Immunophenotype of High-Grade Prostatic Adenocarcinoma and Urothelial Carcinoma

Abstract

Morphologic features alone can usually be used to distinguish prostatic adenocarcinoma and urothelial carcinoma of the urinary bladder. Poorly differentiated tumors, however, can occasionally have features of both neoplasms, making determination of site of origin difficult. No study has provided a panel of antibodies to assist in the distinction of these two tumors. For this study, 73 examples of moderately and poorly differentiated prostatic adenocarcinoma and 46 examples of high-grade urothelial carcinoma were obtained from radical resection specimens. Immunohistochemical studies were performed using the following panel of antibodies: cytokeratin (CK) 7, CK 20, 34␤E12, Leu M1, carcinoembryonic antigen (CEA)m, CEAp, p53, Leu 7, prostate-specific acid phosphatase (PSAP), prostate-specific antigen (PSA), and B72.3. Mucicarmine was also performed. Intermediate and high-grade prostatic carcinoma were compared and then high-grade prostatic carcinoma was compared with high-grade urothelial carcinoma. PSA and PSAP each stained 94% of prostatic adenocarcinomas, but no urothelial carcinomas. Leu 7 stained 94% of prostate and 17% of urothelial carcinomas. Over half of the urothelial carcinomas showed positivity for 34␤E12 (65%), as did two cases of prostatic carcinoma (6%). Eighty-three percent of urothelial carcinomas and 12% of prostatic adenocarcinomas stained with CK 7. Forty-one percent of urothelial carcinomas and 12% of prostatic carcinomas were reactive for CEAm, and p53 stained 33% and 3% of urothelial and prostatic adenocarcinomas, respectively. No significant difference was seen in the expression of CEAp, CK 20, B72.3, Leu M1, or mucicarmine between prostate and urothelial carcinoma. We propose a panel of six antibodies to assist in the distinction of high-grade prostatic adenocarcinoma from high grade urothelial carcinoma: PSA, PSAP, 34␤E12, Leu 7, CK 7, and p53. The first three antibodies should be used initially; if results are negative, the remaining antibodies may be employed.KEY WORDS: 34␤E12; CK 7; immunohistochemistry; Leu 7; prostatic adenocarcinoma; PSA; PSAP; urothelial carcinoma. Mod Pathol 2000;13(11):1186 -1191Prostatic adenocarcinoma and urothelial carcinoma of the urinary bladder are the most common and fifth most common cancers in men, respectively (1). Both neoplasms usually are found in patients older than 50 years; in a subset of patients, both neoplasms occur synchronously or metachronously. Indeed, for patients who undergo cystoprostatectomy for urothelial carcinoma of the bladder, the reported incidence of concurrent prostatic adenocarcinoma is reported to be from 46 to 70% (2-4). At Memorial Sloan-Kettering Cancer Center (MSKCC), we frequently encounter patients with bladder neck tumors that clinically and pathologically are not clearly urothelial carcinoma or prostatic adenocarcinoma. Cystoscopy typically reveals a mass at the bladder neck, whereas the remainder of the bladder is unremarkable. Biopsies show a tumor that is often high grade and has morphologic features of both urothelia...

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

“…7 As we have shown, an immunohistochemical panel that includes CK7, CK20, and 34bE12 can be useful in establishing the correct diagnosis. Positive staining for CK7 and 34bE12, with or without positive immunoreactivity for CK20, represents the immunophenotype expected for carcinomas of urothelial origin 8 and supports the diagnosis of urothelial-type adenocarcinoma. Tamboli et al 9 have shown that the addition of villin to such a panel is helpful in distinguishing between colonic adenocarcinoma metastatic to the urinary tract (villin positive) and primary urothelial carcinoma showing glandular differentiation (villin negative).…”

Osteoclast-rich undifferentiated carcinomas of the urinary tract

“…It is recognized that p53 gene alteration is one of the important pathways leading to high-grade urothelial carcinoma with p53 immunohistochemical expression seen in 27.2-66% of urothelial carcinomas. 33,34 Based on our study, osteoclast-like giant-cell carcinomas of the urothelial tract should be considered as variants of urothelial carcinoma. Evidence to support this conclusion are: (1) the presence of keratin positivity in the majority of cases; (2) association with conventional urothelial carcinoma; and (3) matched p53 positivity in both the mononuclear cells and the accompanying urothelial neoplasm.…”

Comparison of different prostatic markers in lymph node and distant metastases of prostate cancer

“…3 It has been demonstrated that even some cases of primary prostate cancer were negative for PSA but could be detected by prostate-specific acid phosphatase (PSAP) and thus might be a good additional marker. 7,8 In contrast to PSA, prostate-specific membrane antigen (PSMA) and prostein (also known as p501s or SLC45A3) were recently described to be highly specific for prostatic tissue. 9,10 Since TMPRSS2-ERG rearrangements, leading to an ETSrelated gene (ERG) overexpression, 11 are amongst the most common and disease-specific genetic alterations in locally defined prostate cancer, [12][13][14] ERG might be of diagnostic potential.…”