{"id":2298,"date":"2021-09-20T11:16:03","date_gmt":"2021-09-20T09:16:03","guid":{"rendered":"https:\/\/www.newslab.sk\/prostaticky-karcinom-s-aberantnou-expresiou-p63-kazuistika\/"},"modified":"2021-09-20T12:33:11","modified_gmt":"2021-09-20T10:33:11","slug":"prostatic-carcinoma-with-aberrant-expression-of-p63-a-case-report","status":"publish","type":"post","link":"https:\/\/www.newslab.sk\/en\/prostatic-carcinoma-with-aberrant-expression-of-p63-a-case-report\/","title":{"rendered":"Prostatic carcinoma with aberrant expression of p63. A case report"},"content":{"rendered":"

*A rare case of autochthonous human dirofilariasis with the manifestation of pseudotumor of the epididymis caused by helminth Dirofilaria repens<\/strong><\/span><\/p>\n

 <\/p>\n

\u00davod<\/strong><\/h3>\n

Tzv. karcin\u00f3m s aberantnou expresiou p63 (PKAE) je novodefinovan\u00fd typ adenokarcin\u00f3mu prostaty(1-6). Kv\u00f4li expresii baz\u00e1lneho markeru p63 a \u010dasto aj blandnej morfol\u00f3gii predstavuje v prostatickej biopsii jeden z diagnostick\u00fdch pitfalov. Tumor sa l\u00ed\u0161i od konven\u010dn\u00fdch adenokarcin\u00f3mov aj biologick\u00fdm spr\u00e1van\u00edm a jeho vydelenie ako osobitn\u00e9ho typu je pod\u013ea nov\u00fdch poznatkov opr\u00e1vnen\u00e9(2,7). V tejto kazuistike by sme radi prezentovali pr\u00edpad PKAE z na\u0161ej klinickej a bioptickej praxe.<\/p>\n

 <\/p>\n

Klinick\u00fd popis<\/h3>\n

I\u0161lo o 79-ro\u010dn\u00e9ho mu\u017ea, ktor\u00fd bol vy\u0161etren\u00fd pre slab\u00fd pr\u00fad mo\u010du, preru\u0161ovan\u00e9 mo\u010denie a nykt\u00farie. V osobnej anamn\u00e9ze bola resekcia \u017eal\u00fadka pre adenokarcin\u00f3m dif\u00fazneho typu, stage II. Fyzik\u00e1lny n\u00e1lez bol v norme, okrem zv\u00e4\u010d\u0161enej prostaty, ktor\u00e1 v\u0161ak bola bez podozrenia na malignitu. Sonograficky bola prostata homog\u00e9nna a mala 55 g. PSA bolo 9,2. Z toho d\u00f4vodu bola vykonan\u00e1 punk\u010dn\u00e1 biopsia prostaty. Po histologickej dg. PKAE sa pacient rozhodol pre akt\u00edvne sledovanie. V s\u00fa\u010dasnosti, rok po diagn\u00f3ze, je pacient lie\u010den\u00fd leuprolidacet\u00e1tom (Eligard) pre elev\u00e1ciu PSA na 13,54 a je napl\u00e1novan\u00e1 r\u00e1dioterapia prostaty 6 mesiacov od za\u010datia hormon\u00e1lnej lie\u010dby.<\/p>\n

