Background The 2004 World Health Organization classification introduced atypical pituitary adenoma (aPA), which was equivocally defined as invasion with increased mitotic activity that had a Ki-67 labeling index (LI) greater than 3%, and extensive p53 immunoreactivity. However, aPAs that exhibit all of these features are rare and the predictive value for recurrence in pituitary adenomas (PAs) remains uncertain. Thus, we sought to characterize pathological features of PAs that correlated with recurrence.
Methods One hundred and sixty-seven cases of surgically resected PA or aPA were retrieved from 2011 to 2013 in Seoul St. Mary’s Hospital. Among them, 28 cases were confirmed to be recurrent, based on pathologic or radiologic examination. The pathologic characteristics including mitosis, invasion, Ki-67 LI and p53 immunoreactivity were analyzed in relation to recurrence.
Results Analysis of the pathologic features indicated that only Ki-67 LI over 3% was significantly associated with tumor recurrence (p = .02). The cases with at least one pathologic feature showed significantly higher recurrence rates (p < .01). Analysis indicated that cases with two pathologic features, Ki-67 LI over 3% and extensive p53 immunoreactivity 20% or more, were significantly associated with tumor recurrence (p < .01).
Conclusions Based on these results, PA tumor recurrence can be predicted by using mitosis, invasion, Ki-67 LI (3%), or extensive p53 immunoreactivity (≥ 20%). Assessment of these features is recommended for PA diagnosis for more accurate prediction of recurrence.
Citations
Citations to this article as recorded by
The Value of ER∝ in the Prognosis of GH- and PRL-Secreting PitNETs: Clinicopathological Correlations Roxana-Ioana Dumitriu-Stan, Iulia-Florentina Burcea, Valeria Nicoleta Nastase, Raluca Amalia Ceaușu, Anda Dumitrascu, Laurentiu Catalin Cocosila, Alexandra Bastian, Sabina Zurac, Marius Raica, Catalina Poiana International Journal of Molecular Sciences.2023; 24(22): 16162. CrossRef
Ki-67/MIB-1 and Recurrence in Pituitary Adenoma Kent Tadokoro, Colten Wolf, Joseph Toth, Cara Joyce, Meharvan Singh, Anand Germanwala, Chirag Patel Journal of Neurological Surgery Part B: Skull Base.2022; 83(S 02): e580. CrossRef
Association of PTTG1 expression with invasiveness of non-functioning pituitary adenomas Su Jung Kum, Hye Won Lee, Soon Gu Kim, Hyungsik Park, Ilseon Hwang, Sang Pyo Kim Journal of Pathology and Translational Medicine.2022; 56(1): 22. CrossRef
A Preoperative MRI-Based Radiomics-Clinicopathological Classifier to Predict the Recurrence of Pituitary Macroadenoma Within 5 Years Yu Zhang, Yuqi Luo, Xin Kong, Tao Wan, Yunling Long, Jun Ma Frontiers in Neurology.2022;[Epub] CrossRef
Endoscopic Endonasal Pituitary Surgery For Nonfunctioning Pituitary Adenomas: Long-Term Outcomes and Management of Recurrent Tumors Anne-Laure Bernat, Pénélope Troude, Stefano Maria Priola, Ahmad Elsawy, Faisal Farrash, Ozgur Mete, Shereen Ezzat, Sylvia L. Asa, John De Almeida, Allan Vescan, Eric Monteiro, Joao Paulo Almeida, Gelareh Mohammed Zadeh, Fred Gentili World Neurosurgery.2021; 146: e341. CrossRef
A Nomogram for Preoperatively Predicting the Ki-67 Index of a Pituitary Tumor: A Retrospective Cohort Study Xiangming Cai, Junhao Zhu, Jin Yang, Chao Tang, Feng Yuan, Zixiang Cong, Chiyuan Ma Frontiers in Oncology.2021;[Epub] CrossRef
