Best practice in diagnostic immunohistochemistry

Prostate carcinoma and its mimics in needle core biopsies

Gladell P. Paner, Daniel J. Luthringer, Mahul Amin

Research output: Contribution to journalReview article

55 Citations (Scopus)

Abstract

Context. - The unrelenting challenge encountered when differentiating limited-volume prostate carcinoma and sometimes subtle variants from its many morphologic mimics has increased the use of ancillary immunohistochemistry in routine prostate needle biopsies. The availability of prostate cancer-associated and basal cell-associated markers has been an invaluable addition to diagnostic surgical pathology. Objective. - To review commonly used immunohistochemical stains, including innovative combinations, for confirmation or differential diagnosis of prostate carcinoma, and to propose appropriately constructed panels using morphologic patterns in prostate needle biopsies. Data Sources. - These best practices are based on our experience with routine and consultative case sign-outs and on a review of the published English-language literature from 1987 through 2008. Conclusions. - Basal cell-associated markers p63, high-molecular-weight cytokeratin 34βE12, cytokeratin 5/6 or a cocktail containing p63 and high-molecular-weight cytokeratin 34βE12 or cytokeratin 5/6 and prostate carcinoma-specific marker α-methylacyl coenzyme A (coA) racemase alone or in combination are useful adjuncts in confirming prostatic carcinoma that either lacks diagnostic, qualitative or quantitative features or that has an unusual morphologic pattern (eg, atrophic, pseudohyperplastic) or is in the setting of prior treatment. The combination of α-methylacyl coA racemase positivity with negative staining for basal cell-associated markers supports a malignant diagnosis in the appropriate morphologic context. Dual chromogen basal cell-associated markers (p63 [nuclear] and high-molecular-weight cytokeratin 34βE12/cytokeratin 5/6 [cytoplasmic]) and α-methylacyl coA racemase in an antibody cocktail provide greater sensitivity for the basal cell layer, easing evaluation and minimizing loss of representation of the focal area interest because the staining is performed on one slide. In the posttreatment setting, pancytokeratin facilitates detection of subtle-treated cancer cells. Prostate-specific antigen and prostatic acid phosphatase markers are helpful in excluding secondary malignancies involving the prostate, such as urothelial carcinoma, and occasionally in excluding nonprostatic benign mimickers, such as nephrogenic adenoma, mesonephric gland hyperplasia, and Cowper glands. There is no role for ordering immunohistochemistry prospectively in all cases of prostatic needle biopsies.

Original languageEnglish (US)
Pages (from-to)1388-1396
Number of pages9
JournalArchives of Pathology and Laboratory Medicine
Volume132
Issue number9
StatePublished - Sep 1 2008
Externally publishedYes

Fingerprint

Large-Core Needle Biopsy
Practice Guidelines
Prostate
Immunohistochemistry
Keratin-6
Keratin-5
Carcinoma
Racemases and Epimerases
Needle Biopsy
Coenzyme A
Keratins
Molecular Weight
Bulbourethral Glands
Negative Staining
Surgical Pathology
Information Storage and Retrieval
Prostate-Specific Antigen
Adenoma
Hyperplasia
Neoplasms

All Science Journal Classification (ASJC) codes

  • Pathology and Forensic Medicine
  • Medical Laboratory Technology

Cite this

Best practice in diagnostic immunohistochemistry : Prostate carcinoma and its mimics in needle core biopsies. / Paner, Gladell P.; Luthringer, Daniel J.; Amin, Mahul.

In: Archives of Pathology and Laboratory Medicine, Vol. 132, No. 9, 01.09.2008, p. 1388-1396.

Research output: Contribution to journalReview article

@article{7e36a513fcd44fd5ac0f9b89be1172c8,
title = "Best practice in diagnostic immunohistochemistry: Prostate carcinoma and its mimics in needle core biopsies",
abstract = "Context. - The unrelenting challenge encountered when differentiating limited-volume prostate carcinoma and sometimes subtle variants from its many morphologic mimics has increased the use of ancillary immunohistochemistry in routine prostate needle biopsies. The availability of prostate cancer-associated and basal cell-associated markers has been an invaluable addition to diagnostic surgical pathology. Objective. - To review commonly used immunohistochemical stains, including innovative combinations, for confirmation or differential diagnosis of prostate carcinoma, and to propose appropriately constructed panels using morphologic patterns in prostate needle biopsies. Data Sources. - These best practices are based on our experience with routine and consultative case sign-outs and on a review of the published English-language literature from 1987 through 2008. Conclusions. - Basal cell-associated markers p63, high-molecular-weight cytokeratin 34βE12, cytokeratin 5/6 or a cocktail containing p63 and high-molecular-weight cytokeratin 34βE12 or cytokeratin 5/6 and prostate carcinoma-specific marker α-methylacyl coenzyme A (coA) racemase alone or in combination are useful adjuncts in confirming prostatic carcinoma that either lacks diagnostic, qualitative or quantitative features or that has an unusual morphologic pattern (eg, atrophic, pseudohyperplastic) or is in the setting of prior treatment. The combination of α-methylacyl coA racemase positivity with negative staining for basal cell-associated markers supports a malignant diagnosis in the appropriate morphologic context. Dual chromogen basal cell-associated markers (p63 [nuclear] and high-molecular-weight cytokeratin 34βE12/cytokeratin 5/6 [cytoplasmic]) and α-methylacyl coA racemase in an antibody cocktail provide greater sensitivity for the basal cell layer, easing evaluation and minimizing loss of representation of the focal area interest because the staining is performed on one slide. In the posttreatment setting, pancytokeratin facilitates detection of subtle-treated cancer cells. Prostate-specific antigen and prostatic acid phosphatase markers are helpful in excluding secondary malignancies involving the prostate, such as urothelial carcinoma, and occasionally in excluding nonprostatic benign mimickers, such as nephrogenic adenoma, mesonephric gland hyperplasia, and Cowper glands. There is no role for ordering immunohistochemistry prospectively in all cases of prostatic needle biopsies.",
author = "Paner, {Gladell P.} and Luthringer, {Daniel J.} and Mahul Amin",
year = "2008",
month = "9",
day = "1",
language = "English (US)",
volume = "132",
pages = "1388--1396",
journal = "Archives of Pathology and Laboratory Medicine",
issn = "0003-9985",
publisher = "College of American Pathologists",
number = "9",

}

TY - JOUR

T1 - Best practice in diagnostic immunohistochemistry

T2 - Prostate carcinoma and its mimics in needle core biopsies

AU - Paner, Gladell P.