 <\/p>\n

Histologick\u00fd n\u00e1lez<\/h3>\n

Vy\u0161etrili sme 10 punkt\u00e1tov prostaty (5 z pravej a 5 z \u013eavej strany). V \u0161tyroch punkt\u00e1toch pravej strany bola pr\u00edtomn\u00e1 maloacin\u00e1rna infiltr\u00e1cia tkaniva (obr\u00e1zok 1 a 2)<\/strong>. Ac\u00edny boli dobre definovan\u00e9, zv\u00e4\u010d\u0161a blandn\u00e9ho alebo n\u00edzko atypick\u00e9ho vzh\u013eadu, s fok\u00e1lne zrete\u013en\u00fdmi nukleolmi. Cytoplazma bola stredn\u00e9ho a\u017e mal\u00e9ho (pseudoatrofick\u00e9ho) objemu. Vo ve\u013emi ojedinel\u00fdch ac\u00ednoch bola eozinofiln\u00e1 \u201ePaneth cell-like\u201c zmena cytoplazmy. Mitotick\u00e1 aktivita bola minim\u00e1lna. Inv\u00e1ziu perineuria a ciev sme nena\u0161li. Presved\u010div\u00e9 \u0161trukt\u00fary high-grade PIN na danej strane neboli pr\u00edtomn\u00e9. V jednom punkt\u00e1te kontralater\u00e1lne bolo drobn\u00e9 lo\u017eisko high-grade PIN. V konven\u010dn\u00fdch hematoxyl\u00ednovo-eoz\u00ednov\u00fdch rezoch sme zva\u017eovali najm\u00e4 adenokarcin\u00f3m podobn\u00fd atrofii, aden\u00f3zu a mezonefrick\u00fa l\u00e9ziu.<\/p>\n

Imunohistochemicky bol tumor prekvapivo ve\u013emi silne pozit\u00edvny na marker baz\u00e1lnych buniek p63 (DAK-p63, DAKO) (obr\u00e1zok 3)<\/strong>, pri\u010dom expresia sa viazala na v\u0161etky bunky ac\u00ednov, t. j. ne\u0161lo o pozitivitu limitovan\u00fa len na baz\u00e1lne ulo\u017een\u00e9 bunky. CK5\/6 a HMW-CK (cytokerat\u00edn s vysokou molekul\u00e1rnou hmotnos\u0165ou) boli bez expresie baz\u00e1lnej vrstvy. HMW-CK ozna\u010doval len ve\u013emi ojedinel\u00e9 lumin\u00e1lne bunky ac\u00ednov (obr\u00e1zok 4)<\/strong>. Polovica buniek ac\u00ednov bola pozit\u00edvna na alpha-methylacyl-CoA-racem\u00e1zu (AMACR) (obr\u00e1zok 5)<\/strong>. Ac\u00edny boli silne pozit\u00edvne na PSA a NKX3. 1. Negat\u00edvne boli GATA3 a p53. MIB1-index bol 3 %. Kontralater\u00e1lna high-grade PIN bola konven\u010dn\u00e1, bez expresie p63 v lumin\u00e1lnych bunk\u00e1ch. Na z\u00e1klade morfol\u00f3gie a imunohistochemick\u00fdch n\u00e1lezov bola stanoven\u00e1 diagn\u00f3za PKAE.<\/p>\n

 <\/p>\n

Diskusia<\/h3>\n

Prostatick\u00fd karcin\u00f3m s aberantnou expresiou p63 (PKAE) op\u00edsal v r. 2008 Osunkoya a spol.(1) a n\u00e1sledne pribudli \u010fal\u0161ie pozorovania tohto n\u00e1doru(2-6). Tumor sa vyzna\u010duje \u010dasto ve\u013emi blandnou maloacin\u00e1rnou morfol\u00f3giou, ktor\u00e1 napodob\u0148uje ben\u00edgne maloacin\u00e1rne l\u00e9zie. Typick\u00e1 je pre\u0148 siln\u00e1 expresia markera baz\u00e1lnych buniek p63, \u010do m\u00f4\u017ee s\u0165a\u017ei\u0165 bioptick\u00fa diagn\u00f3zu. Ide o zriedkav\u00fd typ karcin\u00f3mu. V prvej publikovanej \u0161t\u00fadii \u0161lo o 21 pr\u00edpadov, ktor\u00e9 boli identifikovan\u00e9 v s\u00fabore 8 251 konzulta\u010dn\u00fdch biopsi\u00ed prof. Epsteina (0,25 % konzult\u00e1ci\u00ed)(1). Ke\u010f\u017ee na konzult\u00e1ciu prich\u00e1dzaj\u00fa zv\u00e4\u010d\u0161a biopsie s problematickou morfol\u00f3giou, predpoklad\u00e1 sa, \u017ee skuto\u010dn\u00fd v\u00fdskyt m\u00f4\u017ee by\u0165 e\u0161te ni\u017e\u0161\u00ed. Na druhej strane treba vzia\u0165 do \u00favahy, \u017ee s \u010dastej\u0161\u00edm pou\u017e\u00edvan\u00edm p63 v diagnostike by, naopak, mohlo percento v\u00fdskytu st\u00fapnu\u0165. Domnievame sa, \u017ee hlavne vy\u0161etrenia p63 v skupine \u201eatrophy-like\u201c karcin\u00f3mov(8) by mohli odhali\u0165 viac pr\u00edpadov.<\/p>\n