Comparative Proteomic Study Shows the Expression of Hint-1 in Pituitary Adenomas Carolina Carrillo-Najar, Daniel Rembao-Bojórquez, Martha L. Tena-Suck, Sergio Zavala-Vega, Noemí Gelista-Herrera, Miguel A. Ramos-Peek, Juan L. Gómez-Amador, Febe Cazares-Raga, Fidel de la Cruz Hernández-Hernández, Alma Ortiz-Plata Diagnostics.2021; 11(2): 330. CrossRef
Prediction of recurrence in solid nonfunctioning pituitary macroadenomas: additional benefits of diffusion-weighted MR imaging Ching-Chung Ko, Tai-Yuan Chen, Sher-Wei Lim, Yu-Ting Kuo, Te-Chang Wu, Jeon-Hor Chen Journal of Neurosurgery.2020; 132(2): 351. CrossRef
Pituitary tumors: epidemiology and clinical presentation spectrum Marta Araujo-Castro, Víctor Rodríguez Berrocal, Eider Pascual-Corrales Hormones.2020; 19(2): 145. CrossRef
Ki67 in endocrine neoplasms: to count or not to count, this is the question! A systematic review from the English language literature E. Guadagno, E. D’Avella, P. Cappabianca, A. Colao, M. Del Basso De Caro Journal of Endocrinological Investigation.2020; 43(10): 1429. CrossRef
Study of Simple Immunohistochemical Cytocolorimetric Assay Application for More Accurate Assessment of Prognosis in Patients with Pituitary Adenomas Pavel V. Nikitin, Marina V. Ryzhova, Lyudmila V. Shishkina, Svetlana V. Shugay, Irina V. Zubova World Neurosurgery.2019; 122: e1047. CrossRef
The Prognostic Roles of the Ki-67 Proliferation Index, P53 Expression, Mitotic Index, and Radiological Tumor Invasion in Pituitary Adenomas Rovshan Hasanov, Berna İmge Aydoğan, Saba Kiremitçi, Esra Erden, Sevim Güllü Endocrine Pathology.2019; 30(1): 49. CrossRef
Residual Tumor Confers a 10-Fold Increased Risk of Regrowth in Clinically Nonfunctioning Pituitary Tumors Jelena Maletkovic, Asmaa Dabbagh, Dongyun Zhang, Abdul Zahid, Marvin Bergsneider, Marilene B Wang, Michael Linetsky, Noriko Salamon, William H Yong, Harry V Vinters, Anthony P Heaney Journal of the Endocrine Society.2019; 3(10): 1931. CrossRef
Atypical pituitary adenoma: a clinicopathologic case series Martin J. Rutkowski, Ryan M. Alward, Rebecca Chen, Jeffrey Wagner, Arman Jahangiri, Derek G. Southwell, Sandeep Kunwar, Lewis Blevins, Han Lee, Manish K. Aghi Journal of Neurosurgery.2018; 128(4): 1058. CrossRef
Both invasiveness and proliferation criteria predict recurrence of non-functioning pituitary macroadenomas after surgery: a retrospective analysis of a monocentric cohort of 120 patients Julie Lelotte, Anne Mourin, Edward Fomekong, Alex Michotte, Christian Raftopoulos, Dominique Maiter European Journal of Endocrinology.2018; 178(3): 237. CrossRef
Letter to the Editor. Atypical pituitary adenoma Lauren E. Rotman, T. Brooks Vaughan, James R. Hackney, Kristen O. Riley Journal of Neurosurgery.2018; 129(6): 1657. CrossRef
Molecular targeted therapies in adrenal, pituitary and parathyroid malignancies Anna Angelousi, Georgios K Dimitriadis, Georgios Zografos, Svenja Nölting, Gregory Kaltsas, Ashley Grossman Endocrine-Related Cancer.2017; 24(6): R239. CrossRef
Background The pathologic distinction between high-grade prostate adenocarcinoma (PAC) involving the urinary bladder and high-grade urothelial carcinoma (UC) infiltrating the prostate can be difficult. However, making this distinction is clinically important because of the different treatment modalities for these two entities.
