Inverted papillomas of the prostatic urethra.

Inverted papillomas of the genitourinary tract are uncommon benign neoplasms usually occurring in the urinary bladder and less frequently in the upper urinary tract. To date, there are scant data and no comprehensive studies of inverted papilloma originating in the prostatic urethra. We identified 21 cases and evaluated their demographic, clinical, and histopathologic features. Patients had a mean age of 65.1 years (range: 30 to 89 y), with 10/21 (47.6%) presenting with gross hematuria (n = 8) or irritative symptoms (n = 2) related to the inverted papilloma and 11/21 (52.4%) detected incidentally during work-up/treatment of prostate cancer (n = 6) or benign prostatic hypertrophy (BPH) (n = 5). Fourteen cystoscopically evaluated lesions measured 0.1 to 2.0 cm, and were described as polypoid (n = 9), papillary (n = 4), or an enlarged median lobe (n = 1). Lesions were diagnosed on transurethral resection (n = 8), biopsy/polypectomy targeted to the lesion (n = 6), radical prostatectomy for prostate cancer (n = 4), or biopsy unrelated to the lesion (n = 3). Histologically, 14/21 cases (67%) displayed classic inverted papilloma architecture. The remaining cases showed foci of squamous metaplasia with moderate atypia (n = 4), rare true papillary fronds in a classic inverted papilloma background (n = 2), or both (n = 1). Eleven cases with prostatic tissue revealed adenocarcinoma of the prostate [n = 6; Gleason score 6 (n = 3) or 7 (n = 3)], high-grade prostatic intraepithelial neoplasia (n = 1), benign prostatic hypertrophy (n = 3), or adenosis (n = 1). No patients had a prior history of either inverted papilloma or urothelial carcinoma, whereas 2 patients were diagnosed with high-grade urothelial carcinoma of the bladder synchronous with their inverted papilloma diagnosis. Only 1 of the 18 patients with available follow-up had a recurrence of inverted papilloma in the prostatic urethra. None of the other patients had local recurrences or recurrences at other locations in the urinary tract (mean follow-up 39.9 mo; range: 3 to 120 mo). Inverted papillomas of the prostatic urethra are benign lesions that are commonly detected incidentally and are not associated with a history of urothelial malignancy. Although urothelial carcinoma elsewhere in the genitourinary tract may occur simultaneously, malignant transformation or recurrence as a malignant lesion has not been identified in inverted papilloma of the prostatic urethra.

Immunohistochemical staining of precursor forms of prostate-specific antigen (proPSA) in metastatic prostate cancer.

Precursors of prostate-specific antigen (proPSA) have been previously shown to be more concentrated in prostate cancer tissue. This study characterizes the immunohistochemical staining (IHS) of proPSA forms in metastatic prostate cancer compared with prostate specific antigen (PSA) and prostatic acid phosphatase (PAP). A tissue microarray, consisting of 74 cases of metastatic prostate carcinoma and control tissues, was used. IHS, using monoclonal antibodies against proPSA with a truncated proleader peptide containing 2 amino acids ([-2]pPSA), native ([-5/-7]pPSA), PSA, and PAP, was analyzed. The monoclonal antibodies were specific for both benign and malignant prostatic glandular tissue. IHS with [-5/-7]pPSA showed the least number of cases with negative staining (3%), and the most number of cases with moderate or strong staining (76%). In the 60 cases where all 4 stains could be evaluated, none of them were negative for proPSA and positive for PSA or PAP, and all 7 cases that were negative for both PSA and PAP showed IHS to proPSA. [-5/-7]pPSA (native proPSA) may be a better marker than PSA and PAP in characterizing metastatic prostate adenocarcinoma, with most of the cases showing positivity for the marker. Even cases that were negative for PSA and PAP, were reactive for proPSA. Such enhanced detection is particularly important in poorly differentiated carcinomas involving metastatic sites where prostate carcinoma is a consideration. A panel of markers, including proPSA, should be performed when metastatic prostate carcinoma is in the differential diagnosis.

Telomere length abnormalities occur early in the initiation of epithelial carcinogenesis.