Histologick\u00fd obraz PKAE v punk\u010dnej biopsii tvoria ac\u00edny, sol\u00eddne skupiny alebo tr\u00e1mce buniek. Charakteristick\u00fd je pseudoatrofick\u00fd pomer medzi jadrami a cytoplazmou. Jadr\u00e1 obsahuj\u00fa aspo\u0148 fok\u00e1lne dobre zrete\u013en\u00e9 nukleoly. Opisovan\u00e9 Gleasonove \u0161trukt\u00fary boli od Gleason 3 po Gleason 5(1,2). V na\u0161om pr\u00edpade sa morfol\u00f3gia podobala na dobre diferencovan\u00fd acin\u00e1rny karcin\u00f3m Gleason 3 + 3, pseudoatrofickej morfol\u00f3gie, s ojedinelou \u201ePaneth cell-like\u201c zmenou cytoplaz- my. Imunohistochemicky je PKAE dif\u00fazne pozit\u00edvny na p63 (definuj\u00faci znak jednotky) a vykazuje pre karcin\u00f3m typick\u00e9 absencie in\u00fdch markerov baz\u00e1lnej vrstvy, ako je HMW-CK a CK5\/6. V niektor\u00fdch pr\u00edpadoch m\u00f4\u017ee by\u0165 HMW-CK pozit\u00edvny v \u010dasti buniek tumoru, \u010do sme pozorovali aj v na\u0161ej biopsii. T\u00e1to expresia v na\u0161om pr\u00edpade by mohla by\u0165 vysvetlen\u00e1 \u201ebasal cell\u201c diferenci\u00e1ciou n\u00e1dorovej bunky. Zauj\u00edmav\u00e9 v\u0161ak je, \u017ee expresia \u010fal\u0161ieho baz\u00e1lneho markeru CK5\/6 nebola v op\u00edsan\u00fdch pr\u00edpadoch PKAE zisten\u00e1, ako to bolo aj v na\u0161ej biopsii. PLAE b\u00fdva podobne ako in\u00e9 prostatick\u00e9 karcin\u00f3my pozi- t\u00edvny na AMACR. V imunohistoch\u00e9mii PKAE je d\u00f4le\u017eit\u00fd n\u00e1lez n\u00edzkeho prolifera\u010dn\u00e9ho indexu Ki-67 (MIB1-index), ktor\u00fd bol vo v\u00e4\u010d\u0161ine pr\u00edpadov ni\u017e\u0161\u00ed ako 5 % a je v s\u00falade s ni\u017e\u0161ou biologickou agresivitou tumoru. V na\u0161om pr\u00edpade bol MIB1-index len 3 %.<\/p>\n

