Biyopsi Değerlendirilmesinde Gleason (3+3) Tanılı Hastaların Prostatlarında Kribriform Alan Şüphesi. Kısıtlı Morfolojik Görünüm Hastaları Takip Grubuna Almak için Yeterli Olmayabilir

Abstract

Objectives: Histologic grade is the most useful predictor of prognosis of prostate cancer. The Gleason scoring is the only grading method for prostatic carcinoma, which is recommended by World Health Organization. The Gleason grading (3+3) 6 is the lowest score currently assigned. In radical materials, we can see all prostate areas and decide certain grading easily. However, in the biopsy, we can see only a part of the tumor and we cannot be sure of the histologic grade of the total tumor. If the tumor has a potential for cribriform formation, we cannot detect it with current methods. Our aim in this study was to detect molecular heterogeneity in well-differentiated prostate cancers. Materials and Methods: Twenty-six prostate needle biopsies from patients with prostate carcinoma Gleason (3+3) were stained and analyzed with immunohistochemical markers of Betacatenin, Cyclin D1, Pax2 and Pax8. Results: While intense staining was observed with Betacatenin in tumor, no significant findings were detected with Cyclin D1, Pax2 and Pax8. Conclusion: Betacatenin, Cyclin D1, Pax2 and Pax8 are the markers that we use frequently in daily pathology practice and have also been the subject of studies in the literature on urogenital system carcinogenesis. However, while intense staining was observed with Betacatenin in welldifferentiated tumoral acinar structures, no significant findings were detected with Cyclin D1, Pax2 and Pax8.

Keywords

• Prostate Carcinoma
• Immunohistochemical Heterogeneity
• Betacatenin

Biyopsi Değerlendirilmesinde Gleason (3+3) Tanılı Hastaların Prostatlarında Kribriform Alan Şüphesi. Kısıtlı Morfolojik Görünüm Hastaları Takip Grubuna Almak için Yeterli Olmayabilir

Abstract

Amaç: Histolojik derece, prostat kanseri prognozunun en yararlı öngörücüsüdür. Gleason skorlaması, Dünya Sağlık Örgütü tarafından önerilen prostat karsinomu için tek derecelendirme yöntemidir. Gleason (3+3) 6 şu anda tanımlanan en düşük skordur. Radikal materyallerde tüm prostat bölgelerini görebilir ve temel skorlamaya kolayca karar verebiliriz. Ancak biyopside tümörün sadece bir kısmını görebiliriz ve tümörün tümünün histolojik derecesinden kesin emin olamayız. Tümörün kribriform yapılanma potansiyeli varsa biz bunu mevcut yöntemler ile tespit edemiyoruz. Bu çalışmada amacımız iyi diferansiye prostat kanserlerinde moleküler heterojenite saptayabilmektir. Gereç ve Yöntem: Prostat karsinomu Gleason (3+3) tanılı hastalara ait 26 adet prostat iğne biyopsisi Betakatenin, Siklin D1, Pax2 ve Pax8 immünohistokimyasal belirteçleri ile boyanıp incelenmiştir. Bulgular: Tümör yapılarında Betakatenin ile yoğun boyanma izlenmişken, Siklin D1, Pax2 ve Pax8 ile anlamlı bulgu tespit edilememiştir. Sonuç: Betakatenin, Siklin D1, Pax2 ve Pax8 günlük patoloji pratiğinde sıkça kullandığımız belirteçler olup ayrıca ürogenital sistem kanserogenezinde literatürde çalışmalara konu olmuştur. Ancak iyi diferansiye tümöral asiner yapılarda Betakatenin ile yoğun boyanma izlenmişken, Siklin D1, Pax2 ve Pax8 ile anlamlı bulgu tespit edilememiştir.

