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Alrohaibani A, Osunkoya AO. Primary mucinous adenocarcinoma of the urethra: A contemporary clinicopathologic analysis of 17 patients. Pathol Res Pract 2024; 256:155273. [PMID: 38565023 DOI: 10.1016/j.prp.2024.155273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 03/13/2024] [Accepted: 03/26/2024] [Indexed: 04/04/2024]
Abstract
Mucinous adenocarcinoma of the urethra is rare. Here we performed a contemporary clinicopathologic analysis of this entity in both male and female patients. All cases with secondary tumors involving the urethra were excluded. Clinicopathologic parameters and follow up was obtained. Seventeen patients were included in the study, 9/17 (53 %) male and 8/17 (47 %) female. The mean patient age was 68 years (range: 53-88 years). The majority (11/17, 65 %) of patients were African American, with an even greater incidence (7/8, 87 %) in female patients. In male patients, prostatic urethra was the most common part of the urethra (6/9, 67 %) where the tumor arose from. Immunohistochemical stains were performed in 11/17 (65 %) tumors and were positive for CK20 (11/11, 100 %), CDX2 (11/12, 92 %), CK7 (8/9, 88 %), GATA3 (3/8, 37 %) and negative for NKX3.1, PSA, p63, PAX8, and Beta-Catenin. In resection specimens, tumors were categorized as pT2 (3/11, 27 %), pT3 (1/11, 9 %), and pT4 (7/11, 64 %). Lymph node status was categorized as pN0 (6/9, 67 %), pN1 (1/9, 11 %), and pN2 (2/9, 22 %). Available follow up data showed 7/13 (54 %) patients developed recurrence after surgical resection and chemotherapy, of which 3/7 (43 %) died of widespread metastatic disease. It is critical for pathologists and urologic oncologists to be aware of this entity in both male and female patients in view of potential diagnostic pitfalls, prognosis, and therapeutic implications.
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Affiliation(s)
- Alaaeddin Alrohaibani
- Department of Pathology, Emory University School of Medicine, Atlanta, GA 30322, United States
| | - Adeboye O Osunkoya
- Department of Pathology, Emory University School of Medicine, Atlanta, GA 30322, United States; Winship Cancer Institute of Emory University, Atlanta, GA 30322, United States; Department of Urology, Emory University School of Medicine, Atlanta, GA 30322, United States; Department of Pathology, Veterans Affairs Medical Center, Decatur, GA 30033, United States.
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2
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Khokhar AA, Howles SA, Leiblich AW, Samdani K, Ahmed M. Mucinous Adenocarcinoma of the Prostate With Normal Prostate-Specific Antigen Levels, Pulmonary Metastasis, and the Absence of Nodal Disease: A Case Report. Cureus 2024; 16:e56563. [PMID: 38646307 PMCID: PMC11029818 DOI: 10.7759/cureus.56563] [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] [Accepted: 03/20/2024] [Indexed: 04/23/2024] Open
Abstract
A 74-year-old man was suffering from nine months of perineal pain and progressive worsening of urinary symptoms including nocturia and urgency. His prostate-specific antigen (PSA) levels were 1.48 ng/mL at the time of referral. Initially, a differential diagnosis of prostatitis or seminal vesicle inflammation was made, and four weeks of antibiotics were prescribed, which were later extended to six weeks due to failure of symptoms to resolve. Magnetic resonance imaging (MRI) of the prostate was then conducted. The impression was that there was ejaculatory duct obstruction caused by enlarged seminal vesicles with no evidence of significant prostate cancer. The prostate-specific antigen density (PSAd) was 0.04, and the prostate imaging reporting and data system (PIRADS) score was I-II. A CT chest with contrast was conducted for further investigation of pulmonary nodules found on the CT urogram. It revealed multiple calcified pulmonary nodules which were suspicious of malignancy. A CT-guided biopsy of one of the pulmonary nodules was taken, and histopathological analysis revealed a mucinous adenocarcinoma. A transurethral resection of the prostate (TURP) was then performed. Histopathological analysis of the prostatic surgical specimen revealed invasive mucinous adenocarcinoma. Based on the findings, a diagnosis of mucinous adenocarcinoma of the prostate with atypical lung metastasis without osseous or regional lymph node involvement was made, stage T4 N0 M1a. The patient is currently on a treatment regimen consisting of carboplatin, pemetrexed, and pembrolizumab.
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Affiliation(s)
- Arham A Khokhar
- Urology Department, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, GBR
| | - Sarah A Howles
- Urology Department, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, GBR
| | - Aaron W Leiblich
- Urology Department, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, GBR
| | - Khubaib Samdani
- Surgery Department, Benazir Bhutto Hospital, Rawalpindi, PAK
| | - Mubariz Ahmed
- Medicine Department, Isfandyar Bukhari District Hospital, Attock, PAK
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3
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Abstract
The Gleason scoring system and Grade Group systems facilitate accurate grading and reporting of prostate cancer, which are essential tasks for surgical pathologists. Gleason Pattern 4 is critical to recognize because it signifies a risk for more aggressive behavior than Gleason Pattern 3 carcinoma. Prostatic adenocarcinoma with radiation or androgen therapy effect, with aberrant P63 expression, or with Paneth cell-like differentiation represent pitfalls in prostate cancer grading because although they display architecture associated with aggressive behavior in usual prostatic adenocarcinoma, they do not behave aggressively and using conventional Gleason scoring in these tumors would significantly overstate their biologic potential.
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Affiliation(s)
- Ezra Baraban
- Department of Pathology, Johns Hopkins Medical Institutions, 401 North Broadway, Weinberg Building, Room 2242, Baltimore, MD 21287, USA.
| | - Jonathan Epstein
- Department of Pathology, Johns Hopkins Medical Institutions, 401 North Broadway, Weinberg Building, Room 2242, Baltimore, MD 21287, USA; Department of Urology, Johns Hopkins Medical Institutions, 401 North Broadway, Weinberg Building, Room 2242, Baltimore, MD 21287, USA; Department of Oncology, Johns Hopkins Medical Institutions, 401 North Broadway, Weinberg Building, Room 2242, Baltimore, MD 21287, USA.