PURPOSE: Telomeres help maintain chromosomal integrity. Dysfunctional telomeres can cause genetic instability in vitro and an increased cancer incidence in telomerase knock out mouse models. We recently reported that telomere shortening was a prevalent alteration in human prostate, pancreas, and breast cancer precursor lesions. In the present study, we address whether the previous findings are broadly applicable to human epithelial cancer precursors in general. EXPERIMENTAL DESIGN: Surgical specimens of epithelial cancer precursor lesions from the urinary bladder, esophagus, large intestine, oral cavity, and uterine cervix were examined using a recently developed technique for direct in situ telomere length assessment in formalin-fixed human tissue specimens. RESULTS: Widespread telomere length abnormalities were nearly universal (97.1% of cases) in the preinvasive stages of human epithelial carcinogenesis in all sites examined in this series, with telomere shortening the predominant abnormality (88.6% of cases). CONCLUSIONS: Telomere length abnormalities appear to be one of the earliest and most prevalent genetic alterations acquired in the multistep process of malignant transformation. These findings support a model whereby telomere dysfunction induces chromosomal instability as an initiating event in many, perhaps most, human epithelial cancers. Together with previous findings from the prostate and pancreas, the percentage of intraepithelial neoplasia lesions showing telomere length abnormalities is 95.6%. The implications of these findings include the potential that telomere length assessment in situ may be a widely useful biomarker for monitoring disease prevention strategies and for improved early diagnosis.

Radiation or chemotherapy cystitis with "pseudocarcinomatous" features.

BACKGROUND: The features of radiation or chemotherapy cystitis mimicking invasive urothelial cancer are not widely known. DESIGN: A search of the consultation files from our institution between January 1996 and September 2003 identified 20 patients with bladder biopsies showing cystitis mimicking invasive urothelial cancer. RESULTS: The mean age at diagnosis was 69 years (range, 40-85 years); 80% were males. Complete history was not available in 1 patient. Seventeen patients had a history of pelvic irradiation (15 prostate cancer and 2 endometrial cancer). Two patients had systemic chemotherapy (1 metastatic colon cancer and 1 mixed connective tissue disease). All patients presented with hematuria. The mean time from radiation and/or chemotherapy to presentation was 27 months (range, 0-84 months). All cases showed epithelial proliferation that mimicked invasive cancer within the lamina propria, with marked proliferation seen in 45% of cases. Mild to moderate nuclear pleomorphism was seen in all cases. A characteristic feature was the presence of pseudoinvasive urothelial nests wrapping around the vessels associated with fibrin deposition. Most cases did not show any mitoses (75%). Ulceration was seen in 39% of cases. All cases showed some degree of hemorrhage, fibrin deposition and fibrin thrombi, fibrosis, and acute and chronic inflammation, with hemosiderin identified in 60% of cases. Edema and vascular congestion were common features (95% and 80%, respectively). Thickened vessels and vascular changes associated with radiation injury were identified in 75% of cases. Seventeen patients were followed for a mean of 9 months (range, 0.25-37 months), and none developed bladder cancer. CONCLUSIONS: Radiation or chemotherapy cystitis can show epithelial proliferations that may be confused with invasive urothelial carcinomas. Other findings characteristic of radiation or chemotherapy cystitis, such as hemorrhage, fibrin, and vascular changes, are often seen in association with the epithelial proliferations and are helpful in distinguishing it from invasive cancer. Pathologists must be aware that these changes may be seen with a remote radiation or chemotherapy history, where this information may not be provided or known at the time of the biopsy evaluation.

Florid von Brunn nests mimicking urothelial carcinoma: a morphologic and immunohistochemical comparison to the nested variant of urothelial carcinoma.

