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Diagnostic utility of antibody cocktail expression in differentiating prostatic intraepithelial neoplasia with carcinoma

Author: 
Piyush Sagar, Atin Singhai, Suresh Babu, Nuzhat Husain and Sankhwar, S.N.
Subject Area: 
Health Sciences
Abstract: 

Objectives Histopathologists often face difficulties in diagnosing Prostatic Intraepithelial Neoplasia (PIN) or borderline Adenocarcinoma (PAC) cases on the basis of hematoxylin and eosin (H & E) stain alone. Recent immunohistochemistry (IHC) studies have shown ERG overexpression linkage with carcinomatous changes whereas CK5 expression in normal basal cell layers in prostate is an established fact. Limited review of literature reveals high specificity of multiplex antibody cocktail mixtures comprising of neoplastic acinar as well as basal cell markers for demarcating prostatic lesions. Aims: Objective of this study is to evaluate diagnostic efficacy of multiplex antibody cocktail mixture of ERG and CK5 in delineating PIN and PAC cases. Settings and Design: A sample size of 30 cases was targeted including Hyperplasia (BPH), PIN and PAC. All the relevant clinical details including serum PSA were recorded. Methods and Materials: Cases were subjected to routine H & E staining along with IHC evaluation by multiplex antibody cocktail mixture of ERG & CK5. Results: Out of 30 cases, 11 were labeled as BPH, 9 PIN and rest 10 as PAC on H & E staining. Of 11 BPH, 10 showed CK5 positivity alone, while 1 showed both ERG & CK5 coexpression. Subsequently diagnosis was revised as PIN. Of 9 PIN, 5 were ERG negative and CK5 positive; hence diagnosis revised as BPH. 2 were ERG positive and CK5 negative; hence rechristened as PAC. Rests 2 were consistent with PIN in form of ERG negativity and CK5 positivity. Of 10 PAC, all were CK5 negative, but only 7 were ERG positive. On review, rest 3 ERG negative cases had high Gleason’s score. Conclusion: Immunohistochemical evaluation by multiplex antibody cocktail mixture of ERG and CK5 has great utility in resolving diagnostic and prognostic problems of PIN and PAC cases. It has potential to be considered as screening immunohistochemical module for reporting of prostatic biopsies.

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