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Prostatic Adenocarcinoma With Hormone Exposure Related Changes in a Patient With Hepatic Cirrhosis – Value of Autopsy in a Case Report

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ABSTRACT

Hepatic cirrhosis is commonly associated with hyperestrogenism. Previous studies have reported morphologic changes in benign and malignant prostate tissue exposed to estrogen or anti-androgens. To our knowledge, histopathologic features of prostatic adenocarcinoma in patients with cirrhosis have not been well-reported. We present a case of incidental, but pathologically significant, prostatic adenocarcinoma detected on autopsy in a 67-year-old male patient with cirrhosis and spider angiomata. The morphologic and immunohistochemical features (including variable ERG expression) of the prostatic adenocarcinoma were consistent with hormone exposure related changes, suggesting that cirrhosis-induced elevated estrogen-to-testosterone ratio and exogenous hormone therapy might induce similar phenotypes.

No MeSH data available.


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Histologic features of benign and malignant prostate tissue at the time of autopsy in a patient with cirrhosis. (A) Benign prostate glands demonstrating a prominent basal cell layer (H&E, 100× with scale bar 200 microns), (B) prostatic adenocarcinoma demonstrating small glands with atrophic features (H&E, 200× with scale bar 100 microns), (C) prostatic adenocarcinoma with relatively small and pyknotic nuclei infiltrating around a residual benign prostatic gland (toward top of the image, H&E, 200× with scale bar 100 microns), (D) PIN4 immunohistochemistry demonstrates loss of basal cell marker expression in the prostatic adenocarcinoma with retained expression in the single benign gland toward top of the image (H&E, 200× with scale bar 100 microns), (E) prostatic adenocarcinoma cells resembling histiocytes with small nuclei, indistinct nucleoli, and vacuolated cytoplasm (H&E, 400× with scale bar 50 microns), (F) cleft-like spaces filled with mucin and rare carcinoma cells (H&E, 200× with scale bar 100 microns), (G–H) prostatic adenocarcinoma adjacent to metastatic poorly differentiated hepatocellular carcinoma within a lymphovascular space (H&E, 100× with scale bar 200 microns, and H&E, 200× with scale bar 100 microns, respectively).
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fig1: Histologic features of benign and malignant prostate tissue at the time of autopsy in a patient with cirrhosis. (A) Benign prostate glands demonstrating a prominent basal cell layer (H&E, 100× with scale bar 200 microns), (B) prostatic adenocarcinoma demonstrating small glands with atrophic features (H&E, 200× with scale bar 100 microns), (C) prostatic adenocarcinoma with relatively small and pyknotic nuclei infiltrating around a residual benign prostatic gland (toward top of the image, H&E, 200× with scale bar 100 microns), (D) PIN4 immunohistochemistry demonstrates loss of basal cell marker expression in the prostatic adenocarcinoma with retained expression in the single benign gland toward top of the image (H&E, 200× with scale bar 100 microns), (E) prostatic adenocarcinoma cells resembling histiocytes with small nuclei, indistinct nucleoli, and vacuolated cytoplasm (H&E, 400× with scale bar 50 microns), (F) cleft-like spaces filled with mucin and rare carcinoma cells (H&E, 200× with scale bar 100 microns), (G–H) prostatic adenocarcinoma adjacent to metastatic poorly differentiated hepatocellular carcinoma within a lymphovascular space (H&E, 100× with scale bar 200 microns, and H&E, 200× with scale bar 100 microns, respectively).

Mentions: Microscopically, focal areas of the prostatic tumor showed both well- and poorly formed glands with cells demonstrating nucleolomegaly characteristic of prostatic adenocarcinoma. The majority of the prostatic adenocarcinoma, however, demonstrated areas with atrophic features, mucinous pools with absent-to-rare carcinoma cells (reminiscent of acellular clefts), and tumor cells with vacuolated cytoplasm and small nuclei with inconspicuous nucleoli, resembling histiocytes (Fig. 1). The background benign prostatic tissue showed a prominent basal cell layer with foci of basal cell hyperplasia. Metastatic hepatocellular carcinoma was also identified within the lymphovascular spaces in the prostate gland (Fig. 1).