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4
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Uhlig R, Günther K, Bröker N, Gorbokon N, Lennartz M, Dwertmann Rico S, Reiswich V, Viehweger F, Büscheck F, Kluth M, Hube-Magg C, Hinsch A, Fraune C, Bernreuther C, Lebok P, Sauter G, Izbicki JR, Steurer S, Burandt E, Marx AH, Krech T, Simon R, Minner S, Clauditz TS, Jacobsen F. Diagnostic and prognostic role of pancreatic secretory granule membrane major glycoprotein 2 (GP2) immunohistochemistry: A TMA study on 27,681 tumors. Pathol Res Pract 2022; 238:154123. [PMID: 36137400 DOI: 10.1016/j.prp.2022.154123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/01/2022] [Accepted: 09/13/2022] [Indexed: 11/29/2022]
Abstract
Pancreatic secretory granule membrane major glycoprotein 2 (GP2) is a membrane component of zymogen granules which is abundantly secreted by pancreatic acinar cells. Because RNA based analyses suggest a strict limitation of GP2 expression to the pancreas in normal tissues, and a strong preference to pancreatic cancer among tumors, GP2 expression analysis might have diagnostic utility. To better understand the role of GP2 protein expression, GP2 was successfully analyzed in 27,965 tumor samples from 132 different tumor types and subtypes as well as 8 samples each of 76 different normal tissue types by immunohistochemistry in a tissue microarray format (TMA). GP2 immunostaining was seen in 14 of 16 (87.5 %) acinar cell carcinomas, 6 of 507 (1.2 %) ductal adenocarcinomas, and 3 of 99 neuroendocrine neoplasms of the pancreas (3.0 %). GP2 was also found in 23 extra-pancreatic tumor entities including several types of neuroendocrine neoplasms (14.3-58.8 %), prostatic adenocarcinomas (8.2-18.8 %), various other adenocarcinomas (0.1-7.7 %), and several categories of benign and malignant salivary gland tumors (2.3-3.1 %). A strong GP2 positivity was only seen in 6 tumor categories including 50 % of 16 pancreatic acinus cell carcinomas, 11.8 % of 17 neuroendocrine tumors of the lung, 1.3 % of 80 primary Gleason 4 + 4 % and 0.6 % of 181 recurrent prostate cancers, as well as 0.8 % of 133 adenocarcinomas of the lung. In a cohort of 14,747 prostate cancers with follow up data, GP2 immunostaining was strongly linked to advanced pT stage, high Gleason grade, lymph node metastasis, and recurrence free survival (p < 0.0001 each). The prognostic impact of GP2 positivity was independent of established parameters in TMPRSS2:ERG fusion-negative cancers (p < 0.0001). In summary, our data show that GP2 is preferentially expressed in acinar cell carcinomas of the pancreas but the glycoprotein can - rarely - also be expressed in a variety of other tumor entities.
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Affiliation(s)
- Ria Uhlig
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Karin Günther
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nina Bröker
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Natalia Gorbokon
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maximilian Lennartz
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Viktor Reiswich
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Florian Viehweger
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Franziska Büscheck
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martina Kluth
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Claudia Hube-Magg
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andrea Hinsch
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Fraune
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Bernreuther
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Patrick Lebok
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Institute of Pathology, Clinical Center Osnabrueck, Osnabrueck, Germany
| | - Guido Sauter
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jakob R Izbicki
- General, Visceral and Thoracic Surgery Department and Clinic, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Steurer
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Eike Burandt
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andreas H Marx
- Department of Pathology, Academic Hospital Fuerth, Fuerth, Germany
| | - Till Krech
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Institute of Pathology, Clinical Center Osnabrueck, Osnabrueck, Germany
| | - Ronald Simon
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Sarah Minner
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Till S Clauditz
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Frank Jacobsen
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Nova-Camacho LM, Villafruela Mateos A. A Rare Case of Co-Existing Mucin-Producing Urothelial-Type Adenocarcinoma of the Prostate and Acinar Adenocarcinoma. Int J Surg Pathol 2022:10668969221105624. [PMID: 35903905 DOI: 10.1177/10668969221105624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Mucin-producing urothelial-type adenocarcinoma of the prostate is an extremely rare neoplasm, and its coexistence with acinar adenocarcinoma is exceptional. A 70-year-old man presented with treatment resistant symptoms of urinary obstruction. The serum prostate specific antigen (PSA) level was normal. Cystoscopy revealed a kind of "cottony fluff" in the prostatic urethra. A computed tomography (CT) scan and magnetic resonance imaging (MRI) showed a polylobulated, hyperintense lesion with mucinous content. It was located in the right lobe of the prostate and measured 35 × 27 × 35 mm. The bladder cavity did not show lesions and the gastrointestinal endoscopy was normal. Thus, the patient underwent a radical cystoprostatectomy. The histological sections showed the characteristics of a mucin-producing adenocarcinoma with extensive areas of mucin pools formation. No areas of necrosis, glandular urethritis, or carcinoma in situ were identified. Neither lymphovascular and perineural invasion nor lymph node metastases were identified. The immunohistochemical study showed diffuse positivity for keratin (KRT) 7, KRT20, and membranous beta-catenin and focal positivity for KRT34betaE12 and caudal-related homeobox gene 2 (CDX2). In addition, we identified a 10-mm focus of prostatic acinar adenocarcinoma that was positive for racemase and NKX3.1. There is no treatment algorithm for this condition; however, surgery (radical prostatectomy) with or without adjuvant chemotherapeutic treatment represents a therapeutic alternative.
