Immunohistochemical diagnosis of a case of metastatic prostate cancer to breast

Bilateral breast mass was found in a 71-year-old male who had been placed on estrogen therapy for stage D2 prostatic adenocarcinoma. Microscopically the mass contained adenocarcinoma morphologically similar to that of the prostate, but the differential diagnosis was impossible between metastatic prostatic carcinoma and primary breast carcinoma. Formalin-paraffin sections of both tumors were stained positively by PSA (prostatic specific antigen) and PAP (prostatic acid phosphatase) using B-SA (biotin-streptavidin) system technique and prostatic origin of the breast mass was confirmed. Prostatic origin for metastatic carcinoma in the breast is are with only 30 reported cases in the literature including 5 Japanese cases. In most of them the diagnosis of the breast lesion as prostatic carcinoma has been made on morphologic and clinical grounds only. Accurate diagnosis is important for the prognosis of the patient, and immunohistochemical method is useful for he diagnosis of breast carcinoma metastasized from prostatic origin.     

Metastatic prostatic adenocarcinoma of male breast

Three cases of metastatic adenocarcinoma of the male breast from prostatic carcinoma are added to the 15 well-documented cases reported in the literature. These 15 cases had received estrogen therapy for prostatic cancer and gynecomastia developed; 14 had clinically palpable breast nodules containing adenocarcinoma. Our 3 cases also received estrogen therapy but differed in that gynecomastia developed in only 1 patient clinically, and diagnoses were made at autopsy with no clinical symptoms related to breast metastases. Moreover, 1 case also showed remarkable florid lactation-like changes of the breast almost indistinguishable morphologically from that seen in the female breast during pregnancy. The histopathologic differential diagnosis of metastatic prostatic carcinoma of the breast from promary cancer of the male breast is stressed. Its importance is obvious because of the differences in clinical treatment and prognosis. Microscopically, the differential points consist of duct hypertrophy and periductal fibrosis (gynecomastia), absence of any ductal involvement by carcinoma cells, frequent presence of cancer cells in lymphatics and vascular channels, morphologic similarity between the cancers in the breast and prostate, and finally, the usual presence of acid phosphatase in the tumors of the prostate and breast.     

Expression of androgen receptor and prostatic specific markers in salivary duct carcinoma: an immunohistochemical analysis of 13 cases and review of the literature

Salivary duct carcinoma (SDC) is an uncommon, pathologically distinct entity characterized by its morphologic resemblance to ductal carcinoma of the breast and highly aggressive behavior. Approximately two thirds of patients die within 4 years of initial diagnosis despite aggressive, combined surgical resection and radiotherapy. Review of the literature indicates that androgen receptor (AR), a marker frequently detected in prostatic carcinoma, is expressed in over 90% of SDCs, whereas two common breast carcinoma markers, estrogen and progesterone receptors (ER and PR), are expressed in only 1.3% and 6% of the tumors, respectively, by immunohistochemistry. This hormonal profile suggests that SDC, in contrast to its histiologic similarity to ductal carcinoma of the breast, is immunophenotypically more related to prostatic carcinoma. To substantiate this hypothesis, we performed immunohistochemical staining of 13 cases of SDC for the presence of AR and two prostatic markers, prostate specific antigen (PSA) and prostatic acid phosphatase (PAP). Our results showed multifocal, scattered, moderate immunostaining for PAP and diffuse, moderate immunostaining for PSA in seven (58.3%) and two (16.7%) cases, respectively. These results create a potential diagnostic challenge to surgical pathologists who are dealing with a metastatic adenocarcinoma of AR+/PSA+/-/PAP+/- phenotype, particularly in male patients of unknown primary. Metastatic salivary duct carcinoma should be given serious thought if clinical investigation fails to reveal a prostatic primary. The immunophenotypic homology that exists between SDC and prostatic carcinoma also suggests that antiandrogen therapy as used in the treatment of prostatic carcinoma might be beneficial in patients with metastatic SDC when all other conventional modalities fail.     

Exfoliative cytology of prostatic carcinoma using a prostatic fluid collecting catheter

In 152 patients who were suspected to have prostatic disease prostatic fluid obtained by a specially designed catheter was examined cytologically. Cytology was positive in 16 of 20 patients who initially were diagnosed clinically as having prostatic carcinoma, in 10 of 41 patients with suspected carcinoma and in 3 of 91 patients with clinical prostatic hypertrophy or other benign diseases. All but one of these cytologically positive cases finally were confirmed histologically to have prostatic carcinoma. In 4 patients initially diagnosed as having prostatic carcinoma cytology was not positive but in one the initial clinical diagnosis was incorrect and only 3 were false negative. This method of diagnosis is simple and highly effective in detecting prostatic carcinoma.     

Metastatic prostatic carcinoma to breast or primary breast carcinoma?

