Double Trouble Establishing Synchronous Primary Tumors of the Urothelium and Prostate by Immunohistomorphology
A Report of Two Cases
DOI:
https://doi.org/10.21141/PJP.2020.06Keywords:
immunohisotchemistry, PSA, prostatic adenocarcinoma, urothelial carcinomaAbstract
Synchronous primary tumors of the urothelium and prostate are a diagnostic challenge among
pathologists. Differentiating carcinomas of urothelial and prostatic origin requires careful assessment of histomorphology coupled with ancillary studies such as immunohistochemistry stains (IHC) to support the diagnosis. We report two cases of adult patients who underwent transurethral resection of the prostate (TURP), with two distinct morphologies noted on routine H&E sections. After a panel of immunohistochemical stains (HMWCK, CK5/6, CK7, CK20, GATA-3, p63, NKX3.1, and PSA), both cases were signed out as papillary urothelial carcinoma and prostatic acinar adenocarcinoma. Correlation of histomorphology with an IHC panel consisting of cytokeratins (CK5/6, CK7, CK20), a urothelial marker (GATA-3), and at least two prostatic markers (PSA, NKX3.1) is recommended in such cases.
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References
1. International Agency for Research on Cancer WHO. Age standardized (World) incidence rates, prostate, all ages [Internet]. Vol. 876, Globocan. 2018. Available from: http://gco.iarc.fr/today.
2. International Agency for Research on Cancer WHO. Bladder Globocan 2018 [Internet]. Globocan. 2019 [cited 2019 Sep 17]. Available from: http://gco.iarc.fr/today.
3. Heidegger I, Oberaigner W, Horninger W, Pichler R. High incidence of clinically significant concomitant prostate cancer in patients undergoing radical cystectomy for bladder cancer: a 10-year single-center experience. Urol Oncol. 2017;35(4):152.e1-152.e5. https://www.ncbi.nlm.nih.gov/pubmed/27956007. https://doi.org/10.1016/j.urolonc.2016.11.004.
4. Barbisan F, Mazzucchelli R, Scarpelli M, et al. Urothelial and incidental prostate carcinoma in prostates from cystoprostatectomies for bladder cancer: is there a relationship between urothelial and prostate cancer? BJU Int. 2009;103(8):1058–63. https://www.ncbi.nlm.nih.gov/pubmed/19076141. https://doi.org/10.1111/j.1464-410X.2008.08207.x.
5. Sellman DP, Peard L, Simpson G, et al. Collision metastasis of prostatic adenocarcinoma and urothelial carcinoma of the bladder. Urol Ann. 2018;10(3):342–4. https://www.ncbi.nlm.nih.gov/pubmed/30089999. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6060602. https://doi.org/10.4103/UA.UA_97_17.
6. Pacchioni D, Casetta G, Piovano M, et al. Prostatic duct carcinoma with combined prostatic duct adenocarcinoma and urothelial carcinoma features: report of a case. Int J Surg Pathol. 2004;12(3):293–7. https://www.ncbi.nlm.nih.gov/pubmed/15306945. https://doi.org/10.1177/106689690401200314.
7. Litwin MS, Tan HJ. The diagnosis and treatment of prostate cancer: a review. JAMA. 2017;317(24):2532–42. https://www.ncbi.nlm.nih.gov/pubmed/28655021. https://doi.org/10.1001/jama.2017.7248.
8. Chang SS, Boorjian SA, Chou R, et al. Diagnosis and treatment of non-muscle invasive bladder cancer: AUA/SUO guideline. J Urol. 2016;196(4):1021–9. https://www.ncbi.nlm.nih.gov/pubmed/27317986. https://doi.org/10.1016/j.juro.2016.06.049.
9. Moch H, Humphrey PA, Ulbright TM, Reuter VE eds. WHO classification of tumours of the urinary system and male genital organs, Fourth ed. Lyon: International Agency for Research on Cancer (IARC); 2016.
