Letters to the Editor
However, immunoreactivity with these markers can be patchy and limited to a few tumor cells in UEC and may be negative in limited material such as an endometrial biopsy. Although cytokeratin positivity has not been reported in YWHAE-NUTM2 ESS, this has not been systematically investigated, and many sarcomas, including low-grade ESS, may be cytokeratin positive.12,13 Estrogen receptor and progesterone receptor are not useful in the distinction, as both tumor types are typically negative. It has recently been shown that cyclin D1 is strongly and diffusely positive (> 70% tumor cells) in YWHAENUTM2 ESS, and this marker can be used to distinguish this neoplasm from other mesenchymal tumors, which are usually negative or only focally positive.1 In fact, a diagnosis of YWHAENUTM2 ESS can be strongly suspected and provisionally made on the basis of diffuse cyclin D1 staining in a tumor that is morphologically compatible with this diagnosis,1 although molecular conformation is desirable. We recently encountered 2 tumors in endometrial biopsies from 55- and 78year-old women, which were composed of a diffuse monomorphic population of small round cells, which were broadspectrum cytokeratin, estrogen receptor and progesterone receptor negative, and diffusely and strongly cyclin D1 positive (Fig. 1), suggesting a diagnosis of YWHAE-NUTM2 ESS. However, resection specimens in both cases showed minor foci of low-grade endometrioid adenocarcinoma admixed with the diffuse population of small round cells; the latter, as well as exhibiting diffuse strong positive staining with cyclin D1, showed focal strong positive staining with broadspectrum cytokeratins and EMA, resulting in a final diagnosis of mixed UEC and low-grade endometrioid adenocarcinoma (dedifferentiated endometrioid adenocarcinoma). We subsequently performed cyclin D1 immunohistochemistry on 8 additional cases of UEC (4 pure, 4 dedifferentiated). All 8 tumors showed cyclin D1 expression, 4 diffuse and strong and 4 patchy. The low-grade endometrioid component also expressed cyclin D1 in all 6 cases where this was present (3 diffuse, 3 patchy). As YWHAE-NUTM2 ESS is typically negative for CD10 (except in
724 | www.ajsp.com
Am J Surg Pathol
the associated low-grade component, if present),4,5 we stained 7 of our 10 cases of UES with this marker. Four cases were negative, and 3 exhibited minor foci of positivity, illustrating that this marker is of little or no value in distinguishing YWHAE-NUTM2 ESS from UES. In summary, diffuse cyclin D1 staining is common in UEC and cannot be used to distinguish this from YWHAE-NUTM2 ESS. In cases in which these 2 tumors are in the differential diagnosis and in which there is diffuse strong positive staining with cyclin D1 and negative staining with cytokeratins and EMA, molecular studies are necessary for diagnosis. Varsha I. Shah, FRCPath* W. Glenn McCluggage, FRCPathw *Department of Pathology, Singleton Hospital, Swansea wDepartment of Pathology, Belfast Health and Social Care Trust, Belfast United Kingdom Conflicts of Interest and Source of Funding: The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.
REFERENCES 1. Lee CH, Ali RH, Rouzbahman M, et al. Cyclin D1 as a diagnostic immunomarker for endometrial stromal sarcoma with YWHAE-FAM22 rearrangement. Am J Surg Pathol. 2012;36:1562–1570. 2. Kurman RJ, Carcangiu ML, Herrington CS, et al. WHO Classification of Tumours of Female Reproductive Organs. Lyon: International Agency for Research on Cancer; 2014. 3. Tavassoli FA, Devilee P. World Health Organization Classification of Tumours Pathology and Genetics. Tumours of the Breast and Female Genital Organs. Lyon: IARC Press; 2003. 4. Lee CH, Marino-Enriquez A, Ou W, et al. The clinicopathologic features of YWHAEFAM22 endometrial stromal sarcomas: a histologically high-grade and clinically aggressive tumor. Am J Surg Pathol. 2012;36:641–653. 5. Croce S, Hostein I, Ribeiro A, et al. YWHAE rearrangement identified by FISH and RTPCR in endometrial stromal sarcomas: genetic and pathological correlations. Mod Pathol. 2013;26:1390–1400. 6. Lee CH, Hoang LN, Reyes C, et al. Frequent immunohistochemical expression of KIT in YWHAE-FAM22 endometrial stromal sarcoma. Mod Pathol. 2014;27:751–757. 7. Silva EG, Deavers MT, Malpica A. Undifferentiated carcinoma of the endometrium: a review. Pathology. 2007;39:134–138.
