Incidental adenocarcinoma after open prostatic adenectomy

Adenocarcinoma of the prostate occasionally is discovered incidentally in the enucleated gland at open prostatic adenectomy for benign disease. Among 468 men who underwent open prostatic adenectomy, unsuspected adenocarcinoma of the prostate was found on pathological examination in 28 (6.0 per cent). The tumors were stage A1 in 14 patients and stage A2 in 14. Careful tissue review resulted in reassigning 5 cases from stage A1 to stage A2. At a mean followup of 10.6 years disease progression had occurred in 4 patients with stage A2 disease. When stage A adenocarcinoma is discovered after open prostatectomy we recommend careful review of the surgical specimen for accurate staging, and adjuvant therapy for all patients with stage A2 disease an for younger patients (less than 65 years old) with stage A1 disease who have favorable life expectancies.     

前列腺增生的偶发癌：附10例报告

１９９０～１９９２年，从１０８例良性前列腺增生（ＢＰＨ）的手术标本中，连续病理切片检出前列腺偶发癌１０例，检出率为９．２５％。病理报告均为腺癌。其中低分化腺癌３例，分化较好或高分化７例。结合文献对前列腺偶发癌发生率，ＢＰＨ与前列腺癌关系，偶发癌的治疗及预后进行讨论。     

Incidental prostate adenocarcinoma in a thirty-year-old Native American.

We report a case of prostatic adenocarcinoma in a thirty-year-old Native American. The tumor was an incidental autopsy finding. We speculate on the biological and clinical significance of prostate tumors in young males.     

Incidental adenocarcinoma of the prostate: a retrospective analysis.

Between January 1980 and June 1990, 5875 patients underwent either TURP (5,529) or open prostatectomy (346) for the management of benign prostatic hyperplasia. Incidental carcinoma was identified in 53 patients (0.9%) - 49 in the TURP group and 4 in the open prostatectomy group. The overall incidence of stage A prostate carcinoma during the same period was 13.1% (53/406). Of those 50 regularly followed patients, only 6 (12.0%) underwent subsequent radical prostatectomy with pelvic lymphadenectomy, and residual tumors were identified in 4 patients (66.7%). The progression rate was 33.3% (3/9) in high-grade tumors (Gleason's score greater than 6) and 7.7% (2/26) in low-grade tumors (Gleason's score less than 5). In those 50 patients, 41 (82.0%) presented no evidence of disease and 9 (18.0%) stayed alive with progression. The mean length of follow-up was 34 months (range: 2-108 months). Our study demonstrates that the outcome of incidental carcinoma of the prostate is good. However, the residual tumor rate still remains high at 66.7%. Radical prostatectomy is recommended in young patients or in patients with high grade tumor.     

Amphiregulin expression in prostatic intraepithelial neoplasia and adenocarcinoma: a study of 93 cases

