Comedonecrosis Revisited: Assocations with Intraductal Carcinoma of the Prostate.
Samson W Fine, Kazuma Udo, Hikmat A Al-Ahmadie, Ying-Bei Chen, Anuradha Gopalan, Satish K Tickoo, Victor E Reuter. Memorial Sloan-Kettering Cancer Center, New York, NY
Background: Within the current Gleason grading system, comedocarcinoma or cancer displaying intraluminal necrotic cells and/or karyorrhexis within cribriform/solid architecture, is assigned Gleason pattern 5. Intraductal growth of carcinoma resembles high grade adenocarcinoma architecturally and cytologically and may also show central necrosis, yet due to the presence of basal cells at the duct periphery is not graded in the Gleason system. We hypothesized that comedonecrosis was more commonly seen in intraductal than in invasive disease.
Design: From a large series of consecutively mapped radical prostatectomy specimens (n=386) from a single year, we selected 51 high grade, high volume tumors with available slides for review. All slides were examined for the presence of unequivocal comedonecrosis, utilizing strict criteria to exclude dense pink secretions, crush/cautery artifact as well as foci of large cribriform masses exhibiting perineural invasion. Standard immunohistochemistry for basal cell markers, 34βE12 and 4A4/p63, was performed to detect basal cell labeling in these foci.
Results: 10 of 51 cases showed some degree of comedonecrosis – 6 cases with one focus and 4 cases with ≥ 2 foci. Immunohistochemical stains revealed moderate to strong labeling for 34βE12 and 4A4/p63 in a basal cell distribution for all cancer foci displaying comedonecrosis, such that these foci were interpreted as intraductal carcinoma.
Conclusions: These initial results suggest that comedonecrosis is closely associated with intraductal growth of prostatic carcinoma. Although further studies are underway with a larger cohort of cases, if these findings are confirmed, routine assignment of Gleason grade 5 to comedocarcinoma should be reconsidered.
Category: Genitourinary (including renal tumors)
Monday, February 28, 2011 1:00 PM
Poster Session II # 154, Monday Afternoon