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Volume 39, Number 5, May 2015
8. Altrabulsi B, Malpica A, Deavers MT, et al. Undifferentiated carcinoma of the endometrium. Am J Surg Pathol. 2005;2:1316–1321. 9. Tafe LJ, Garg K, Chew I, et al. Endometrial and ovarian carcinomas with undifferentiated components: clinically aggressive and frequently underrecognised neoplasms. Mod Pathol. 2010;23:781–789. 10. Silva EG, Deavers MT, Bodurka DC, et al. Association of low grade endometrioid carcinoma of the uterus and ovary with undifferentiated carcinoma: a new type of dedifferentiated carcinoma?. Int J Gynecol Pathol. 2006;25:52–58. 11. Garg K, Leitao MM Jr, Kauff ND, et al. Selection of endometrial carcinomas for DNA mismatch repair protein immunohistochemistry using patient age and tumor morphology enhances detection of mismatch repair abnormalities. Am J Surg Pathol. 2009;33:925–933. 12. Farhood AI, Abrams J. Immunohistochemistry of endometrial stromal sarcoma. Hum Pathol. 1991;22:224–230. 13. Adegboyega PA, Qiu S. Immunohistochemical profiling of cytokeratin expression by endometrial stromal sarcoma. Hum Pathol. 2008;39:1459–1464.
Metastatic Prostate Adenocarcinoma to the Penis Presenting as Pagetoid Carcinoma A Phenomenon Not Previously Reported To the Editor: We read with great interest the paper by Ellis and Epstein titled “Metastatic Prostate Adenocarcinoma to the Penis. A Series of 29 Cases With Predilection for Ductal Adenocarcinoma,” as at the time we were struggling with a penile resection in a 76-year-old patient with a remote history of prostatic adenocarcinoma 19.5 years earlier.1 In May 1995, our patient’s outside pathology specimens, including several needle biopsies, prostate transurethral resections, and bladder biopsies from earlier that year, were reviewed at the Cleveland Clinic. The tumor was diagnosed as prostatic adenocarcinoma of ductal type. The prostatic adenocarcinoma showed comedonecrosis and intraductal adenocarcinoma, including a cribriform pattern, which showed
2015 Wolters Kluwer Health, Inc. All rights reserved.
Am J Surg Pathol
Volume 39, Number 5, May 2015
Letters to the Editor
FIGURE 1. A, Penile urethra with intraepidermal infiltration of malignant cells consistent with pagetoid carcinoma (hematoxylin and eosin). B, Diffuse expression in tumor cells with NKX3.1 immunostain. C, Diffuse expression in tumor cells with prostatespecific membrane antigen immunostain. D, Lack of expression of tumor cells with GATA3 antibody.
involvement of the surface urethral epithelium as well. The tumor involved both prostatic resections and 1 of the prostate biopsies. Urothelial carcinoma was not identified in any of the specimens. Immunostains performed revealed expression by the tumor of prostatic acid phosphatase but no expression of prostate-specific antigen (PSA) in all 3 specimens stained. The final Gleason score was 3+5 = 8, where 3 is for the cribriform pattern that today would be considered Gleason pattern 4 and Gleason pattern 5 for the areas with comedonecrosis.2–4 Radical prostatectomy was performed elsewhere the same year and is not available for review. Yearly annual examination revealed no problems until 2006 when the patient developed urinary hesitancy and associated pain, frequent urgency, and voiding. Urine analysis Copyright
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was negative, and the clinical impression was of urethral stricture, requiring periodic dilations. Serum PSA remained low (< 0.05 ng/mL). Clinical recurrence or new malignancy was not identified. Suprapubic catheterization and anterior urethral reconstruction was performed in early 2013 because of extensive urethral stricture disease in the proximal and mid-bulbar urethra. Biopsies performed at the time were negative for malignancy. Eighteen months after reconstruction, the patient presented with some obstructive voiding complaints. A cystoscopy in the office demonstrated a proximal anastomotic stricture; in addition, a perimeatal glossy reddened area was identified. A biopsy of the lesion and urethrotomy were performed. Pathology of the perimeatal biopsy revealed pagetoid
