Prostate-specific antigen expression and lipochrome pigment granules in the differential diagnosis of prostatic adenocarcinoma versus seminal vesicle-ejaculatory duct epithelium.
BACKGROUND
Lipochrome pigment granules (LPGs) and prostate-specific antigen (PSA) localization have been cited as helpful adjuncts in differentiating atypical histologic patterns of seminal vesicle-ejaculatory duct (SVED) from prostatic adenocarcinoma. However, LPGs have been described in both benign and neoplastic prostatic acini, and PSA expression within the intraprostatic SVED has not been fully explored.


METHODS
Fifty radical prostatectomy specimens were studied for LPGs and 9 cases for PSA expression.


RESULTS
Two morphologic types of LPGs (type 1 and type 2) were observed. The reproducibility in classifying LPGs was evaluated by kappa statistics, which demonstrated a strong agreement between 4 observers. Type 1 was restricted to SVED in all 50 specimens. Type 2 was subclassified into 2A and 2B. Type 2 LPGs were observed in prostatic acini of different zones, high-grade prostatic intraepithelial neoplasia, prostatic adenocarcinoma, and occasionally with type 1 LPG in SVED. Focal reactivity for PSA in the distal portion of SVED near urethra was noted in 1 of 9 cases.


CONCLUSIONS
Awareness about morphologic differences between the 2 types of LPGs could help to avoid a potential diagnostic pitfall of misinterpreting SVED epithelium for adenocarcinoma. Caution is recommended in interpreting PSA expression, since rare focal PSA reactivity was observed in the distal SVED.
Shidham
V B
VB
Department of Surgical Pathology, Medical College of Wisconsin, Milwaukee 53226, USA. vshidham@mcw.edu
Lindholm
P F
PF
Kajdacsy-Balla
A
A
Basir
Z
Z
George
V
V
Garcia
F U
FU
D000230:Adenocarcinoma / Q000175:diagnosis* / Q000276:immunology* / Q000473:pathology; D000368:Aged; D000369:Aged, 80 and over; D003594:Cytoplasmic Granules / Q000473:pathology*; D003937:Diagnosis, Differential; D004543:Ejaculatory Ducts / Q000473:pathology*; D004848:Epithelium / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010858:Pigmentation; D017430:Prostate-Specific Antigen / Q000378:metabolism*; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000276:immunology* / Q000473:pathology; D012669:Seminal Vesicles / Q000473:pathology*; D013194:Staining and Labeling
D017430:Prostate-Specific Antigen