Histologick\u00e1 diferenci\u00e1lna diagn\u00f3zu PKAE zahr\u0148uje najm\u00e4 acin\u00e1rne prostatick\u00e9 l\u00e9zie, ako je aden\u00f3za, sklerotizuj\u00faca aden\u00f3za, postatrofick\u00e1 hyperpl\u00e1zia a mezonefrick\u00e1 hyperpl\u00e1zia(9-13). Aden\u00f3za m\u00e1 menej atypie a nukleolov a vykazuje typick\u00fa distrib\u00faciu pozitiv\u00edt baz\u00e1lnych markerov(9,13). Sklerotizuj\u00edca aden\u00f3za obsahuje myoepitelov\u00fa vrstvu s expresiou S100 prote\u00ednu a akt\u00ednu(9,12,13). V atrofii a postatrofickej hyperpl\u00e1zii nie je nukle\u00e1rna atypia a prominencia nukleolov, pri\u010dom imunohistoch\u00e9mia baz\u00e1lnych markerov vyk\u00e1\u017ee typick\u00fa expresiu a AMACR bude negat\u00edvna(9,13). Mezonefrick\u00e9 l\u00e9zie s\u00fa negat\u00edvne na prostatick\u00e9 markery NKX3.1 a PSA(9-11).<\/p>\n

Pre klinick\u00fa a prognostick\u00fa implik\u00e1ciu n\u00e1lezu PKAE je d\u00f4le\u017eit\u00e1 jeho rozdielnos\u0165 od konven\u010dn\u00e9ho karcin\u00f3mu. Pod\u013ea doteraj\u0161\u00edch v\u00fdsledkov je PKAE biologicky menej agres\u00edvny ako konven\u010dn\u00e9 karcin\u00f3my. N\u00e1padn\u00fd je rozdiel medzi Gleasonovou \u0161trukt\u00farou a ukazovate\u013emi progn\u00f3zy. Hoci Gleasonovo sk\u00f3re bolo v publikovan\u00fdch pr\u00edpadoch priemerne 8 a viac, tumor bol v troch najv\u00fdznamnej\u0161\u00edch \u0161t\u00fadi\u00e1ch limitovan\u00fd na prostatu v 100 %, 100 % a 76 % pr\u00edpadov(1-3). Pre t\u00fato diskrepanciu medzi Gleasonov\u00fdm sk\u00f3re a biologick\u00fdm spr\u00e1van\u00edm je navrhovan\u00e9, aby sa pri PKAE upustilo od Gleasonovho gradingu(2). Biologick\u00e1 povaha tumoru zost\u00e1va priaznivej\u0161ia i v pr\u00edpadoch, ke\u010f sa okrem PKAE n\u00e1jde v prostate aj kon- ven\u010dn\u00fd adenokarcin\u00f3m (aj ten m\u00e1 obvykle n\u00edzky prolifera\u010dn\u00fd index, podobne ako asociovan\u00fd PKAE)(2).<\/p>\n

Molekul\u00e1rno geneticky sa PKAE l\u00ed\u0161i od konven\u010dn\u00e9ho karcin\u00f3mu predov\u0161etk\u00fdm absenciou TMPRSS2-ERG translok\u00e1cie a expresiou GSTP1(3,6,7). Pod\u013ea Tana a spol. fenotyp PKAE je zmie\u0161an\u00fd lumin\u00e1lny a baz\u00e1lny, zatia\u013e \u010do konven\u010dn\u00e9 karci- n\u00f3my s\u00fa lumin\u00e1lne(7).<\/p>\n

Hoci nov\u00e9 poznatky o PKAE s\u00fa st\u00e1le limitovan\u00e9 len na r\u00e1dovo desiatky pr\u00edpadov, je u\u017e teraz zrejm\u00e9, \u017ee tumor predstavuje osobitn\u00fd typ prostatick\u00e9ho adenokarcin\u00f3mu. Pre klinikov i patol\u00f3gov je d\u00f4le\u017eit\u00e1 znalos\u0165 biologick\u00fdch vlastnost\u00ed tohto novodefinovan\u00e9ho tumoru. V bioptickej praxi je potrebn\u00e9 pozna\u0165 pri PKAE \u00faskalia jeho morfologickej a najm\u00e4 imunohistochemickej diagnostiky.<\/p>\n

 <\/p>\n

Po\u010fakovanie<\/em><\/strong><\/p>\n

MUDr.<\/em> Jozefovi<\/em> Kurucovi<\/em> z<\/em> Medicytu<\/em> Tren\u010d\u00edn \u010fakujeme za fotodokument\u00e1ciu pr\u00edpadu.<\/em><\/p>\n