2015 Wolters Kluwer Health, Inc. All rights reserved.
spread of carcinoma with positive margins. On the basis of immunostains performed, including diffuse expression of cytokeratin (CK) 20 and focal expression of CK 7, the lesion was diagnosed by consensus as pagetoid involvement by urothelial carcinoma. The patient was counseled to undergo distal urethrectomy and wide perimeatal resection. Negative margins were obtained. Three months later, a new 3 3 mm area of erythema, superior (dorsal) to the area of prior resection and well away from the neomeatus of the urethra, was noted, and the proximal anastomotic stricture was noted to be denser than before the urethrotomy, raising wider suspicion for urethral carcinoma. Urine cytology was positive. Biopsies of the glans penis, urethra, including the anastomotic stricture, and bladder www.ajsp.com |
725
Letters to the Editor
were conducted and diffusely positive. Staging did not suggest locoregional spread. The patient underwent cystectomy, urethrectomy, and glans resection in December 2014. Pathology revealed pagetoid carcinoma involving the right ureter, penile urethra, and bladder mucosa. In addition, there was nodular carcinoma involving the bladder mucosa, invading into the lamina propria, as well as the glandular pattern of carcinoma involving the erectile tissue of the penis (Fig. 1A). This unusual glandular pattern, tied to the remote history of prostate ductal carcinoma, raised the possibility of recurrent prostatic carcinoma in addition to urothelial carcinoma. Immunostains performed in the bladder mucosa, as well as penile erectile tissue and urothelial pagetoid carcinoma, revealed that all neoplastic cells showed a similar immunophenotype: diffuse immunoreactivity for NKX3.1, prostatic-specific membrane antigen, and prostein (p501s), whereas GATA3, p63, and PSA were all negative (Figs. 1B–D). To our surprise, this profile suggested that all the tumor foci, including the pagetoid involvement of bladder, urethra, and penile mucosa were of prostatic origin. Reviewing the paper by Ellis and Epstein, we learned that 8 of 29 cases of prostatic adenocarcinoma involving the penis had ductal features, as our case. However, pagetoid involvement of the penile urethra was not described in their series. As in our current case, 3 of their tumors were originally interpreted as urothelial in origin. A literature search of pagetoid involvement of prostatic carcinoma revealed 5 citations.5–9 Overall, 4
726 | www.ajsp.com
Am J Surg Pathol
cases of pagetoid prostate carcinoma to the skin were reported but only 1 as a penile lesion.5 Reading carefully into the latter case from 1977 in which the authors interchanged prostatic duct carcinoma and transitional cell carcinoma of the prostate, their reported tumor was most likely of urothelial origin rather than prostatic origin. The other cases reported pagetoid spread of prostatic carcinoma involving inguinal skin (2 cases), axillary skin, and within intraprostatic transitional lined prostatic ducts. Prostate carcinoma had been diagnosed 8 and 16 years before the pagetoid spread to the inguinal skin, whereas the axillary lesion was diagnosed before the prostatic primary. In summary, we describe a case of recurrent prostate adenocarcinoma, 19 years after original diagnosis, presenting as pagetoid carcinoma that closely mimicked urothelial carcinoma. To our knowledge, similar pagetoid spread by prostatic adenocarcinoma has not been previously reported. Knowing that this phenomenon can very rarely occur expands the differential diagnosis in patients with a recent or remote history of prostatic adenocarcinoma who present with pagetoid carcinoma involving the urothelium, a feature that is generally not considered within the spectrum of behavior of prostate cancer. Andres A. Roma, MD* Cristina Magi-Galluzzi, MD, PhD* Hadley Wood, MDw Amr Fergany, MDw Jesse K. McKenney, MD* *Department of Anatomic Pathology Robert J. Tomsich Pathology & Laboratory Medicine Institute
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Volume 39, Number 5, May 2015
wDepartment of Urology, The Glickman Urological & Kidney Institute, Cleveland Clinic Lerner College of Medicine, Cleveland Clinic Cleveland, OH
Conflicts of Interest and Source of Funding: The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.