BACKGROUND: Amphiregulin (AMP) is a heparin-binding glycoprotein that is structurally and functionally related to epidermal growth factor. Its effects are mediated by the tyrosine kinase activity of the epidermal growth factor receptor (EGF-R), and specific nuclear targeting sequences. AMP induces cell proliferation after androgen stimulation of human prostate cancer cell lines. An autocrine proliferative loop involving AMP, androgen, and EGF-R may, therefore, play a role in prostatic carcinogenesis. The purpose of this study was to compare the expression of AMP in benign prostatic epithelium, high-grade prostatic intraepithelial neoplasia (PIN), and adenocarcinoma. METHODS: We performed an immunohistochemical study of select sections from 93 radical prostatectomies performed at the Mayo Clinic between 1987 and 1991. All patients were previously untreated and found to have pathologic stage T2N0M0 adenocarcinoma after routine handling of surgical specimens. Affinity-purified polyclonal antibody directed against AMP was applied to tissue sections using the streptavidin-biotin method. For each case, the percentage of immunoreactive cells in benign epithelium, PIN, and adenocarcinoma was estimated in 10% increments. Intensity on a scale from 0 (negative) to 3 (strongly immunoreactive) and pattern of expression (nuclear versus cytoplasmic) also were recorded. RESULTS: AMP immunoreactivity was present in benign prostatic epithelium, PIN, and prostatic adenocarcinoma in all cases. The mean percentage of AMP-immunoreactive cells was 53.8% in benign epithelium, 65.9% in PIN, and 74.3% in cancer. Intensity was moderate in all cases. The pattern of expression was usually nuclear in benign epithelium (secretory and basal cells), and usually cytoplasmic or nuclear and cytoplasmic in PIN and adenocarcinoma. There were rare scattered immunoreactive cells in the stroma, ejaculatory duct epithelium, and urethral urothelium. Endothelial cells were invariably unstained. CONCLUSIONS: AMP expression in prostate increases progressively from benign epithelium to PIN and cancer. Increased expression of AMP may contribute to the development of prostatic adenocarcinoma. Predominantly nuclear staining was observed in benign epithelium, whereas cytoplasmic or nuclear and cytoplasmic staining was observed in PIN and adenocarcinoma. The differences in nuclear and cytoplasmic localization of immunoreactivity may reflect the presence of two pathways of activation, and hence varying biological functions of AMP.     

Flow cytometry in prostatic adenocarcinoma

Summary We have examined the reproducibility of DNA histograms produced by flow cytometry in two strains of the Dunning R3327 rat prostatic tumor model, determining the extent of variability between tumors in the same animal, from animal to animal within the same strain and from strain to strain. We have also investigated the ability of flow cytometry to monitor changes in DNA histograms produced by tumor age and hormonal manipulation. We have found that there is a considerable difference in aneuploidy in tumors from the two strains, and also much variability in its extent within each strain. While orchiectomy (ORCH) tended to decrease the extent of aneuploidy, this could only be reliably detected if each tumor acted as its own control, with sampling being done pre- and post-ORCH.     

Papillary adenocarcinoma of the prostatic urethra

Three cases of papillary carcinoma of the prostate (also called endometrial adenocarcinoma of the prostate; endometrioid carcinoma) were studied for prostate-specific antigen in order to determine their origin and histogenesis. All 3 cases were prostate-specific antigen positive. Two patients were treated with hormonal therapy, 1 with radiotherapy.     

Metastasis of prostatic adenocarcinoma simulating a falx meningioma

A 56-year-old man, with known metastatic carcinoma of the prostate, presented with a single Jacksonian seizure. Examination revealed a tumor of the falx cerebri which demonstrated many characteristics of a meningioma. Although exceedingly rare, the tumor proved to be a meningeal metastasis of the prostatic adenocarcinoma. The relevant literature is reviewed.     

Deoxythymidine kinase in the staging of prostatic adenocarcinoma

The role of prostate-specific antigen in the management of prostatic adenocarcinoma is still not fully ascertained. Its place in the monitoring of patients who have undergone radical treatment is without question but its role in the primary assessment of a lesion is a point of continuous discussion. This study reports the analysis of prostate-specific antigen (PSA) in 92 patients with different stages of prostatic adenocarcinoma prior to treatment; in the case of the localized lesions, this was based to a great extent on the findings at lymphadenectomy. Apart from PSA analysis, deoxythymidine kinase (dTK) analyses were also performed in an attempt to discover whether the latter could provide additional information about the tumor load in the different patient categories, viz. those with lymph node involvement (group 1), those with lymph node involvement but without distant metastases (group 2), and those with disseminated disease (group 3). The median PSA and dTK values in groups 1–3 were 6.5 μg/L and 2.7 U/μl, 16 μg/L and 2.6 U/μL, and 90 μg/L and 7.8 U/μL, respectively. If the two analyses were used concomitantly, they could differentiate true localized disease from metastatic in approximately 92% of cases. The combination should prove of value in the primary assessment of a patient with a newly diagnosed prostatic adenocarcinoma. © 1996 Wiley-Liss, Inc.     