 <\/p>\n

LITERAT\u00daRA<\/strong><\/p>\n

    \n
  1. Osunkoya AO, Hansel DE, Sun X, et Aberrant diffuse expression of p63 in adenocarcinoma of the prostate on needle biopsy and radical prostatectomy: report of 21 cases. Am J Surg Pathol 2008; 32: 461-467.<\/li>\n
  2. Giannico GA, Ross HM, Lotan T, et al. Aberrant expression of p63 in adenocarcinoma of the prostate: a radical prostatectomy study. Am J Surg Pathol 2013; 37:1401-1406.<\/li>\n
  3. Baydar DE, Kulac I, Gurel B, et A case of prostatic adenocarcinoma with aberrant p63 expression: presentation with detailed immunohistochemical study and FISH analysis. Int J Surg Pathol 2011; 19: 131-136.<\/li>\n
  4. Leung A, Ross F, Roberts M, et Aberrant p63 expression in prostate adenocarcinoma: a potential diagnostic pitfall. Pathology. 2017; 49: S77.<\/li>\n
  5. Casimero FA, Andal JJ, So Aberrant diffuse expression of p63 in prostate adenoacrcinoma. A case report. Phillip J Pathol 2018 (March 11), on-line only: https:\/\/philippinejournalofpathology.org\/index.php\/PJP\/ article\/view\/89\/117<\/li>\n
  6. Wu A, Kunju Prostate cancer with aberrant diffuse p63 expression: report of a case and review of the literature and morphologic mimics. Arch Pathol Lab Med 2013; 137: 1179-1184.<\/li>\n
  7. Tan HL, Haffner MC, Esopi DM, et al. Prostate adenocarcinomas ab- errantly expressing p63 are molecularly distinct from usual-type prostatic Mod Pathol 2015; 28: 446-456.<\/li>\n
  8. Egan AJ, Lopez-Beltran A, Bostwick D Prostatic adenocarcinoma with atrophic features: malignancy mimicking a benign process. Am J Surg Pathol 1997; 21: 931-935.<\/li>\n
  9. Paner GP, Luthringer DJ, Amin MB. Best practice in diagnostic immunohistochemistry: prostate carcinoma and its mimics in needle core biArch Pathol Lab Med 2008; 132: 1388-1396.<\/li>\n
  10. Gikas PW, Del Buono EA, Epstein Florid hyperplasia of mesonephric remnants involving prostate and periprostatic tissue. Possible confusion with adenocarcinoma. Am J Surg Pathol. 1993; 17: 454-460.<\/li>\n
  11. Jones EC, Clement PB, Young Sclerosing adenosis of the prostate gland: a clinicopathological and immunohistochemical study of 11 cases. Am J Surg Pathol 1991; 15: 1171\u20131180.<\/li>\n
  12. Harik LR, O\u2018Toole Nonneoplastic lesions of the prostate and bladder. Arch Pathol Lab Med 2012; 136: 721-734.<\/li>\n<\/ol>\n

     <\/p>\n","protected":false},"excerpt":{"rendered":"

    *A rare case of autochthonous human dirofilariasis with the manifestation of pseudotumor of the epididymis caused by helminth Dirofilaria repens   \u00davod Tzv. karcin\u00f3m s aberantnou expresiou p63 (PKAE) je novodefinovan\u00fd typ adenokarcin\u00f3mu prostaty(1-6). Kv\u00f4li expresii baz\u00e1lneho markeru p63 a \u010dasto aj blandnej morfol\u00f3gii predstavuje v prostatickej biopsii jeden z diagnostick\u00fdch pitfalov. Tumor sa l\u00ed\u0161i<\/p>\n","protected":false},"author":7,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_mi_skip_tracking":false,"footnotes":""},"categories":[296],"tags":[763,438,1788,1789,1792,1791,1790],"class_list":["post-2298","post","type-post","status-publish","format-standard","hentry","category-biopsy","tag-immunohistochemistry","tag-imunohistochemia-en","tag-p63-en","tag-prostata-en","tag-prostate","tag-prostatic-carcinoma-with-aberrant-expression-of-p63","tag-prostaticky-karcinom-s-aberantnou-expresiou-p63-en","typ_clanku-casuistry"],"acf":{"abstrakt":"

