Re: Can a biopsy be wrong?
- From: J <nexsw@nvalid,anon>
- Date: Thu, 13 Sep 2007 06:19:37 -0400
RR wrote:
In principle biopsy CAN'T be wrong,
it is the doctor who gets it wrong
RR
<
http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list_uids=15958851&dopt=AbstractPlus
Small glandular proliferations on needle biopsies: most common benign mimickers of
prostatic adenocarcinoma sent in for expert second opinion.
Herawi M, Parwani AV, Irie J, Epstein JI.
Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD,
USA.
The current study aimed to determine the incidence of various benign mimickers of
prostatic adenocarcinoma most commonly encountered in a busy consultation practice.
All prostate needle biopsies from the consult service of one of the authors were
prospectively evaluated over a 7-month period. Only cases with foci where the
contributor questioned malignancy and which upon expert review the entire case was
determined to be benign were included in this study.
A total of 567 separate suspected atypical foci from 345 patients of a total of
4,046 patients (8.5%) received in consultation were identified. Of these, 281 foci
(49.5%) had immunohistochemical (IHC) studies performed by the outside institution,
which included high molecular weight cytokeratin (HMWCK) (n = 280),
alpha-methylacyl-CoA racemase (AMACR) (P504s) (n = 45), and p63 (n = 34).
The most common mimicker was partial atrophy (203 of 567; 35.8%). Technically
adequate IHC for basal cells was performed in 117 cases of partial atrophy with
patchy or patchy/negative staining seen in 102 of 117 (87%), with the remaining 13%
of cases completely negative. A total of 15 of 19 (79%) cases of partial atrophy
were positive with AMACR.
Crowded benign glands, insufficiently crowded or numerous to warrant a diagnosis of
adenosis, was the second most common mimicker (146 of 567; 25.7%). Crowded benign
glands had patchy or patchy/negative IHC for basal cells in 66 of 81 (81%) cases
with the remaining 19% of cases completely negative.
A total of 7 of 11 (64%) cases of crowded glands were positive for AMACR.
In the past, complete atrophy, adenosis, seminal vesicle, and granulomatous
prostatitis were considered common mimickers of prostate cancer on prostatic needle
biopsies.
Our study shows that currently partial atrophy and crowded benign glands are the
most common benign changes causing diagnostic difficulty and prompting consultation.
Negative or patchy staining for basal cells and positive staining for AMACR may
contribute to diagnostic difficulty in these entities.
PMID: 15958851 [PubMed - indexed for MEDLINE]
<
http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list_uids=14976539&dopt=AbstractPlus
Mod Pathol. 2004 Mar;17(3):328-48.Click here to read Links
Benign mimickers of prostatic adenocarcinoma.
Srigley JR.
Department of Pathology and Molecular Medicine, McMaster University, Hamilton,
ON, Canada.
The diagnosis of prostatic adenocarcinoma, especially when present in small
amounts, is often challenging. Before making a diagnosis of carcinoma, it is prudent
for the pathologist to consider the various benign patterns and processes that can
simulate prostatic adenocarcinoma.
A useful method of classifying benign mimickers is in relationship to the major
growth patterns depicted in the classical Gleason diagram. The four major patterns
are small gland, large gland, fused gland and solid.
Most mimickers fit within the small gland category and the most common ones giving
rise to false-positive cancer diagnosis are atrophy, post-atrophic hyperplasia,
atypical adenomatous hyperplasia and seminal vesicle-type tissue. A number of other
histoanatomic structures such as Cowper's gland, verumontanum mucosal glands,
mesonephric glands and paraganglionic tissue may be confused with adenocarcinoma.
Additionally, metaplastic and hyperplastic processes within the prostate may be
confused with adenocarcinoma.
Furthermore, inflammatory processes including granulomatous prostatitis,
xanthogranulomatous prostatitis and malakoplakia may simulate high-grade
adenocarcinoma. Atypical adenomatous hyperplasia (adenosis), a putative precursor of
transition zone adenocarcinoma, has overlapping features with low-grade
adenocarcinoma and may cause problems in differential diagnosis, especially in the
needle biopsy setting.
The pathologist's awareness of the vast array of benign mimickers is important in
the systematic approach to the diagnosis of prostatic adenocarcinoma.
Knowledge of these patterns on routine microscopy coupled with the prudent use of
immunohistochemistry will lead to a correct diagnosis and avert a false-positive
cancer interpretation.
PMID: 14976539 [PubMed - indexed for MEDLINE]
Related Links
* [Differential diagnosis of prostate cancer: impact of pattern analysis and
immunohistochemistry] [Pathologe. 2005]
* Small glandular proliferations on needle biopsies: most common benign
mimickers of prostatic adenocarcinoma sent in for expert second opinion. [Am J Surg
Pathol. 2005]
* [Histopathological features of prostate cancer] [Nippon Rinsho. 2005]
* Diagnosis and reporting of limited adenocarcinoma of the prostate on
needle biopsy. [Mod Pathol. 2004]
* Number and location of nucleoli and presence of apoptotic bodies in
diagnostically challenging cases of prostate adenocarcinoma on needle biopsy. [Hum
Pathol. 2005]
.
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