Vishal S. Chandan

Evaluation of prostatitis in autopsied prostates--is chronic inflammation more associated with benign prostatic hyperplasia or cancer?

PURPOSE Chronic inflammation is associated with prostate cancer and benign prostatic hyperplasia. However, the prevalence of chronic inflammation in malignant and benign glands has not been compared. We evaluated the association of inflammation, benign prostatic hyperplasia and cancer in autopsied prostates. MATERIALS AND METHODS We prospectively analyzed 167 autopsied prostates. Pathological analysis identified each focus of cancer, benign prostatic hyperplasia nodules and areas of acute or chronic inflammation. Any cancer focus or benign prostatic hyperplasia nodule involved directly with inflammation was recorded. The association of the prevalence of prostate cancer, benign prostatic hyperplasia and inflammation was statistically assessed. RESULTS Inflammation was present in 113 (67.6%) of 167 cases. Chronic inflammation was identified in 88 (53%), acute inflammation in 6 (4%), and chronic inflammation and acute inflammation in 19 (11%) glands. In the majority of cases inflammation was present in the transitional zone. A total of 93 glands (56%) were involved with benign prostatic hyperplasia and 49 (29%) with cancer. Of the glands harboring benign prostatic hyperplasia 75% were also involved with chronic inflammation compared to only 50% of those without benign prostatic hyperplasia (p <0.01). Comparatively the glands with or without any evidence of cancer were similarly involved with chronic inflammation (55% vs 58%, p >0.1). Of the 27 glands involved with cancer and benign prostatic hyperplasia, chronic inflammation was more associated with benign prostatic hyperplasia than cancer (p = 0.006). Acute inflammation was not significantly associated with either benign prostatic hyperplasia or cancer. CONCLUSIONS Chronic inflammation was a common finding in autopsied prostates. It appeared to be directly associated with the presence of benign prostatic hyperplasia but not with cancer.

Pancreatic Heterotopia in the Gastric Antrum

17-year-old adolescent boy presented with a history of epigastric pain for the past 10 to 12 weeks. He had no significant family or personal medical history. The results of a physical examination were nonrevealing, therefore an esophagogastroduodenoscopy was performed. When the endoscope was introduced into the stomach, a 1-cm polypoidal lesion was seen in the gastric antrum. The lesion appeared to be submucosal with an intact submucosa and muscularis propria interface. No lymphadenopathy was seen. This lesion in the gastric antrum was excised and sent for histopathologic examination. On microscopic examination, a well-circumscribed submucosal nodular lesion with overlying benign gastric mucosa was evident (Figure 1). The lesion displayed unremarkable pancreatic lobules with acini, ducts (Figure 2), and islets of Langerhans cells (Figure 3, arrow). No evidence of cellular pleomorphism, necrosis, mitosis, or stromal reaction was present. Heterotopic pancreas is defined as pancreatic tissue outside the boundaries of the pancreas that lacks anatomic and vascular continuity to this organ. Heterotopic pancreas is a relatively infrequent lesion, with an incidence ranging from 0.5% to 13% in autopsy studies. Heterotopic pancreas is usually found in the upper gastrointestinal tract, with more than 90% of the cases involving the stomach, duodenum, jejunum, and Meckel diverticulum. 1 Unusual locations are the colon, spleen, liver, biliary tract, mesentry, skin, lymph nodes, and fallopian tube. The pathogenesis of this lesion is unknown; it is believed to arise during embryonic development of the gastrointestinal tract. The normal pancreas is derived from several evaginations originating from the wall of the primitive duodenum. During embryogenesis, if one or more evaginations remain in the wall of the bowel, then it may be carried away from the remainder of the gland by the developing gastrointestinal tract and may give rise to heterotopic pancreas. 2 The other theory proposes pancreatic metaplasia of endodermal tissues that end up in the submucosa during embryonic life. Pancreatic heterotopia grossly resembles normal pancreatic parenchyma as a submucosal nodule, as an intramural mass, or as a nodular lesion involving the serosa. On gross examination, the color is yellow to yellow-white, and cut section reveals a lobulated appearance. The size

