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Cantley RL, Wang X, Reichert ZR, Chinnaiyan AM, Mannan R, Cao X, Spratt DE, Vaishampayan UN, Alumkal JJ, Morgan TM, Palapattu G, Davenport MS, Pantanowitz L, Mehra R. Metastatic prostate cancer diagnosed by fine-needle aspiration: Contemporary cytopathologic and biomarker assessment with clinical correlates. Cancer Cytopathol 2023; 131:117-135. [PMID: 36264673 PMCID: PMC10092797 DOI: 10.1002/cncy.22652] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 08/22/2022] [Accepted: 08/22/2022] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The diagnosis of metastatic prostatic cancer (MPC) by fine needle aspiration (FNA) can usually be rendered by typical cytomorphologic and immunohistochemical (IHC) features. However, MPC diagnosis may be complicated by transformation to atypical phenotypes such as small cell carcinoma, typically under pressure from androgen deprivation therapy (ADT). Predictive and prognostic biomarkers can also be assessed by IHC. This study illustrates how careful assessment of cytologic and biomarker features may provide therapeutic and prognostic information in MPC. DESIGN We reviewed our anatomic pathology archives for MPC diagnosed by FNA from January 2014 to June 2021. Clinical histories, cytology slides, and cell blocks were reviewed. Extensive IHC biomarker workup was performed, including markers of prostate lineage, cell-cycle dysfunction, Ki-67, neuroendocrine markers, PDL1, and androgen receptor splice variant 7. Cases were reclassified into three categories: conventional type, intermediary type, and high-grade neuroendocrine carcinoma (HGNC). RESULTS Eighteen patients were identified. Twelve had conventional MPC, including six of six ADT-naive patients. Six of twelve (50%) with prior ADT were reclassified as intermediary or HGNC. Four intermediary cases included two with squamous differentiation and two with pro-proliferative features. Two HGNC cases had typical small cell carcinoma cytomorphology. Expression of PDL1 was identified in two cases and ARv7 in three cases. Five of five intermediary and HGNC patients died of disease versus six of eleven with with conventional type. CONCLUSIONS Aggressive cytomorphologic variants were commonly identified in patients with prior ADT. Identification of nonconventional cytomorphology and increased proliferation can provide important prognostic information. Recognition of these changes is important for an accurate diagnosis, and the identification of high-grade variants can affect therapeutic decision-making. Clinically actionable biomarkers such as PDL1 and ARv7 can be assessed by IHC.
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Affiliation(s)
- Richard L Cantley
- Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Xiaoming Wang
- Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Michigan Center for Translational Pathology, Ann Arbor, Michigan, USA
| | - Zachery R Reichert
- Rogel Cancer Center, Michigan Medicine, Ann Arbor, Michigan, USA.,Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Arul M Chinnaiyan
- Michigan Center for Translational Pathology, Ann Arbor, Michigan, USA.,Rogel Cancer Center, Michigan Medicine, Ann Arbor, Michigan, USA.,Howard Hughes Medical Institute, Ann Arbor, Michigan, USA
| | - Rahul Mannan
- Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Michigan Center for Translational Pathology, Ann Arbor, Michigan, USA
| | - Xuhong Cao
- Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Michigan Center for Translational Pathology, Ann Arbor, Michigan, USA
| | - Daniel E Spratt
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Ulka N Vaishampayan
- Rogel Cancer Center, Michigan Medicine, Ann Arbor, Michigan, USA.,Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Joshi J Alumkal
- Rogel Cancer Center, Michigan Medicine, Ann Arbor, Michigan, USA.,Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Todd M Morgan
- Rogel Cancer Center, Michigan Medicine, Ann Arbor, Michigan, USA.,Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Ganesh Palapattu
- Rogel Cancer Center, Michigan Medicine, Ann Arbor, Michigan, USA.,Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Matthew S Davenport
- Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Department of Radiology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Liron Pantanowitz
- Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Rohit Mehra
- Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Rogel Cancer Center, Michigan Medicine, Ann Arbor, Michigan, USA
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Liu Y, Dai Z, Hao J, Wang L, Liu Z. Cervical lymphadenopathy as initial presentation of metastatic prostate cancer: A retrospective study of five cases and literature review. Front Surg 2023; 10:1081951. [PMID: 36793314 PMCID: PMC9922865 DOI: 10.3389/fsurg.2023.1081951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 01/10/2023] [Indexed: 01/31/2023] Open
Abstract
Cervical lymphadenopathy as the initial presentation of metastatic prostate cancer is particularly uncommon, and easily misdiagnosed. In the current study, we describe five cases of metastatic prostate cancer in our hospital that presented with cervical lymphadenopathy as an initial symptom. The diagnosis was confirmed by needle biopsy of the suspicious lymph nodes and the serum prostate specific antigen (PSA) levels of all patients exceeded 100 ng/ml. The five patients were treated with hormonal therapy; four received traditional hormonal therapy, including bicalutamide and goserelin; one patient received hormonal therapy that included abiraterone and goserelin. Case 1 developed into castration-resistant prostate cancer (CRPC) after 7 months and died after 12 months. Case 2 rejected regular hormonal therapy for personal reasons and died 6 months after the initial diagnosis. Case 3 was still alive at the time of writing. Case 4 was administered with abiraterone, prednisolone and goserelin; the treatment was effective and the patient has remained symptom-free for the last 24 months. Case 5 was treated with hormonal and chemotherapy but died 8 months after diagnosis. In conclusion, any elderly male presenting with cervical lymphadenopathy should be considered the possibility of prostate cancer, especially when the needle biopsy reveals adenocarcinoma. The prognosis for patients presented with cervical lymphadenopathy as the initial presentation is usually poor. Hormone therapy based on abiraterone may yield a better response in such cases.