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Affiliation(s)
- Luiz M Nova-Camacho
- Department of Pathology, 16650Hospital Universitario Donostia, San Sebastian, Spain
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Shimizu K, Inoue R, Tomochika S, Isoyama N, Yamamoto Y, Matsumoto H, Shiraishi K, Yoshino S, Tsuzuki T, Matsuyama H. Mucin-producing urothelial-type adenocarcinoma of the prostate diagnosed after robot-assisted radical prostatectomy. IJU Case Rep 2022; 5:32-35. [PMID: 35005467 PMCID: PMC8720726 DOI: 10.1002/iju5.12380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 09/07/2021] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Mucin-producing adenocarcinoma of the prostate is a rare disease that includes prostate adenocarcinoma with mucus production, secondary adenocarcinoma from the bladder or colorectum, and adenocarcinoma from the urothelium of the prostatic urethra. We describe prostate-specific antigen-negative mucin-producing urothelial-type adenocarcinoma of the prostate. CASE PRESENTATION The patient had urinary retention and a serum prostate-specific antigen level of 0.74 ng/mL. Computed tomography and magnetic resonance imaging revealed a prostate tumor with a mucous component. We diagnosed adenocarcinoma by prostate biopsy and subsequently performed robot-assisted radical prostatectomy. Mucin-producing urothelial-type adenocarcinoma of the prostate was diagnosed by pathological examinations. Lung metastasis, developing within 3 months after surgery, was treated using chemotherapy. CONCLUSION Endocrine therapy is ineffective for mucin-producing urothelial-type adenocarcinoma of the prostate. Mucin-producing urothelial-type adenocarcinoma of the prostate diagnosis requires pathological and immunohistochemical analyses. It is important to surgically remove the primary lesion, and robot-assisted radical prostatectomy may provide an effective approach. Multimodal therapy is essential to treat for mucin-producing urothelial-type adenocarcinoma of the prostate.
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Affiliation(s)
- Kosuke Shimizu
- Departments of UrologyGraduate School of MedicineYamaguchi UniversityUbeJapan
| | - Ryo Inoue
- Departments of UrologyGraduate School of MedicineYamaguchi UniversityUbeJapan
| | - Shinobu Tomochika
- Department of GastroenterologicalBreast and Endocrine SurgeryGraduate School of MedicineYamaguchi UniversityUbeJapan
| | - Naohito Isoyama
- Departments of UrologyGraduate School of MedicineYamaguchi UniversityUbeJapan
| | - Yoshiaki Yamamoto
- Departments of UrologyGraduate School of MedicineYamaguchi UniversityUbeJapan
| | - Hiroaki Matsumoto
- Departments of UrologyGraduate School of MedicineYamaguchi UniversityUbeJapan
| | - Koji Shiraishi
- Departments of UrologyGraduate School of MedicineYamaguchi UniversityUbeJapan
| | | | - Toyonori Tsuzuki
- Department of Surgical PathologySchool of MedicineAichi Medical UniversityNagakuteJapan
| | - Hideyasu Matsuyama
- Departments of UrologyGraduate School of MedicineYamaguchi UniversityUbeJapan
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7
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Kanas AF, Fenelon SS, Santos JMMM, Coelho RF, Guglielmetti GB, Nahas WC, Viana PCC. Case 297: Mucinous Adenocarcinoma of the Prostate. Radiology 2021; 302:238-242. [PMID: 34928731 DOI: 10.1148/radiol.202949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
History A 70-year-old man was referred to our institution with chronic obstructive urinary symptoms and constipation for 2 years before admission. His medical history was unremarkable. Outside laboratory tests revealed an elevated serum prostate-specific antigen level (21.7 ng/mL [normal range, 0.00-4.00 ng/mL]), and urinalysis results were negative. He was admitted for evaluation of possible prostate cancer. The patient reported no specific symptoms of infection and denied fever, dysuria, hematuria, and abdominal pain. He had no family history of prostate cancer. On physical examination, he was afebrile, and the digital rectal examination was not painful. These findings were evidence of an enlarged prostate and a hard multilobulated mass, which was palpable bilaterally. The urologic team performed MRI of the prostate.
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Affiliation(s)
- Alexandre Fligelman Kanas
- From the Department of Radiology and Oncology, Divisions of Interventional Radiology (A.F.K., P.C.C.V.) and Diagnostic Radiology (S.S.F., J.M.M.M.S., P.C.C.V.), and Department of Surgery, Division of Urology (R.F.C., G.B.G., W.C.N.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar 255, Cerqueira César, São Paulo, SP 05403-000
| | - Sandro Santos Fenelon
- From the Department of Radiology and Oncology, Divisions of Interventional Radiology (A.F.K., P.C.C.V.) and Diagnostic Radiology (S.S.F., J.M.M.M.S., P.C.C.V.), and Department of Surgery, Division of Urology (R.F.C., G.B.G., W.C.N.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar 255, Cerqueira César, São Paulo, SP 05403-000
| | - João Manoel Miranda Magalhães Santos
- From the Department of Radiology and Oncology, Divisions of Interventional Radiology (A.F.K., P.C.C.V.) and Diagnostic Radiology (S.S.F., J.M.M.M.S., P.C.C.V.), and Department of Surgery, Division of Urology (R.F.C., G.B.G., W.C.N.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar 255, Cerqueira César, São Paulo, SP 05403-000
| | - Rafael Ferreira Coelho
- From the Department of Radiology and Oncology, Divisions of Interventional Radiology (A.F.K., P.C.C.V.) and Diagnostic Radiology (S.S.F., J.M.M.M.S., P.C.C.V.), and Department of Surgery, Division of Urology (R.F.C., G.B.G., W.C.N.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar 255, Cerqueira César, São Paulo, SP 05403-000
| | - Giuliano Betoni Guglielmetti
