acid-phosphatase and Urethral-Neoplasms

Clear cell adenocarcinoma of the lower urinary tract is a rare neoplasm whose histogenesis has not been thoroughly investigated. We have examined six specimens of clear cell adenocarcinomas collected from three institutions using histological, histochemical, and immunohistochemical techniques. Results indicate that almost all clear cell adenocarcinomas of this region express morphological and antigenic features, suggesting müllerian differentiation, and that müllerian differentiation is not a feature of either nonclear cell adenocarcinomas or normal female paraurethral glands. Including the authors' six specimens, 46 specimens have been reported in the available English literature. The accumulated experience confirms the initial impression that these tumors develop predominantly in the urethras of women and occur over a wide age range. Despite high stage at diagnosis, most patients have been alive with no evidence of disease when reported, a prognosis that seems to apply regardless of length of follow-up.

Topics: Acid Phosphatase; Adenocarcinoma, Clear Cell; Adult; Aged; CA-125 Antigen; Female; Humans; Immunoenzyme Techniques; Immunohistochemistry; Male; Middle Aged; Prostate-Specific Antigen; Urethra; Urethral Neoplasms; Urinary Bladder Neoplasms

Urethral adenomatous polyps with prostatic epithelium (also known as benign prostatic epithelial polyps [BPEPs]) are a documented cause of hematuria, dysuria, and hematospermia, conditions that may prompt cytologic evaluation of urine.. The urine cytologic test findings in 5 cases of biopsy-proven BPEPs and in 1 case of prostatic ductal adenocarcinoma (PDA) that presented as a urethral polyp were retrospectively evaluated. Immunocytochemical stain for prostate-specific antigen (PSA), prostatic acid phosphatase (PAP), and high-molecular-weight cytokeratin (34betaE12) were used in evaluation of the lesions.. In 4 of 5 cases of BPEPs, clusters of bland columnar cells with uniform, oval nuclei were seen. Positive immunostaining for PSA and PAP confirmed the prostatic origin of the clusters in 2 cases. One urine sample contained abundant goblet cells and extracellular mucin, consistent with intestinal metaplasia coexisting in the bladder biopsy specimen. The urine sample in the fifth case of BPEPs contained no columnar cells. The last case had multiple urine cytologic evaluations that demonstrated PSA-positive, malignant-appearing clusters of columnar cells. A biopsy specimen of the polyps was described as a high-grade prostatic intraepithelial neoplasm in adenomatous polyp. However, in this patient, PDA was diagnosed on transurethral resection of the prostate specimen 4 years after the initial urine cytologic test.. Benign prostatic epithelial polyps should be considered in the differential diagnosis of clusters of columnar cells in urine cytologic testing. Cells with malignant nuclear features should instigate a careful search for a (prostatic) neoplasm, which may present as urethral polyps (e.g., PDA). Stains for PSA or PAP are useful adjuncts in differential diagnosis of this condition.

Topics: Acid Phosphatase; Adenocarcinoma; Adenomatous Polyps; Adult; Aged; Diagnosis, Differential; Humans; Keratins; Male; Middle Aged; Prostate-Specific Antigen; Prostatic Neoplasms; Urethral Neoplasms; Urine

The case of a 46-year-old women with well-differentiated adenocarcinoma of the female prostate (Skene's paraurethral glands and ducts) with inguinal metastases is reported. Besides adenocarcinomatous structures, also more solid parts of the tumor and anaplastic regions with dark cells were found on histological examination. Clear cancerous cells were typical for glandular and solid tumor parts. The cancerous cells showed distinct immunohistochemical positivity of prostate specific antigen (PSA) and prostate (specific) acid phosphatase [P(S)AcP]. These are the first published results of electron microscopic examination of formalin fixed tissue showing the ultrastructure of female prostate carcinoma, comparable to that of the male prostate carcinoma. In the female, similar to the male, the prostate carcinoma probably originates from the secretory (luminal) cells of the female prostatic glands.