Methods A total of 249 patient cases (PAC, 111 cases; UC, 138 cases) collected between June 1995 and July 2009 at Seoul St. Mary’s Hospital were studied. An immunohistochemical evaluation of prostatic markers (prostate-specific antigen [PSA], prostate-specific membrane antigen [PSMA], prostate acid phosphatase [PAP], P501s, NKX3.1, and α-methylacyl coenzyme A racemase [AMACR]) and urothelial markers (CK34βE12, p63, thrombomodulin, S100P, and GATA binding protein 3 [GATA3]) was performed using tissue microarrays from each tumor.
Results The sensitivities of prostatic markers in PAC were 100% for PSA, 83.8% for PSMA, 91.9% for PAP, 93.7% for P501s, 88.3% for NKX 3.1, and 66.7% for AMACR. However, the urothelial markers CK34βE12, p63, thrombomodulin, S100P, and GATA3 were also positive in 1.8%, 0%, 0%, 3.6%, and 0% of PAC, respectively. The sensitivities of urothelial markers in UC were 75.4% for CK34βE12, 73.9% for p63, 45.7% for thrombomodulin, 22.5% for S100P, and 84.8% for GATA3. Conversely, the prostatic markers PSA, PSMA, PAP, P501s, NKX3.1, and AMACR were also positive in 9.4%, 0.7%, 18.8%, 0.7%, 0%, and 8.7% of UCs, respectively.
Conclusions Prostatic and urothelial markers, including PSA, NKX3.1, p63, thrombomodulin, and GATA3 are very useful for differentiating PAC from UC. The optimal combination of prostatic and urothelial markers could improve the ability to differentiate PAC from UC pathologically.
Citations
Citations to this article as recorded by
Unusual Perineal Metastasis in a Case of Prostate Cancer on 68Ga-PSMA-11 PET/CT Ritanshu Solanki, Bhagwant Rai Mittal, Rajender Kumar, Aravindh Sekar, Narender Kumar Clinical Nuclear Medicine.2024; 49(2): e73. CrossRef
NKX3.1 Expression in Non-Prostatic Tumors and Characterizing its Expression in Esophageal/Gastroesophageal Adenocarcinoma Ansa Mehreen, Kiran G. Manjee, Divyangi Paralkar, Gladell P. Paner, Thanh Lan Advances in Anatomic Pathology.2024; 31(3): 202. CrossRef
Clinical Management of Intraductal Carcinoma of the Prostate Gabriel Wasinger, Olivier Cussenot, Eva Compérat Cancers.2024; 16(9): 1650. CrossRef
Adenocarcinomas of the Gynecologic Tract Involving the Urinary Bladder: A Series of 16 Cases Potentially Mimicking Urothelial Malignancy Daniel H. Russell, Jonathan I. Epstein, Oleksandr N. Kryvenko, Matthew Schlumbrecht, Merce Jorda, Andre Pinto Archives of Pathology & Laboratory Medicine.2024; 148(6): 705. CrossRef
Assessing the diagnostic impact of P63, PSA and BCL-2 proteins in premalignant and malignant prostate tissues Aderonke C. Ogunlayi, Victor O. Ekundina, Adedapo O. Kehinde, Linus A. Enye, Adegoke O. Aremu International Journal of Scientific Reports.2024; 10(6): 188. CrossRef
Concurrent occurrence of adenocarcinoma and urothelial carcinoma of the prostate gland: A case report Jhe Yuan Hsu, Yi Sheng Lin, Li Hua Huang, Tang Yi Tsao, Chao Yu Hsu, Yen Chuan Ou, Min Che Tung World Journal of Clinical Cases.2024; 12(26): 5952. CrossRef
Metastatic prostate cancer presenting as a posterior mediastinal mass: A rare presentation Muhammad Haider, Arun Umesh Mahtani, Bachar Botrus, Foma Munoh Kenne, Madiha Fatima Master Clinical Case Reports.2023;[Epub] CrossRef
