Immunohistochemical antibody cocktail staining (p63/HMWCK/AMACR) of ductal adenocarcinoma and Gleason pattern 4 cribriform and noncribriform acinar adenocarcinomas of the prostate
Immunohistochemical antibody cocktail staining (p63/HMWCK/AMACR) of ductal adenocarcinoma and Gleason pattern 4 cribriform and noncribriform acinar adenocarcinomas of the prostate
复制标题
DOI：
10.1097/01.pas.0000213447.16526.7f
复制
发表时间：
2007-06-01
影响因子：
5.6
通讯作者：
Epstein, Jonathan I.
中科院分区：
文献类型：
--
作者：
Herawi, Mehsati;Epstein, Jonathan I.
α -甲基酰基辅酶A消旋酶（AMACR）过表达并缺乏基底细胞标志物[即p63和高分子量细胞角蛋白（HMWCK）]是典型的腺泡性前列腺腺癌。我们研究了p63/ HMWCK/AMACR免疫组化鸡尾酒染色在导管腺癌和筛状Gleason 4型腺泡癌中的表达和诊断价值，并将其与非筛状Gleason 4型腺泡癌进行了比较。本研究纳入了62例根治性前列腺切除术标本中的1至4例具有代表性的福尔马林固定石蜡-em层状档案组织块，其中包括导管前列腺癌（n = 51）、筛状Gleason 4型腺泡（n = 27）和非筛状Gleason 4型腺泡腺癌（n = 48）。采用AMACR、p63和HMWCK的三重染色进行免疫组化。只有中等或强烈的染色才被认为是阳性的。记录不同组织学类型前列腺腺癌中p63/HMWCK染色强度百分比及偶见基底细胞阳性。77%的导管性前列腺腺癌、67%的筛状腺泡性前列腺癌和81%的非筛状腺泡性前列腺癌显示AMACR阳性。3种组织学类型间AMACR染色差异无统计学意义，但非筛状腺泡前列腺癌AMACR的表达有高于筛状腺泡前列腺癌的趋势（P = 0.07）。染色通常是不均匀的，在同一组织学类型的癌中染色强度不同。在31.4%（16/51）的导管癌和29.6%（8/27）的筛状腺泡癌中，p63和HMWCK以斑块形式检测到基底细胞，而在非筛状腺泡癌中，这一比例为2.1%（1/48）。综上所述：(1)大多数前列腺导管癌和筛状腺泡癌强烈表达AMACR，但这些前列腺癌的亚群要么完全阴性，要么只有弱阳性；(2) AMACR染色在同一组织学类型的肿瘤中，甚至在同一病例中，其强度往往是不均匀的；(3)斑块状基底细胞染色在非筛状腺泡前列腺癌中是罕见的。相比之下，p63/ HMWCK鉴定的基底细胞残留物在导管和筛状腺泡前列腺癌中都以斑块形式出现，这很可能代表肿瘤在导管内扩散。
Overexpression of alpha-methylacyl coenzyme A racemase (AMACR) in combination with absence of basal cell markers [ie, p63 and high molecular weight cytokeratin (HMWCK)] is typical of classic acinar prostatic adenocarcinoma. We studied the expression and diagnostic utility of p63/ HMWCK/AMACR immunohistochemical cocktail staining in ductal adenocarcinoma and cribriform Gleason pattern 4 acinar prostate cancer and compared it to noncribriform Gleason pattern 4 acinar prostate cancer. One to 4 representative formalin-fixed paraffin-em bedded archival tissue blocks from 62 radical prostatectomy specimens harboring prostate cancer of ductal (n = 5 1), cribriform Gleason pattern 4 acinar (n = 27), and noncribriform Gleason pattern 4 acinar adenocarcinoma (n = 48) were included in this study. Immunohistochemistry was performed using a triple stain of AMACR, p63, and HMWCK. Only staining that was moderate or strong was considered positive. The percentage of staining intensity and the presence of occasional basal cells positive with p63/HMWCK were recorded in each histologic type of prostatic adenocarcinoma. Seventy-seven percent of ductal prostatic adenocarcinoma, 67% of cribriform acinar prostatic carcinoma, and 81% of noncribriform acinar prostatic carcinoma showed positive staining for AMACR. There was no statistically significant difference between AMACR staining among the 3 histologic types, although there was a trend for noncribriform acinar prostatic carcinoma to have greater expression of AMACR than cribriform acinar prostatic carcinoma (P = 0.07). Staining was often heterogeneous, varying in staining intensities within the same histologic type of carcinoma. Basal cells were detectable by p63 and HMWCK in a patchy fashion in 31.4% (16/51) of ductal and 29.6% (8/27) of cribriform acinar carcinomas compared with 2.1% (1/48) of noncribriform acinar carcinomas. In summary: (1) the majority of prostatic ductal and cribriform acinar carcinomas strongly expressed AMACR, however, subpopulations of these prostatic carcinoma were either completely negative or only weakly positive; (2) AMACR staining was often heterogeneous in intensity in the same histologic type of tumor, even within the same case; (3) patchy basal cell staining in noncribriform acinar prostatic carcinoma is rare. In contrast, remnants of basal cells identified by p63/ HMWCK were seen in a patchy fashion in a significant minority of both ductal and cribriform acinar prostatic adenocarcinoma, which most likely represents intraductal spread of tumor.