An Evaluation of the Pathologic Reporting of Prostate Biopsy and Prostate Transurethral Resections with Urothelial Carcinoma
Eric J Fichtenbaum, Debra L Zynger. The Ohio State University Medical Center, Columbus, OH
Background: Urothelial carcinoma (UC) involving the prostate is almost always via secondary spread from a primary bladder tumor. In situ UC within the prostate occurs in the prostatic urethra or prostatic ducts. Invasive tumor extends into the prostatic subepithelial tissue or fibromuscular stroma. Invasion into the fibromuscular stroma (pT4a) of the prostate forecasts a far more ominous prognosis. Moreover, treatment options differ depending on the extent of prostatic involvement. We aim to understand problematic areas in the reporting of UC within prostate biopsy/TURP (transurethral resection of the prostate) specimens.
Design: We conducted a retrospective review between 2007 and 2010 of prostate biopsy/TURP (n=60) containing UC at our institution. All reports and available slides (30/60) were re-reviewed to assess reporting terminology and determine stage concordance.
Results: Upon re-review, definitive prostate tissue was present in 87% (26/30) of cases. Of the 4 cases that had no prostate tissue present, 2 included a statement that no prostate was present and 2 did not. 13% (8/60) of reports had a diagnosis of invasive urothelial carcinoma with no depth of invasion stated (ambiguous with respect to prostatic subepithelial invasion vs pT4a). 3 of the 8 cases were available for re-review with 2 determined to be pT4a, while 1 was in situ within the ducts. Terminology used for bladder anatomy (muscularis propria and lamina propria) was found in 37% (22/60) of reports. 13 of 22 (59%) reported muscularis propria and/or lamina propria without explicit reference to the bladder or prostate. 5 of these 13 (38%) were available for review with 2 containing bladder tissue while the remaining 3 did not. Discordant stage between the pathology report and re-review was identified in 10% (3/30) of cases. 2 cases were reported as pT4a but only had in-situ tumor within the ducts. 1 case stated that the tumor extended into the muscularis propria but was found in prostatic fibromuscular stroma (pT4a).
Conclusions: In this study we reveal reporting ambiguities of UC within prostate biopsies/TURP. We provide the following recommendations for these specimens: 1. Depth of tumor involvement within the prostate should be clearly stated as non-invasive/in-situ, invasive into the subepithelial tissue, or invasive into the fibromuscular stroma, 2. Absence of prostatic tissue should be documented, 3. Presence of bladder tissue should be noted, 4. Tumor involving bladder tissue should be reported with specific reference to the bladder.
Category: Genitourinary (including renal tumors)
Wednesday, March 21, 2012 1:00 PM
Poster Session VI # 173, Wednesday Afternoon