Diagnostic and Prognostic Roles of GATA3 Immunohistochemistry in Urothelial Carcinoma Daeseon Yoo, Kyueng-Whan Min, Jung-Soo Pyo, Nae Yu Kim Medicina.2023; 59(8): 1452. CrossRef
Primary high-grade urothelial carcinoma of prostate with prostatic hyperplasia: a rare case report and review of the literature Liang Liu, Fu-zhen Sun, Pan-ying Zhang, Yu Xiao, Xiao Yue, Dong-Ming Wang, Qiang Wang The Aging Male.2023;[Epub] CrossRef
Expression of Gata Binding Protein 3 as a Prognostic Factor in Urogenital Lesions and Its Association With Morphology T Govardhan, Debahuti Mohapatra, Sujata Naik, Prateek Das, Pranita Mohanty, Ankita Pal Cureus.2023;[Epub] CrossRef
Histological and immunohistochemical investigation of canine prostate carcinoma with identification of common intraductal carcinoma component Simone de Brot, Jennifer Lothion‐Roy, Llorenç Grau‐Roma, Emily White, Franco Guscetti, Mark A. Rubin, Nigel P. Mongan Veterinary and Comparative Oncology.2022; 20(1): 38. CrossRef
Urothelial Carcinoma and Prostate-specific Membrane Antigen: Cellular, Imaging, and Prognostic Implications Arsalan Tariq, Amy E. McCart Reed, Andrew Morton, Sima Porten, Ian Vela, Elizabeth D. Williams, John W. Yaxley, Peter C. Black, Matthew J. Roberts European Urology Focus.2022; 8(5): 1256. CrossRef
Immunohistochemical Reactivity of Prostate-Specific Membrane Antigen in Salivary Gland Tumors Haruto Nishida, Yoshihiko Kondo, Takahiro Kusaba, Hiroko Kadowaki, Tsutomu Daa Head and Neck Pathology.2022; 16(2): 427. CrossRef
Weak NKX3.1 expression in a urothelial carcinoma: A diagnostic pitfall Maryam Abdo, Robert Hoyt, Ashley Highfill, Daniel Mettman Human Pathology Reports.2022; 27: 300599. CrossRef
Gene of the month: NKX3.1 Jon Griffin, Yuqing Chen, James W F Catto, Sherif El-Khamisy Journal of Clinical Pathology.2022; 75(6): 361. CrossRef
Diagnostic Value of GATA3 and Uroplakin 3 in Differentiating Urothelial Carcinoma from Prostatic and Colorectal Carcinoma Maha Salama, Dina A. Khairy Open Access Macedonian Journal of Medical Sciences.2022; 10(A): 514. CrossRef
Diagnostic challenges for the distinction of high-grade prostatic adenocarcinoma and high-grade urothelial carcinoma of simultaneous occurrences - A literature review Shreyas Bhushan Jayade, Manana Jikurashvili GEORGIAN SCIENTISTS.2022;[Epub] CrossRef
Cytomorphology, immunoprofile, and clinicopathologic correlation of metastatic prostatic carcinoma Xiaoqi Lin, Qiuying Shi, Ximing J. Yang Human Pathology.2022; 130: 36. CrossRef
Cutaneous Metastasis of Prostate Adenocarcinoma: A Rare Presentation of a Common Disease Alexander Dills, Okechukwu Obi, Kevin Bustos, Jesse Jiang, Shweta Gupta Journal of Investigative Medicine High Impact Case Reports.2021;[Epub] CrossRef
Mining The Cancer Genome Atlas gene expression data for lineage markers in distinguishing bladder urothelial carcinoma and prostate adenocarcinoma Ewe Seng Ch’ng Scientific Reports.2021;[Epub] CrossRef
Immunohistochemical analysis of thrombomodulin expression in myocardial tissue from autopsy cases of ischemic heart disease Takeshi Kondo, Motonori Takahashi, Gentaro Yamasaki, Marie Sugimoto, Azumi Kuse, Mai Morichika, Kanako Nakagawa, Makoto Sakurada, Migiwa Asano, Yasuhiro Ueno Legal Medicine.2021; 51: 101897. CrossRef