10. Sanguedolce F, Russo D, Mancini V, et al. Morphological and immunohistochemical biomarkers in distinguishing prostate carcinoma and urothelial carcinoma: a comprehensive review. Int J Surg Pathol. 2019;27(2):120-33. https://www.ncbi.nlm.nih.gov/pubmed/30509113. https://doi.org/10.1177/1066896918814198.
11. Humphrey PA. Histopathology of prostate cancer. Cold Spring Harb Perspect Med. 2017;7(10): pii: a030411. https://www.ncbi.nlm.nih.gov/pubmed/28389514. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5629988. https://doi.org/10.1101/cshperspect.a030411.
12. Gordetsky J, Epstein JI. Pseudopapillary features in prostatic adenocarcinoma mimicking urothelial carcinoma: a diagnostic pitfall. Am J Surg Pathol. 2014;38(7):941–5. https://www.ncbi.nlm.nih.gov/pubmed/24503758. https://doi.org/10.1097/PAS.0000000000000178.
13. Verma A, Menon S, Bakshi G, Desai S. Pseudopapillary prostatic adenocarcinoma: a diagnostic pitfall for pathologists. Indian J Pathol Microbiol. 2016;59(2):203–5. https://www.ncbi.nlm.nih.gov/pubmed/27166042. https://doi.org/10.4103/0377-4929.182020.
14. Dabbs DJ. Diagnostic immunohistochemistry theranostic and genomic applications, fifth ed. Philadephia: Elsevier; 2019.
15. Cox RM, Magi-galluzzi C, Mckenney JK. Immunohistochemical pitfalls in genitourinary pathology. Adv Anat Pathol. 2018;25(6):387–99. https://www.ncbi.nlm.nih.gov/pubmed/30157041. https://doi.org/10.1097/PAP.0000000000000205.
16. Tian W, Guner G, Miyamoto H, et al. Utility of uroplakin II expression as a marker of urothelial carcinoma. Hum Pathol. 2015;46(1):58–64. https://www.ncbi.nlm.nih.gov/pubmed/25449628. https://doi.org/10.1016/j.humpath.2014.09.007.
17. Oh WJ, Chung AM, Kim JS, et al. Differential immunohistochemical profiles for distinguishing prostate carcinoma and urothelial carcinoma. J Pathol Transl Med. 2016;50(5):345–54. https://www.ncbi.nlm.nih.gov/pubmed/27498545. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5042899. https://doi.org/10.4132/jptm.2016.06.14.
2. International Agency for Research on Cancer WHO. Bladder Globocan 2018 [Internet]. Globocan. 2019 [cited 2019 Sep 17]. Available from: http://gco.iarc.fr/today.
3. Heidegger I, Oberaigner W, Horninger W, Pichler R. High incidence of clinically significant concomitant prostate cancer in patients undergoing radical cystectomy for bladder cancer: a 10-year single-center experience. Urol Oncol. 2017;35(4):152.e1-152.e5. https://www.ncbi.nlm.nih.gov/pubmed/27956007. https://doi.org/10.1016/j.urolonc.2016.11.004.
4. Barbisan F, Mazzucchelli R, Scarpelli M, et al. Urothelial and incidental prostate carcinoma in prostates from cystoprostatectomies for bladder cancer: is there a relationship between urothelial and prostate cancer? BJU Int. 2009;103(8):1058–63. https://www.ncbi.nlm.nih.gov/pubmed/19076141. https://doi.org/10.1111/j.1464-410X.2008.08207.x.
5. Sellman DP, Peard L, Simpson G, et al. Collision metastasis of prostatic adenocarcinoma and urothelial carcinoma of the bladder. Urol Ann. 2018;10(3):342–4. https://www.ncbi.nlm.nih.gov/pubmed/30089999. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6060602. https://doi.org/10.4103/UA.UA_97_17.
