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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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Immunohistochemical and fluorescence in situ hybridization analysis of prostatic adenocarcinoma. (A) Tumor cells show diffuse moderate-to-strong PSA expression (200× with scale bar 100 microns), (B) variable AR expression (H&E, 200× with scale bar 100 microns), and (C) variable ERG expression (H&E, 200× with scale bar 100 microns). (D) The tumor was diffusely positive for ERG rearrangement by FISH at the genomic level. Dual-color, break apart FISH method to determine ERG rearrangement status: wild type ERG allele = yellow signal (colocalized signals), and rearranged ERG allele with loss of the 5′ ERG (red) probe = single green signal.
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fig2: Immunohistochemical and fluorescence in situ hybridization analysis of prostatic adenocarcinoma. (A) Tumor cells show diffuse moderate-to-strong PSA expression (200× with scale bar 100 microns), (B) variable AR expression (H&E, 200× with scale bar 100 microns), and (C) variable ERG expression (H&E, 200× with scale bar 100 microns). (D) The tumor was diffusely positive for ERG rearrangement by FISH at the genomic level. Dual-color, break apart FISH method to determine ERG rearrangement status: wild type ERG allele = yellow signal (colocalized signals), and rearranged ERG allele with loss of the 5′ ERG (red) probe = single green signal.

Mentions: Immunohistochemical staining confirmed diffuse PSA and PSMA expression in the prostate cancer cells, which were as expected negative for basal cell marker (p63 and CK34BE12) expression. Focal AMACR and variable (absent to moderate nuclear) androgen receptor expression were present. ERG expression, which when positive in our series of untreated patients is diffusely strong,4 was variable in this case (from absent to strong) as has previously been described in the context of anti-androgen therapy. Assessment of TMPRSS2:ERG gene fusion using an interphase FISH assay (following previous protocol4) confirmed that this tumor was diffusely positive for ERG rearrangement at the genomic level through a deletion mechanism (Fig. 2).


Prostatic Adenocarcinoma With Hormone Exposure Related Changes in a Patient With Hepatic Cirrhosis – Value of Autopsy in a Case Report
Immunohistochemical and fluorescence in situ hybridization analysis of prostatic adenocarcinoma. (A) Tumor cells show diffuse moderate-to-strong PSA expression (200× with scale bar 100 microns), (B) variable AR expression (H&E, 200× with scale bar 100 microns), and (C) variable ERG expression (H&E, 200× with scale bar 100 microns). (D) The tumor was diffusely positive for ERG rearrangement by FISH at the genomic level. Dual-color, break apart FISH method to determine ERG rearrangement status: wild type ERG allele = yellow signal (colocalized signals), and rearranged ERG allele with loss of the 5′ ERG (red) probe = single green signal.
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Related In: Results  -  Collection

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fig2: Immunohistochemical and fluorescence in situ hybridization analysis of prostatic adenocarcinoma. (A) Tumor cells show diffuse moderate-to-strong PSA expression (200× with scale bar 100 microns), (B) variable AR expression (H&E, 200× with scale bar 100 microns), and (C) variable ERG expression (H&E, 200× with scale bar 100 microns). (D) The tumor was diffusely positive for ERG rearrangement by FISH at the genomic level. Dual-color, break apart FISH method to determine ERG rearrangement status: wild type ERG allele = yellow signal (colocalized signals), and rearranged ERG allele with loss of the 5′ ERG (red) probe = single green signal.
Mentions: Immunohistochemical staining confirmed diffuse PSA and PSMA expression in the prostate cancer cells, which were as expected negative for basal cell marker (p63 and CK34BE12) expression. Focal AMACR and variable (absent to moderate nuclear) androgen receptor expression were present. ERG expression, which when positive in our series of untreated patients is diffusely strong,4 was variable in this case (from absent to strong) as has previously been described in the context of anti-androgen therapy. Assessment of TMPRSS2:ERG gene fusion using an interphase FISH assay (following previous protocol4) confirmed that this tumor was diffusely positive for ERG rearrangement at the genomic level through a deletion mechanism (Fig. 2).

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