- From the Department of Radiology and Oncology, Divisions of Interventional Radiology (A.F.K., P.C.C.V.) and Diagnostic Radiology (S.S.F., J.M.M.M.S., P.C.C.V.), and Department of Surgery, Division of Urology (R.F.C., G.B.G., W.C.N.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar 255, Cerqueira César, São Paulo, SP 05403-000
| | - William Carlos Nahas
- From the Department of Radiology and Oncology, Divisions of Interventional Radiology (A.F.K., P.C.C.V.) and Diagnostic Radiology (S.S.F., J.M.M.M.S., P.C.C.V.), and Department of Surgery, Division of Urology (R.F.C., G.B.G., W.C.N.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar 255, Cerqueira César, São Paulo, SP 05403-000
| | - Publio Cesar Cavalcante Viana
- From the Department of Radiology and Oncology, Divisions of Interventional Radiology (A.F.K., P.C.C.V.) and Diagnostic Radiology (S.S.F., J.M.M.M.S., P.C.C.V.), and Department of Surgery, Division of Urology (R.F.C., G.B.G., W.C.N.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar 255, Cerqueira César, São Paulo, SP 05403-000
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Abuelnaga M, Chaudry A, Ngai J, Khoshzaban S, Tassadaq T. Primary enteric-type adenocarcinoma of the prostatic urethra after brachytherapy: A case report and review of the literature. JOURNAL OF CLINICAL UROLOGY 2021. [DOI: 10.1177/2051415819886743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Aasem Chaudry
- Department of Urology, Bedford Hospital NHS Trust, UK
| | - Julian Ngai
- Department of Urology, Bedford Hospital NHS Trust, UK
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9
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Shen H, Liao K, Wu W, Li G, Chen S, Nan N, Yu H, Wu H. Case Report: Mucinous Adenocarcinoma Arising From Congenital Ejaculatory Duct Cyst. Pathol Oncol Res 2021; 27:528050. [PMID: 34257524 PMCID: PMC8262157 DOI: 10.3389/pore.2021.528050] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 01/05/2021] [Indexed: 11/27/2022]
Abstract
Herein we present a previously unreported rare case of mucinous adenocarcinoma arising from a congenital ejaculatory duct cyst. Radiographic and endoscopic examinations revealed the tumor occurred in a cyst running through the prostate. Initially, the immunohistochemical pathology results showed that it was a metastatic mucinous adenocarcinoma, but no other primary lesions were clinically evidenced. Based on the embryonic development process of the male urogenital tract, the malformation of the patient's ejaculatory duct, and the pathological examination of the resected specimen, we considered the tumor to be a primary mucinous adenocarcinoma which originating from the hypoplastic ejaculatory duct. The tumor may have developed from the foci of intestinal metaplasia from cloacal remnants during embryonic development.
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Affiliation(s)
- Hua Shen
- Department of Urology, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, China
| | - Kai Liao
- Department of Urology, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, China
| | - Weili Wu
- Department of Urology, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, China
| | - Gongyu Li
- Department of Urology, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, China
| | - Shijin Chen
- Department of Pathology, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, China
| | - Nan Nan
- Department of Radiology, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, China
| | - Hongbo Yu
- Department of Urology, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, China
| | - Hongfei Wu
- Department of Urology, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, China
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10
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Zhang Y, Shen H, Liao K, Wu W, Li J, Yu H, Wu H, Wang Z. Case Report: Prostate Adenocarcinoma With Mucinous Features of Normal-Level Serum PSA, Atypical Imaging, Biopsy-Negative, and Peculiar Urethrocystoscopic Manifestation. Front Oncol 2020; 10:504381. [PMID: 33425711 PMCID: PMC7786235 DOI: 10.3389/fonc.2020.504381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 10/15/2020] [Indexed: 01/01/2023] Open
Abstract
Background Mucinous tumors of the prostate are seen as rare morphological variants of prostate carcinoma. Misdiagnosis and missed diagnosis are frequent clinically, especially when the clinical performance appears atypical. Furthermore, there has not been reported about the urethrocystoscopic performance of mucinous adenocarcinoma growing into the prostatic urethra so far. Case Presentation The current case report describes a 48-year old Asian male who was hospitalized because of intermittent gross hematuria for more than two months. The patient was diagnosed as prostatic space occupying lesions and an examination of needle biopsy was conducted on him, which did not indicate a definite malignancy. Transurethral plasma kinetic resection of the prostate (TUPKP) was performed for the patient, but the postoperative pathology revealed prostatic adenocarcinoma with mucinous features. Specifically, two cord-like neoplasms, extending to the bladder neck, were found through urethrocystoscopy in the prostatic urethra, both of which grew pedicles. The pedicles were situated on the right side of the parenchyma of the prostate. Finally, the patient underwent radical prostatectomy three weeks later. Conclusion Here, we reported a case that prostatic adenocarcinoma with mucinous features was diagnosed after TUPKP. The patient had normal serum prostate-specific antigen levels with atypical images and negative biopsy result. This report lays stress on the vigilance of clinicians in prostate mucinous adenocarcinoma and makes a description of its peculiar urethrocystoscopic manifestation, typical imaging, and unique growth pattern for the first time.
