TY - JOUR
T1 - Atypical small acinar proliferation
T2 - Biopsy artefact or distinct pathological entity?
AU - Flury, Sarah C.
AU - Galgano, Mary T.
AU - Mills, Stacey E.
AU - Smolkin, Mark E.
AU - Theodorescu, Dan
PY - 2007/4
Y1 - 2007/4
N2 - OBJECTIVE: To determine if atypical small acinar proliferation (ASAP) represents minimally sampled prostate cancer not fully evaluated on a biopsy or a distinct pathological entity, by examining prostates removed at radical cystectomy, as a finding of ASAP of the prostate on needle-core biopsy is closely associated with the detection of cancer on subsequent biopsy. PATIENTS AND METHODS: In all, 65 consecutive cystoprostatectomy specimens taken from June 1990 to March 2004 had prostatic material reviewed by one genitourinary pathologist (S.E.M.). The presence of high-grade prostatic intraepithelial neoplasia (HGPIN), ASAP, and adenocarcinoma was recorded. Foci of ASAP found in the absence of cancer were assessed with additional sectioning, high-molecular weight keratin (CK903), and α-methylacyl coenzyme A racemase (AMACR) immunohistochemistry. RESULTS: In all, 24 of 65 specimens (37%) had adenocarcinoma. Of the 41 without cancer, 18 (44%) had neither HGPIN nor ASAP, 14 (34%) had HGPIN alone, three (7%) had ASAP alone (four foci), and six had both HGPIN and ASAP (15%). Two foci of ASAP were not present on any further sectioning. The remaining eight foci all lacked CK903 stain, indicating disruption of the basal cell layer. Of these eight, only five were present for the AMACR stain, all of which were positive. Two of these five developed into a lesion considered cancer on further sectioning. CONCLUSION: ASAP identified in incidental prostates represented marginally sampled cancer in at least two of 10 foci assessed. The remainder could not be resolved as benign on further evaluation, and remained suspicious for malignancy.
AB - OBJECTIVE: To determine if atypical small acinar proliferation (ASAP) represents minimally sampled prostate cancer not fully evaluated on a biopsy or a distinct pathological entity, by examining prostates removed at radical cystectomy, as a finding of ASAP of the prostate on needle-core biopsy is closely associated with the detection of cancer on subsequent biopsy. PATIENTS AND METHODS: In all, 65 consecutive cystoprostatectomy specimens taken from June 1990 to March 2004 had prostatic material reviewed by one genitourinary pathologist (S.E.M.). The presence of high-grade prostatic intraepithelial neoplasia (HGPIN), ASAP, and adenocarcinoma was recorded. Foci of ASAP found in the absence of cancer were assessed with additional sectioning, high-molecular weight keratin (CK903), and α-methylacyl coenzyme A racemase (AMACR) immunohistochemistry. RESULTS: In all, 24 of 65 specimens (37%) had adenocarcinoma. Of the 41 without cancer, 18 (44%) had neither HGPIN nor ASAP, 14 (34%) had HGPIN alone, three (7%) had ASAP alone (four foci), and six had both HGPIN and ASAP (15%). Two foci of ASAP were not present on any further sectioning. The remaining eight foci all lacked CK903 stain, indicating disruption of the basal cell layer. Of these eight, only five were present for the AMACR stain, all of which were positive. Two of these five developed into a lesion considered cancer on further sectioning. CONCLUSION: ASAP identified in incidental prostates represented marginally sampled cancer in at least two of 10 foci assessed. The remainder could not be resolved as benign on further evaluation, and remained suspicious for malignancy.
KW - Pathology
KW - Prostate
KW - Prostatic intraepithelial neoplasia
KW - Prostatic neoplasms
KW - Radical cystectomy
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U2 - 10.1111/j.1464-410X.2006.06703.x
DO - 10.1111/j.1464-410X.2006.06703.x
M3 - Article
C2 - 17378841
AN - SCOPUS:33947310622
SN - 1464-4096
VL - 99
SP - 780
EP - 785
JO - BJU International
JF - BJU International
IS - 4
ER -