Keywords

• Prostat Karsinomu
• İmmünohistokimyasal Heterojenite
• Betakatenin

References

1. 1. Kryvenko ON, Epstein JI. Prostate Cancer Grading: A Decade After the 2005 Modified Gleason Grading System. Arch Pathol Lab Med. 2016;140:1140-1152.
2. 2. Braunhut BL, Punnen S, Kryvenko ON. Updates on Grading and Staging of Prostate Cancer. Surg Pathol Clin. 2018;11:759-774.
3. 3. Epstein JI, Egevad L, Amin MB, et al. The 2014 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma: Definition of Grading Patterns and Proposal for a New Grading System. Am J Surg Pathol. 2016;40:244-252.
4. 4. Goodman M, Ward KC, Osunkoya AO, et al. Frequency and determinants of disagreement and error in Gleason scores: a population-based study of prostate cancer. Prostate. 2012;72:1389-1398.
5. 5. Al-Maghrabi JA, Bakshi NA, Farsi HM. Gleason grading of prostate cancer in needle core biopsies: a comparison of general and urologic pathologists. Ann Saudi Med. 2013;33:40-44.
6. 6. Hofer DR, Sherwood ER, Bromberg WD, et al. Autonomous growth of androgen-independent human prostatic carcinoma cells: role of transforming growth factor alpha. Cancer Res. 1991;51:2780-2785.
7. 7. Demark-Wahnefried W, Moyad MA. Dietary intervention in the management of prostate cancer. Curr Opin Urol. 2007;17:168-174.
8. 8. Gülhan Ö, Mahi B. The Role of AMACR, CD10, TMPRSS2-ERG, and p27 Protein Expression Among Different Gleason Grades of Prostatic Adenocarcinoma on Needle Biopsy. Clin Med Insights Oncol. 2020;14:1179554920947322.

9. 9. Gu M, Roy S, Raina K, et al. Inositol hexaphosphate suppresses growth and induces apoptosis in prostate carcinoma cells in culture and nude mouse xenograft: PI3K-Akt pathway as potential target. Cancer Res. 2009;69:9465-9472.
10. 10. Wise HM, Hermida MA, Leslie NR. Prostate cancer, PI3K, PTEN and prognosis. Clin Sci (Lond). 2017;131:197-210.
11. 11. Francis JC, McCarthy A, Thomsen MK, et al. Brca2 and Trp53 deficiency cooperate in the progression of mouse prostate tumourigenesis. PLoS Genet. 2010;6:e1000995.
12. 12. Li W, Yang G, Yang D, et al. LncRNA LEF1-AS1 promotes metastasis of prostatic carcinoma via the Wnt/beta-catenin pathway. Cancer Cell Int. 2020;20:543.
13. 13. Bauman TM, Vezina CM, Ricke EA, et al. Expression and colocalization of beta-catenin and lymphoid enhancing factor-1 in prostate cancer progression. Hum Pathol. 2016;51:124-133.
14. 14. Gupta V, Garg M, Chaudhry M, et al. Role of cyclin D1 immunoreactivity and AgNOR staining in the evaluation of benign and malignant lesions of the prostate. Prostate Int. 2014;2:90-96.
15. 15. Fusté NP, Castelblanco E, Felip I, et al. Characterization of cytoplasmic cyclin D1 as a marker of invasiveness in cancer. Oncotarget. 2016;7:26979- 26991.
16. 16. Bose SK, Gibson W, Bullard RS, et al. PAX2 oncogene negatively regulates the expression of the host defense peptide human beta defensin-1 in prostate cancer. Mol Immunol. 2009;46:1140-1148.
17. 17. Khoubehi B, Kessling AM, Adshead JM, et al. Expression of the developmental and oncogenic PAX2 gene in human prostate cancer. J Urol. 2001;165:2115-2120.
18. 18. Qi M, Li Y, Liu J, et al. Morphologic features of carcinomas with recurrent gene fusions. Adv Anat Pathol. 2012;19:417-424.
19. 19. Kumar A, Hatwal D, Batra N, et al. Role of nm23H1 in predicting metastases in prostatic carcinoma. Indian J Pathol Microbiol. 2018;61:70-75.
20. 20. Shridhar P. The lymphatics of the prostate gland and their role in the spread of prostatic carcinoma. Ann R Coll Surg Engl. 1979;61:114-122.
21. 21. Bisegna C, Gravina GL, Pierconti F, et al. Regulation of PDE5 expression in normal prostate, benign prostatic hyperplasia and adenocarcinoma. Andrology. 2020;8:427-433.
22. 22. Xu B, Chevarie-Davis M, Chevalier S, et al. The prognostic role of ERG immunopositivity in prostatic acinar adenocarcinoma: a study including 454 cases and review of the literature. Hum Pathol. 2014;45:488-497.