Prostatic Adenocarcinoma With Hormone Exposure Related Changes in a Patient With Hepatic Cirrhosis – Value of Autopsy in a Case Report
Histologic features of benign and malignant prostate tissue at the time of autopsy in a patient with cirrhosis. (A) Benign prostate glands demonstrating a prominent basal cell layer (H&E, 100× with scale bar 200 microns), (B) prostatic adenocarcinoma demonstrating small glands with atrophic features (H&E, 200× with scale bar 100 microns), (C) prostatic adenocarcinoma with relatively small and pyknotic nuclei infiltrating around a residual benign prostatic gland (toward top of the image, H&E, 200× with scale bar 100 microns), (D) PIN4 immunohistochemistry demonstrates loss of basal cell marker expression in the prostatic adenocarcinoma with retained expression in the single benign gland toward top of the image (H&E, 200× with scale bar 100 microns), (E) prostatic adenocarcinoma cells resembling histiocytes with small nuclei, indistinct nucleoli, and vacuolated cytoplasm (H&E, 400× with scale bar 50 microns), (F) cleft-like spaces filled with mucin and rare carcinoma cells (H&E, 200× with scale bar 100 microns), (G–H) prostatic adenocarcinoma adjacent to metastatic poorly differentiated hepatocellular carcinoma within a lymphovascular space (H&E, 100× with scale bar 200 microns, and H&E, 200× with scale bar 100 microns, respectively).
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fig1: Histologic features of benign and malignant prostate tissue at the time of autopsy in a patient with cirrhosis. (A) Benign prostate glands demonstrating a prominent basal cell layer (H&E, 100× with scale bar 200 microns), (B) prostatic adenocarcinoma demonstrating small glands with atrophic features (H&E, 200× with scale bar 100 microns), (C) prostatic adenocarcinoma with relatively small and pyknotic nuclei infiltrating around a residual benign prostatic gland (toward top of the image, H&E, 200× with scale bar 100 microns), (D) PIN4 immunohistochemistry demonstrates loss of basal cell marker expression in the prostatic adenocarcinoma with retained expression in the single benign gland toward top of the image (H&E, 200× with scale bar 100 microns), (E) prostatic adenocarcinoma cells resembling histiocytes with small nuclei, indistinct nucleoli, and vacuolated cytoplasm (H&E, 400× with scale bar 50 microns), (F) cleft-like spaces filled with mucin and rare carcinoma cells (H&E, 200× with scale bar 100 microns), (G–H) prostatic adenocarcinoma adjacent to metastatic poorly differentiated hepatocellular carcinoma within a lymphovascular space (H&E, 100× with scale bar 200 microns, and H&E, 200× with scale bar 100 microns, respectively).
Mentions: Microscopically, focal areas of the prostatic tumor showed both well- and poorly formed glands with cells demonstrating nucleolomegaly characteristic of prostatic adenocarcinoma. The majority of the prostatic adenocarcinoma, however, demonstrated areas with atrophic features, mucinous pools with absent-to-rare carcinoma cells (reminiscent of acellular clefts), and tumor cells with vacuolated cytoplasm and small nuclei with inconspicuous nucleoli, resembling histiocytes (Fig. 1). The background benign prostatic tissue showed a prominent basal cell layer with foci of basal cell hyperplasia. Metastatic hepatocellular carcinoma was also identified within the lymphovascular spaces in the prostate gland (Fig. 1).

View Article: PubMed Central - PubMed

ABSTRACT

Hepatic cirrhosis is commonly associated with hyperestrogenism. Previous studies have reported morphologic changes in benign and malignant prostate tissue exposed to estrogen or anti-androgens. To our knowledge, histopathologic features of prostatic adenocarcinoma in patients with cirrhosis have not been well-reported. We present a case of incidental, but pathologically significant, prostatic adenocarcinoma detected on autopsy in a 67-year-old male patient with cirrhosis and spider angiomata. The morphologic and immunohistochemical features (including variable ERG expression) of the prostatic adenocarcinoma were consistent with hormone exposure related changes, suggesting that cirrhosis-induced elevated estrogen-to-testosterone ratio and exogenous hormone therapy might induce similar phenotypes.

No MeSH data available.


Related in: MedlinePlus