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Affiliation(s)
- Yao Zhang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hua Shen
- Department of Urology, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, China
| | - Kai Liao
- Department of Urology, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, China
| | - Weili Wu
- Department of Urology, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, China
| | - Jiuming Li
- Department of Urology, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, China
| | - Hongbo Yu
- Department of Urology, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, China
| | - Hongfei Wu
- Department of Urology, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, China
| | - Zengjun Wang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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11
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Patel N, Foster BR, Korngold EK, Jensen K, Turner KR, Coakley FV. MRI of prostatic urethral mucinous urothelial carcinoma: Expanding the differential diagnosis for T2 hyperintense prostatic masses. Clin Imaging 2020; 68:68-70. [PMID: 32574932 DOI: 10.1016/j.clinimag.2020.06.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 05/21/2020] [Accepted: 06/07/2020] [Indexed: 11/16/2022]
Abstract
We report the case of a 66-year-old previously healthy man presenting with blood and mucus in his urine. Cystoscopy revealed a mass in the prostatic urethra, and endoscopic biopsy showed adenocarcinoma in situ with mucinous features. Endorectal multiparametric prostate MRI demonstrated a 1.9 cm T2 hyperintense mass in the peripheral zone of the left prostatic apex with extension into the urethral lumen. No diffusion restriction or early enhancement was seen in the mass. Radical prostatectomy was performed, and final pathology demonstrated a mucin-producing urothelial adenocarcinoma arising from the prostatic urethra. The peripheral zone T2 hyperintense abnormality correlated with abundant pools of mucin extending into the prostatic stroma and surrounded by neoplastic prostatic glandular cells. We conclude prostatic urethral mucinous urothelial carcinoma should be included in the differential diagnosis for T2 hyperintense prostatic masses.
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Affiliation(s)
- Neel Patel
- Department of Diagnostic Radiology (NP, BRF EKK, KJ, FVC), Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code: L340, Portland, OR 97239, United States of America; Department of Pathology (KRT), Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code: L340, Portland, OR 97239, United States of America.
| | - Bryan R Foster
- Department of Diagnostic Radiology (NP, BRF EKK, KJ, FVC), Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code: L340, Portland, OR 97239, United States of America; Department of Pathology (KRT), Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code: L340, Portland, OR 97239, United States of America
| | - Elena K Korngold
- Department of Diagnostic Radiology (NP, BRF EKK, KJ, FVC), Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code: L340, Portland, OR 97239, United States of America; Department of Pathology (KRT), Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code: L340, Portland, OR 97239, United States of America
| | - Kyle Jensen
- Department of Diagnostic Radiology (NP, BRF EKK, KJ, FVC), Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code: L340, Portland, OR 97239, United States of America; Department of Pathology (KRT), Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code: L340, Portland, OR 97239, United States of America
| | - Kevin R Turner
- Department of Diagnostic Radiology (NP, BRF EKK, KJ, FVC), Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code: L340, Portland, OR 97239, United States of America; Department of Pathology (KRT), Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code: L340, Portland, OR 97239, United States of America
| | - Fergus V Coakley
- Department of Diagnostic Radiology (NP, BRF EKK, KJ, FVC), Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code: L340, Portland, OR 97239, United States of America; Department of Pathology (KRT), Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code: L340, Portland, OR 97239, United States of America
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12
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Solakhan M, Erturhan MS, Sevinç A, Çetin S. Aggressive course in a patient with mucin-producing urothelial-type adenocarcinoma of the prostate: A case report and review of the literature. Turk J Urol 2018; 45:S135-S138. [PMID: 32027595 DOI: 10.5152/tud.2018.30837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 03/16/2018] [Indexed: 01/14/2023]
Abstract
Prostate cancer is one of the frequently seen types of cancers in men. The most frequent histological type of prostate cancer is the acinar adenocarcinoma. Mucin-producing urothelial-type adenocarcinoma of the prostate is a very rare subtype. The mucin-producing urothelial-type adenocarcinoma of the prostate has microscopic similarities with colon and bladder adenocarcinoma. It has a more aggressive clinical course and does not respond to androgen deprivation therapy. A 77-year-old male patient diagnosed with mucinous prostate cancer was presented in the current case report.
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Affiliation(s)
- Mehmet Solakhan
- Department of Urology, Bahçesehir University School of Medicine, Gaziantep Medicalpark Hospital, Gaziantep, Turkey
| | | | - Alper Sevinç
- Department of Medical Oncology, Gaziantep Medicalpark Hospital, Gaziantep, Turkey
| | - Safiye Çetin
- Department of Pathology, Special Patolab Center, Antalya, Turkey
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13
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PTEN Expression in Mucinous Prostatic Adenocarcinoma, Prostatic Adenocarcinoma With Mucinous Features, and Adjacent Conventional Prostatic Adenocarcinoma: A Multi-institutional Study of 92 Cases. Appl Immunohistochem Mol Morphol 2018; 26:225-230. [DOI: 10.1097/pai.0000000000000417] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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14
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Mucinous and secondary tumors of the prostate. Mod Pathol 2018; 31:S80-S95. [PMID: 29297488 DOI: 10.1038/modpathol.2017.132] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 08/03/2017] [Accepted: 08/03/2017] [Indexed: 12/19/2022]
Abstract
Primary mucinous tumors and secondary tumors involving the prostate gland are relatively uncommon, however they have important diagnostic, therapeutic, and prognostic implications. The primary mucinous tumors of the prostate include mucinous (colloid) adenocarcinoma of the prostate, prostatic adenocarcinoma with mucinous features, and mucinous adenocarcinoma of the prostatic urethra (mucin-producing urothelial-type adenocarcinoma of the prostate). Mucinous adenocarcinoma of the prostate is defined as a primary prostatic acinar tumor characterized by the presence of at least 25% of the tumor composed of glands with extraluminal mucin. This diagnosis can only be made in radical prostatectomy specimens. Recent studies have shown that these tumors have a similar or in some cases better prognosis than conventional prostatic adenocarcinoma treated by radical prostatectomy. The preferred terminology for tumors that are composed of <25% extraluminal mucinous component in radical prostatectomy specimens is 'prostatic adenocarcinoma with mucinous features.' All cases of prostatic adenocarcinoma with extraluminal mucinous components in prostate needle core biopsies or transurethral resection of the prostate specimens are also referred to as 'prostatic adenocarcinoma with mucinous features.' Mucinous adenocarcinoma of the prostatic urethra (mucin-producing urothelial-type adenocarcinoma of the prostate) as the name implies, does not arise from prostatic acini or ducts, and is a distinct entity that arises from the prostatic urethra usually from urethritis glandularis or glandular metaplasia with malignant transformation, and is analogous to adenocarcinoma with mucinous differentiation arising from the urinary bladder. This tumor is aggressive and has a relatively poor prognosis. The most common secondary tumors that arise from adjacent organs and spread (direct extension or metastasis) to the prostate gland, include urothelial carcinoma of the bladder and colorectal adenocarcinoma. Other secondary tumors that may involve the prostate include metastatic epithelial tumors from several other sites, malignant melanoma and soft tissue tumors.
