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Presented by Peter Illei, M.D. and prepared by Safia Salaria, M.B.B.S.
Case 3: Seventy year old male patient with lytic bone lesion.
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Question 1 of 1
1. Question
Week 506: Case 3
Seventy year old male patient with lytic bone lesion.images/1alex/121211case3image1.jpg
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images/1alex/121211case3image5.jpgCorrect
Answer: Metastatic adenocarcinoma of prostate
Histology: Sections of the bone marrow biopsy show cellular necrosis,necrotic bone and solid sheets of atypical epithelioid cells infiltrating and replacing the marrow. The tumor cells have large nuclei and prominent nucleoli. Immunostains show that the tumor cells are positive for cytokeratin (CAM5.2), and prostate markers (PSMA, PSA and p501s/prostein) while negative for TTF-1, CK903 and PAX8. The tumor cells are also positive for CD138, focally and weakly positive for pankeratin and negative for CD3, CD20, CD34, CD10, CD56, BCL6, kappa, lambda, PAX-5, MUM1, CD30, C-kit, TDT and CD45. A Ki67 stain shows increased proliferative activity. This immunoprofile supports a diagnosis of metastatic adenocarcinoma of the prostate.
Discussion: In view of the clinical presentation and the initial stanining pattern a plasma cell neoplasm was suspected. The strong cytokeratin positivity, however, favored an epithelial origin and in view of the cytologic appearance the work up included prostate specific markers. Following the diagnosis the clinical history of prostate cancer was confirmed by the patient’s physician.
Incorrect
Answer: Metastatic adenocarcinoma of prostate
Histology: Sections of the bone marrow biopsy show cellular necrosis,necrotic bone and solid sheets of atypical epithelioid cells infiltrating and replacing the marrow. The tumor cells have large nuclei and prominent nucleoli. Immunostains show that the tumor cells are positive for cytokeratin (CAM5.2), and prostate markers (PSMA, PSA and p501s/prostein) while negative for TTF-1, CK903 and PAX8. The tumor cells are also positive for CD138, focally and weakly positive for pankeratin and negative for CD3, CD20, CD34, CD10, CD56, BCL6, kappa, lambda, PAX-5, MUM1, CD30, C-kit, TDT and CD45. A Ki67 stain shows increased proliferative activity. This immunoprofile supports a diagnosis of metastatic adenocarcinoma of the prostate.
Discussion: In view of the clinical presentation and the initial stanining pattern a plasma cell neoplasm was suspected. The strong cytokeratin positivity, however, favored an epithelial origin and in view of the cytologic appearance the work up included prostate specific markers. Following the diagnosis the clinical history of prostate cancer was confirmed by the patient’s physician.