Florid von Brunn nests may mimic the nested variant of urothelial carcinoma. We examined formalin-fixed, paraffin-embedded tissue from 21 cases of florid von Brunn nests and 11 cases of nested variant of urothelial carcinoma. Morphologic features were recorded in detail. Also, cases were stained with monoclonal antibodies against MIB-1, p53, p27, and cytokeratin 20. Percentage positivity was calculated by counting 300 to 500 cells from each case. Clinical follow-up information was also obtained. Florid von Brunn nests from the bladder were comprised of large nests with regular spacing, and all the nests extended to the same horizontal level at the base of the proliferation. Central lumen formation was often seen within florid von Brunn nests, at times with cystic dilatation, such that there was a spectrum from proliferating von Brunn nests to cystitis glandularis to cystitis cystica. Small, crowded nests with variable spacing and an infiltrative base characterized nested variant of urothelial carcinoma. Four cases showed detrusor muscle invasion on biopsy with an additional case showing detrusor muscle invasion at cystectomy. One additional patient with nested variant of urothelial carcinoma had distant metastases and another had prostatic invasion. Nine of 21 florid von Brunn nests cases were from either the ureter or renal pelvis, whereas all cases of nested variant of urothelial carcinoma arose in the bladder. The ureteral and pelvic florid von Brunn nest cases showed smaller, more variable nests with irregular spacing closely mimicking nested variant of urothelial carcinoma but had a noninfiltrative base and often areas with either a lobular or linear array. Immunohistochemical studies showed nested variant of urothelial carcinoma to have higher MIB-1 expression (8.8% vs. 2.8%, P = 0.01). Nested variant of urothelial carcinoma had nonsignificantly higher p53 positivity (4.2% vs. 1.5%, P = 0.06) and lower p27 positivity (4.7% vs. 7.8%, P = 0.22). Cytokeratin 20 staining was not discriminatory. However, staining with each antibody was widely variable. Wide variation in staining for MIB-1, p53, p27, and cytokeratin 20 was seen in both florid von Brunn nests and nested variant of urothelial carcinoma, such that except for a few cases, a specific cutoff value could not be determined for diagnostic purposes. The findings underscore the importance of morphologic assessment in the distinction of florid von Brunn nests and nested variant of urothelial carcinoma.

Metastatic malignant melanoma in liver aspirate: cytomorphologic distinction from hepatocellular carcinoma.

Hepatic metastases of malignant melanoma are not unusual and frequently occur with a clinically long latent period following resection of a cutaneous or ocular primary. Due to its overlapping cytomorphology with a primary hepatocellular carcinoma, diagnostic difficulties may arise on fine-needle aspiration of these lesions if the clinical history of melanoma is not known. Thirty-two cases of metastatic melanoma in the liver and primary hepatocellular carcinoma were studied. Aspiration was performed under ultrasound guidance using 22-gauge spinal needle. Slides were stained with Diff-Quik and Papanicolaou stain; cell blocks were stained with H&E. A panel of immunostains was performed using conventional methodology. Of the 12 cytologic parameters assessed, the most helpful in making a metastatic melanoma diagnosis were the presence of sheet-like architecture, plasmacytoid and/or biphasic (epithelioid/spindled cell) morphology, cytoplasmic tails, necrosis, and cytoplasmic melanin-like pigment. For hepatocellular carcinoma, the presence of trabeculae, perivascular cellular clustering, endothelial wrapping, and centrally located nuclei with granular cytoplasm were helpful features. In selected cases, IPOX studies were critical in arriving at the correct diagnosis.

Mollaret's meningitis: cytopathologic analysis of fourteen cases.