Incidence and histological findings of unsuspected prostatic adenocarcinoma in radical cystoprostatectomy for transitional cell carcinoma of the bladder

OBJECTIVE: The present study is designed to evaluate the incidence, histological features and significance of prostatic adenocarcinoma in patients undergoing cystoprostatectomy for Transitional Cell Carcinoma (TCC) of the bladder. PATIENTS, MATERIAL AND METHODS: From January 1990 to December 1996, 59 male patients (mean age 66.5 years), with no evidence of prostatic malignancy on preoperative clinical and biochemical assessment, underwent cystoprostatectomy for TCC of the bladder. The bladder was adequately sampled and the entire prostate sectioned at 5-mm intervals and examined histologically, in order to identify unsuspected prostatic cancer (PCa). RESULTS: Sixteen out of 59 patients (27%) were found to have PCa, which was multifocal in 5 cases (31.25%). The mean tumor size was 0.24 cm. The tumors were equally distributed in the anterior and posterior parts of the prostate and in the peripheral and transition zones, with uniform distribution in both prostatic lobes. In 5 patients (31.25%), the single focus of the tumor was in the apex. All were grade I tumors except one, and all were organ-confined with no capsular penetration. The follow-up ranged from 12-74 months (mean 39 months). Within this period, 7 patients died from metastatic bladder cancer. One patient with PCa localized in the prostatic apex had recurrent prostatic disease in the urethro-ileal anastomosis of an orthotopic bladder substitute; he is alive and on androgen deprivation. The remaining patients are relapse-free. CONCLUSIONS: Incidental PCa is quite a common finding in cystoprostatectomy specimens of bladder cancer patients. Its tendency to appear in the apex of the prostate demands careful and complete excision of the organ.     

High-grade prostatic intraepithelial neoplasialike ductal adenocarcinoma of the prostate: a clinicopathologic study of 28 cases

Most of the prostatic ductal adenocarcinomas of the prostate are characterized by cribriform and/or papillary architecture lined by columnar pseudostratified malignant epithelium. We report 28 cases of ductal adenocarcinomas on needle biopsy and transurethral resection of prostate closely resembling high-grade prostatic intraepithelial neoplasia (HGPIN) composed of simple glands with flat, tufting, or micropapillary architecture. The mean age of the patients was 68 years (range, 50 to 91 y). Prostate specific antigen serum level at diagnosis ranged from 1.2 to 12.1 ng/mL. Treatment included radical prostatectomy (n=9), hormone therapy (n=7), radiotherapy (n=5), and cryotherapy (n=1). Three patients had recent biopsies without information on treatment and 3 patients were lost to follow-up after diagnosis. The number of cores involved by tumor in each case ranged from 1 to 18, with more than 1 core involved in 13 cases. Flat was the most common pattern (42%), followed by tufted (41%), and micropapillary (17%) (some with more than 1 pattern). Fourteen cases revealed segments of dilated gland on the edge of the biopsies, suggesting a large gland component. In radical prostatectomies, tumor was primarily composed of small (25%), medium (17%), or cystically dilated (58%) cancer glands, with all cases demonstrating a mixture of different gland sizes. Cytologically, tumors were characterized by tall columnar atypical cells, basally located nuclei, and amphophilic cytoplasm. The tumors lacked marked pleomorphism, necrosis, solid areas, cribriform formation, or true papillary fronds. Immunohistochemically, alpha-methyl acyl coenzyme-A racemase staining was seen in 93% of cases, with the majority showing strong and diffuse staining. No basal cells were present on p63 and/or high molecular weight cytokeratin staining. In the radical prostatectomy specimens, tumor volumes ranged from a small focus (less than 0.01 cm3) to 1.2 cm3. Concurrent conventional acinar Gleason score 6 adenocarcinomas were seen in 6 of the 9 radical prostatectomy cases, in all cases as separate nodules from the PIN-like ductal adenocarcinomas. Only one of the PIN-like ductal adenocarcinomas at radical prostatectomy had extraprostatic extension, which was focal. PIN-like ductal adenocarcinoma differs from HGPIN by the presence of cystically dilated glands, a greater predominance of flat architecture, and less frequently prominent nucleoli. Verification often requires the immunohistochemical documentation of the absence of basal cells in numerous atypical glands. Although usual ductal adenocarcinoma is considered comparable to Gleason score 8, PIN-like ductal adenocarcinoma was accompanied by Gleason score 6 acinar carcinoma and behaved similar to Gleason score 6 acinar cancer. Recognition of this entity is critical to differentiate it from both HGPIN and conventional ductal adenocarcinoma.     

