Primary signet-ring cell carcinoma of the prostate

Mucin-producing tumors and tumor-like lesions involving the prostate: a comprehensive review

Mucin-producing tumors of the prostate include both primary and secondary tumors with mucinous differentiation or features involving the prostate gland. These tumors are relatively rare and have variable prognostic and therapeutic implications. Primary mucinous (colloid) adenocarcinoma of the prostate is defined as prostatic adenocarcinoma with mucinous differentiation involving 25% or more of the entire tumor. Another primary tumor of the prostate that may have mucinous features is primary mucin-producing urothelial-type adenocarcinoma of the prostate (mucinous prostatic urethral adenocarcinoma). Primary mucin-producing urothelial-type adenocarcinoma of the prostate is a distinct entity that typically arises from the prostatic urethra possibly from urethritis glandularis or glandular metaplasia with malignant transformation, and it is analogous to adenocarcinoma with mucinous differentiation arising from the urinary bladder. Signet ring cell tumors of the prostate, though rare, may also have mucinous features. Secondary tumors with mucinous differentiation that may involve the prostate include adenocarcinomas of the urinary bladder and colorectum. Pathologists should also be aware of mucin-producing tumor-like lesions involving the prostate, including mucinous metaplasia, and benign Cowper glands that may mimic malignancy. Herein we present an updated and comprehensive review of the clinicopathologic, immunohistochemical, molecular, and prognostic features of mucinous tumors and tumor-like lesions involving the prostate gland, with emphasis on mucinous prostatic adenocarcinoma and its mimickers, including potential diagnostic pitfalls.

Variants and unusual patterns of prostate cancer: clinicopathologic and differential diagnostic considerations

Beyond the typical acinar morphology observed in the majority of prostatic adenocarcinomas, a spectrum of morphologic variants and prostate cancer subtypes exists. These unusual entities may be classified as: (1) cancer morphologies arising by divergent differentiation of prostatic ductal, acinar, or basal cells and associated with unique clinical features and/or therapeutic approaches, and (2) histologies occurring in the context of usual prostatic adenocarcinoma that may result in diagnostic misinterpretation or difficulties in Gleason grade assignment, especially in limited samples. This article details a number of variants, with emphasis on diagnostic criteria, differential diagnoses, and clinical significance.

An aggressive signet ring cell carcinoma of the prostate in a Japanese man

Signet ring cell carcinoma (SRCC) of the prostate is rare, with approximately 100 case reports to date. Here we report a very aggressive case of SRCC of the prostate in a Japanese man. The patient received estramustine, docetaxel, and carboplatin combination chemotherapy, followed by TS-1 and CPT-11 combination therapy. Unfortunately, the disease progressed, and he died of general metastatic disease treated over 16 month with systemic chemotherapy.

Primary signet ring cell carcinoma of the prostate

Nine patients treated with primary signet ring cell carcinoma of the prostate were identified among 29,783 cases of prostate cancer evaluated at Mayo Clinic from January 15, 1970, until January 2, 2009. A PubMed search of the English-language literature published from January 1, 1980, to January 1, 2010, was then performed using the key words signet ring cell and prostate, identifying 42 cases. This study reviews those cases, along with the additional 9 reported herein, and evaluates clinical characteristics, histologic diagnoses, treatment modalities, and outcomes. Mean age at diagnosis was 68 years (range, 50-85 years), and mean prostate-specific antigen level was 95.3 ng/mL (range, 1.9-536.0 ng/mL; to convert to μg/L, multiply by 1). Most patients (66%) had non-stage IV carcinoma, the most common Gleason sum was 8 (33%), and mean survival was 29 months. The presence of a primary signet ring cell carcinoma of the prostate was best confirmed by negative findings on gastrointestinal work-up, a positive stain for prostate-specific acid phosphatase, and negative carcinoembryonic antigen test results.

