Prostatic Adenocarcinoma and Its Mimics | |||||||
Antibody | Adenocarcinoma | Seminal Vessel & Ejaculatory Duct | Nephrogenic Adenoma | Cowper Gland | Mesonephric Hyperplasia* | Stromal Sarcoma | Small Cell Carcinoma |
PSA | + | −/+ | −/weak + | −/+ (rare) | − | − | − |
PAP | + | −/+ | −/weak+ | − | − | − | − |
PSMA | + | − | − | − | − | − | − |
CD57 | + | − | − | − | − | − | − |
AR | + | + | − | − | + | − | +/− |
AMACR | + | −/NS | +/− | − | − | − | −/+ (47%) |
HMCK(34βE12) | − | + (basal cells) | −/+ | + | −/+ (33%) | − | − |
PAN-CK(AE1/AE3) | + | + | + | + | −/+ | − | + (dot-like) |
Pax-2 | − | + | + | ND | − | − | − |
Actin-sm | − | − | − | + | − | −/+ | − |
Desmin | − | − | − | ND | − | −/+ | − |
MyoD1 | − | − | − | − | − | − | − |
Myogenin | − | − | − | − | − | − | − |
CD99 | − | − | − | − | ND | − | −/+ |
CD45(LCA) | − | − | − | − | − | − | − |
ER | +/− | − | − | ND | − | −/+ | − |
PR | +/− | − | − | ND | − | + | − |
CD34 | − | − | − | − | − | + | − |
p63 | − | + (basal cells) | −/+ | + | +/− | − | − |
CD117 | − | − | − | − | − | − | − |
Synaptophysin | V | − | − | − | − | − | + |
Chromogranin | V | − | − | − | − | − | + |
CD56 | V | − | − | − | − | − | + |
TTF-1 | − | − | − | − | − | − | + |
ND = No Data, V = Variable, NS = Nonspecific staining in pigment. *Mesonephric remnants also positive for CD10, calretinin, and vimentin. | |||||||
Important Immunohistochemical Stains in Diagnosis of Prostate Carcinoma | |
Immunostain | Rationale for Use |
Basal cell-associated markers HMCK(34βE12), CK5/6, p63, basal cell cocktail | Benign vs. malignant proliferation; complete absence of basal cell layer is defining criterion for invasive prostate carcinoma |
Prostate carcinoma-associated marker AMACR (p504S) | Benign vs. malignant proliferation; absence of basal cell-associated markers favoring invasive prostate carcinoma |
Epithelial lineage PAN-CK(AE1/AE3) | Identification of subtle infiltrating cells in post-treatment setting; in differential diagnosis of carcinoma vs. nonepithelial process or malignancy |
Prostate lineage-specific marker PSA, PAP, PSMA | Prostatic vs. nonprostatic origin, e.g., Cowper gland, mesonephric remnant, nephrogenic adenoma, seminal vesicle vs. prostate cancer |
Atypical Glandular Proliferations, Small Glands | ||||||
Antibody | Benign Glands | Post-Atrophic Hyperplasia and Atrophy | Prostatic Adenocarcinoma | Basal Cell Hyperplasia | Outpouching of High-Grade PIN | AAH (Adenosis) |
Basal cell-associated markers | + | + (patchy) | − | + | + | −/+ (patchy) |
AMACR | −/+ (rare) | −/+ | + (strong circumferential) | − | + | −/+ |
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