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15
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Trpkov K. Benign mimics of prostatic adenocarcinoma. Mod Pathol 2018; 31:S22-46. [PMID: 29297489 DOI: 10.1038/modpathol.2017.136] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 08/25/2017] [Accepted: 08/26/2017] [Indexed: 01/27/2023]
Abstract
Benign mimics present either as common challenges in daily routine practice or may cause diagnostic dilemmas because some are less commonly seen and one may be less familiar in recognizing them. There are a multitude of mimics of prostatic adenocarcinoma, which may represent normal gland structures, benign proliferations, atrophic lesions, hyperplastic or metaplastic changes, and inflammatory processes. Some of them are preferentially found in certain anatomic areas of the prostate, either confined to the prostate, or outside of the gland. Various benign mimics of prostatic carcinoma may be also evaluated based on their morphologic similarity to Gleason patterns 3-5 of prostatic adenocarcinoma. Most of the mimics are easily recognizable in larger specimens, such as TUR of the prostate or radical prostatectomy specimens, but they may pose diagnostic problems when the evaluation is done on limited tissue, such as needle-core biopsies or if prostate specimens are infrequently encountered in practice. Therefore, before signing out a report with a diagnosis of prostatic carcinoma, pathologists should carefully consider and rule out the various benign lesions that may mimic carcinoma. This is particularly relevant in the current prostate biopsy practice which relies on using extended biopsy core templates. The awareness and familiarity with the characteristic features of the mimics and judicial use of additional ancillary tests, including immunohistochemistry can prevent overdiagnosis and false-positive interpretation. This review provides a contemporary update on the broad spectrum of the benign prostatic lesions that can mimic prostate adenocarcinoma, outlines their key morphologic and immunohistochemical diagnostic features, and provides a diagnostic, pattern-based approach in establishing a correct diagnosis and distinguishing them reliably from prostatic adenocarcinoma.
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Affiliation(s)
- Kiril Trpkov
- Department of Pathology and Laboratory Medicine, Calgary Laboratory Services and University of Calgary, Rockyview General Hospital, Calgary, AB, Canada
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16
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Bryce AH, Borad MJ, Egan JB, Condjella RM, Liang WS, Fonseca R, McCullough AE, Hunt KS, Ritacca NR, Barrett MT, Patel MD, Young SW, Silva AC, Ho TH, Halfdanarson TR, Stanton ML, Cheville J, Swanson S, Schneider DE, McWilliams RR, Baker A, Aldrich J, Kurdoglu A, Izatt T, Christoforides A, Cherni I, Nasser S, Reiman R, Cuyugan L, McDonald J, Adkins J, Mastrian SD, Von Hoff DD, Craig DW, Stewart AK, Carpten JD. Comprehensive Genomic Analysis of Metastatic Mucinous Urethral Adenocarcinoma Guides Precision Oncology Treatment: Targetable EGFR Amplification Leading to Successful Treatment With Erlotinib. Clin Genitourin Cancer 2016; 15:e727-e734. [PMID: 28057415 PMCID: PMC7513310 DOI: 10.1016/j.clgc.2016.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 11/20/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Alan H Bryce
- Division of Hematology/Oncology, Mayo Clinic, Phoenix, AZ; Mayo Clinic Cancer Center, Phoenix, AZ; Center for Individualized Medicine, Mayo Clinic, Rochester, MN.
| | - Mitesh J Borad
- Division of Hematology/Oncology, Mayo Clinic, Phoenix, AZ; Mayo Clinic Cancer Center, Phoenix, AZ; Center for Individualized Medicine, Mayo Clinic, Rochester, MN
| | - Jan B Egan
- Center for Individualized Medicine, Mayo Clinic, Rochester, MN
| | | | | | - Rafael Fonseca
- Division of Hematology/Oncology, Mayo Clinic, Phoenix, AZ; Mayo Clinic Cancer Center, Phoenix, AZ; Center for Individualized Medicine, Mayo Clinic, Rochester, MN
| | - Ann E McCullough
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, AZ
| | | | | | - Michael T Barrett
- Mayo Clinic Cancer Center, Phoenix, AZ; Translational Genomics Research Institute, Phoenix, AZ
| | | | - Scott W Young
- Department of Radiology, Mayo Clinic, Scottsdale, AZ
| | - Alvin C Silva
- Department of Radiology, Mayo Clinic, Scottsdale, AZ
| | - Thai H Ho
- Division of Hematology/Oncology, Mayo Clinic, Phoenix, AZ; Mayo Clinic Cancer Center, Phoenix, AZ; Center for Individualized Medicine, Mayo Clinic, Rochester, MN
| | - Thorvardur R Halfdanarson
- Division of Hematology/Oncology, Mayo Clinic, Phoenix, AZ; Mayo Clinic Cancer Center, Phoenix, AZ; Center for Individualized Medicine, Mayo Clinic, Rochester, MN
| | - Melissa L Stanton
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, AZ
| | - John Cheville
- Department of Anatomic and Clinical Pathology, Mayo Clinic, Rochester, MN
| | | | | | - Robert R McWilliams
- Center for Individualized Medicine, Mayo Clinic, Rochester, MN; Mayo Clinic Cancer Center, Rochester, MN
| | - Angela Baker
- Translational Genomics Research Institute, Phoenix, AZ
| | | | | | - Tyler Izatt
- Translational Genomics Research Institute, Phoenix, AZ
| | | | - Irene Cherni
- Translational Genomics Research Institute, Phoenix, AZ
| | - Sara Nasser
- Translational Genomics Research Institute, Phoenix, AZ
| | | | - Lori Cuyugan
- Translational Genomics Research Institute, Phoenix, AZ
| | | | | | | | | | - David W Craig
- Translational Genomics Research Institute, Phoenix, AZ
| | - A Keith Stewart
- Division of Hematology/Oncology, Mayo Clinic, Phoenix, AZ; Mayo Clinic Cancer Center, Phoenix, AZ; Center for Individualized Medicine, Mayo Clinic, Rochester, MN
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17
