleeding (HR = 2.195, p = 0.041) retained independent poor prognostic values. There were 13 patients survived for more than 3 years, the longest survival time was 96 months. Total pelvic extenteration (TPE) combined with hormonal therapy in 12 hormone-untreated prostate cancer give us six of thirteen long-term survivors for more than 3 years in this series. Our findings suggest that rectal involvement does not necessarily predict a worse outcome when presenting as a previously hormone-untreated disease and that the prognosis was worse when presenting as a hormone relapsed disease. Prior hormone therapy and rectal bleeding were associated independently with a significantly poor overall survival in prostate cancer patients with rectal involvement. TPE combined with hormonal therapy appears to confer better overall survival in hormonally untreated patients.Virtual slides: The virtual slide(s) for this article can be found here:
    Diagnostic Pathology 02/2014; 9(1):35. DOI:10.1186/1746-1596-9-35 · 2.60 Impact Factor
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    • "This increases the diagnostic utility of using these immunostains when used together in the assessment of an unknown primary, possibly of a prostatic origin. Recently, Netto and his coworkers also concluded that the combination of PSA and p501s is better than either alone in confirming prostate origin in work-up of metastatic or locally advanced lesions [24]. "
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    ABSTRACT: Immunohistochemical detection of prostate specific antigen (PSA) is widely used to identify metastatic prostatic adenocarcinoma. However, PSA may not be expressed in some poorly differentiated prostatic carcinomas and its immunoreactivity has been found in some non-prostatic tissues. P501s (prostein) is a prostate-specific marker that is expressed in the cytoplasm of benign and malignant prostatic glandular cells. It has not been detected in any other normal or malignant tissues. The purpose of this study was to evaluate the expression of P501s in metastatic prostatic adenocarcinoma and compare its expression with PSA. Immunohistochemical stains with anti-P501s antibodies were performed on 5-micron sections of tissue microarray (TMA) specimens. The TMA is constructed with normal donor prostates (NDP), prostatic adenocarcinoma (PRCA), non-neoplastic prostatic tissues adjacent to malignant glands (NAT), benign prostatic hyperplasia (BPH), high-grade prostatic neoplasia (PIN), metastatic adenocarcinoma to lymph nodes (MLN), metastatic adenocarcinoma to other sites (MC), and samples of benign testis, colon, adrenal and kidney. The two groups of metastatic lesions were also subjected to stains with antibodies to PSA. A composite score (ranging from 0 to 3) was assigned to score intensity of staining. Granular staining pattern of p501s was seen in all benign glands (score = 1.77 - 2.1) and malignant acini (score = 1.52) at the apical aspect of cytoplasm, predominantly adjacent to the nuclei. No staining was observed in controls including testis, colon, adrenal and kidney. The MLN group received a score of 1.0, with 10% of cases negative for p501s. The MC cases had a score of 0.64, with 16.7% of case showing loss of p501s expression. Although the metastatic lesions demonstrated similar rate of negative expression with PSA antibody, only 2 MC cases (3.3%) showed simultaneous negative stains for both P501S and PSA. P501s is an organ specific marker for benign and malignant prostatic epithelial cells. Its characteristic cytoplasmic stain pattern provides an additional valuable immunomarker for detection of metastatic prostatic malignancy, even though the intensity of its expression is reduced, as in the case with PSA. Simultaneous stains with P501S and PSA will greatly improve the detection rate and identify a significant majority of the metastases.
    Diagnostic Pathology 02/2007; 2(1, article 41):41. DOI:10.1186/1746-1596-2-41 · 2.60 Impact Factor
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    ABSTRACT: We present a case report of a 70-year-old man with a known history of sigmoid adenocarcinoma, treated with chemotherapy and surgical resection of synchronous lung metastases. Four years after initial diagnosis, the patient was diagnosed with metastases to the prostate gland, proven pathologically. To our knowledge, colon adenocarcinoma metastasizing to the prostate has not been previously described on magnetic resonance imaging and positron emission tomography-computed tomography.
    Journal of computer assisted tomography 05/2013; 37(3):463-465. DOI:10.1097/RCT.0b013e3182898248 · 1.41 Impact Factor
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