6. Pacchioni D, Casetta G, Piovano M, et al. Prostatic duct carcinoma with combined prostatic duct adenocarcinoma and urothelial carcinoma features: report of a case. Int J Surg Pathol. 2004;12(3):293–7. https://www.ncbi.nlm.nih.gov/pubmed/15306945. https://doi.org/10.1177/106689690401200314.
7. Litwin MS, Tan HJ. The diagnosis and treatment of prostate cancer: a review. JAMA. 2017;317(24):2532–42. https://www.ncbi.nlm.nih.gov/pubmed/28655021. https://doi.org/10.1001/jama.2017.7248.
8. Chang SS, Boorjian SA, Chou R, et al. Diagnosis and treatment of non-muscle invasive bladder cancer: AUA/SUO guideline. J Urol. 2016;196(4):1021–9. https://www.ncbi.nlm.nih.gov/pubmed/27317986. https://doi.org/10.1016/j.juro.2016.06.049.
9. Moch H, Humphrey PA, Ulbright TM, Reuter VE eds. WHO classification of tumours of the urinary system and male genital organs, Fourth ed. Lyon: International Agency for Research on Cancer (IARC); 2016.
10. Sanguedolce F, Russo D, Mancini V, et al. Morphological and immunohistochemical biomarkers in distinguishing prostate carcinoma and urothelial carcinoma: a comprehensive review. Int J Surg Pathol. 2019;27(2):120-33. https://www.ncbi.nlm.nih.gov/pubmed/30509113. https://doi.org/10.1177/1066896918814198.
11. Humphrey PA. Histopathology of prostate cancer. Cold Spring Harb Perspect Med. 2017;7(10): pii: a030411. https://www.ncbi.nlm.nih.gov/pubmed/28389514. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5629988. https://doi.org/10.1101/cshperspect.a030411.
12. Gordetsky J, Epstein JI. Pseudopapillary features in prostatic adenocarcinoma mimicking urothelial carcinoma: a diagnostic pitfall. Am J Surg Pathol. 2014;38(7):941–5. https://www.ncbi.nlm.nih.gov/pubmed/24503758. https://doi.org/10.1097/PAS.0000000000000178.
13. Verma A, Menon S, Bakshi G, Desai S. Pseudopapillary prostatic adenocarcinoma: a diagnostic pitfall for pathologists. Indian J Pathol Microbiol. 2016;59(2):203–5. https://www.ncbi.nlm.nih.gov/pubmed/27166042. https://doi.org/10.4103/0377-4929.182020.
14. Dabbs DJ. Diagnostic immunohistochemistry theranostic and genomic applications, fifth ed. Philadephia: Elsevier; 2019.
15. Cox RM, Magi-galluzzi C, Mckenney JK. Immunohistochemical pitfalls in genitourinary pathology. Adv Anat Pathol. 2018;25(6):387–99. https://www.ncbi.nlm.nih.gov/pubmed/30157041. https://doi.org/10.1097/PAP.0000000000000205.
16. Tian W, Guner G, Miyamoto H, et al. Utility of uroplakin II expression as a marker of urothelial carcinoma. Hum Pathol. 2015;46(1):58–64. https://www.ncbi.nlm.nih.gov/pubmed/25449628. https://doi.org/10.1016/j.humpath.2014.09.007.
17. Oh WJ, Chung AM, Kim JS, et al. Differential immunohistochemical profiles for distinguishing prostate carcinoma and urothelial carcinoma. J Pathol Transl Med. 2016;50(5):345–54. https://www.ncbi.nlm.nih.gov/pubmed/27498545. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5042899. https://doi.org/10.4132/jptm.2016.06.14.
Published
03/26/2020
How to Cite
Ong, D. J. ., Alcazaren, E. A. ., & Carnate Jr., J. . (2020). Double Trouble Establishing Synchronous Primary Tumors of the Urothelium and Prostate by Immunohistomorphology : A Report of Two Cases. PJP, 5(1), 44–49. https://doi.org/10.21141/PJP.2020.06
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Case Reports
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The Philippine Journal of Pathology is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Based on works made open access at http://philippinejournalofpathology.org
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