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Elo T, Yu L, Valve E, Mäkelä S, Härkönen P. Deficiency of ERβ and prostate tumorigenesis in FGF8b transgenic mice. Endocr Relat Cancer 2014; 21:677-90. [PMID: 24938408 DOI: 10.1530/erc-13-0480] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Estrogens contribute to the development and growth of the prostate and are implicated in prostate tumorigenesis. In their target tissues, estrogens mediate their effects via estrogen receptor α (ERα (ESR1)) and β (ERβ (ESR2)). Hyperplasia and decreased differentiation of epithelial cells in the prostate have been reported in ERβ knockout (BERKO) mice. Herein, we studied the effect of ERβ deficiency on prostate tumorigenesis by crossing BERKOFVB mice with prostate-targeted human fibroblast growth factor 8b transgenic (FGF8b-Tg) mice. Consistent with results described in our previous report, the prostates of 1-year-old FGF8b-Tg mice displayed stromal aberrations, prostatic intraepithelial neoplasia (mPIN) lesions, inflammation, and occasionally cancer. The prostates of BERKOFVB mice exhibited mild epithelial hypercellularity and inflammation. The prostate phenotypes of FGF8b-Tg-BERKOFVB mice closely resembled those of FGF8b-Tg mice. However, mucinous metaplasia, indicated by Goblet-like cells in the epithelium, was significantly more frequent in the prostates of FGF8b-Tg-BERKOFVB mice when compared with FGF8b-Tg mice. Furthermore, compared with FGF8b-Tg mice, there was a tendency for increased frequency of inflammation but milder hyperplasias in the prostate stroma of FGF8b-Tg-BERKOFVB mice. The expression levels of mRNAs for FGF8b-regulated genes including osteopontin (Spp1), connective tissue growth factor (Ctgf), fibroblast growth factor receptors (Fgfrs), and steroid hormone receptors and cytokines were similar in the prostates of FGF8b-Tg and FGF8b-Tg-BERKOFVB mice. Our results indicate that ERβ plays a role in the differentiation of the prostatic epithelium and, potentially, in the defensive mechanism required for protection against inflammation but do not support a direct tumor-suppressive function of ERβ in the prostate of FGF8b-Tg mice.
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Affiliation(s)
- Teresa Elo
- Departments of Cell Biology and AnatomyPharmacologyDrug Development and TherapeuticsTurku Center for Disease ModelingInstitute of Biomedicine, University of Turku, Kiinamyllynkatu 10, 20520 Turku, FinlandFunctional Foods ForumUniversity of Turku, Turku, FinlandDepartment of Laboratory MedicineMAS University Hospital, Lund University, Malmö, Sweden
| | - Lan Yu
- Departments of Cell Biology and AnatomyPharmacologyDrug Development and TherapeuticsTurku Center for Disease ModelingInstitute of Biomedicine, University of Turku, Kiinamyllynkatu 10, 20520 Turku, FinlandFunctional Foods ForumUniversity of Turku, Turku, FinlandDepartment of Laboratory MedicineMAS University Hospital, Lund University, Malmö, Sweden
| | - Eeva Valve
- Departments of Cell Biology and AnatomyPharmacologyDrug Development and TherapeuticsTurku Center for Disease ModelingInstitute of Biomedicine, University of Turku, Kiinamyllynkatu 10, 20520 Turku, FinlandFunctional Foods ForumUniversity of Turku, Turku, FinlandDepartment of Laboratory MedicineMAS University Hospital, Lund University, Malmö, Sweden
| | - Sari Mäkelä
- Departments of Cell Biology and AnatomyPharmacologyDrug Development and TherapeuticsTurku Center for Disease ModelingInstitute of Biomedicine, University of Turku, Kiinamyllynkatu 10, 20520 Turku, FinlandFunctional Foods ForumUniversity of Turku, Turku, FinlandDepartment of Laboratory MedicineMAS University Hospital, Lund University, Malmö, SwedenDepartments of Cell Biology and AnatomyPharmacologyDrug Development and TherapeuticsTurku Center for Disease ModelingInstitute of Biomedicine, University of Turku, Kiinamyllynkatu 10, 20520 Turku, FinlandFunctional Foods ForumUniversity of Turku, Turku, FinlandDepartment of Laboratory MedicineMAS University Hospital, Lund University, Malmö, Sweden
| | - Pirkko Härkönen
- Departments of Cell Biology and AnatomyPharmacologyDrug Development and TherapeuticsTurku Center for Disease ModelingInstitute of Biomedicine, University of Turku, Kiinamyllynkatu 10, 20520 Turku, FinlandFunctional Foods ForumUniversity of Turku, Turku, FinlandDepartment of Laboratory MedicineMAS University Hospital, Lund University, Malmö, SwedenDepartments of Cell Biology and AnatomyPharmacologyDrug Development and TherapeuticsTurku Center for Disease ModelingInstitute of Biomedicine, University of Turku, Kiinamyllynkatu 10, 20520 Turku, FinlandFunctional Foods ForumUniversity of Turku, Turku, FinlandDepartment of Laboratory MedicineMAS University Hospital, Lund University, Malmö, Sweden
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18
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Sebesta EM, Mirheydar HS, Parsons JK, Wang-Rodriguez J, Kader AK. Primary mucin-producing urothelial-type adenocarcinoma of the prostatic urethra diagnosed on TURP: a case report and review of literature. BMC Urol 2014; 14:39. [PMID: 24885582 PMCID: PMC4059493 DOI: 10.1186/1471-2490-14-39] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 04/17/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mucin-producing urothelial-type adenocarcinoma of the prostatic urethra is extremely rare. These lesions must be differentiated from other mucinous tumors including mucin-producing prostatic adenocarcinoma and metastases from either colonic or bladder primaries. CASE PRESENTATION We report here a case of urothelial-type adenocarcinoma arising from the prostatic urethra. The patient is an 81 year-old man with a history of pT1 urothelial cell carcinoma of the bladder status post trans-urethral resection of bladder tumor (TURBT) who initially presented with irritative lower urinary tract symptoms and mucosuria refractory to Flomax and finasteride. A shared decision was made for the patient to undergo trans-urethral resection of prostate (TURP). At the time of surgery, a papillary tumor emanating from the prostatic urethra was found and no urothelial lesions were noted in the bladder. Pathology of the resected prostatic chips revealed an invasive adenocarcinoma with intestinal-type differentiation that stained positive for CK7, CK20, and villin, but negative for PSA, PSAP, uroplakin, and CDX-2. Colonoscopy was normal and CT scan did not show any evidence of colonic lesions nor visceral or lymph node metastases. Thus, the patient was diagnosed with a primary urothelial-type adenocarcinoma of the prostatic urethra. CONCLUSION Herein we review the literature regarding this unusual entity, and discuss the differential diagnosis, immunohistochemistry, and the importance of correctly identifying this rare tumor.
