Secondary prostatic adenocarcinoma: A cytopathological study of 50 cases

Abstract

Positive diagnosis of metastatic prostate adenocarcinoma (PAC) can be made by microscopic examination of the cytologic specimens and immunostaining for prostate-specific antigen (PSA) and prostate acid phosphatase (PAP). Immunohistochemical markers have been known to display negative, weak, or focal staining in poorly differentiated PAC and in patients with prior hormonal and/or radiation therapy. The purpose of this study is to characterize the cytopathology of metastatic PAC as it has not been documented in large series. Fifty cases of metastatic PAC with cytological specimens consisting of 41 fine-needle aspiration biopsies (FNAB), 6 pleural fluid aspirates, and 3 catheterized urine samples were reviewed and correlated with the surgical specimens and the clinical charts. Immunostaining for PSA, PAP, cytokeratin AE1/3, cytokeratin 7 (CK7), cytokeratin 20 (CK20), vimentin, and carcinoembryonic antigen (CEA) was done. Mean patient age was 77 +/- 8 yr; serum PSA, 4.1 +/- 2.3; and primary PAC Gleason score, 8.1 +/- 1.5. Cytologically, the specimens consisted of cell clusters or cell sheets with overlapping uniform hyperchromatic nuclei with or without nucleoli. Twelve cases were not reactive to PSA and PAP and 44 cases displayed negative immunoreactivity to both CK7 and CK20. Carcinoid-like lesions and small cell carcinomas were seen in 4 cases and were misdiagnosed as nonprostatic origin based on the following features: negative immunoreactivity to PSA and PAP with or without positive reactivity to CEA, and different histopathological features when compared with the primary PAC. In addition to the frequency of high-grade PAC, awareness of the negative immunoreactivity to PSA and PAP, the discrepancy in the histopathological patterns between the primary and secondary tumors, especially the frequent neuroendocrine differentiation, are helpful features for the diagnosis of metastases of prostatic origin.

Fine‐needle aspiration of metastatic prostatic neuroendocrine carcinomas: Cytomorphologic and immunophenotypic features

“…Unfortunately, these markers are often negative for the NE carcinomas of prostatic origin. 8,9,12,14 Not surprisingly, all our five cases were negative for PSA and PSAP. Since lung is the most common primary site for metastatic NE carcinoma, it is mandatory to rule out a lung primary.…”

“…[13][14][15] There are, however, only a few reports that address NE differentiation in the FNAB diagnosis of metastatic prostatic carcinoma.…”

“…[13][14][15] There are, however, only a few reports that address NE differentiation in the FNAB diagnosis of metastatic prostatic carcinoma. 14,15 This study aims to review the FNAB findings of metastatic NE carcinoma in patients with a history of prostatic carcinoma in our institution. The diagnosis of metastatic prostatic NE carcinomas was achieved by cytomorphological evaluation and immunohistochemical studies on the materials obtained by FNAB, retrospective review of prior prostatic biopsies/resections, and clinical exclusion of another primary site.…”

Cytology of metastatic prostate cancer following orchiectomy and antiandrogen therapy: A diagnostic challenge

“…10 The cytologic appearance of androgenindependent prostate carcinoma can appear carcinoid-like with ''salt and pepper'' chromatin or have small cell carcinoma morphology. 5 Frequently, positive immunohistochemical staining for neuroendocrine markers can be found even in the absence of PSA staining however this finding is variable. Ali and Parwani 11 found five of seven cases of metastatic prostate carcinoma diagnosed by FNA exhibiting small cell carcinoma morphology to be PSA positive while only three cases were positive for neuroendocrine markers.…”

“…Acinar structures and prominent nucleoli are distinguishing diagnostic features. Until recently, 5 the cytologic characteristics of metastatic prostate adenocarcinoma following androgen deprivation have not been well described. Mai et al describe the varied cytologic and immunohistochemical patterns, which can be seen in secondary prostate carcinoma, particularly after therapy.…”