Expression of alpha-methylacyl-coenzyme A racemase in nephrogenic adenoma
Expression of alpha-methylacyl-coenzyme A racemase in nephrogenic adenoma
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DOI：
10.1097/01.pas.0000131544.18266.a4
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发表时间：
2004-09-01
影响因子：
5.6
通讯作者：
Yang, XMJ
中科院分区：
文献类型：
--
作者：
Gupta, A;Wang, HLL;Yang, XMJ
肾源性腺瘤是一种由小腺体结构组成的良性病变，沿沿着发展，其发病机制尚不清楚。一些研究者认为肾源性腺瘤是由于尿道损伤引起的化生过程，而另一些人则认为它是由肾小管脱落引起的。肾源性腺瘤可能存在于前列腺尿道，形态学上类似前列腺腺癌。α-甲基酰基辅酶A消旋酶（AMACR）是最近发现的前列腺癌标志物，在正常尿路上皮和前列腺中通常为阴性，在远端曲肾小管中为阳性，除前列腺癌外。因此，检测AMACR在肾源性腺瘤中的表达，对肾源性腺瘤的病理诊断和发病机制的认识具有重要意义。我们研究了38个肾源性腺瘤的临床，组织学，AMACR（P504 S）和高分子量细胞角蛋白（34 β E12）的免疫组化分析。38例肾源性腺瘤中有22例（58%）表现出AMACR强胞浆阳性，范围从斑片状、局灶性到弥漫性染色。此外，26例肾源性腺瘤中有16例（62%）34 β E12阴性。据我们所知，这是第一个报告的一个完全良性病变，可以发现在前列腺，显示出强烈的AMACR免疫反应。我们的研究结果表明，在解释前列腺标本中阳性AMACR免疫染色时要谨慎。这些发现可以解释为可能的肾小管起源或肾分化，至少在一个子集，肾源性腺瘤。
Nephrogenic adenoma is a benign lesion composed of small glandular structures that develops along the urothelium with uncertain pathogenesis. Some investigators believe that nephrogenic adenoma develops by a metaplastic process in response to injury to the urothelium, while others believe that it arises from detached renal tubules. Nephrogenic adenoma may be present in the prostatic urethra and morphologically mimic prostatic adenocarcinoma. Alphamethylacyl-coenzyme A racemase (AMACR), a recently identified prostate cancer marker, is typically negative in normal urothelium and prostatic glands, and positive in distal convoluted renal tubules in addition to prostatic adenocarcinomas. Therefore, evaluation of AMACR expression in nephrogenic adenoma will have significance in the pathologic diagnosis and in understanding pathogenesis of this lesion. We studied 38 nephrogenic adenomas by clinical, histologic, and immunohistochemical analyses for AMACR (P504S) and high molecular weight cytokeratin (34betaE12). Twenty-two of 38 nephrogenic adenomas (58%) demonstrated strong cytoplasmic positivity for AMACR, ranging from patchy, focal to diffuse staining. In addition, 16 of 26 (62%) nephrogenic adenomas were negative for 34betaE12. To our knowledge, this is one of the first report of a completely benign lesion, which can be found in the prostate, showing strong AMACR immunoreactivity. Our findings suggest using caution when interpreting positive AMACR immunostaining in prostatic specimens. These findings could be explained by possible renal tubular origin or renal differentiation, at least in a subset, of nephrogenic adenomas.