Variants and Unusual Patterns of Prostate Cancer

Beyond the typical acinar morphology observed in most prostatic adenocarcinoma, a spectrum of morphologic variants and prostate cancer subtypes exists. These unusual entities may be further classified into (1) cancer morphologies arising by divergent differentiation of prostatic ductal, acinar, or basal cells and associated with unique clinical features or therapeutic approaches, and (2) histologies occurring in the context of usual prostatic adenocarcinoma that may result in diagnostic misinterpretation or difficulties in Gleason grade assignment, especially in limited samples. This article details several variants, with emphasis on diagnostic criteria, differential diagnoses, and clinical significance.

Prostatic signet-ring cell carcinoma: case report and literature review

Signet-ring cell carcinoma (SRCC) of the prostate is a very rare neoplasm and there have been only 38 cases reported to date. Here the 39th case of prostatic SRCC containing a small amount of neutral mucin, prostatic specific antigen (PSA) and prostatic specific acid phosphatase (PSAP) in the signet-ring cells is reported. It was also found that some intracytoplasmic lumina were derived from the shallow or deep invagination of luminal membranes of cancer cells that formed the neoplastic glands. Using immunohistochemistry, a combination of monoclonal antibodies against cytokeratins 7 and 20 as well as PSA and PSAP may be useful in differentiating prostatic primary SRCC from metastatic SRCC originating in the gastrointestinal tract.

The monoclonal antibody 7E12H12 can differentiate primary adenocarcinoma of the bladder and prostate

OBJECTIVE

To determine if the monoclonal antibody 7E12H12, which reacts with a 40 kDa protein in normal human enterocytes and has been shown to be a marker for intestinal metaplasia and adenocarcinoma arising in the bladder, could assist in distinguishing prostatic, urachal and vesical adenocarcinoma, using a sensitive immunohistochemical assay.

MATERIALS AND METHODS

Fifteen primary prostatic adenocarcinomas and five adenocarcinomas of the urinary bladder were selected for a retrospective evaluation. The monoclonal antibody 7E12H12 (IgM isotype) was used in an immunoperoxidase assay to survey formalin-fixed, paraffin-embedded archival tissue specimens.

RESULTS

All vesical adenocarcinomas reacted positively with the antibody, regardless of grade; none of the 15 prostatic specimens reacted positively in either the benign or malignant glandular epithelium.

CONCLUSION

The monoclonal antibody 7E12H12 can differentiate primary adenocarcinoma of the bladder from secondary adenocarcinoma arising in the prostate and may be a useful tool in diagnostic pathology.

Unusual histologic types of high-grade prostatic intraepithelial neoplasia

High-grade prostatic intraepithelial neoplasia (HGPIN) is the most likely precursor proliferation of peripheral zone, moderately to poorly differentiated prostatic adenocarcinomas. The usual cell type of the epithelial lining of HGPIN is a glandular epithelial cell with characteristic nuclear abnormalities. Here we report nine cases of unusual types of HGPIN, including three cases of signet-ring cell HGPIN, one case of small cell neuroendocrine HGPIN, and five cases of HGPIN with distinctive mucinous features. The three examples of signet-ring cell PIN were all associated with an invasive primary signet-ring cell carcinoma of the prostate. The HGPIN assumed a classical tufted and micropapillary architectural growth pattern, with the constituent cells exhibiting a morphologic appearance identical to that of the invasive signet-ring cells. The intraepithelial and invasive signet-ring cells were mucin negative and were immunoreactive for prostate-specific antigen (PSA). A fourth case displayed a mixed intraepithelial glandular-small cell neoplastic proliferation, where intraepithelial small cells were histologically identical to surrounding invasive small cell carcinoma cells. The small cell HGPIN and invasive small cell carcinoma cells were positive for the neuroendocrine markers chromogranin, synaptophysin, and neuron-specific enolase. In five cases, mucinous distension of HGPIN glands, producing a flat pattern of the epithelial lining layer, comprised the third unusual pattern of HGPIN. These blue mucinous secretions were readily detected by hematoxylin and eosin staining and were composed of both neutral (periodic acid-Schiff-positive) and acidic (alcian blue-positive) mucins. Herein we document the existence of an intraepithelial proliferation of neoplastic cell types-small cell neuroendocrine and signet-ring cell-that are usually considered as stromal-invasive cells in the prostate. The presence of these rare prostatic cell types in both HGPIN and invasive carcinoma provides further support for a close relationship between HGPIN and invasive carcinoma of the prostate. All three unusual types of HGPIN-signet-ring cell, small cell neuroendocrine, and mucinous-are important to diagnostically recognize because of the strength of association of HGPIN with invasive carcinoma.

