Utility of Triple Antibody Cocktail Stain in Radical Prostatectomy Specimens with Crushed Surgical Margins
Gangyong Li, Najla Al Daoud, Andrew J Evans, Theodorus H Van der Kwast. University Health Network, Toronto, Canada; Jordan University of Science and Technology, Irbid, Jordan
Background: Triple antibody cocktail stain is in routine use to establish a diagnosis of prostate cancer in biopsies with a small suspect lesion. Due to crushing artefacts it may occasionally be difficult to diagnose a positive surgical margin in prostatectomy specimens. The potential utility of the cocktail stain as a decision aid in the distinction between carcinoma and benign glands at the crushed margin of a prostatectomy has not been investigated so far.
Design: Ten cases with crushed benign glands at the surgical margins of radical prostatectomies and 20 cases with crushed margins positive for carcinoma were retrieved from the pathology archives of Toronto General Hospital. Sixteen (80%) of the positive margins were apical margins, two (10%) were incised intra-prostatic margins, and one (5%) was a soft tissue margin. Two-colour triple antibody stain using a cocktail of antibodies against AMACR, HMWK and p63 was performed on the selected slides.
Results: In 10/10 specimens with crushed benign glands, basal cell staining continued to be detectable, while AMACR staining was completely negative in all cases (0/10). As for the positive margin cases, the crushed glands did not express basal cell marker staining (0/20), whereas 14/20 (70%) of the cases showed variable levels of racemase positivity at the inked margin.
Conclusions: In some instances, two-colour triple antibody cocktail stain may be of use in problematic radical prostatectomies with crushed glands at the surgical margins, helping to ascertain whether these glands are malignant or benign.
Category: Genitourinary (including renal tumors)
Monday, March 19, 2012 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 159, Monday Morning