Aberrant diffuse expression of p63 in adenocarcinoma of the prostate on needle biopsy and radical prostatectomy

Report of 21 cases

Adeboye O. Osunkoya, Donna E. Hansel, Xinlai Sun, George J. Netto, Jonathan Ira Epstein

Research output: Contribution to journalArticle

Abstract

Aberrant diffuse expression of p63 in prostate carcinoma cells is a rare and poorly understood phenomenon. We studied 19 cases of prostate cancer with aberrant diffuse expression of p63 on needle biopsy and reviewed the subsequent radical prostatectomies in 6 cases. In 19/21 cases, 100% of the cancer nuclei stained intensely for p63, with 70% staining in the remaining 2 cases. Two additional radical prostatectomies with aberrant p63 staining with no needle biopsies available for review were also analyzed. On the hematoxylin and eosin-stained slides, 19/21 cases (90.5%) showed a distinctive morphology composed predominantly of glands, nests, and cords with atrophic cytoplasm, hyperchromatic nuclei, and visible nucleoli. Needle biopsy cases ranged from Gleason patterns 3 to 5 with tumor identified on one or more cores, ranging from a minute focus to 80% of the core. In all 8 radical prostatectomies p63 positive cancer was present, with in 2/8 cases both p63 positive cancer and usual p63 negative acinar prostate cancer. In all 8 cases, the tumors were organ confined with negative margins and there was no seminal vesicle involvement or lymph node metastasis. The presence of p63 positive atypical glands with an infiltrative pattern and perineural invasion on radical prostatectomy confirmed the needle biopsy diagnosis of carcinoma. Rarely, prostate cancer can aberrantly express diffuse p63 staining in a nonbasal cell distribution leading to the erroneous diagnosis of atrophy or atypical basal cell proliferation. The diagnosis of prostate cancer is based on the morphology and confirmed by the absence of high molecular weight cytokeratin staining and positivity for α-methylacyl-CoA racemase in the atypical glands. Pathologists need to be aware of this rare and unusual phenomenon, which is a potential pitfall in prostate cancer diagnosis.

Original languageEnglish (US)
Pages (from-to)461-467
Number of pages7
JournalAmerican Journal of Surgical Pathology
Volume32
Issue number3
DOIs
StatePublished - Mar 2008

Fingerprint

Needle Biopsy
Prostatectomy
Prostate
Prostatic Neoplasms
Adenocarcinoma
Staining and Labeling
Neoplasms
Carcinoma
Racemases and Epimerases
Seminal Vesicles
Coenzyme A
Hematoxylin
Eosine Yellowish-(YS)
Keratins
Atrophy
Cytoplasm
Molecular Weight
Lymph Nodes
Cell Proliferation
Neoplasm Metastasis

Keywords

  • Aberrant diffuse expression of p63
  • AMACR/HMWCK/p63 cocktail
  • Atrophic glands
  • Needle biopsy
  • Prostate cancer
  • Radical prostatectomy

ASJC Scopus subject areas

  • Anatomy
  • Pathology and Forensic Medicine

Cite this

Aberrant diffuse expression of p63 in adenocarcinoma of the prostate on needle biopsy and radical prostatectomy : Report of 21 cases. / Osunkoya, Adeboye O.; Hansel, Donna E.; Sun, Xinlai; Netto, George J.; Epstein, Jonathan Ira.

In: American Journal of Surgical Pathology, Vol. 32, No. 3, 03.2008, p. 461-467.

Research output: Contribution to journalArticle

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abstract = "Aberrant diffuse expression of p63 in prostate carcinoma cells is a rare and poorly understood phenomenon. We studied 19 cases of prostate cancer with aberrant diffuse expression of p63 on needle biopsy and reviewed the subsequent radical prostatectomies in 6 cases. In 19/21 cases, 100{\%} of the cancer nuclei stained intensely for p63, with 70{\%} staining in the remaining 2 cases. Two additional radical prostatectomies with aberrant p63 staining with no needle biopsies available for review were also analyzed. On the hematoxylin and eosin-stained slides, 19/21 cases (90.5{\%}) showed a distinctive morphology composed predominantly of glands, nests, and cords with atrophic cytoplasm, hyperchromatic nuclei, and visible nucleoli. Needle biopsy cases ranged from Gleason patterns 3 to 5 with tumor identified on one or more cores, ranging from a minute focus to 80{\%} of the core. In all 8 radical prostatectomies p63 positive cancer was present, with in 2/8 cases both p63 positive cancer and usual p63 negative acinar prostate cancer. In all 8 cases, the tumors were organ confined with negative margins and there was no seminal vesicle involvement or lymph node metastasis. The presence of p63 positive atypical glands with an infiltrative pattern and perineural invasion on radical prostatectomy confirmed the needle biopsy diagnosis of carcinoma. Rarely, prostate cancer can aberrantly express diffuse p63 staining in a nonbasal cell distribution leading to the erroneous diagnosis of atrophy or atypical basal cell proliferation. The diagnosis of prostate cancer is based on the morphology and confirmed by the absence of high molecular weight cytokeratin staining and positivity for α-methylacyl-CoA racemase in the atypical glands. Pathologists need to be aware of this rare and unusual phenomenon, which is a potential pitfall in prostate cancer diagnosis.",
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