Primary signet ring cell adenocarcinoma of the prostate treated by radical prostatectomy after preoperative androgen deprivation

We report a case of primary signet ring cell adenocarcinoma of the prostate gland in a 76-year-old man. Radical prostatectomy was performed 4 months after bilateral orchiectomy, which proved to be a successful preoperative androgen deprivation therapy. To date 3 years have passed with no clinical or serologic evidence of recurrent disease. Immunohistochemical testing showed the cancer tissue to be positive for prostate specific antigen and negative for carcinoembryonic antigen. This is the first reported case of primary prostate signet ring cell adenocarcinoma treated by radical prostatectomy, and this mode of therapy should be considered as a treatment of choice for the disease.

Signet-ring carcinoma of the prostate

A case of prostatic signet-ring adenocarcinoma is described in a man with a history of open prostatectomy for prostate carcinoma (18 years previously). Immunostaining confirmed the prostatic origin of the signet-ring tumor which stained for prostatic acid phosphatase (PSAP) and prostate specific antigen (PSA). Cytokeratin immunostaining showed the vacuoles to be true lamina with clear and distinct outlines, the feature confirmed by ultrastructural examination. This aggressive tumor is an uncommon but distinct variant of primary prostatic carcinoma which should be distinguished from artefactual vacuolation of tumor, inflammatory and stromal cells, and metastatic disease.

Locally-confined signet-ring cell carcinoma of the prostate: a case report of a long-term survivor

It is generally believed that signet-ring cell carcinoma (SRCC) of the prostate is a high-grade neoplasm with a poor prognosis. We report a case of a long-term survivor diagnosed with localized prostatic SRCC (T3N0M0), who has been alive without any clinical evidence of disease for 100 months after combination therapy which consisted of local irradiation and hormone administration. A posttreatment needle biopsy confirmed the pathological complete response.

Signet ring cell adenocarcinoma of prostate

Primary signet ring cell adenocarcinoma of the prostate is a rare malignancy with a total of 13 cases reported to date in the English literature. We report a very unusual case of signet ring adenocarcinoma of the prostate occurring in a patient who presented initially with irritative voiding symptoms and a bladder mass. Results of immunohistochemical, flow cytometric, and cytogenetic analyses of the tumor are presented.

Primary prostatic signet-ring cell carcinoma

We report an uncommon case of primary prostatic signet-ring cell carcinoma which meets all criteria that define this clinicopathologic entity. Histologically, the tumor showed three different growth patterns, all of which contained large numbers of signet-ring cells. The predominant pattern, comprising approximately 50 percent of the tumor, was solid sheets of pure signet-ring cells. An intriguing finding was the presence of intestinal metaplasia involving the prostatic urethra and the large periurethral ducts. All mucin stains were intensely positive within the signet-ring cells and in the mucin lakes. Signet-ring cells stained positively for prostatic specific antigen, prostatic acid phosphatase, and carcinoembryonic antigen immunoperoxidase markers. Our patient presented with symptoms of urinary tract obstruction and locally widespread disease, infiltrating the rectum and the bladder, thus demonstrating the aggressive biologic behavior that traditionally has been ascribed to signet-ring cell carcinomas.

