Leite Katia Ramos Moreira, Mitteldorf Cristina A T S, Srougi Miguel, Dall'Oglio Marcos F, Antunes Alberto A, Pontes José, Camara-Lopes Luiz Heraldo
Laboratory of Surgical and Molecular Pathology, Hospital Sirio Libanes, São Paulo 01308-050, Brazil; Laboratory of Medical Investigation, Urology-LIM 55, Medical School USP, São Paulo 01246-903, Brazil.
Laboratory of Surgical and Molecular Pathology, Hospital Sirio Libanes, São Paulo 01308-050, Brazil.
Ann Diagn Pathol. 2008 Aug;12(4):260-266. doi: 10.1016/j.anndiagpath.2007.11.001. Epub 2008 Apr 18.
There are some unusual histologic variants of prostate carcinoma, including mucinous, signet-ring cells, and ductal carcinomas that can metastasize in a problematic way and simulate lung, colorectal, or bladder primaries. Currently, antibodies that are organ-specific have been used in the routine surgical pathology practice. Our aim is to study the profile of expression of Cdx2, thyroid transcription factor 1 (TTF1), and cytokeratin 20 (CK20) in prostate cancer with unusual histologic finding. Twenty-nine prostate adenocarcinomas with unusual histologic findings were submitted to immunohistochemistry with prostate-specific antigen (PSA), CK20, Cdx2, and TTF1 antibodies. There were 7 mucinous, 5 ductal, 2 signet-ring cells, and 15 usual acinar adenocarcinomas with focal mucinous differentiation. To compare the results with usual acinar adenocarcinomas, we studied 10 primary and their respective lymph node metastases in a tissue microarray, 2 unusual metastatic adenocarcinomas, and 6 usual acinar high-grade carcinomas. For tumors with special histologic finding, Cdx2 was expressed by 9 (31.0%) mucinous, signet-cell, or with focal mucinous differentiation. Thyroid transcription factor 1 was moderately positive in mucinous differentiation areas of 2 (6.9%) adenocarcinomas. Cytokeratin 20 was expressed by 9 (31.0%) tumors, among them, 3 ductal adenocarcinomas. Prostate-specific antigen was positive in 28 (96.6%) cases and negative in 1 ductal adenocarcinoma. There was only 1 worrisome ductal adenocarcinoma that was strongly CK20 positive and PSA negative. Almost one third of mucinous prostate carcinomas express Cdx2. Cytokeratin 20 can be positive also in one third of prostate carcinomas, especially the ductal type. Pathologist should be alert when evaluating immunohistochemical profiles of unusual histologic findings of prostate cancer, mostly in distant sites.
前列腺癌存在一些不常见的组织学变异型，包括黏液性、印戒细胞和导管癌，它们可能以一种棘手的方式发生转移，并类似肺、结肠或膀胱的原发性肿瘤。目前，器官特异性抗体已用于常规外科病理实践。我们的目的是研究具有不常见组织学表现的前列腺癌中Cdx2、甲状腺转录因子1（TTF1）和细胞角蛋白20（CK20）的表达情况。29例具有不常见组织学表现的前列腺腺癌接受了前列腺特异性抗原（PSA）、CK20、Cdx2和TTF1抗体的免疫组织化学检测。其中有7例黏液性癌、5例导管癌、2例印戒细胞癌以及15例伴有局灶黏液性分化的普通腺泡腺癌。为了将结果与普通腺泡腺癌进行比较，我们在组织芯片中研究了10例原发性肿瘤及其相应的淋巴结转移灶、2例不常见的转移性腺癌以及6例普通腺泡高级别癌。对于具有特殊组织学表现的肿瘤，9例（31.0%）黏液性、印戒细胞或伴有局灶黏液性分化的肿瘤表达Cdx2。2例（6.9%）腺癌的黏液性分化区域甲状腺转录因子1呈中度阳性。9例（31.0%）肿瘤表达细胞角蛋白20，其中包括3例导管腺癌。28例（96.6%）病例前列腺特异性抗原呈阳性，1例导管腺癌呈阴性。仅有1例令人担忧的导管腺癌CK20强阳性且PSA阴性。几乎三分之一的黏液性前列腺癌表达Cdx2。细胞角蛋白20在三分之一的前列腺癌中也可能呈阳性，尤其是导管型。病理学家在评估前列腺癌不常见组织学表现的免疫组织化学特征时应保持警惕，尤其是在远处转移灶。