Topics: Acid Phosphatase; Adenocarcinoma; Biomarkers, Tumor; Female; Humans; Immunohistochemistry; Lymphatic Metastasis; Male; Microscopy, Electron; Middle Aged; Prostate; Prostate-Specific Antigen; Urethral Neoplasms

The clinico-pathological features of nine urethral and urinary bladder polyps with prostate-type epithelium are described. The average age of the patients was 46 years. Three patients previously had cystoscopy and the lesion was not noticed on the initial examination. The commonest presentation in this series was haematuria, dysuria and frequency of micturition. One patient presented with postmicturition dribble and another with haemospermia. The polyps contained acini and papillae lined by prostate-type epithelium which was confirmed by immunohistochemical tests for prostate specific antigen and prostate acid phosphatase. In this series no age versus location relationship could be established. Symptoms resolved following resection or initial biopsy followed by fulguration. Recurrence is extremely rare.

Topics: Acid Phosphatase; Adult; Epithelium; Humans; Immunohistochemistry; Male; Middle Aged; Polyps; Prostate; Prostate-Specific Antigen; Urethral Neoplasms; Urinary Bladder Neoplasms

We describe two cases of mucinous adenocarcinomas involving and confined to the prostate and originating from the prostatic urethra. These cases were identical to adenocarcinomas arising within the urinary bladder and differed from mucinous adenocarcinoma of the prostate. In both cases, an in situ adenocarcinoma component was identified in the overlying prostatic urethra. In one case the in situ adenocarcinoma arose in a villous adenoma of the urethra. Both cases contained lakes of mucin lined by tall columnar epithelium with varying degrees of cytologic atypia, and one case had mucin-positive signet cells. In contrast, mucinous adenocarcinomas of the prostate demonstrate tubules and cribriform glands floating within mucin; mucin-positive signet cells are rare. Both tumors were negative immunohistochemically for prostate-specific antigen and prostate-specific acid phosphatase and positive for carcinoembryonic antigen. One case was treated by radical prostatectomy, and the patient was without evidence of disease with short follow-up. Following simple prostatectomy, the other patient did not undergo definitive therapy for several years, at which point the tumor had progressed locally to an advanced stage. In terms of therapy, the distinction between mucinous adenocarcinoma or urinary bladder-type arising in the prostate depicted within the current study and mucinous adenocarcinoma of the prostate is significant.

Topics: Acid Phosphatase; Adenocarcinoma, Mucinous; Aged; Carcinoembryonic Antigen; Diagnosis, Differential; Humans; Immunohistochemistry; Male; Mucins; Prostate-Specific Antigen; Prostatic Neoplasms; Urethral Neoplasms

A case of clear cell adenocarcinoma arising from the female urethra is described. Histologically, solid and glandular areas consisted of clear cells. The tumor cells stained positively with antibodies to prostate-specific antigen and prostatic acid phosphatase, suggesting that the clear cell adenocarcinoma arises from the female paraurethral duct, rather than embryonic remnants.

Topics: Acid Phosphatase; Adenocarcinoma, Clear Cell; Antibodies; Female; Humans; Male; Middle Aged; Prostate; Prostate-Specific Antigen; Staining and Labeling; Urethral Neoplasms

An autopsy case of adenocarcinoma of Skene's paraurethral gland co-incident with renal cell carcinoma is described. The adenocarcinoma showed distinct prostate specific antigen and prostate specific acid phosphatase pointing to the equivalence between the male prostate and Skene's paraurethral glands and ducts. Skene's gland are the homologue of the prostate in females and tumours arising from them are immunohistochemically similar to male prostate carcinoma.

Topics: Acid Phosphatase; Adenocarcinoma; Aged; Carcinoma, Renal Cell; Female; Humans; Kidney Neoplasms; Male; Neoplasms, Multiple Primary; Prostate; Prostate-Specific Antigen; Urethral Neoplasms

A 38-year-old man was admitted to our hospital complaining of difficult, frequent urination to our hospital. Transrectal echography and digital examination showed chronic prostatitis. He was treated with medication for chronic prostatitis but his condition did not improve. Retrograde urethrography revealed an obstructive change in the prostatic urethra and urethroscopic findings showed a urethral tumor in the posterior urethra. Transurethral resection of the tumor was performed. Pathological diagnosis of the urethral tumor indicated a urethral caruncle. After one year, the patient was readmitted to our hospital with the same complaints as before. Urethroscopic findings revealed the recurrence of a urethral polyp in the posterior urethra. Transurethral resection of the polyp was performed. Pathological findings revealed that the inner structure of the polyp showed a prostatic glandular pattern that after staining with anti-prostatic acid phosphatase antibody. The final diagnosis was that the polyp had a prostatic-type epithelium in the prostatic urethra.