Signet ring cell differentiation in adenocarcinoma of the prostate: a study of five cases

Signet ring cell differentiation in adenocarcinoma of the prostate is uncommon. In a review of 200 cases of prostatic carcinoma, we identified five cases with this change, all in moderately to poorly differentiated prostatic carcinomas. The signet ring cells in prostatic carcinoma contain an intracytoplasmic lumen, shown on electronmicroscopy to be lined by microvilli. Transition stages were seen from solid to acinar to signet ring cells to mucinous variants. We believe that this change is part of the spectrum of appearances of prostatic carcinoma and should not be regarded as a subtype of specific significance.

Metastatic signet-ring cell melanoma in a patient with an unknown primary tumor. Histologic, immunohistochemical, and ultrastructural findings

Signet-ring cell melanoma is a rare morphologic variant of malignant melanoma. We describe a 27-year-old man with widespread cutaneous and internal metastases of an unknown primary tumor. One skin biopsy specimen and a fine-needle aspirate showed polygonal tumor cells consistent with the diagnosis of metastatic melanoma, but a second skin biopsy specimen revealed neoplastic cells with a signet-ring cell appearance. Both specimens, however, yielded identical immunohistochemical findings. Tumor cells were positive for vimentin and S-100 protein and reacted with the melanoma markers HMB-45 and NKI-C3. Ultrastructural studies revealed abundant intermediate filaments in the cytoplasm of the signet-ring cells. Based on these findings, a diagnosis of metastatic melanoma was made. In this report we describe the fourth case of metastatic signet-ring cell melanoma, and discuss how malignant melanoma may lead to metastases that have divergent morphologic appearances in the same patient.

The ultrastructure of signet-ring cell non-Hodgkin's lymphoma

New ultrastructural findings are reported from two lymphomas of vacuolar signet-ring cell morphology (SR+), one of B cell and one of T cell lineage. When these lymphomas were compared ultrastructurally a difference in the relationship of the endoplasmic reticulum (ER) to the vacuole was noted, although the fine structure of the vacuoles themselves was similar and they were interpreted as giant multivesicular bodies (mvbs). Smooth ER was found near the vacuoles in both cases. Dark mvbs with a complex, reticulate form are emphasised as readily identified but hitherto unreported cell components in these tumours. A further B cell lymphoma of centroblastic/centrocytic type which was SR- was found to be rich in mvbs and may be a transitional form between SR- and SR+ lymphomas. In addition, the occurrence of mvbs has been studied quantitatively in a number of other lymphomas and in B and T lymphocytes in reactive nodes. Although increased numbers of mvbs were found in neoplastic compared with reactive lymphocytes, and in T compared with B cell lymphomas, these differences were not statistically significant. The possible roles of endoplasmic reticulum and mvbs in the generation of SR+ change are discussed.

Mucins in prostatic carcinoma

Mucin production by prostatic carcinomas is not unusual and the identification of acidic mucin with an appropriate stain may be a useful adjunct in routine diagnostic surgical pathology. In our series of 53 cases of prostatic carcinoma, 20 (38%) showed significant acidic mucin production. This may allow differentiation from benign, hyperplastic tissues which produce neutral mucins only. A case of colloid carcinoma of prostate is described which satisfies Elbadawi's criteria for this uncommon variant. Some suggestions are made which, if rigorously applied, will permit the recognition of genuine cases of colloid carcinoma and of the prognostic significance of mucin-rich tumours.

Signet ring cell carcinoma of prostate. Immunohistochemical and ultrastructural study of a case

Signet ring cell adenocarcinoma (SRCA) is an extremely rare tumor of the prostate. We document with histochemistry, immunohistochemistry, and electron microscopy an incidental "signet ring" cell adenocarcinoma of the prostate in a fifty-seven-year-old white male with chronic lymphocytic leukemia who died of an intracerebral hemorrhage. The signet ring cells stained weakly for neutral mucin and were strongly positive for both prostate-specific antigen and prostate acid phosphatase. In addition, electron microscopy demonstrated intracellular lumina with microvilli and cytoplasmic vacuoles of mucin. This case conclusively supports the existence of SRCA of the prostate.