AU - Luthringer, Daniel J.

AU - Amin, Mahul

PY - 2008/9/1

Y1 - 2008/9/1

N2 - Context. - The unrelenting challenge encountered when differentiating limited-volume prostate carcinoma and sometimes subtle variants from its many morphologic mimics has increased the use of ancillary immunohistochemistry in routine prostate needle biopsies. The availability of prostate cancer-associated and basal cell-associated markers has been an invaluable addition to diagnostic surgical pathology. Objective. - To review commonly used immunohistochemical stains, including innovative combinations, for confirmation or differential diagnosis of prostate carcinoma, and to propose appropriately constructed panels using morphologic patterns in prostate needle biopsies. Data Sources. - These best practices are based on our experience with routine and consultative case sign-outs and on a review of the published English-language literature from 1987 through 2008. Conclusions. - Basal cell-associated markers p63, high-molecular-weight cytokeratin 34βE12, cytokeratin 5/6 or a cocktail containing p63 and high-molecular-weight cytokeratin 34βE12 or cytokeratin 5/6 and prostate carcinoma-specific marker α-methylacyl coenzyme A (coA) racemase alone or in combination are useful adjuncts in confirming prostatic carcinoma that either lacks diagnostic, qualitative or quantitative features or that has an unusual morphologic pattern (eg, atrophic, pseudohyperplastic) or is in the setting of prior treatment. The combination of α-methylacyl coA racemase positivity with negative staining for basal cell-associated markers supports a malignant diagnosis in the appropriate morphologic context. Dual chromogen basal cell-associated markers (p63 [nuclear] and high-molecular-weight cytokeratin 34βE12/cytokeratin 5/6 [cytoplasmic]) and α-methylacyl coA racemase in an antibody cocktail provide greater sensitivity for the basal cell layer, easing evaluation and minimizing loss of representation of the focal area interest because the staining is performed on one slide. In the posttreatment setting, pancytokeratin facilitates detection of subtle-treated cancer cells. Prostate-specific antigen and prostatic acid phosphatase markers are helpful in excluding secondary malignancies involving the prostate, such as urothelial carcinoma, and occasionally in excluding nonprostatic benign mimickers, such as nephrogenic adenoma, mesonephric gland hyperplasia, and Cowper glands. There is no role for ordering immunohistochemistry prospectively in all cases of prostatic needle biopsies.

AB - Context. - The unrelenting challenge encountered when differentiating limited-volume prostate carcinoma and sometimes subtle variants from its many morphologic mimics has increased the use of ancillary immunohistochemistry in routine prostate needle biopsies. The availability of prostate cancer-associated and basal cell-associated markers has been an invaluable addition to diagnostic surgical pathology. Objective. - To review commonly used immunohistochemical stains, including innovative combinations, for confirmation or differential diagnosis of prostate carcinoma, and to propose appropriately constructed panels using morphologic patterns in prostate needle biopsies. Data Sources. - These best practices are based on our experience with routine and consultative case sign-outs and on a review of the published English-language literature from 1987 through 2008. Conclusions. - Basal cell-associated markers p63, high-molecular-weight cytokeratin 34βE12, cytokeratin 5/6 or a cocktail containing p63 and high-molecular-weight cytokeratin 34βE12 or cytokeratin 5/6 and prostate carcinoma-specific marker α-methylacyl coenzyme A (coA) racemase alone or in combination are useful adjuncts in confirming prostatic carcinoma that either lacks diagnostic, qualitative or quantitative features or that has an unusual morphologic pattern (eg, atrophic, pseudohyperplastic) or is in the setting of prior treatment. The combination of α-methylacyl coA racemase positivity with negative staining for basal cell-associated markers supports a malignant diagnosis in the appropriate morphologic context. Dual chromogen basal cell-associated markers (p63 [nuclear] and high-molecular-weight cytokeratin 34βE12/cytokeratin 5/6 [cytoplasmic]) and α-methylacyl coA racemase in an antibody cocktail provide greater sensitivity for the basal cell layer, easing evaluation and minimizing loss of representation of the focal area interest because the staining is performed on one slide. In the posttreatment setting, pancytokeratin facilitates detection of subtle-treated cancer cells. Prostate-specific antigen and prostatic acid phosphatase markers are helpful in excluding secondary malignancies involving the prostate, such as urothelial carcinoma, and occasionally in excluding nonprostatic benign mimickers, such as nephrogenic adenoma, mesonephric gland hyperplasia, and Cowper glands. There is no role for ordering immunohistochemistry prospectively in all cases of prostatic needle biopsies.

UR - http://www.scopus.com/inward/record.url?scp=51349103515&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=51349103515&partnerID=8YFLogxK

M3 - Review article

VL - 132

SP - 1388

EP - 1396

JO - Archives of Pathology and Laboratory Medicine

JF - Archives of Pathology and Laboratory Medicine

SN - 0003-9985

IS - 9

ER -