REFERENCES 1. Ellis CL, Epstein JI. Metastatic prostate adenocarcinoma to the penis: a series of 29 cases with predilection for ductal adenocarcinoma. Am J Surg Pathol. 2015;39:67–74. 2. Mellinger GT, Gleason D, Bailar J III. The histology and prognosis of prostatic cancer. J Urol. 1967;97:331–337. 3. Gleason DF, Mellinger GT. Prediction of prognosis for prostatic adenocarcinoma by combined histological grading and clinical staging. J Urol. 1974;111:58–64. 4. Epstein JI, Allsbrook WC Jr, Amin MB, et al. The 2005 International Society of Urological Pathology (ISUP) consensus conference on gleason grading of prostatic carcinoma. Am J Surg Pathol. 2005;29:1228–1242. 5. Ikezawa Z, Ohashi Y, Nakajima H, et al. An unusual case of extramammary Paget’s disease. Paget’s disease of the glans penis probably originating from a prostatic duct carcinoma (transitional cell carcinoma of the prostate). J Dermatol. 1977;4:19–25. 6. Segal R, Penneys NS, Nahass G. Metastatic prostatic carcinoma histologically mimicking malignant melanoma. J Cutan Pathol. 1994;21:280–282. 7. Petcu EB, Gonzalez-Serva A, Wright RG, et al. Prostate carcinoma metastatic to the skin as an extramammary Paget’s disease. Diagn Pathol. 2012;7:106. 8. Wang EC, Kwah YC, Tan WP, et al. Extramammary Paget disease: Immunohistochemistry is critical to distinguish potential mimickers. Dermatol Online J. 2012;18:4. 9. Kanomata N, Kozuka Y, Moriya T. Prostatic intraepithelial pagetoid histiocyte: a potential diagnostic pitfall. Pathol Int. 2011;61:551.
2015 Wolters Kluwer Health, Inc. All rights reserved.
However, immunoreactivity with these markers can be patchy and limited to a few tumor cells in UEC and may be negative in limited material such as an endometrial biopsy. Although cytokeratin positivity has not been reported in YWHAE-NUTM2 ESS, this has not been systematically investigated, and many sarcomas, including low-grade ESS, may be cytokeratin positive.12,13 Estrogen receptor and progesterone receptor are not useful in the distinction, as both tumor types are typically negative. It has recently been shown that cyclin D1 is strongly and diffusely positive (> 70% tumor cells) in YWHAENUTM2 ESS, and this marker can be used to distinguish this neoplasm from other mesenchymal tumors, which are usually negative or only focally positive.1 In fact, a diagnosis of YWHAENUTM2 ESS can be strongly suspected and provisionally made on the basis of diffuse cyclin D1 staining in a tumor that is morphologically compatible with this diagnosis,1 although molecular conformation is desirable. We recently encountered 2 tumors in endometrial biopsies from 55- and 78year-old women, which were composed of a diffuse monomorphic population of small round cells, which were broadspectrum cytokeratin, estrogen receptor and progesterone receptor negative, and diffusely and strongly cyclin D1 positive (Fig. 1), suggesting a diagnosis of YWHAE-NUTM2 ESS. However, resection specimens in both cases showed minor foci of low-grade endometrioid adenocarcinoma admixed with the diffuse population of small round cells; the latter, as well as exhibiting diffuse strong positive staining with cyclin D1, showed focal strong positive staining with broadspectrum cytokeratins and EMA, resulting in a final diagnosis of mixed UEC and low-grade endometrioid adenocarcinoma (dedifferentiated endometrioid adenocarcinoma). We subsequently performed cyclin D1 immunohistochemistry on 8 additional cases of UEC (4 pure, 4 dedifferentiated). All 8 tumors showed cyclin D1 expression, 4 diffuse and strong and 4 patchy. The low-grade endometrioid component also expressed cyclin D1 in all 6 cases where this was present (3 diffuse, 3 patchy). As YWHAE-NUTM2 ESS is typically negative for CD10 (except in
724 | www.ajsp.com
Am J Surg Pathol
the associated low-grade component, if present),4,5 we stained 7 of our 10 cases of UES with this marker. Four cases were negative, and 3 exhibited minor foci of positivity, illustrating that this marker is of little or no value in distinguishing YWHAE-NUTM2 ESS from UES. In summary, diffuse cyclin D1 staining is common in UEC and cannot be used to distinguish this from YWHAE-NUTM2 ESS. In cases in which these 2 tumors are in the differential diagnosis and in which there is diffuse strong positive staining with cyclin D1 and negative staining with cytokeratins and EMA, molecular studies are necessary for diagnosis. Varsha I. Shah, FRCPath* W. Glenn McCluggage, FRCPathw *Department of Pathology, Singleton Hospital, Swansea wDepartment of Pathology, Belfast Health and Social Care Trust, Belfast United Kingdom Conflicts of Interest and Source of Funding: The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.
