Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD.
Am J Surg Pathol. 2021 Mar 1;45(3):341-346. doi: 10.1097/PAS.0000000000001557.
Distinguishing between poorly differentiated urothelial carcinoma and high-grade prostatic adenocarcinoma is a common challenge in genitourinary pathology, particularly when the tumor involves the bladder neck or prostatic urethra. Clinically, the distinction between these 2 tumors can also be difficult. Proper diagnosis in these patients is essential as they have differing prognoses and clinical management. GATA3 is thought to be a sensitive and relatively specific marker of urothelial carcinoma. However, there is scant data regarding GATA3 labeling of high-grade prostatic adenocarcinoma. The aim of this study is to describe rare cases with strong aberrant GATA3 staining in prostatic adenocarcinoma as a potential diagnostic pitfall. We identified 9 cases of prostatic adenocarcinoma with aberrant positive GATA3 staining from 2015 to 2020 as part of a large consultation service at our institution. All 9 cases were grade group 5, 8 had a Gleason score of 5+5=10 and 1 had a score of 4+5=9. Five of the cases were from the prostate, 3 from the urinary bladder, and 1 from the prostatic urethra. All cases were morphologically typical of high-grade prostatic adenocarcinoma, although were sent for consultation due to uncertainty in the diagnosis. GATA3 positivity was strong, diffuse in 4 cases; strong, patchy in 2 cases and strong, focal in 3 cases. All cases were positive for NKX3.1, 6 positive for p501s, and 6 positive for PSA, with 7/9 cases showing expression of at least 2 prostate-specific markers. The current study describes that rare cases of prostatic adenocarcinoma can show focal or diffuse strong staining for GATA3. In order to avoid this diagnostic pitfall, undifferentiated carcinomas involving the prostate, bladder neck, or trigone should be evaluated not only with GATA3 but also prostate-specific markers.
鉴别低分化尿路上皮癌和高级别前列腺腺癌是泌尿生殖系统病理学中的常见挑战，尤其是当肿瘤涉及膀胱颈部或前列腺尿道时。临床上，这两种肿瘤的鉴别也可能具有挑战性。对这些患者进行正确诊断至关重要，因为它们的预后和临床管理不同。GATA3 被认为是尿路上皮癌的一个敏感且相对特异的标志物。然而，关于 GATA3 标记高级别前列腺腺癌的数据很少。本研究旨在描述前列腺腺癌中罕见的具有强异常 GATA3 染色的病例，作为潜在的诊断陷阱。我们从 2015 年至 2020 年作为我们机构的大型咨询服务的一部分，确定了 9 例前列腺腺癌伴异常阳性 GATA3 染色的病例。这 9 例均为 5 级，8 例为 Gleason 评分 5+5=10，1 例为 4+5=9。其中 5 例来自前列腺，3 例来自膀胱，1 例来自前列腺尿道。所有病例在形态学上均为高级别前列腺腺癌，尽管由于诊断不确定而进行了咨询。GATA3 阳性染色强，弥漫性 4 例；强，斑片状 2 例；强，局灶性 3 例。所有病例均为 NKX3.1 阳性，6 例为 p501s 阳性，6 例为 PSA 阳性，7/9 例显示至少 2 种前列腺特异性标志物表达。本研究描述了罕见的前列腺腺癌病例可出现局灶性或弥漫性强 GATA3 染色。为避免这种诊断陷阱，涉及前列腺、膀胱颈部或三角区的未分化癌不仅应使用 GATA3 评估，还应使用前列腺特异性标志物评估。
