Department of Pathology and Laboratory Medicine, University Health Network, Toronto, Ontario, Canada.
J Clin Pathol. 2013 Sep;66(9):779-86. doi: 10.1136/jclinpath-2013-201586. Epub 2013 Jun 17.
Pathological separation of poorly differentiated urothelial and prostate carcinoma is difficult, but imperative because of the impact on patient management. Tumour morphology, in conjunction with a panel of immunohistochemistry (IHC), such as prostate-specific antigen (PSA), prostatic acid phosphatase (PSAP), CK7, CK20, p63 and high molecular weight keratins (HMWKs) are usually employed to resolve this issue. Androgen receptor (AR) expression is maintained in high-grade, undifferentiated prostate carcinoma, and thus, could be considered as a potentially useful adjunct to the conventional panel of markers.
We performed an institutional review of all cases from 2006 to 2012 in which AR IHC had been performed to determine its diagnostic utility in discriminating between poorly differentiated urothelial and prostate carcinoma. Of the eligible cases (n=40), there were 9 high-grade urothelial carcinomas, 27 prostate carcinomas and 4 with both prostate and bladder tumours. All diagnoses were made by integrating the clinical, radiological, morphological and IHC results.
In all the prostate carcinomas, there was diffuse, intense nuclear staining for AR. The urothelial tumours were either negative, had cytoplasmic staining or showed occasionally weak nuclear staining. The difference was highly significant with p<0.0001 (Mann-Whitney U test).
We conclude that AR is an important marker as it is best able to distinguish between poorly differentiated urothelial and prostate carcinoma. AR appears superior to PSA and PSAP, which are not consistently expressed in high-grade prostate carcinoma. Also, high-grade urothelial carcinoma may be negative for CK20, p63/HMWK and occasionally CK7. We advocate the inclusion of AR in the panel of markers to differentiate these tumours.
低分化尿路上皮癌和前列腺癌的病理性分离较为困难，但这是必要的，因为这会影响患者的治疗管理。肿瘤形态学结合免疫组织化学（IHC）标志物，如前列腺特异性抗原（PSA）、前列腺酸性磷酸酶（PSAP）、CK7、CK20、p63 和高分子量角蛋白（HMWKs），通常用于解决这个问题。雄激素受体（AR）在高级别、未分化的前列腺癌中表达，因此，可被视为传统标志物组合的潜在有用辅助手段。
我们对 2006 年至 2012 年期间所有进行 AR IHC 检测的病例进行了机构审查，以确定其在鉴别低分化尿路上皮癌和前列腺癌方面的诊断效用。在符合条件的病例（n=40）中，有 9 例高级别尿路上皮癌、27 例前列腺癌和 4 例同时患有前列腺和膀胱肿瘤。所有诊断均通过整合临床、影像学、形态学和 IHC 结果得出。
所有前列腺癌中，AR 均呈弥漫性、强烈核染色。尿路上皮肿瘤要么阴性，要么有细胞质染色，偶尔有弱核染色。差异具有高度显著性（p<0.0001，Mann-Whitney U 检验）。
我们得出结论，AR 是一个重要的标志物，因为它最能区分低分化尿路上皮癌和前列腺癌。AR 似乎优于 PSA 和 PSAP，因为它们在高级别前列腺癌中并不始终表达。此外，高级别尿路上皮癌可能 CK20、p63/HMWK 阴性，偶尔 CK7 也阴性。我们主张将 AR 纳入标志物组合，以区分这些肿瘤。
