Ductal and Acinar Adenocarcinoma of Prostate: Morphological and Immunohistochemical Characterization

Abstract

Objectives: We sought to characterize the ductal and acinar subtype of prostate adenocarcinoma using hematoxylin and eosin (H&E) staining and an immunohistochemical antibody cocktail. We also investigated the clinical features, prostate-specific antigen (PSA) levels, and biological aggressiveness of these tumors.

Methods: We utilized tumor bearing prostate biopsies, obtained between 2010 and 2014 from Dow Diagnostic Research and Reference Laboratory, to identify cases of prostatic ductal and acinar adenocarcinoma using routine H&E and immunohistochemical staining. The immunohistochemical antibody cocktail 34βE12/p63/AMACR was used for staining. The association of clinicopathological variables including patient's age at diagnosis, Gleason score, and PSA levels before surgery was retrospectively analyzed.

Results: A total of 10 ductal and 140 non-ductal cases were identified. Ductal cases were predominantly high grade with advanced histopathological features (90%; p=0.030). Marked elevation in PSA level was also reported in most cases. No other significant statistical difference was observed.

Conclusions: Pathological and immunohistochemical examination could be used to characterize ductal and acinar adenocarcinoma of the prostate. Ductal adenocarcinoma of the prostate is a rare subtype of prostate carcinoma and is be more likely to present with advanced grade cancer suggesting that timely detection of the disease is vital.

Keywords: Acinar Carcinoma; Adenocarcinoma; Ductal Carcinoma; Gleason Score; Immunohistochemistry; Prostate.

Figure 1

(a) Prostatic ductal adenocarcinoma with papillary morphology, 10× magnification. 
(b) Cribriform prostatic ductal adenocarcinoma with central necrosis, 40× magnification. 
(c) Acinar adenocarcinoma exhibiting small round crowded glands lined by a single layer of cuboidal cells, 40× magnification. (d) Ductal adenocarcinoma with a red cytoplasmic granular staining pattern of AMACR and basal cells with dark brown nuclear (p63) and cytoplasmic (34βE12) staining in adjacent benign glands in the same slides, 40× magnification.