Topics: Acid Phosphatase; Adult; Humans; Immunohistochemistry; Male; Neoplasm Recurrence, Local; Polyps; Prostate; Urethral Neoplasms

A rare case of urethral metastasis from prostatic adenocarcinoma is reported. Ordinary histological examination by hematoxylin and eosin staining could not determine whether the primary site was the prostate or the urethra. However, with an immunoperoxidase technique using prostate-specific acid phosphatase and prostate-specific antigen as markers for prostatic cells, we obtained a precise diagnosis of the primary sites. As a result, the patient could be successfully treated with hormonal therapy.

Topics: Acid Phosphatase; Adenocarcinoma; Aged; Antigens; Antigens, Neoplasm; Humans; Immunoenzyme Techniques; Male; Prostate; Prostate-Specific Antigen; Prostatic Neoplasms; Urethral Neoplasms

Ectopic prostatic glands in the bulbar urethra of a sixty-year-old man were identified by an indirect immunoperoxidase stain for prostatic acid phosphatase. Cystoscopically the appearances were those of "urethritis" without the polypoid appearance previously reported in cases of ectopic prostatic tissue.

Topics: Acid Phosphatase; Choristoma; Humans; Immunoenzyme Techniques; Male; Middle Aged; Prostate; Urethra; Urethral Neoplasms

In seven patients with undifferentiated carcinoma of the prostate, the immunohistochemical stain for prostate-specific antigen was negative. The stain for prostatic acid phosphatase done on the same tissue samples was diffusely positive in three, focally positive in three, and negative in one. Only the three with diffusely positive immunostaining had elevated serum acid phosphatase levels, although five had evidence of metastatic disease. All seven neoplasms were histologically similar, being composed of large cells with large nuclei, a moderate amount of cytoplasm, and indistinct cell borders. All tumors grew as broad sheets within the prostatic stroma as well as in the prostatic urethra; in six cases. Thus, prostatic carcinoma with this histologic pattern frequently loses prostate-specific antigen immunoreactivity. Awareness of this occurrence should prevent a misdiagnosis of urothelial carcinoma in such cases. The prostatic origin of these neoplasms can usually be verified by prostatic acid phosphatase immunostaining, which proves to be more sensitive in this particular setting.

Topics: Acid Phosphatase; Antigens; Carcinoma; Diagnosis, Differential; Histocytochemistry; Humans; Immunochemistry; Male; Neoplasm Metastasis; Prostate-Specific Antigen; Prostatic Neoplasms; Urethral Neoplasms

Twenty prostate glands from patients with either high-grade papillary tumors (19 patients, 15 of whom also had peripheral carcinoma in situ) or multifocal carcinoma in situ (1 patient) of the bladder who underwent cystoprostatectomy were studied histologically by mapping. Prostatic duct involvement by urothelial carcinoma was noted in nine patients, two with extensive involvement and seven with focal involvement confined to periurethral ducts. Carcinoma in situ of the bladder was observed in each of the nine patients and intraepithelial permeation appeared to be the predominant manner of spread of cancer cells into the prostate. The prostatic involvement was clinically silent and it may be a potential source of failure of conservative modalities of treatment of high-grade bladder cancer. A routine diagnostic transurethral prostatic biopsy may be recommended in the workup of patients with carcinoma in situ and high-grade carcinomas of the bladder. An incidental observation was the presence of 14 occult prostatic adenocarcinomas.

