Fine Needle Aspiration (FNA) Cytology of Metastatic Prostate Carcinoma. Is Cytoplasmic Vacuolization a Morphologic Feature of Anti-Androgen Effect and an Aid in the Differential Diagnosis?
Carla L Ellis, Qing K Li. The Johns Hopkins Hospital, Baltimore, MD
Background: Anti-androgen therapy has been used for the treatment of prostate cancer for decades. Its major usages include preoperative shrinkage of tumor, symptomatic relief of obstructive effects and prophylaxis of tumor progression. This therapy also has a profound morphological effect on tumor, such as loss of glandular architecture and cytoplasmic degeneration. These features have been well documented in the surgically resected tumor; however, they have not been studied in FNA cytologic material, particularly in metastatic prostate cancers. The androgen deprivation treatment-induced morphological changes may cause diagnostic difficulty in the FNA specimen. In this study, we have reviewed the cytomorphology on FNA of metastatic prostate cancer and potential anti-androgenic treatment effect on tumor cells.
Design: A computer search of cytopathology specimens for a 20 year period in the archives of our academic medical center yielded 32 FNA cases with the diagnosis of metastatic prostate cancer. The cytomorphology of the metastatic tumor was correlated with immunohistochemical studies, morphology of the primary tumor and clinical information.
Results: The patients' ages ranged from 51 to 84 years, with a mean age of 71.5 years. The most common metastatic site in descending order is: lung (7 cases), regional LN (6 cases), liver (5 cases), pleura (4 cases), soft tissue (3 cases), bone (2 cases), adrenal (1 case) and others (4 cases). Among 32 cases, 24 had documented androgen deprivation therapy ranging from 2 months to more than 10 years of duration. Of 24 cases, the most notable feature is cytoplasmic vacuolization which occurs in 37% of cases (9/24) in greater than 50% of the cytoplasm. This feature is not present in the primary tumors. The clinical information for these cases is summarized in Table 1.
|Case||Age||Treatment||GS of Primary||Metastatic Site|
|5||72||Leuprolide||Ductal ADC||Lymph Node|
|7||69||Leuprolide, Zoledronic acid||4+3||Liver|
|8||68||Leuprolide, Zoledronic acid||3+3||Lymph Node|