A second primary malignancy in the breast of a man with prostatic carcinoma was studied by means of immunohistochemical techniques for prostatic acid phosphatase (PAP) and prostatic specific antigen (PA). These two techniques enabled us to arrive at the proper diagnosis of breast carcinoma rather than metastatic prostatic carcinoma of the breast.     

Morphology of the clinical stage O of the prostatic carcinoma (incidental carcinoma) (author's transl)]

141 prostatic carcinomas of the clinical stage O (incidental carcinoma) have been analyzed morphologically. The tumors were highly differentiated carcinomas in 41.8% of the cases as compared to only 11.8% in the whole material of 989 carcinomas of all clinical stages in our prostatic carcinoma registry. In 42 cases (29.8%) the tumor involved less than 10% of the surgical material examined and here we find especially the highly differentiated carcinomas. In 22 cases (15.6%) the whole material was completely invaded by carcinomas and here the less differentiated carcinoma types are dominating. In 27 cases (19.2%) the carcinoma has spread to the periprostatic tissue and from here to perivascular and perineural lymphatics. Short-term follow-up was available in 117 cases. In only 17 cases no carcinoma therapy was initiated after the histological diagnosis. The morphological analysis shows that the clinical stage O of prostatic carcinoma includes completely different degrees of differentiation and extension. In planning the course of therapy the morphological findings have to be taken into consideration. The morphological analysis shows that the clinical stage O of prostatic carcinoma includes completely different degrees of differentiation and extension. In planning the course of therapy the morphological findings have to be taken into consideration.     

Carcinoma of prostate metastatic to breast

Clinically diagnosed breast metastasis from prostatic carcinoma is rare. Primary breast carcinoma in patients with prostatic primary is also uncommon. Four patients who presented with breast malignancies in the course of their prostatic carcinoma are described. All but one of them had diffuse metastatic disease. Three of them were on estrogens at the time breast malignancy was diagnosed. Difficulties always arise in differentiating primary lesions from metastasis clinically and histopathologically. The development of histochemical methods for acid phosphatase, and the newest indirect immunofluorescent antibody technique, used in one of our patients, helped in making the differentiation between primary lesion and metastatic disease. Diagnosis of prostatic carcinoma metastatic to breast carries a poor prognosis, and may be an indication for aggressive therapy.     

中药鸦胆子油乳治疗中、晚期前列腺癌

本文报道33例中、晚期前列腺癌采用中药鸦胆子油乳(以下称鸦油乳)注射疗法,对14例C期用鸦油乳腺体内注射+去势术(含2例未去势术)治疗,对19例D期采用鸦油乳腺体内注射和静肪内滴注+去势术(含4例未去势术)治疗后,近期疗效满意。C期14例达CR,D期3例达CR和16例达PR效果。与既往常用之单纯去势、内分泌治疗和放疗相比3年生存率高且无副作用。     

Mixed carcinoma of the prostate with penile metastases and priapism

A case report of mixed prostatic carcinoma metastasizing to the penis is presented. A review of the literature revealed only 55 cases of prostatic carcinoma metastasizing to the penis report to date. To the best of our knowledge, no such unusual case has been reported before.     

Cytological changes in endocrine therapies of prostatic carcinoma

We studied cytological changes by endocrine therapies of prostatic carcinoma in 31 cases. We originated a method of cytology, in which a prostatic fluid collecting catheter was used. This has been already reported in previous papers. By the therapies, carcinoma cells usually became edematous, swollen, squamous and finally keratinized and in the cytoplasm hematoxylin-stained granules often appeared. These findings were usually seen in two weeks after the onset of the endocrine therapy. But the degree of the changes differed among the cases and among the therapies. In some there was no response or only squamous metaplasia was found. Most of the carcinoma cells were viable. In these cases the therapies were thought to be ineffective and their mortality was high. On the contrary, in those with only keratinized cells, the therapies were thought to be effective and the mortality was low. We conclude that the cytological methods were useful for evaluating the therapies.     

鸦胆子油乳治疗中、晚期前列腺癌疗效观察(附33例报告)

为探讨治疗中、晚期前列腺癌（PCa）的有效方法，采用中药鸦胆子油乳注射疗法治疗中、晚期PCa33例，其中14例C期PCa采用鸦胆子油乳腺体内注射加卓九切除术（含2例未作睾丸切除术者）治疗，19例D期PCa采用鸦胆子油乳腺体内注射和静脉内滴注加睾丸切除术（含4例未作睾丸切除术者）治疗。结果2年内近期疗效满意，14例C期PCa达到完全缓解，19例D期PCa中有3例达到完全缓解，16例达到部分缓解。3年生存率达78．8％。认为，与既往常用的单纯睾丸切除内分泌治疗和放疗相比，鸦胆子油乳注射治疗中、晚期PCa患者的3年生存率高，且无副作用。     

