Abstract
Background: Prostatic carcinoma is the most common cancer in elderly men and 75-80% occur in peripheral zone. It is diagnosed by architectural, nuclear, cytoplasmic and intraluminal features. Perineural invasion is one of the pathognomonic histological features of adenocarcinoma and its significance was studied.
Objectives
Primary Objective
- To describe perineural invasion in prostatic carcinoma.
- To identify proportion of patients with perineural invasion having metastatic prostatic carcinoma.
- To find out the association of perineural invasion and metastatic prostatic carcinoma.
Secondary Objective
- To describe the use of S100 expression in enhancing detection of perineural invasion by demonstration of nerves.
Methods:
Study Design : Cross sectional analytical study
Study Population: Study sample includes all the cases of prostatic carcinoma biopsy specimens received in the Department of Pathology during the study period.
Sample Size : 155
Sampling Procedure :Continuous sampling
Results and Discussion: The mean age of the study population was 68.72 years. The predominant Gleason score was 7 in 40.5% of cases, 4+3 and 3+4 respectively. Perineural invasion was found in 46% cases. PNI was seen in 57% of Gleason scores 8-10 and 35% in Gleason score 7. PNI and its association with metastatic prostate carcinoma had weak positive relationship between the two variables.51% of cases showed PNI by S100 immunohistochemistry.
Conclusion: In the present study, perineural invasion was found in 46% of the biopsy specimens and was associated with higher grade prostatic carcinomas. The significance of PNI in metastatic prostate carcinoma could not be proved as there was only weak positive relationship between PNI and metastatic prostatic carcinoma. Our data showed 5% increase in detection of PNI which suggested that detection of perineural invasion may be enhanced by S100 immunohistochemistry.
Keywords: Prostatic carcinoma, Perineural invasion, metastasis, Gleason score, PSA, S100.
References
- Holger Moch, Peter A Humprey, Thomas M Ulbright, Victor E Reuter WHO Classification of Tumors of the Urinary System and Male Genital Organs 4TH edition Lyon 2016 :138-140.
- Steven R Potter, MD, Alan W Partin, MD, PhD The significance of Perineural invasion found on needle biopsy of the prostate: Implications for definitive therapy Reviews in Urology 2000 Spring;2(2):87-90.
- Sara O.Vargas MD, Michael Jiroutek MS, et.al Perineural Invasion in Prostate Needle Biopsy Specimens American Journal of Clinical Pathology 1999;111:223-228.
- Catherine Liebeg MD, Gustavo Ayala MD, Jonathan a Wilks MD, David H Berger MD and Daniel Albo MD PhD Perineural Invasion in Cancer American Cancer Society 2009:3379-3391.
- Abhishek Kumar, Nisha J Marla, Hilda Fernandes, Praseena Kallingal Usefulness and significance of morphological criteria with regard to Gleason grade in the diagnosis of adenocarcinoma prostate Muller Journal of Medical Sciences and Research 2015 (6) :147-153.
- Leah Lawrence Perineural Invasion Linked with prostate cancer bone metastasis Cancer network home of the ONCOLOGY journal 2015.
- Juan Rosai, Rosai And Ackerman’s Surgical Pathology 10th edition Missouri 2011 :1295-1310.
- Alexandre de la Taille, Aaron Katz, Emilia Bagiella, Carl A Olsson, Kathleen M O Toole, Mark A Rubin Perineural invasion on prostate needle biopsy:an independent predictor of final pathologic stage Urology December 1999(54) : 1039-1043.
- Kevin A Kurtz,;Henry T Hoffman,; M Bridget Zimmerman; Robert A Robinson, Perineural and Vascular Invasion in Oral cavity Squamous Carcinoma Arch Pathol Lab Med,March 2005(129):354-359.
- Garg M, Kaur G, Malhotra V, Garg R. Histopathological spectrum of 364 prostatic specimens including immunohistochemistry with special reference to grey zone lesions. Prostate International. 2013;1(4):146-151
- Barakzai MA, Mubarak M, Kazi JI. Histopathological lesions in transrectal ultrasound guided biopsies of prostate in patients with raised serum prostate specific antigen: a preliminary report. Nephro-Urol Mon. 2011;3:186-90.
- Baig F, Hamid A, Mirza T, Syed S. Ductal and Acinar Adenocarcinoma of Prostate: Morphological and Immunohistochemical Characterization. Oman Medical Journal. 2015;30(3):162-166.
- Lojanapiwat B, Anutrakulchai W, Chongruksut W, Udomphot C. Correlation and diagnostic performance of the prostate-specific antigen level with the diagnosis, aggressiveness, and bone metastasis of prostate cancer in clinical practice. Prostate International. 2014;2(3):133-139.
- Hosein I, Sukhraj R, Goetz L, Rambarran N, Persaud S. A Clinicopathological Profile of Prostate Cancer in Trinidad and Tobago. Advances in Urology. 2016;2016:1-5.
- Coard KC, Freeman VL. Gleason grading of prostate cancer: level of concordance between pathologists at the University Hospital of the West Indies. Am J ClinPathol 2004;122:373-6.
- Bastacky SI, Walsh PC, Epstein JI. Relationship between perineuraltumor invasion on needle biopsy and radical prostatectomy capsular penetration in clinical stage B adenocarcinoma of the prostate. Am J SurgPathol. 1993;17:336-41.
- Zhao* J, Chen J, Zhang M, Tang X, Sun G, Shen P et al. The clinical significance of perineural invasion in patients with metastatic prostate cancer. Journal of Urology. 2019;201.
- Zhou M, Patel A, Rubin M. Prevalence and Location of Peripheral Nerve Found on Prostate Needle Biopsy. American Journal of Clinical Pathology. 2001;115(1):39-43.
- Aufranc S, Rosen S, Li T, et al. Unrecognized perineural invasion in prostate needle biopsies is revealed by staining for S-100 protein. Mod Pathol. 2000;13:92A.
Corresponding Author
Dr Alvin Vincent
Junior Resident, Department of Pathology, Government Medical College, Kottayam, Kerala, India
DOI: https://dx.doi.org/10.18535/jmscr/v9i2.36