Mollaret's meningitis (MM) is a rare disease of benign nature characterized by recurrent episodes of aseptic meningitis. Cerebrospinal fluid (CSF) examination remains the sole diagnostic modality. Eighteen CSF samples from 14 patients were studied along with the clinical data. Specimens were prepared by cytocentrifugation and Millipore filtration and were stained with Diff-Quik and Papanicolaou stains. Eight patients were men and six were women, with an age range of 17-74 yr (mean age 37 yr). Most common clinical presentation was recurrent episodes of headaches and photophobia followed by a sustained mild fever lasting 5-7 days. The CSF showed markedly increased cellularity with pleocytosis. The differential count showed predominant monocytosis ranging from 84% to 100% (mean 96). In our series, two patients had herpes simplex virus type 2 (HSV-2) DNA detected by polymerase chain reaction (PCR) in the CSF. The monocytes were seen predominantly singly, but three cases showed a strong tendency to aggregate in small groups. Phenotypically, these cells had bean-shaped bilobed nuclei as well as multiple deep nuclear clefts depicting the so-called "footprint" appearance. In four cases, multiple blunt-tipped cytoplasmic pseudopods were noted. Degenerated monocytes with the appearance of the so-called "ghost cells" were noted in one-half of the cases. Background cells were mostly small mature lymphocytes; however, one-half of cases showed a significant amount of plasma cells and/or polymorphonuclear leukocytes (PMNs). Lysed blood with hemosiderin-laden macrophages and numerous leptomeningeal cells were seen in two cases. CSF examination of MM presents a spectrum of cytomorphologic features. When interpreted in light of the appropriate clinical setting. the latter, although nonspecific, provides an accurate diagnosis. The differential diagnosis includes various degenerative, inflammatory/infectious, and lymphoproliferative disorders of the central nervous system.

Teaching cytopathology to second-year medical students. An interactive, case-based approach.

OBJECTIVE: To develop and implement an electronic, interactive, case-based cytopathology educational system for second-year medical students. STUDY DESIGN: Ten different learning modules, corresponding to various organ systems in pathology and encompassing the essence of clinical cytopathology, were developed. The modules are software-based, menu-driven, digital programs that are displayed on a computer monitor and can be projected onto a large screen via LCD projectors. Each module takes 15-20 minutes to complete and contains three to four case-based interactive clinical scenarios. Each case contains sequenced, multiple-choice questions with immediate feedback. Each module also includes an atlas mode for viewing all the case images plus additional images to enrich the learning experience. RESULTS: Preliminary feedback from students taking the pathology course has shown encouraging responses. The students enjoyed the practical approach of the modules, finding them easy to use. Their interest level remained high as they discovered how their general medical knowledge could apply to solving real-life clinical cytopathology cases. CONCLUSION: By utilizing these unique instructional modules in the second-year pathology course, medical students learn the application of clinical cytopathology in everyday medical practice. This not only provides them with the theoretical background and morphologic knowledge of the diseases taught but also gives them the ability to apply it in simulated real-life clinical scenarios.

Malignant solitary fibrous tumor of the kidney: report of a case and comprehensive review of the literature.

Renal solitary fibrous tumors (SFTs) have been reported infrequently. We report a 76-year-old man with a left renal mass that had previously been shown radiographically to be stable, but was now growing. Grossly, the mass measured 12 cm, was poorly circumscribed, and invaded beyond the renal capsule. Approximately 10% of the neoplasm consisted of haphazardly arranged spindle cells admixed with dense collagenous bands, which is typical of benign SFT. However, the remainder of the mass was composed of pleomorphic, spindled sarcoma cells with frequent mitoses and foci of necrosis. Immunohistochemically, we observed CD34 labeling in the benign SFT component with loss of expression in the sarcomatous component, focal labeling for Bcl-2 protein in both areas, and absence of labeling for cytokeratin, renal cell carcinoma marker, S100 protein, CD117, and muscle markers in both areas. To our knowledge, this is the first reported case of malignant renal SFT, likely representing transformation from a histologically documented benign SFT component.

Patient and urologist driven second opinion of prostate needle biopsies.

PURPOSE: We reviewed second opinion prostate needle biopsies that were patient and urologist driven to determine how often an expert opinion resulted in a different diagnosis. MATERIALS AND METHODS: Of 3,155 prostate needle biopsy consultations received during a 6-month interval 684 were sent at the request of the patient or urologist. A significant change in outside diagnosis was one that could potentially result in a change in therapy or prognosis. RESULTS: The second opinion was requested by patients (21.6%), urologist (63.9%) and patients plus urologists (14.5%). The distribution of the 684 outside diagnoses was benign in 6.1%, HGPIN in 7.6%, atypical (ATYP) in 29.8% and cancer in 56.5%. In 241 cases (35.2%) a change in diagnosis was rendered upon expert review. We agreed with the majority of outside cancer, benign and HGPIN diagnoses, in contrast to only 36.8% of outside ATYP cases (p <0.0001). Uncommonly did a cancer diagnosis become a benign one or vice versa. Of changes affecting outside cancer diagnoses 73.5% were due to changes in Gleason score. The diagnosis was more likely to be changed when the consultation was requested by the urologist rather than by the patient (41.4% vs 25%, p <0.0001). CONCLUSIONS: Cases diagnosed as ATYP have the highest likelihood of being changed upon expert review. Urologists should consider sending such cases for consultation to attempt to resolve the diagnosis as definitively benign or malignant before subjecting the patient to repeat biopsy.