Cytological atypia in the prostate gland: frequency, distribution and possible relevance to carcinoma

Frequency and distribution of atypical prostatic hyperplasia were assessed in 51 total prostatectomy specimens for cancer and the data were compared to similar data obtained from analysis of 51 autopsy specimens. Enlargement of columnar cell nuclei in conjunction with preservation of basal cells was chosen as the only criterion for atypia. Depending on the degree of nuclear enlargement, atypia was divided into mild and severe degrees. The evaluation of nuclear atypia was applied to areas of carcinoma as well as to atypical prostatic hyperplasia. There were 3 major findings. 1) Atypical prostatic hyperplasia was found more frequently in prostatectomy specimens (48 of 51 cases) than in autopsy specimens (14 of 37 cases after exclusion of cancer-associated cases) and the difference was significant (p less than 0.001). In addition, atypical prostatic hyperplasia found in prostatectomy specimens was more frequently of severe degree than that in the autopsy specimens (42 of 48 versus 3 of 14 cases, p less than 0.001). 2) The distribution of atypical prostatic hyperplasia and carcinoma in prostatectomy specimens was similar. 3) In a majority of prostatectomy specimens atypical prostatic hyperplasia, when found, was located at sites separate from carcinoma as well as in contiguous areas. Based on these data it is suggested that the presence of a severe degree of nuclear atypia in specimens removed for benign conditions or in prostatic needle biopsies may signify an increased incidence of coexisting carcinoma elsewhere in the prostate or of carcinoma developing in the future. Close followup of these patients may be indicated.     

Melatonin and Steroid-Dependent Carcinomas/Melatonin und Steroid-abhängige Carcinome

In this study the concentrations of plasma melatonin in patients with either prostatic or breast carcinoma were compared to the levels of controls. The mean melatonin was statistically lower in patients with breast cancer as compared to controls (p less than 0.005). In prostatic carcinoma patients, the mean melatonin was statistically higher than in the control group (p less than 0.005). From the results it would seem that low melatonin levels could possibly play a role in breast carcinoma, but the same did not necessarily applied to prostatic cancer.     

Elastosis in malignant tumours

Elastosis is common in infiltrating ductal and lobular carcinomas of the breast, occurring in approximately 90% of cases. It is also well described in some benign lesions of the breast and tumours of the salivary gland. Reports of venous elastosis in association with large-bowel carcinomas are rare. We describe elastosis in single cases of prostatic, gastric, bronchiolar-alveolar and cervical carcinoma.     

Histologic sampling of grossly benign breast biopsies. How much is enough?

To develop a cost-effective approach to the detection of clinically significant lesions in grossly benign breast biopsies, we reviewed 384 consecutive breast biopsies performed because of a palpable mass in which gross examination revealed only benign fibrofatty tissue. All tissue was submitted for histologic examination (total of 3,342 blocks). Carcinoma or atypical hyperplasia (AH) was detected in 26 cases (6.8%). This group included 12 cases of lobular carcinoma in situ, four cases of atypical lobular hyperplasia, four cases of ductal carcinoma in situ, three cases of atypical ductal hyperplasia, and three cases of invasive carcinoma. In 25 of the 26 cases, at least a portion of the lesion was present in fibrous parenchyma; in only one case of atypical lobular hyperplasia was the lesion present exclusively in grossly fatty tissue. If, as a maximum, the first five tissue blocks had been submitted for each case and the remaining tissue was submitted only for cases of carcinoma or atypical hyperplasia, 1,386 (41%) fewer blocks would have been submitted. However, six (23%) of the carcinomas or atypical hyperplasias would have gone undetected. In contrast, submitting the first 10 blocks in each case would have resulted in 610 (18%) fewer blocks submitted but in the detection of all cases of carcinoma and atypical hyperplasia, except for a single focus of lobular carcinoma in situ in one case. We also used statistical models to investigate further the factors important in determining the probability of detecting carcinoma or atypical hyperplasia in grossly benign breast biopsies. We found that the percentage of blocks containing the lesion and the actual number of blocks submitted were the most important of these factors and that the total specimen size was a relatively minor determinant of the probability of detection. We conclude that (a) the likelihood of detecting carcinoma or atypical hyperplasia exclusively in the adipose tissue component of grossly benign breast biopsies is extremely low, and (b) a possible cost-effective method of sampling grossly benign breast biopsies consists of initially submitting a maximum of 10 blocks of fibrous parenchyma for each case, then examining the remaining tissue histologically only if carcinoma or atypical hyperplasia is found among these blocks.     