Pathological Characteristics of Prostate Cancer in Elderly Men

PURPOSE Recent guidelines recommend that men older than 75 years should not be screened for prostate cancer. However, increased life expectancy and the development of less invasive treatments have led to an interest in characterizing prostate cancer in elderly men. We determined how prostate cancer pathological characteristics differ in men older vs younger than 70 years. MATERIALS AND METHODS We studied differences in prostate cancer pathological characteristics in autopsied glands from men 70 years old or older and compared findings to those in men younger than 70 years. All men died of causes unrelated to prostate cancer. Prostates were whole mounted at 4 mm intervals. Histological analysis was done to identify and characterize each cancer focus observed. Tumor volume was measured by computerized planimetry. Cancer was defined as clinically significant or insignificant based on established histological characteristics. RESULTS Of 211 prostates evaluated 74 were from men 70 years old or older. We identified cancer in 33 men (45%) in this age group vs in 26 of 137 (19%) younger than 70 years (p <0.001). Men older than 70 years had significantly larger cancer and more clinically significant cancer (64% vs 23%, p <0.005). Older men had more advanced stage cancer and greater Gleason scores (p <0.001). CONCLUSIONS In an autopsy study of men with no history of prostate cancer those older than 70 years were more likely to have larger and higher grade prostate cancer than younger men.

The role of immunolocalization of CD57 and GLUT-1 in cell blocks in fine-needle aspiration diagnosis of papillary thyroid carcinoma

CD57 (Leu7), a marker for natural killer lymphocytes, and glucose transporter‐1 (GLUT‐1), a facilitative cell surface glucose transport protein, are expressed in a wide spectrum of epithelial malignancies. The usefulness of CD57 and GLUT‐1 immunostaining was evaluated as an adjunct to assist in the diagnosis of papillary carcinoma in fine‐needle aspirations (FNAs) of the thyroid.

Postirradiation angiosarcoma of the prostate

Angiosarcomas are high-grade sarcomas of vascular origin that rarely arise in the prostate. We describe a unique case of angiosarcoma arising in the prostate 10 years after radiotherapy for adenocarcinoma of the prostate. A review of literature regarding angiosarcomas of prostate is also discussed.

The utility of GLUT-1 immunolocalization in cell blocks: An adjunct to the fine needle aspiration diagnosis of cystic squamous lesions of the head and neck.

Cytologic distinction of metastatic cystic squamous cell carcinoma (SCC) from benign squamous cell lesions, especially the ones with superimposed inflammatory atypia, can be very challenging. The authors evaluated the usefulness of glucose transporter‐1 (GLUT‐1) immunostaining as an adjunct to fine‐needle aspirations of squamous lesions of the head and neck.

Diagnostic accuracy of extended biopsies for the staging of microfocal prostate cancers in autopsy specimen

Clinically insignificant prostate cancers may be predicted when biopsies show a microfocal cancer (MiFC). However, at least one-third of MiFC are underestimated by biopsies. The aim of this study was to evaluate the staging accuracy of different biopsy regimen showing a MiFC. We performed 18 biopsy cores on 164 autopsy prostates. Six cores were taken from the mid-peripheral zone (MPZ), 6 from the lateral PZ (LPZ) and 6 from the central zone (CZ). We tested seven different biopsy regimens by distinguishing the MPZ, LPZ or CZ biopsies either separately or associated with each other. Of the cancers detected by biopsies, we selected those showing a MiFC and compared our findings with whole mount analysis. The positive predictive value of a MiFC referred to how often, when needle biopsies showed a MiFC, there was a clinically insignificant cancer on whole mount prostate analysis. We found that the positive predictive value of a MiFC on 6 or 12 biopsy cores was similar irrespective of biopsy location (P≈1). On MPZ, MPZ plus LPZ and all 18 biopsies, it was 40, 70 and 87%, respectively (P<0.1). Tumor volume of cancers showing a MiFC on MPZ biopsies was significantly higher than those showing a MiFC on MPZ plus LPZ, or all 18 biopsies (P<0.05). These results show that performing additional cores in case of MiFC on sextant biopsies may help differentiating significant from insignificant cancers.

Immunostains Used to Subtype Hepatic Adenomas Do Not Distinguish Hepatic Adenomas From Hepatocellular Carcinomas.

