title: Is atypical adenomatous hyperplasia of the prostate a precursor lesion?
abstract: BACKGROUND
  Alpha-methylacyl-CoA racemase (AMACR) is highly expressed in prostatic adenocarcinoma. The precursor nature of atypical adenomatous hyperplasia (AAH) is uncertain.
  
  
  METHODS
  One hundred twenty-one AAH foci from 101 patients who underwent transurethral prostatic resection or prostatectomy were immunohistochemically analyzed for AMACR, high molecular weight cytokeratin 34βE12, and p63 expression by a triple antibody (PIN4) cocktail stain.
  
  
  RESULTS
  Sixty-eight foci (56%) of AAH showed no AMACR immunostaining. Fourteen cases (12%) showed weak AMACR immunoreactivity in 1-9% of lesional cells. Sixteen cases (13%) showed strong immunopositivity for AMACR in >50% of lesional cells. AMACR expression in AAH was significantly higher in cases in which coexisting PCA was present, compared with its expression in AAH foci without coexisting PCA (P = 0.03). Strong diffuse AMACR positivity in over 50% of lesional cells was seen almost exclusively in AAH foci with coexisting PCA (P = 0.002). AMACR expression in AAH showed no correlation with patient age (P = 0.38), specimen type (P = 0.35), prostate weight (P = 0.80), zonal location (P = 0.50), distance to cancer (P = 0.28), Gleason score (P = 0.06), or pathologic stage (P = 0.23). Increased AMACR expression showed a negative correlation with the size of AAH foci (P = 0.03). All AAH lesions showed fragmented basal cell layers, highlighted by p63 and high molecular weight cytokeratin staining.
  
  
  CONCLUSIONS
  A significant percentage of AAH cases show stronger and more extensive AMACR expression when associated with prostatic adenocarcinoma, as compared to AAH foci found without coexisting prostate cancer. Our data provide additional evidence linking AAH to prostatic adenocarcinoma.
authors.affiliation: Department of Pathology, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA.
authors.forename: Chen
authors.initials: C
authors.lastname: Zhang
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Montironi
authors.forename: Gregory T
authors.initials: GT
authors.lastname: MacLennan
authors.forename: Antonio
authors.initials: A
authors.lastname: Lopez-Beltran
authors.forename: Yan
authors.initials: Y
authors.lastname: Li
authors.forename: Puay-Hoon
authors.initials: PH
authors.lastname: Tan
authors.forename: Mingsheng
authors.initials: M
authors.lastname: Wang
authors.forename: Shaobo
authors.initials: S
authors.lastname: Zhang
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Iczkowski
authors.forename: Liang
authors.initials: L
authors.lastname: Cheng
mesh_terms: D000230:Adenocarcinoma / Q000378:metabolism / Q000473:pathology*; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000378:metabolism; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009929:Organ Size; D011230:Precancerous Conditions / Q000378:metabolism / Q000473:pathology*; D011470:Prostatic Hyperplasia / Q000378:metabolism / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000378:metabolism / Q000473:pathology*; D019998:Racemases and Epimerases / Q000378:metabolism
chemical_list: D014408:Biomarkers, Tumor; D019998:Racemases and Epimerases; C108352:alpha-methylacyl-CoA racemase