title: Prostate-specific antigen, high-molecular-weight cytokeratin (clone 34betaE12), and/or p63: an optimal immunohistochemical panel to distinguish poorly differentiated prostate adenocarcinoma from urothelial carcinoma.
abstract: An optimal immunohistochemical panel to distinguish poorly differentiated prostate (PCa) from urothelial (UCa) carcinoma was selected from a panel consisting of prostate-specific antigen (PSA) and prostatic acid phosphatase (PAP), high-molecular-weight cytokeratin (HMWCK), clone 34betaE12, cytokeratin (CK) 7, CK20, p63, and alpha-methylacyl-coenzyme A racemase. The pilot group was composed of poorly differentiated UCa (n = 36) and PCa (n = 42). PSA and PAP stained 95% of PCa vs 0% and 11% of UCa cases, respectively. HMWCK and p63 stained 97% and 92% of UCa vs 2% and 0% of PCa cases respectively. CK7/CK20 coexpression was noted in 50% of UCa cases, whereas 86% of PCa cases were negative with both. A panel of PSA, HMWCK, and p63 was optimal for separating 95% PCa (PSA+/HMWCK and/or p63-) vs 97% UCa (PSA-/HMWCK and/or p63+). This panel was used on 26 diagnostically challenging cases and resolved 81% of cases as UCa vs PCa. The majority of PCa cases retain PSA. Negative PSA with positive HMWCK and/or p63 establishes a diagnosis of UCa.
authors.affiliation: Department of Pathology, University of Michigan School of Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, USA.
authors.forename: Lakshmi P
authors.initials: LP
authors.lastname: Kunju
authors.forename: Rohit
authors.initials: R
authors.lastname: Mehra
authors.forename: Matthew
authors.initials: M
authors.lastname: Snyder
authors.forename: Rajal B
authors.initials: RB
authors.lastname: Shah
mesh_terms: D000230:Adenocarcinoma / Q000737:chemistry / Q000175:diagnosis*; D014408:Biomarkers, Tumor / Q000032:analysis; D003937:Diagnosis, Differential; D006801:Humans; D007150:Immunohistochemistry / Q000379:methods*; D007633:Keratins / Q000032:analysis* / Q000737:chemistry; D008297:Male; D008565:Membrane Proteins / Q000032:analysis*; D008970:Molecular Weight; D010865:Pilot Projects; D017430:Prostate-Specific Antigen / Q000032:analysis*; D011471:Prostatic Neoplasms / Q000737:chemistry / Q000175:diagnosis*; D001749:Urinary Bladder Neoplasms / Q000737:chemistry / Q000175:diagnosis*; D019459:Urothelium / Q000737:chemistry / Q000473:pathology
chemical_list: D014408:Biomarkers, Tumor; C081876:CKAP4 protein, human; D008565:Membrane Proteins; D007633:Keratins; D017430:Prostate-Specific Antigen