Crystalloids in latent prostatic carcinoma

Intraglandular crystalloids have been studied in 108 cases of latent prostatic carcinoma collected at autopsy. The morphological features of these crystalloids are essentially the same as reported by previous authors. The crystalloids were identified in 62.0% of cases over age 50 years. They were present in 76.9% of cases in the seventh decade, the highest prevalence among the decades. The number of crystalloids relative to the number of malignant glands tended to be inversely proportional to the size of the carcinoma. We conclude that crystalloids are related to the early development of prostatic carcinoma.     

Intraluminal crystalloids in whole-organ sections of prostate

Demonstration of intraluminal crystalloids and mucin can aid in the diagnosis of prostatic adenocarcinoma. Crystalloids have been reported in 10% to 23% of prostatic adenocarcinomas. This incidence may not be accurate, however, because previous studies were based on specimens obtained by transurethral resection or transrectal biopsy. This study was based on the examination of 54 prostates (9 obtained from radical prostatectomies for prostate cancer and 45 from cystoprostatectomies for bladder carcinoma) processed by a whole-organ section method. Crystalloids were found in all nine prostatic carcinomas from radical prostatectomy specimens. Thirty-one of 45 specimens from cystoprostatectomies had single or multiple foci of adenocarcinoma; of these, 20 cases (64.5%) had crystalloids. Numbers of crystalloids varied not only from case to case but also from area to area within the same case. Crystalloids were occasionally identified in benign and dysplastic glands that were adjacent to areas of carcinoma. Cases without prostatic carcinoma and benign or dysplastic glands distant from areas of carcinoma did not contain crystalloids. Twenty-four prostatic adenocarcinomas had intraluminal mucin; mucin was not found in benign glands. In conclusion we found the incidence of crystalloids to be higher than that reported in previous studies, a difference we believe is because of sampling. We confirm previous observations that intraluminal crystalloids and mucin are helpful in diagnosing prostate adenocarcinoma.     

Acantholytic variant of squamous cell carcinoma of the breast: a case report

Primary squamous cell carcinoma of the breast is a rare clinical entity. Two large review series found only five cases out of a total of 8351 breast malignancies. This case report presents a patient with metaplastic, pseudoangiosarcomatous carcinoma or acantholytic variant of a squamous cell carcinoma of the breast. This diagnosis was based on the histological finding of highly atypical, acantholytic squamous cells. Because the tumor stained positive for keratin and negative for factor VIII, the diagnosis of angiosarcoma was ruled out. Although only scattered case reports have been published on this histological variant, these tumors tend to follow an aggressive course.     

Undescended epididymo-testicular metastasis from prostatic carcinoma

Dear Sir, Metastasis of prostatic carcinoma to testis is un- common in the clinical situation, and the involvement of the epididymis is even rarer. Heidrich et al. [1] found only 80 cases of testicular involvement in prostate cancer in published reports. In 1993, Wiebe et al. [2] found only 14 previous cases of epididymal metastasis from prostatic carcinoma in published work. The simulta- neous involvement of testis and epididymis was reported by Suhler and Blanchard in 1980 [3]. To our knowledge, this was the first documented case of a prostatic carcinoma metastasizing to undescended testis and epididymis.     

Clinical study of tumor markers in prostatic carcinoma--an investigation on the simultaneous measurement of prostatic acid phosphatase (PAP), prostatic antigen (PA) and gamma-seminoprotein (gamma-Sm)

Measurements of prostatic acid phosphatase (PAP), prostatic antigen (PA) and gamma-seminoprotein (gamma-Sm) have been found to be clinically useful in the diagnosis of prostatic carcinoma, but, the usefulness of simultaneous measurement has not yet been elucidated. We determined the clinical significance of simultaneous measurement of these markers, especially, the additional measurement of PA or gamma-Sm to PAP in prostatic carcinoma. Each measurement of PAP, PA and gamma-Sm yielded a very low "false" positive rate (0-6.5%) in patients with non-prostatic urogenital disease or benign prostatic hypertrophy (BPH), which was consistent with the results reported so far by other researchers. Eighteen patients with newly diagnosed prostatic carcinoma of a low stage showed a positive rate of PAP in 16.7%, PA in 33.3% and gamma-Sm in 38.9%. Forty patients having a high stage had a positive rate of 67.5% for each of the markers. In patients with BPH, the positive rate was elevated in only 2.6, 5.2 or 3.9% by the additional measurement of PA or gamma-Sm to PAP, or that of gamma-Sm to PA, respectively. This implied that the additional measurement of other markers to PAP or PA produced only a low elevation of the "false" positive rate. The positive rate in patients with prostatic carcinoma of low stage was increased by the additional measurement of PA or gamma-Sm to PAP or that of gamma-Sm to PA. This suggests that in patients with low stage carcinoma, assay with these combinations would be clinically useful to monitor the patient's clinical course.(ABSTRACT TRUNCATED AT 250 WORDS)