REFERENCES 1. Lee CH, Ali RH, Rouzbahman M, et al. Cyclin D1 as a diagnostic immunomarker for endometrial stromal sarcoma with YWHAE-FAM22 rearrangement. Am J Surg Pathol. 2012;36:1562–1570. 2. Kurman RJ, Carcangiu ML, Herrington CS, et al. WHO Classification of Tumours of Female Reproductive Organs. Lyon: International Agency for Research on Cancer; 2014. 3. Tavassoli FA, Devilee P. World Health Organization Classification of Tumours Pathology and Genetics. Tumours of the Breast and Female Genital Organs. Lyon: IARC Press; 2003. 4. Lee CH, Marino-Enriquez A, Ou W, et al. The clinicopathologic features of YWHAEFAM22 endometrial stromal sarcomas: a histologically high-grade and clinically aggressive tumor. Am J Surg Pathol. 2012;36:641–653. 5. Croce S, Hostein I, Ribeiro A, et al. YWHAE rearrangement identified by FISH and RTPCR in endometrial stromal sarcomas: genetic and pathological correlations. Mod Pathol. 2013;26:1390–1400. 6. Lee CH, Hoang LN, Reyes C, et al. Frequent immunohistochemical expression of KIT in YWHAE-FAM22 endometrial stromal sarcoma. Mod Pathol. 2014;27:751–757. 7. Silva EG, Deavers MT, Malpica A. Undifferentiated carcinoma of the endometrium: a review. Pathology. 2007;39:134–138.
Copyright
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Volume 39, Number 5, May 2015
8. Altrabulsi B, Malpica A, Deavers MT, et al. Undifferentiated carcinoma of the endometrium. Am J Surg Pathol. 2005;2:1316–1321. 9. Tafe LJ, Garg K, Chew I, et al. Endometrial and ovarian carcinomas with undifferentiated components: clinically aggressive and frequently underrecognised neoplasms. Mod Pathol. 2010;23:781–789. 10. Silva EG, Deavers MT, Bodurka DC, et al. Association of low grade endometrioid carcinoma of the uterus and ovary with undifferentiated carcinoma: a new type of dedifferentiated carcinoma?. Int J Gynecol Pathol. 2006;25:52–58. 11. Garg K, Leitao MM Jr, Kauff ND, et al. Selection of endometrial carcinomas for DNA mismatch repair protein immunohistochemistry using patient age and tumor morphology enhances detection of mismatch repair abnormalities. Am J Surg Pathol. 2009;33:925–933. 12. Farhood AI, Abrams J. Immunohistochemistry of endometrial stromal sarcoma. Hum Pathol. 1991;22:224–230. 13. Adegboyega PA, Qiu S. Immunohistochemical profiling of cytokeratin expression by endometrial stromal sarcoma. Hum Pathol. 2008;39:1459–1464.