Penile metastasis of prostatic adenocarcinoma

Prostatic carcinoma metastasizing to the penis is rare. A case of adenocarcinoma of the prostate with metastases to the penile shaft and glans penis is presented.     

Incidental prostatic carcinoma obtained from the tissue by transurethral resection

Between January, 1982 and May, 1988, transurethral resection of the prostatic gland diagnosed as clinically benign prostatic hypertrophy was performed on 461 patients at Yokohama Minami Kyosai Hospital. Thirty-eight cases of incidental carcinoma (8.2%) were found by histopathological examination. The patients with well and moderately differentiated adenocarcinoma decreased in proportion to the increase in the number of the tumor chips. Of the 10 patients with more than 11 tumor chips, 7 patients (70%) had histologically poorly differentiated adenocarcinoma. The cases of INF alpha were only found in the group with the ratio of tumor chips to examined chips of less than 5%. The ratio of the cases of INF gamma increased with the increase in the ratio of tumor chips. Uniform substaging criteria of incidental prostatic carcinoma (stage A) obtained from the tissue by transurethral resection should be established.     

前列腺特异性膜抗原和前列腺特异性抗原在前列腺癌组织中的表达

目的：观察并比较前列腺特异性膜抗原（PSMA）和前列腺特异性抗原（PSA）在不同前列腺为组织中的表达差异；比较组织PSMA与PSA对前列腺癌诊断和鉴别诊断的意义。方法：采用ABC三步法免疫组织化学染色方法，用PSMA和PSA单克隆抗体对70例前列腺癌（PCA）、21例前列腺上皮内瘤（PIN）、20例前列腺良性增生（BPH）组织进行染色。结果：PSMA在前列腺癌组织中明显高表达，PSA则在前列腺良性增生组织中高表达；组织PSMA对前列腺癌的阳性检出率明显高于PSA。结论：PSMA是较PSA更具特异性的前列腺癌瘤标，可望取代PSA成为诊断前列腺癌的新型瘤标，并在前列腺癌免疫治疗方面具有良好的应用前景。     

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.     

血管生长素在前列腺癌和前列腺良性增生组织中的表达

目的研究血管生长素（angiogenin，ANG）在前列腺癌和前列腺良性增生组织中的表达及其与前列腺癌生物学行为的关系。方法采用免疫组化SP法对68例前列腺癌组织和38例前列腺良性增生组织标本ANG蛋白的表达进行检测，并对不同的年龄组、病理分级、临床分期之间的表达差异通过统计学分析进行比较。结果免疫组化实验显示阳性染色为棕黄色和深棕色颗粒。ANG在前列腺癌组织中表达显著高于前列腺良性增生组织（P〈0.01）。ANG表达随前列腺癌患者临床分期的升高而上调（P〈0.05）;随着肿瘤组织Gleason病理分级的增加而呈升高趋势（P〈0.05）;而在不同年龄组前列腺癌患者之间ANG表达无统计学差异（P〉0.05）。结论前列腺癌组织中ANG的表达在判断前列腺癌侵袭性、估计其预后中有一定意义。