Immunostains are used to subtype hepatic adenomas to stratify for the risk of malignant transformation. The most common panel of immunostains used for this purpose includes liver fatty acid–binding protein (LFABP), serum amyloid A (SAA) protein, C-reactive protein (CRP), and glutamine synthetase (GS). Importantly, some pathologists use these stains in an attempt to distinguish hepatocellular carcinomas (HCC) from hepatic adenomas. However, there are limited data on the performance of these stains in HCCs. To investigate the staining characteristics of HCCs, we studied 159 HCCs (92 well-differentiated, 67 moderately differentiated, and 7 poorly differentiated) and 7 fibrolamellar carcinomas for the expression of LFABP, SAA, CRP, and GS. All of the stains were positive in at least a subset of HCCs: SAA was positive in 27 of 159 (17%), CRP in 86 of 159 (54%), and GS in 23 of 47 (49%) cases; LFABP showed loss of staining in 36 of 159 (23%) cases. Fibrolamellar carcinomas were consistently CRP positive (7 of 7 cases) and frequently showed loss of LFABP (4 of 7 cases). There was no association between expression of SAA, CRP, and GS as well as loss of LFABP expression and other clinicopathologic features. HCCs with loss of LFABP were more frequently associated with negative GS expression (11 of 14 cases, P=0.02). These data show that immunostains used to subtype hepatic adenomas are not useful for distinguishing HCCs from hepatic adenomas and should be used only after a diagnosis of hepatic adenoma has been made using other criteria.

Gastric lipid islands.

54-year-old woman presented with a 2- to 3-week history of epigastric pain and discomfort. The patient’s past medical history was unremarkable except for chronic alcoholism. The physical examination was nonrevealing and an esophagogastroduodenoscopy was performed. The fundic gastric mucosa appeared erythematous, although there was no evidence of erosion or ulcer. A 0.4-cm, yellow, villiform mucosal nodule was seen in the antrum. A biopsy of this nodule was taken for histopathologic examination. Routine hematoxylin-eosin‐stained sections revealed subepithelial aggregates of foam cells within the lamina propria without associated leukocytic infiltrate (Figure 1). The overlying epithelium was unremarkable. The foam cells were oval to polygonal with a moderate amount of cytoplasm and central to eccentric small nuclei (Figure 2). No evidence of mitotic activity was seen. The foam cells expressed CD68 but were negative for mucicarmine and periodic acid‐Schiff (with diastase) stains and did not express cytokeratin. Stains for fungi and acid-fast bacilli were also negative. Xanthelasma or xanthoma is a localized collection of tissue histiocytes or macrophages containing lipid. They are usually encountered in the skin and subcutis, presenting as visceral aggregates of foamy macrophages unassociated with inflammation or hemorrhage. They are not commonly seen in the gastrointestinal tract. When present, they occur almost exclusively in the stomach. Gastric xanthelasma, also known as lipid islands, was observed in 0.4% of patients who had not undergone gastric resections. 1 They are usually antral and at the lesser curvature, but occasionally are located in the body or fundus and may be multiple. They are uncommon in other parts of the gastrointestinal tract, but can be found in the small intestine, esophagus, and large intestine. The etiology of lipid islands has not yet been established. It is generally agreed that lipid islands are not found in the healthy stomach, occurring only when pathologic changes, such as chronic gastritis, intestinal metaplasia, atrophic gastritis, gastric ulcer, or changes caused by bile reflux or partial gastrectomy are present. Autopsy studies have shown that lipid islands are more common

Hepatocyte Antigen Expression in Barrett Esophagus and Associated Neoplasia.

Hepatocyte antigen or hepatocyte paraffin 1 (Hep Par 1) is widely used as a diagnostic immunomarker for hepatocellular carcinoma. It has also been identified as a rate-limiting enzyme of the urea cycle, carbamoyl phosphate synthetase 1. Hep Par 1 has been detected in non-neoplastic small intestinal epithelium, but its expression in Barrett esophagus and its related neoplasia has not been well investigated. We immunohistochemically evaluated expression of Hep Par 1 on 75 cases of Barrett esophagus (25 cases without dysplasia, 16 cases with low-grade dysplasia, 25 cases with high-grade dysplasia, and 9 cases with intramucosal adenocarcinoma) on endoscopic biopsies and endoscopic mucosal resections. All 25 cases without dysplasia (100%) showed granular cytoplasmic Hep Par 1 staining (24 diffuse and 1 focal). Of the 16 cases with low-grade dysplasia, 12 (75%) were positive (5 diffuse and 7 focal), whereas 4 (25%) were negative (P=0.018). Of the 25 cases with high-grade dysplasia, 9 (36%) showed focal positivity, whereas 16 (64%) were negative (P=0.0001). Similarly of the 9 cases of intramucosal adenocarcinomas 3 (33%) were focally positive, whereas 6 (67%) were negative (P=0.0001). Hep Par 1 is diffusely expressed in non-neoplastic Barrett esophagus while it is frequently lost in related dysplasia and adenocarcinoma, suggesting decreased level of HepPar1 may represent an early event in Barrett-related tumor genesis. This warrants additional investigation to look for the possible role of carbamoyl phosphate synthetase 1 in the pathogenesis of Barrett-related neoplasia.