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Affiliation(s)
- Yangyang Liu
- Department of Urology, The Second Affiliated Hospital of Dalian Medical University, Dalian, China,Department of Emergency, Xijing Hospital in Xi’an City, Xi’an, Shanxi, China
| | - Zhihong Dai
- Department of Urology, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Jiange Hao
- Department of Urology, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Liang Wang
- Department of Urology, The Second Affiliated Hospital of Dalian Medical University, Dalian, China,Correspondence: Zhiyu Liu Liang Wang
| | - Zhiyu Liu
- Department of Urology, The Second Affiliated Hospital of Dalian Medical University, Dalian, China,Correspondence: Zhiyu Liu Liang Wang
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Zhang W, Chu J, Yang G, Ni T. Correlation between physical characteristics of biopsy specimen and disease of cervical lymph node after contrast-enhanced ultrasound. BMC Surg 2022; 22:223. [PMID: 35690851 PMCID: PMC9188253 DOI: 10.1186/s12893-022-01671-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 04/25/2022] [Indexed: 12/03/2022] Open
Abstract
Background To investigate the correlation between physical characteristics and disease of cervical lymph node biopsy specimens after contrast-enhanced ultrasound. Methods All patients were biopsied after CEUS, 235 patients were divided into three groups A, B and C according to the physical characteristics of specimens: 92 patients in group A were complete tissue specimens; 113 patients in group B were discontinuous tissue specimens. There were 30 patients in group C, including a small number of tissue and floc, purulent and bloody specimens. Pathological examination, pathogen culture examination and Gene X-Pert MIB examination were completed for all patients in the three groups, and statistical analysis was conducted on the integrity and traits of the specimens. Results Group A included 92 intact tissue specimens, 21 with reactive hyperplasia, 17 with lymphoma, 12 with metastatic carcinoma, 13 with lymphadenopathy, 15 with necrotizing lymphadenitis, and rare lymphadenopathy. In group B, 113 patients were treated with intermittent tissue specimens, including infected lymph nodes, lymphoma in 1 case, metastatic carcinoma in 3 cases and sarcoidosis in 1 case. There were 30 patients in group C, including a small amount of tissue and floc, purulent and bloody specimens, all of which were infected lymph nodes. The χ2 value of malignant and benign lymph nodes was 42.401, p = 0.000. Conclusion The physical characteristics of cervical lymph node biopsy specimens after CEUS are correlated with the disease, which has guiding significance for postoperative specimen selection.
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Affiliation(s)
- Wenzhi Zhang
- Department of Ultrasound, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine (Red Cross Hospital of Hangzhou, Integrated Chinese and Western Medicine Hospital of Zhejiang Province), 310003, Hangzhou, China
| | - Jie Chu
- Department of Ultrasound, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine (Red Cross Hospital of Hangzhou, Integrated Chinese and Western Medicine Hospital of Zhejiang Province), 310003, Hangzhou, China
| | - Gaoyi Yang
- Department of Ultrasound, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine (Red Cross Hospital of Hangzhou, Integrated Chinese and Western Medicine Hospital of Zhejiang Province), 310003, Hangzhou, China.
| | - Tu Ni
- Department of Ultrasound, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine (Red Cross Hospital of Hangzhou, Integrated Chinese and Western Medicine Hospital of Zhejiang Province), 310003, Hangzhou, China
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