Application and Pitfalls of Immunohistochemistry in Diagnosis of Challenging Genitourinary Cases Jenny Ross, Guangyuan Li, Ximing J. Yang Archives of Pathology & Laboratory Medicine.2020; 144(3): 290. CrossRef
New Screening Test Improves Detection of Prostate Cancer Using Circulating Tumor Cells and Prostate-Specific Markers Karin Ried, Tasnuva Tamanna, Sonja Matthews, Peter Eng, Avni Sali Frontiers in Oncology.2020;[Epub] CrossRef
An Unlikely Culprit: Gastric Metastasis from Primary Prostatic Adenocarcinoma Eric Omar Then, Spoorthi Nutakki, Andrew Ofosu, Saad Saleem, Vijay Gayam, Tagore Sunkara, Vinaya Gaduputi Journal of Gastrointestinal Cancer.2020; 51(3): 1081. CrossRef
MRI of prostatic urethral mucinous urothelial carcinoma: Expanding the differential diagnosis for T2 hyperintense prostatic masses Neel Patel, Bryan R. Foster, Elena K. Korngold, Kyle Jensen, Kevin R. Turner, Fergus V. Coakley Clinical Imaging.2020; 68: 68. CrossRef
Morphological and Immunohistochemical Biomarkers in Distinguishing Prostate Carcinoma and Urothelial Carcinoma: A Comprehensive Review Francesca Sanguedolce, Davide Russo, Vito Mancini, Oscar Selvaggio, Beppe Calò, Giuseppe Carrieri, Luigi Cormio International Journal of Surgical Pathology.2019; 27(2): 120. CrossRef
A Case of Metastatic Prostate Cancer to the Urethra That Resolved After Androgen Deprivation Therapy Darren J. Bryk, Kenneth W. Angermeier, Eric A. Klein Urology.2019; 129: e4. CrossRef
The Homeodomain Transcription Factor NKX3.1 Modulates Bladder Outlet Obstruction Induced Fibrosis in Mice Mehul S. Patel, Diana K. Bowen, Nicholas M. Tassone, Andrew D. Gould, Kirsten S. Kochan, Paula R. Firmiss, Natalie A. Kukulka, Megan Y. Devine, Belinda Li, Edward M. Gong, Robert W. Dettman Frontiers in Pediatrics.2019;[Epub] CrossRef
Cancer of unknown primary: Ancillary testing of cytologic and small biopsy specimens in the era of targeted therapy Morgan L. Cowan, Christopher J. VandenBussche Cancer Cytopathology.2018; 126(S8): 724. CrossRef
Glandular Tumors of the Urachus and Urinary Bladder: A Practical Overview of a Broad Differential Diagnosis Alexander S. Taylor, Rohit Mehra, Aaron M. Udager Archives of Pathology & Laboratory Medicine.2018; 142(10): 1164. CrossRef
S100P as a Marker for Urothelial Histogenesis: A Critical Review and Comparison With Novel and Traditional Urothelial Immunohistochemical Markers Moushumi Suryavanshi, Julian Sanz-Ortega, Deepika Sirohi, Mukul K. Divatia, Chisato Ohe, Claudia Zampini, Daniel Luthringer, Steven C. Smith, Mahul B. Amin Advances in Anatomic Pathology.2017; 24(3): 151. CrossRef
Primary schwannoma of the thyroid gland: analysis of case characteristics and review of the literature Hangjun Ren, Xingguo Cui, Lianmei Zhang BMC Surgery.2024;[Epub] CrossRef
A Case of Intra-thyroidal Schwannoma Diagnosed by Preoperative Core Needle Biopsy Dong Gyu Choi, Young-Ok Kim, Min Jung Jung, Hyoung Shin Lee Korean Society for Head and Neck Oncology.2023; 39(1): 37. CrossRef
Multimodal ultrasound imaging of primary thyroid schwannoma Hai Na Zhao, Bu Yun Ma, Feng Yan, Yu Lan Peng Medicine.2021; 100(16): e25517. CrossRef
A Case of Anterior Cervical Intramuscular Schwannoma in the Strap Muscle Seul Gi Lee, Ho-Ryun Won, Bon Seok Koo, Jae Won Chang Korean Journal of Otorhinolaryngology-Head and Neck Surgery.2021; 64(4): 263. CrossRef