Alaghehbandan Reza, Vanecek Tomas, Trpkov Kiril, Comperat Eva, Kristiansen Glen, Svajdler Marian, Cempirkova Dana, Pavlovsky Michal, Pivovarcikova Kristyna, Stehlikova Adela, Hora Milan, Michal Michal, Hes Ondrej
Department of Pathology, Faculty of Medicine, University of British Columbia, Royal Columbian Hospital, Vancouver, BC.
Departments of Pathology.
Appl Immunohistochem Mol Morphol. 2019 Aug;27(7):523-528. doi: 10.1097/PAI.0000000000000588.
High-grade prostatic adenocarcinoma mimicking urothelial carcinoma (UC) is a rare and unusual variant, which can present a difficult diagnostic challenge. The aim of this study was to examine telomerase reverse transcriptase (TERT) mutations in order to improve differential diagnostic process in this scenario. Ten prostatic adenocarcinomas mimicking UC were retrieved by searching in-house and consultation files of Charles University Hospital, Plzen, Czech Republic, Tenon Hospital Paris, France, and University of Calgary, Canada. We performed microscopic slide review and immunohistochemical and molecular-genetic analyses using the available paraffin tissue. Patient age at diagnosis ranged from 44 to 86 years (mean, 71.8 y). All cases were transurethral resections, except one which was a prostate biopsy. Gleason score 5+5 was observed in 6 patients, whereas the remaining 4 had a Gleason score of 4+5. The tumors showed pseudopapillary, solid, nested, and cribriform architectural growth patterns. All cases were positive for prostatic markers including PSA, PAP, and NKX3.1. Immunohistochemical staining for urothelial marker, GATA3, was negative in 6 cases and only weakly positive in the remaining 4. All 10 cases showed no evidence of TERT mutations. We describe 10 high-grade prostatic adenocarcinomas that on morphology mimicked UC, but all demonstrated negative TERT mutations. A finding of negative TERT mutations in high-grade prostatic adenocarcinoma which mimics UC supports the notion that TERT promoter mutations are absent in prostate carcinoma, which may also aid the diagnostic work-up in difficult cases.
高级别前列腺腺癌酷似尿路上皮癌（UC）是一种罕见且不寻常的变体，可能带来诊断难题。本研究旨在检测端粒酶逆转录酶（TERT）突变，以改善这种情况下的鉴别诊断过程。通过检索捷克共和国比尔森查理大学医院、法国巴黎特农医院和加拿大卡尔加里大学的内部和会诊档案，获取了10例酷似UC的前列腺腺癌病例。我们使用现有的石蜡组织进行了显微镜玻片复查、免疫组织化学和分子遗传学分析。诊断时患者年龄为44至86岁（平均71.8岁）。除1例为前列腺活检外，所有病例均为经尿道切除术。6例患者的Gleason评分为5+5，其余4例为4+5。肿瘤呈现假乳头、实性、巢状和筛状结构生长模式。所有病例的前列腺标志物包括PSA、PAP和NKX3.1均为阳性。尿路上皮标志物GATA3的免疫组织化学染色在6例中为阴性，其余4例仅为弱阳性。所有10例均未显示TERT突变证据。我们描述了10例形态上酷似UC的高级别前列腺腺癌，但均显示TERT突变阴性。在酷似UC的高级别前列腺腺癌中发现TERT突变阴性支持了前列腺癌不存在TERT启动子突变这一观点，这也可能有助于疑难病例的诊断检查。
