Histopathological Analysis of Prostatic Adenocarcinoma and the Role of Immunohistochemistry in Distinction between Low Grade and High Grade Carcinomas

Nazia Hussain, (2018) Histopathological Analysis of Prostatic Adenocarcinoma and the Role of Immunohistochemistry in Distinction between Low Grade and High Grade Carcinomas. Masters thesis, Thanjavur Medical College, Thanjavur.


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INTRODUCTION: Prostatic adenocarcinoma accounts for about 95% of malignancies of prostate gland. It is the most common malignant tumor among men. Incidence increases from 20% in men in their 50's to 70% in men between ages of 70's and 80's. The relative distribution of prostate cancer is different in each zone, 68% arises in the peripheral zone, 24% in transitional zone, and 8% in the central zone. Both genetic and environmental factors play a role in the origin of this disease. Long term androgen exposure and estrogen receptor β play an important role in the initiation of prostate cancer. Gleason's grading system is used to grade prostate cancers. Gleason's score ranges from 2-10. Serum prostate specific antigen is used to assist the diagnosis and management of prostate cancer. Immunohistochemical markers like cyclin D1, Ki-67 and ER-β are used to distinguish between low and high grade prostate adenocarcinomas. Alcian blue stain is used to demonstrate acid mucin production by tumor cells. AIMS AND OBJECTIVES: 1. To find out the age distribution of prostate carcinoma. 2. To distinguish between low grade and high grade prostate adenocarcinoma using Gleason's scoring method as well as immunohistochemical markers like Ki-67, cyclin D1, estrogen receptor -β. 3. To demonstrate the production of acid mucin by prostate cancer using histochemical stain like Alcian blue. 4. To correlate the level of serum prostate specific antigen with the grade of the tumor. MATERIALS AND METHODS: This is a study done in Thanjavur Medical College and Hospital from January 2015 to June 2017. Specimems obtained by transurethral resection of prostate from 50 cases were studied in the Department of Pathology. 1. Clinical details of patients like age, symptoms, location of the lesion within the prostate gland, serum PSA level were noted. 2. TURP specimens were fixed in 10% neutral buffered formalin, processed in a routine manner and sections were stained with hematoxylin and eosin. The sections were examined under light microscope and using modified Gleason's grading system. The prostate adenocarcinomas were grouped into low grade (score ≤6) and high grade tumors (score ≥7). 3. Immunohistochemistry was performed on whole tissue section using Cyclin D1, Ki67 and ER-b. 4.Also special stain like combined alcian blue -PAS was used to demonstrate the acid mucin production by prostate adenocarcinomas. RESULTS: Out of the 50 cases, 60% of the cases were between the age group of 70 - 80 years of age. Peripheral zone was involved by the tumor in all the 50 cases. There was a steep rise in the serum PSA level with increase in the Gleason's score. Mean serum PSA level in cases with low Gleason's score was 27.9 ng/mL .This was lower than serum PSA level of individuals with high Gleason score in whom it was 139.25 ng/mL. All 16 cases with high grade tumors (100%) showed cyclin D1 positivity. The mean expression of cyclin D1 was higher (35%) in high grade tumors than low grade tumors (16%). 94% of the high grade tumors showed Ki-67 expression when compared to low grade tumors where the expression of Ki-67 was found only in 29 % of the cases. ER-b expression was only 7% in high grade tumors when compared to the low grade tumors where the mean ER-b expression was 30.58%. 59% of the well differentiated tumors showed acid mucin production. None of the poorly differentiated tumors secreted acid mucin. CONCLUSION: Thus, a steep rise was found in the serum prostate specific antigen levels with increase in Gleason's score. Also a significant correlation was found between Gleason's score and cyclin D1, Ki-67 expression. The expression of these two markers was higher in high grade prostate adenocarcinomas. ER-β expression was higher in low grade tumors and its expression gets reduced with increase in Gleason's score. Acid mucin production by tumor cells gets reduced as the Gleason's score of the tumor increases.

Item Type: Thesis (Masters)
Additional Information: Reg.No.107513
Uncontrolled Keywords: Prostate adenocarcinoma, Gleason's score, Serum PSA, Cyclin D1, Ki-67, ER-β, acid mucin.
Subjects: MEDICAL > Pathology
Depositing User: Subramani R
Date Deposited: 17 Jan 2020 01:48
Last Modified: 06 Dec 2020 12:48
URI: http://repository-tnmgrmu.ac.in/id/eprint/11879

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