Metastatic Prostate Adenocarcinoma to the Penis Presenting as Pagetoid Carcinoma A Phenomenon Not Previously Reported To the Editor: We read with great interest the paper by Ellis and Epstein titled “Metastatic Prostate Adenocarcinoma to the Penis. A Series of 29 Cases With Predilection for Ductal Adenocarcinoma,” as at the time we were struggling with a penile resection in a 76-year-old patient with a remote history of prostatic adenocarcinoma 19.5 years earlier.1 In May 1995, our patient’s outside pathology specimens, including several needle biopsies, prostate transurethral resections, and bladder biopsies from earlier that year, were reviewed at the Cleveland Clinic. The tumor was diagnosed as prostatic adenocarcinoma of ductal type. The prostatic adenocarcinoma showed comedonecrosis and intraductal adenocarcinoma, including a cribriform pattern, which showed
2015 Wolters Kluwer Health, Inc. All rights reserved.
Am J Surg Pathol
Volume 39, Number 5, May 2015
Letters to the Editor
FIGURE 1. A, Penile urethra with intraepidermal infiltration of malignant cells consistent with pagetoid carcinoma (hematoxylin and eosin). B, Diffuse expression in tumor cells with NKX3.1 immunostain. C, Diffuse expression in tumor cells with prostatespecific membrane antigen immunostain. D, Lack of expression of tumor cells with GATA3 antibody.
involvement of the surface urethral epithelium as well. The tumor involved both prostatic resections and 1 of the prostate biopsies. Urothelial carcinoma was not identified in any of the specimens. Immunostains performed revealed expression by the tumor of prostatic acid phosphatase but no expression of prostate-specific antigen (PSA) in all 3 specimens stained. The final Gleason score was 3+5 = 8, where 3 is for the cribriform pattern that today would be considered Gleason pattern 4 and Gleason pattern 5 for the areas with comedonecrosis.2–4 Radical prostatectomy was performed elsewhere the same year and is not available for review. Yearly annual examination revealed no problems until 2006 when the patient developed urinary hesitancy and associated pain, frequent urgency, and voiding. Urine analysis Copyright
r
was negative, and the clinical impression was of urethral stricture, requiring periodic dilations. Serum PSA remained low (< 0.05 ng/mL). Clinical recurrence or new malignancy was not identified. Suprapubic catheterization and anterior urethral reconstruction was performed in early 2013 because of extensive urethral stricture disease in the proximal and mid-bulbar urethra. Biopsies performed at the time were negative for malignancy. Eighteen months after reconstruction, the patient presented with some obstructive voiding complaints. A cystoscopy in the office demonstrated a proximal anastomotic stricture; in addition, a perimeatal glossy reddened area was identified. A biopsy of the lesion and urethrotomy were performed. Pathology of the perimeatal biopsy revealed pagetoid
2015 Wolters Kluwer Health, Inc. All rights reserved.
spread of carcinoma with positive margins. On the basis of immunostains performed, including diffuse expression of cytokeratin (CK) 20 and focal expression of CK 7, the lesion was diagnosed by consensus as pagetoid involvement by urothelial carcinoma. The patient was counseled to undergo distal urethrectomy and wide perimeatal resection. Negative margins were obtained. Three months later, a new 3 3 mm area of erythema, superior (dorsal) to the area of prior resection and well away from the neomeatus of the urethra, was noted, and the proximal anastomotic stricture was noted to be denser than before the urethrotomy, raising wider suspicion for urethral carcinoma. Urine cytology was positive. Biopsies of the glans penis, urethra, including the anastomotic stricture, and bladder www.ajsp.com |
725
Letters to the Editor