Incidental stromal-predominant mixed epithelial-stromal tumors of the kidney: a mimic of intraparenchymal renal leiomyoma.

CONTEXT: Mixed epithelial-stromal tumor of the kidney is a recently recognized benign renal tumor that usually occurs in adult women and typically forms a sizable lesion with solid and cystic areas. The recognized morphologic spectrum of this recently described entity is evolving. OBJECTIVE: To review the clinicopathologic features of 3 small mixed epithelial-stromal tumors of the kidney that were incidental findings in kidneys removed for other reasons. DESIGN: The clinical presentation and morphologic findings of the 3 cases were reviewed. A panel of immunohistochemical stains was performed. SETTING: Academic medical center. RESULTS: All 3 lesions contained predominantly fascicles of smooth muscle mimicking leiomyoma, but they also had cellular subpopulations of smaller, müllerian-appearing stromal cells. Tubules present within the lesion were most abundant at the periphery, suggesting that they might be entrapped. Although only the spindled smooth muscle cells were immunoreactive for muscle markers desmin and actin, both the spindled smooth muscle cells and the cellular müllerian-appearing stromal cells demonstrated diffuse nuclear labeling for estrogen and progesterone receptors. CONCLUSIONS: Mixed epithelial-stromal tumor of the kidney may present as an incidental stromal-predominant lesion within the kidney. Such lesions are easily confused with leiomyomas or stromal-predominant angiomyolipomas.

Pathological stage does not alter the prognosis for renal lesions determined to be stage T1 by computerized tomography.

PURPOSE: Pathological stage has been the most widely used prognosticator for evaluating surgically managed cases of renal cell carcinoma. Minimally invasive surgical approaches are being increasingly used to treat small masses for which traditionally pathological information is lacking (morcellation) or absent (radio frequency ablation or cryoablation). Preoperative cross-sectional imaging by computerized tomography (CT) or magnetic resonance imaging has been used to stage renal tumors clinically but it can lead to variances with traditional pathological staging systems, particularly with respect to microscopic invasion beyond the renal capsule. In this study we assessed whether radiographically staged clinical T1 lesions that were pathological T1 behave differently than those that were clinical stage T1 and up staged to pT3a. MATERIALS AND METHODS: The records of 296 patients who underwent surgical treatment for renal cell carcinoma at The Johns Hopkins Hospital between 1990 and 1999 were retrospectively reviewed. All patients had undergone preoperative CT or magnetic resonance imaging, which was used to assign a clinical stage and size (largest diameter) to each tumor in accordance with the 1997 TNM staging system. Following surgical resection pathological stage, size and tumor grade were determined. Only the 186 patients with clinical T1 tumors were included in this analysis. RESULTS: Of the 186 patients who were clinically found to have T1 lesions 125 (67%) had pathological T1 and 57 (31%) had pathological T3a lesions. All surgical margins and lymph nodes were negative at surgical resection. Mean tumor size +/- SD was 3.9 +/- 1.5 cm for pT1 lesions and 3.8 +/- 1.5 cm for pT3a lesions. When comparing these pathological groups using Kaplan-Meier analysis, 5-year recurrence-free survival was not statistically different in patients with pT1 and pT3a lesions (90.6 and 97.5%, respectively). CONCLUSIONS: Patients in whom the initial classification of T1 renal cell carcinoma by CT was up graded to T3a on pathological analysis (invasion of fat within Gerota's fascia) showed the same recurrence-free survival rate as patients with pathologically confirmed T1 lesions. Thus, smaller tumors (less than 7 cm) that are up graded to T3a based on capsule invasion behave much like T1 tumors and exact pathological T staging does not appear to impact overall survival.