Topics: Acid Phosphatase; Adenocarcinoma; Aged; Carcinoma in Situ; Ejaculatory Ducts; Histocytochemistry; Humans; Immunoenzyme Techniques; Male; Middle Aged; Neoplasm Invasiveness; Neoplasms, Multiple Primary; Prostate; Prostatectomy; Prostatic Neoplasms; Urethral Neoplasms; Urinary Bladder Neoplasms

The clinicohistologic features of seven urethral and four urinary bladder polyps with prostatic-type epithelium are described. The average age of the patients was 50 years. Seven patients had prior cystoscopies and in none of them was the lesion noted initially. Histologically the lesions were papillary or polypoid and the surface was lined predominantly by prostatic-type epithelium with interspersed transitional epithelial cells or by transitional epithelium with interspersed prostatic-type epithelial cells. The prostatic-type columnar cells contained foamy, faintly eosinophilic cytoplasm, which stained strongly for prostate specific antigen and prostatic acid phosphatase. In all the lesions, there were prostatic acini in the underlying fibrovascular stroma, which was devoid of smooth muscle. The intermingling of prostatic-type cells and transitional epithelium, on the surface of the polyps, the absence of lesions at previous cystoscopies, the coexistence of cystitis cystica glandularis (a metaplastic lesion), and the older age group of our patients suggest that the prostatic-type epithelium in the polyps of urethra and urinary bladder is an acquired lesion, most likely a metaplastic response of transitional epithelium, which embryologically was multipotential.

Topics: Acid Phosphatase; Antigens, Neoplasm; Cystitis; Epithelium; Humans; Immunoenzyme Techniques; Male; Metaplasia; Middle Aged; Polyps; Prostate; Prostate-Specific Antigen; Urethra; Urethral Neoplasms; Urinary Bladder; Urinary Bladder Neoplasms

Acquired polyps of the male urethra often present with hematuria and sometimes hemospermia. The histogenesis of these tumors has been debated. We report a case of a prostatic urethral polyp that proved to be of prostatic epithelial differentiation, as demonstrated by immunohistochemical identification of prostatic acid phosphatase and prostatic specific antigen within the tumor cells.

Topics: Acid Phosphatase; Antigens; Epithelium; Humans; Immunoenzyme Techniques; Male; Middle Aged; Polyps; Prostate; Urethral Neoplasms

Epithelial polyps of the prostatic urethra are an uncommon and histologically heterogeneous group of lesions. We review the clinical and histologic features of a series of seven such polyps. Six were composed of prostatic-type epithelium. In five instances the epithelium was entirely histologically identical to that of normal prostate. One case contained foci of stratified, mitotically active cells, suggesting adenomatous transformation. All six stained intensely for both prostatic acid phosphatase and prostatic specific antigen. The seventh polyp was cytologically different. It was composed of flattened to cuboidal cells that did not stain for either antigen. All patients were treated by transurethral excision, and none of the six with follow-up developed a recurrence.

Topics: Acid Phosphatase; Adult; Aged; Antigens; Epithelium; Histocytochemistry; Humans; Immunoenzyme Techniques; Male; Middle Aged; Polyps; Prostate; Staining and Labeling; Urethral Neoplasms

A 77-year-old man had a papillary neoplasm of the prostatic urethra removed by transurethral resection. Light microscopically, much of the tissue consisted of a benign villous polyp lined by prostatic epithelium. An adenocarcinoma with cells that resembled those of uterine endometrial carcinoma was also present within the villous polyp. Using immunoperoxidase techniques, prostatic acid phosphatase and prostatic-specific antigen were localized in the epithelial cells of both the villous polyp and the adenocarcinoma. To our knowledge, this is the first reported case of adenocarcinoma arising in a urethral polyp. The immunohistochemical findings and the close association of the adenocarcinoma with the prostatic epithelium of the villous polyp provided evidence that so-called endometrial carcinoma of the prostatic utricle is of prostatic epithelial origin rather than müllerian derivation.

Topics: Acid Phosphatase; Adenocarcinoma; Aged; Antigens, Neoplasm; Humans; Immunoenzyme Techniques; Male; Neoplasms, Multiple Primary; Polyps; Prostate-Specific Antigen; Prostatic Neoplasms; Urethral Neoplasms

Topics: Acid Phosphatase; Aged; Alkaline Phosphatase; Carcinoma; Cystoscopy; Humans; Male; Neoplasm Recurrence, Local; Prostatic Neoplasms; Time Factors; Urethral Neoplasms; Urography