    We report an unusual case of prostatic adenocarcinoma with aberrant expression of p63. In a 79-year-old man, a prostate needle biopsy was performed for elevated PSA (9.2 ng\/mL). In four of five cores of the right side, a well-differentiated small acinar carcinoma with Gleason score 3+3 was found. The tumour contained wellformed acini with rare Paneth cell-like cytoplasm and a surprising strong diffuse expression of p63. It was positive for AMACR and its sporadic cells expressed HMW-CK. CK5\/6 was negative. MIB1-index of the tumour was 3%. One needle sample from the contralateral side contained a small focus of high-grade PIN without p63 pos- itivity in the luminal cells. Twelve months after the diagnosis, the patient is under active surveillance, and he is treated with leuprolide acetate. His PSA was elevated to 13.54 ng\/mL, and currently, radiotherapy is planned. We discuss clinicopathologic features of this newly described carcinoma type which differs from common prostatic carcinomas.<\/p>\n

    Keywords:<\/strong> prostatic carcinoma with aberrant expression of p63, prostate, immunohistochemistry, p63<\/p>\n","casopis":[{"ID":2233,"post_author":"7","post_date":"2021-09-19 22:32:27","post_date_gmt":"2021-09-19 20:32:27","post_content":"We\u2019re bringing you this year\u2019s 1st<\/sup> issue of newslab, the scientific journal<\/strong>\r\n\r\n \r\n

      \r\n \t
    • Genomic variability of virus Sars-CoV-2<\/li>\r\n \t
    • Contribution of immunohistochemistry to histomorphological diagnostics of COVID-19 pneumonia<\/li>\r\n \t
    • Detection of microsatellite instability in Lynch syndrome-associated tumours<\/li>\r\n \t
    • Comparison of platelet glycoprotein analysis in the wholeh blood and plasma rich in platelets<\/li>\r\n \t
    • Tspan1 expression in prostatic adenocarcinoma<\/li>\r\n<\/ul>","post_title":"newslab","post_excerpt":"","post_status":"publish","comment_status":"closed","ping_status":"closed","post_password":"","post_name":"newslab-8","to_ping":"","pinged":"","post_modified":"2021-09-19 22:36:56","post_modified_gmt":"2021-09-19 20:36:56","post_content_filtered":"","post_parent":0,"guid":"https:\/\/www.newslab.sk\/casopis\/newslab-8\/","menu_order":0,"post_type":"casopis","post_mime_type":"","comment_count":"0","filter":"raw"}],"strana":"43 - 46","upload_clanok":{"ID":2295,"id":2295,"title":"NEWSLAB 1-2021_Zamecnik","filename":"NEWSLAB-1-2021_Zamecnik.pdf","filesize":2544338,"url":"https:\/\/www.newslab.sk\/wp-content\/uploads\/2021\/09\/NEWSLAB-1-2021_Zamecnik.pdf","link":"https:\/\/www.newslab.sk\/en\/prostatic-carcinoma-with-aberrant-expression-of-p63-a-case-report\/newslab-1-2021_zamecnik-2\/","alt":"","author":"7","description":"","caption":"","name":"newslab-1-2021_zamecnik-2","status":"inherit","uploaded_to":2298,"date":"2021-09-20 09:15:01","modified":"2021-09-20 09:15:01","menu_order":0,"mime_type":"application\/pdf","type":"application","subtype":"pdf","icon":"https:\/\/www.newslab.sk\/wp-includes\/images\/media\/document.png"}},"_links":{"self":[{"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/posts\/2298","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/users\/7"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/comments?post=2298"}],"version-history":[{"count":0,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/posts\/2298\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/media?parent=2298"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/categories?post=2298"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/tags?post=2298"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}