Comparison of erbium:yttrium-aluminum-garnet and holmium:yttrium-aluminum-garnet lasers for incision of urethra and bladder neck in an in vivo porcine model.

OBJECTIVES: To evaluate, in an animal model, differences in wound healing and scar formation in healthy urethra and bladder neck incised with the erbium (Er):yttrium-aluminum-garnet (YAG) and holmium (Ho):YAG lasers. METHODS: In each of 18 domestic pigs, three 1-cm-long incisions were made, two at the bladder neck and one in the mid-urethra, using either the Er:YAG laser (9 pigs) or the Ho:YAG laser (9 pigs). In each laser group, 3 animals were killed on postoperative days 0, 6, and 14. The width of collateral damage, as evidenced by coagulation necrosis and granulation tissue at the wound base, and the incision depth were evaluated during tissue analysis. RESULTS: The collateral damage with the Er:YAG laser at postoperative day 0, 6, and 14 was 20 +/- 5, 900 +/- 100, and 430 +/- 100 microm, respectively. The collateral damage with the Ho:YAG laser was 660 +/- 110, 2280 +/- 700, and 1580 +/- 250 microm, respectively. The amount of granulation tissue was significantly less (P <0.05) at all time points with the Er:YAG laser. Similarly, the incision depths for the Er:YAG and Ho:YAG laser at postoperative day 6 (1100 +/- 200 microm versus 1500 +/- 300 microm, respectively) and 14 (670 +/- 140 microm versus 1240 +/- 140 microm, respectively) were also significantly less (P <0.05) for the Er:YAG laser group, indicating faster healing of the wound created. CONCLUSIONS: In this in vivo animal study, incisions in the urethra and bladder neck made with the Er:YAG laser healed faster and with less scar formation than incisions made with the Ho:YAG laser.

Significance of psammoma bodies in serous cavity fluid: a cytopathologic analysis.

BACKGROUND: Psammoma bodies (PBs) are encountered only rarely in body cavity fluids (BCF). Although to the authors' knowledge their presence in certain neoplasms (e.g., those of the thyroid, ovary, lung, brain, etc.) is established, their significance in BCF has not been well defined. METHODS: Diagnoses concerning 3335 BCF samples were reviewed from the cytopathology files for the presence of PBs over an 8-year period. Cytologic preparations included cytospin preparations and Millipore filters stained with the Papanicolaou stain. Clinicopathologic correlation was performed on any subsequent surgical studies. RESULTS: Of the 3335 BCF samples studies (2444 pleural samples, 688 peritoneal samples, and 203 pericardial samples), PBs were noted in 123 cases (3.7%). Of these 123 cases, 112 were the peritoneal fluid (91%), 10 were the pleural fluid (8.1%), and 1 was in the pericardial fluid (0.81%). All 11 cases of pleural and pericardial effusions with PBs were malignant (carcinomas of the thyroid, lung, and ovary) compared with 62 of 112 peritoneal fluid samples (55.4%) (carcinoma of the ovary and uterus and mesothelioma). Nine of the remaining 50 cases of cytologically benign peritoneal fluids with PBs detected on follow-up tissue biopsy demonstrated peritoneal metastases from ovarian or endometrial carcinoma. Therefore, 41 of 112 cases of peritoneal fluid with PBs remained benign even after clinical follow-up and/or tissue biopsy (36.6%) and demonstrated ovarian cystadenoma/cystadenofibroma, papillary mesothelial hyperplasia, endosalpingiosis, endometriosis, and other miscellaneous benign diagnoses. CONCLUSIONS: PBs in BCF is a rare finding. Although in the authors' experience their presence in pleural and pericardial effusions signifies carcinomatous involvement, in the current study, peritoneal fluids with PBs were found to be benign in a significant number of cases (36.6%). In the latter scenario and in the absence of an obvious malignancy, attempts should be made to rule out the above-mentioned benign lesions.