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Affiliation(s)
- Elisabeth M Sebesta
- Columbia University College of Physicians and Surgeons, 630 W, 168th St, New York, NY 10032, USA.
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19
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Metastatic Mucinous Adenocarcinoma of the Prostate with PSA Value of 8.6 ng/mL at 5-Year-Followup after Prostatectomy, Radiotherapy, and Androgen Deprivation. Case Rep Urol 2014; 2014:218628. [PMID: 24600526 PMCID: PMC3926244 DOI: 10.1155/2014/218628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 12/24/2013] [Indexed: 11/17/2022] Open
Abstract
Introduction. Mucinous adenocarcinoma of the prostate is a rare variant of prostate cancer. Its malignant potential and the clinical course of the affected patients remain, by and large, controversial. No data exist about the course of metastatic mucinous adenocarcinoma of the prostate. Case Presentation. This case report describes the excellent clinical course of a 68-year-old patient with metastatic mucinous adenocarcinoma of the prostate, treated by radical prostatectomy, irradiation, and androgen deprivation. Conclusion. In our case, mucinous adenocarcinoma of the prostate does not appear to behave differently than acinar prostate cancer. Its malignant potential is dependent on its Gleason score.
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ERG expression in mucinous prostatic adenocarcinoma and prostatic adenocarcinoma with mucinous features: comparison with conventional prostatic adenocarcinoma. Hum Pathol 2013; 44:2241-6. [PMID: 23849895 DOI: 10.1016/j.humpath.2013.05.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 04/29/2013] [Accepted: 05/01/2013] [Indexed: 02/07/2023]
Abstract
TMPRSS2-ERG is the most common gene fusion in conventional prostatic adenocarcinoma (PCa), identified in about 40% to 70% of cases. Mucinous PCa and PCa with mucinous features are rare subtypes of prostate cancer, and ERG expression in these subtypes has not been well characterized in a large series. A search was made through the surgical pathology and expert consultation files of 2 major academic institutions for cases of mucinous PCa and PCa with mucinous features. The former were obtained from radical prostatectomy cases and the latter from radical prostatectomy cases, transurethral resection of the prostate, and prostate needle core biopsies. A tissue microarray composed of additional cases of mucinous PCa was also included in the study. Immunohistochemical stains for ERG were performed on all the cases. A total of 51 cases of mucinous PCa and PCa with mucinous features were identified. Twenty-five of 51 (47%) cases were positive for ERG expression, including 10/24 (42%) radical prostatectomy specimens, 7/14 (50%) biopsies, 2/4 (50%) transurethral resection of the prostate specimens, 6/9 (67%) from a tissue microarray. This is the largest study to date specifically characterizing ERG expression in mucinous PCa and PCa with mucinous features, with emphasis on comparison with adjacent conventional PCa. ERG is expressed in almost 50% of cases of mucinous PCa and PCa with mucinous features, similar to rates of expression in conventional PCa. This study strongly suggests that these rare subtypes of PCa are clonally related to conventional PCa.
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Cimino S, Russo GI, Favilla V, Fragala E, Collura Z, Zanghi A, Castelli T, Madonia M, Morgia G. Expression of CD7, CD20 and CDX-2 in a secondary signet-ring cell tumor of the prostate: a case report. Int J Immunopathol Pharmacol 2013; 26:269-72. [PMID: 23527733 DOI: 10.1177/039463201302600130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
As is well-known, signet ring cell carcinoma (SRCC) rarely appears as a histological finding in the prostatic tissue. Nevertheless, a differentiation should be made between a primary tumor and a metastatic disease. We describe the case of a 52-year-old man with lower urinary tract symptoms, serum total PSA of 0.2 ng/ml, elevated serum CEA and CA19-9 levels. Two years prior to presentation, he underwent total gastrectomy with histological findings indicating poor differentiated adenocarcinoma with signet-ring cell. A palpable nodule was found on digital rectal examination and for this reason he underwent 12-core transperineal prostate biopsy with a diagnosis of poor differentiated adenocarcinoma with signet-ring cell and adipose tissue infiltration. Immunohistochemical examinations revealed positivity for PAS, CK7 and CDX-2, focal positivity for CK20 and negativity for PSA and PSAP. The diagnosis of a prostatic secondary SRCC was possible given the positivity to CK7, CDX-2, focal positivity to CK20 and negativity to PSA.
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