were conducted and diffusely positive. Staging did not suggest locoregional spread. The patient underwent cystectomy, urethrectomy, and glans resection in December 2014. Pathology revealed pagetoid carcinoma involving the right ureter, penile urethra, and bladder mucosa. In addition, there was nodular carcinoma involving the bladder mucosa, invading into the lamina propria, as well as the glandular pattern of carcinoma involving the erectile tissue of the penis (Fig. 1A). This unusual glandular pattern, tied to the remote history of prostate ductal carcinoma, raised the possibility of recurrent prostatic carcinoma in addition to urothelial carcinoma. Immunostains performed in the bladder mucosa, as well as penile erectile tissue and urothelial pagetoid carcinoma, revealed that all neoplastic cells showed a similar immunophenotype: diffuse immunoreactivity for NKX3.1, prostatic-specific membrane antigen, and prostein (p501s), whereas GATA3, p63, and PSA were all negative (Figs. 1B–D). To our surprise, this profile suggested that all the tumor foci, including the pagetoid involvement of bladder, urethra, and penile mucosa were of prostatic origin. Reviewing the paper by Ellis and Epstein, we learned that 8 of 29 cases of prostatic adenocarcinoma involving the penis had ductal features, as our case. However, pagetoid involvement of the penile urethra was not described in their series. As in our current case, 3 of their tumors were originally interpreted as urothelial in origin. A literature search of pagetoid involvement of prostatic carcinoma revealed 5 citations.5–9 Overall, 4
726 | www.ajsp.com
Am J Surg Pathol
cases of pagetoid prostate carcinoma to the skin were reported but only 1 as a penile lesion.5 Reading carefully into the latter case from 1977 in which the authors interchanged prostatic duct carcinoma and transitional cell carcinoma of the prostate, their reported tumor was most likely of urothelial origin rather than prostatic origin. The other cases reported pagetoid spread of prostatic carcinoma involving inguinal skin (2 cases), axillary skin, and within intraprostatic transitional lined prostatic ducts. Prostate carcinoma had been diagnosed 8 and 16 years before the pagetoid spread to the inguinal skin, whereas the axillary lesion was diagnosed before the prostatic primary. In summary, we describe a case of recurrent prostate adenocarcinoma, 19 years after original diagnosis, presenting as pagetoid carcinoma that closely mimicked urothelial carcinoma. To our knowledge, similar pagetoid spread by prostatic adenocarcinoma has not been previously reported. Knowing that this phenomenon can very rarely occur expands the differential diagnosis in patients with a recent or remote history of prostatic adenocarcinoma who present with pagetoid carcinoma involving the urothelium, a feature that is generally not considered within the spectrum of behavior of prostate cancer. Andres A. Roma, MD* Cristina Magi-Galluzzi, MD, PhD* Hadley Wood, MDw Amr Fergany, MDw Jesse K. McKenney, MD* *Department of Anatomic Pathology Robert J. Tomsich Pathology & Laboratory Medicine Institute
Copyright
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Volume 39, Number 5, May 2015
wDepartment of Urology, The Glickman Urological & Kidney Institute, Cleveland Clinic Lerner College of Medicine, Cleveland Clinic Cleveland, OH
Conflicts of Interest and Source of Funding: The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.
REFERENCES 1. Ellis CL, Epstein JI. Metastatic prostate adenocarcinoma to the penis: a series of 29 cases with predilection for ductal adenocarcinoma. Am J Surg Pathol. 2015;39:67–74. 2. Mellinger GT, Gleason D, Bailar J III. The histology and prognosis of prostatic cancer. J Urol. 1967;97:331–337. 3. Gleason DF, Mellinger GT. Prediction of prognosis for prostatic adenocarcinoma by combined histological grading and clinical staging. J Urol. 1974;111:58–64. 4. Epstein JI, Allsbrook WC Jr, Amin MB, et al. The 2005 International Society of Urological Pathology (ISUP) consensus conference on gleason grading of prostatic carcinoma. Am J Surg Pathol. 2005;29:1228–1242. 5. Ikezawa Z, Ohashi Y, Nakajima H, et al. An unusual case of extramammary Paget’s disease. Paget’s disease of the glans penis probably originating from a prostatic duct carcinoma (transitional cell carcinoma of the prostate). J Dermatol. 1977;4:19–25. 6. Segal R, Penneys NS, Nahass G. Metastatic prostatic carcinoma histologically mimicking malignant melanoma. J Cutan Pathol. 1994;21:280–282. 7. Petcu EB, Gonzalez-Serva A, Wright RG, et al. Prostate carcinoma metastatic to the skin as an extramammary Paget’s disease. Diagn Pathol. 2012;7:106. 8. Wang EC, Kwah YC, Tan WP, et al. Extramammary Paget disease: Immunohistochemistry is critical to distinguish potential mimickers. Dermatol Online J. 2012;18:4. 9. Kanomata N, Kozuka Y, Moriya T. Prostatic intraepithelial pagetoid histiocyte: a potential diagnostic pitfall. Pathol Int. 2011;61:551.
2015 Wolters Kluwer Health, Inc. All rights reserved.
