Older Male with Urinary Retention

Specimen Type:

Prostate

History:

A 78-year-old man presented with urinary retention underwent transurethral resection of prostate. Representative cross-sections were submitted.

Pathologic Features:

At low power, sections revealed two different populations of proliferative epithelium (Fig.1). The majority of the tumor consisted of acini with complex papillae, lined by variably columnar epithelium. The cancer cells displayed nuclear overlapping, nuclear enlargement and hyperchromasia, as well as prominent nucleoli.(Fig.2). This neoplastic component was positive for prostatic acid phosphatase (PAP) (Fig.3, red arrow) and negative for high molecular weight cytokeratin (34βE12) (Fig.4, left arrow).

In addition, a second component was highlighted by positive staining for 34BE12 (Fig.4, right arrow) and negativity for PAP (Fig.3, black arrow).

Differential Diagnosis:

Not applicable for this case, please continue to the Diagnosis.

Diagnosis:

Prostatic adenocarcinoma (Gleason 4+5=9) (Ductal subtype) (90%) and invasive grade 3 (of 3) urothelial carcinoma (10%) (WHO 1973 Classification). Immunostains for PAP and CK34BE12 support this diagnosis.

Morphologic features alone can usually be used to distinguish prostatic adenocarcinoma and urothelial carcinoma. However, poorly differentiated tumors can occasionally have features of both neoplasms, making determination of site of origin difficult. We report a case of prostatic ductal carcinoma featuring both prostatic adenocarcinoma of ductal subtype and high-grade urothelial carcinoma. Histopathologic examination of specimens from prostatic transurethral resection revealed a tumor showing 2 different components: prostatic adenocarcinoma of ductal subtype (prostatic adenocarcinoma with endometrioid features, ductal carcinoma) (main pattern) and high-grade urothelial carcinoma (minor part). Immunohistochemically, the areas of ductal carcinoma were positive for PAP and negative for CK34βE12. The presence of necrosis within the ducts warranted Gleason pattern 5. The high-grade urothelial carcinoma areas were negative for PAP, while positive for CK34BE12. Concerning the origin of urothelial carcinoma, large prostatic ducts are favored due to the intimate admixture with ductal carcinoma. However, bladder and urethra should also be considered.

References:

  1. Pacchioni D, Casetta G, Piovano M, Fraire F, Volante M, Sapino A, Tizzani A, Bussolati G. Prostatic duct carcinoma with combined prostatic duct adenocarcinoma and urothelial carcinoma features: report of a case. Int J Surg Pathol. 2004 Jul;12(3):293-7.
  2. Varma M, Morgan M, Amin MB, Wozniak S, Jasani B. High molecular weight cytokeratin antibody (clone 34betaE12): a sensitive marker for differentiation of high-grade invasive urothelial carcinoma from prostate cancer. Histopathology. 2003Feb;42(2):167-72.
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  4. Oxley JD, Abbott CD, Gillatt DA, MacIver AG. Ductal carcinomas of the prostate: a clinicopathological and immunohistochemical study. Br J Urol. 1998 Jan;81(1):109-15.