Carcinosarcoma of the urinary bladder: dynamic contrast-enhanced MR imaging with clinical and pathologic correlation.

OBJECTIVE: This article describes the MR imaging features of carcinosarcoma of the urinary bladder with clinical presentation and pathologic correlation in three adults. CONCLUSION: Carcinosarcoma of the urinary bladder is a rare and aggressive tumor that has a clinical presentation similar to that of transitional cell carcinoma of the bladder. Dynamic gadolinium-enhanced MR imaging features are discussed.

Laparoscopic nephrectomy: assessment of morcellation versus intact specimen extraction on postoperative status.

PURPOSE: We compared pathological evaluation and postoperative recovery in patients undergoing transperitoneal laparoscopic nephrectomy at our institution with morcellated vs intact specimen extraction. MATERIALS AND METHODS: A prospective evaluation of 57 consecutive patients undergoing radical and simple transperitoneal laparoscopic nephrectomy was reviewed. One patient was excluded from study due to transitional cell carcinoma, which was detected intraoperatively. The 33 morcellated specimens were extracted at the umbilical port and the 23 intact specimens were extracted through a midline infraumbilical incision. Data were obtained on narcotic requirements, hospital stay, complications, estimated blood loss, mass size based on preoperative imaging, specimen weight and extraction incision length. RESULTS: Mean incision length in the morcellated and intact specimen removal groups was 1.2 and 7.1 cm, respectively (p <0.001). No significant differences in pain or recovery were noted between the 2 groups. Two cases of microscopic invasion of the perinephric adipose tissue in the intact specimen group were up staged from clinical T1 to pT3a disease. No change in patient treatment was made based on this information. CONCLUSIONS: We did not find a significant difference in surgical time, pain or hospital stay. Only incision length was statistically significant. Postoperative recovery appeared to be similar in these 2 groups. With modern imaging modalities information on pathological stage did not alter patient treatment.

Immunohistochemical staining of prostate cancer with monoclonal antibodies to the precursor of prostate-specific antigen.

OBJECTIVES: To characterize the immunohistochemical staining (IHS) of precursor forms of prostate-specific antigen (pro-PSA) forms in prostate cancer, high-grade prostatic intraepithelial neoplasia (HGPIN), and benign tissue from the peripheral and transition zones. Pro-PSA have previously been shown to be more concentrated in prostate cancer tissue extracts than in benign tissue. METHODS: Prostate needle biopsies showing HGPIN (22 sections, 11 patients) and adenocarcinoma (30 sections, 21 patients) and 17 radical prostatectomy and 3 open prostatectomy specimens were identified from the surgical pathology files of Johns Hopkins Hospital. IHS was performed on formalin-fixed, paraffin-embedded sections using one monoclonal antibody (mAB) against pro-PSA with a truncated pro-leader peptide containing two amino acids, [-2]pPSA, and a second mAB against native pro-PSA ([-5/-7]pPSA). RESULTS: The mABs were specific for both benign and malignant prostatic glandular tissue and did not stain stromal, vascular, or colonic tissue when present in the specimens. All sections with HGPIN and/or adenocarcinoma showed staining with both mABs. HGPIN was strongly positive in most cases (66.1%). The native pro-PSA mAB showed little differential between cancer and benign glands, and the mAB to the truncated [-2]pPSA stained cancer tissue more strongly than benign tissue. Benign atrophic glands often showed negative or weak/patchy staining. No difference was found in the staining pattern between benign glands in the peripheral zone and transition zone. CONCLUSIONS: This study is the first to demonstrate that mABs to pro-PSA can be used as specific IHS for benign and malignant prostatic tissue. [-2]pPSA appears to be preferentially more concentrated in cancer tissue than in benign glands, correlating with previous tissue extract studies. Unlike previous studies with PSA staining, the IHS for pro-PSA remained uniform among the different tumor grades. Therefore, pro-PSA may be a useful marker in differentiating high-grade prostate adenocarcinoma from other non-prostate carcinomas.