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ORIGINAL ARTICLE
Year : 2014  |  Volume : 41  |  Issue : 1  |  Page : 38-40

The study of mucin histochemistry in benign and malignant lesions of prostate


1 Department of Pathology, Pad. Dr. D. Y. Patil Medical Collage, Nerul, Navi Mumbai, Maharashtra, India
2 Department of Pathology, Dr. V. M. Medical Collage, Solapur, Maharashtra, India

Date of Web Publication7-Feb-2014

Correspondence Address:
Durgaprasad N Agrawal
A001, Om Sai Datta Niwas, Plot-32, Next to SBI, Opp Railway Station, Nerul (W) - 400 706, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-5009.126751

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  Abstract 

Objective: To evaluate the usefulness of mucin stains in differentiating benign and malignant lesions of prostate. Materials and Methods: Sections were obtained from archival paraffin blocks which included randomly selected 70 cases of benign hyperplasia and 30 cases of carcinoma prostate. After confirming the diagnosis, sections were stained for Periodic Acid Schiff (PAS) to study neutral mucins, Alcian blue (2.5 pH) to study acidic mucins and combined Alcian blue - PAS to study the mucin character. Results: Benign hyperplasia of prostate showed positivity for neutral mucins (98.57%) but not for acidic mucins, whereas prostatic carcinomas showed positivity for acidic mucins (46.66%) in addition to the positivity for neutral mucins (56.66%). All the cases of low grade prostatic carcinomas showed positivity for acidic mucins but none of the high grade carcinomas showed positivity for the same. Conclusion: Positivity for acidic mucins with Alcian Blue (2.5 pH) technique can be used to differentiate well differentiated adenocarcinomas of prostate from benign hyperplasia especially in those cases where prostatic lesion is a questionable malignancy either because it is so well differentiated histologically or have altered architecture so as to make it cytologically un diagnosable (P = 0.001).

Keywords: Alcian blue, benign hyperplasia, mucin, PAS, prostatic carcinoma


How to cite this article:
Agrawal DN, Zawar MP, Deshpande NM, Sudhamani S. The study of mucin histochemistry in benign and malignant lesions of prostate. J Sci Soc 2014;41:38-40

How to cite this URL:
Agrawal DN, Zawar MP, Deshpande NM, Sudhamani S. The study of mucin histochemistry in benign and malignant lesions of prostate. J Sci Soc [serial online] 2014 [cited 2019 May 23];41:38-40. Available from: http://www.jscisociety.com/text.asp?2014/41/1/38/126751


  Introduction Top


Carcinoma of the prostate is most common internal malignancy in males and is responsible for 10% of cancer related deaths in this population. [1]

Incidence of prostatic carcinoma rises progressively with age after the age of 50 years with a peak incidence in the age group of 75 years and above. [2] The frequency with incidental carcinoma found at autopsy varies between 15% and 70%. [1] Prostatic needle biopsy is an increasingly popular method for its diagnosis. But limited amount of tissue is available for diagnosis. Benign hyperplasia can sometimes mimic adenocarcinomas and there can be contamination by seminal glands adding to the confusions. Serum prostate specific antigen (PSA) is used as an adjunct but again it can also be raised in many non malignant conditions such as benign hyperplasia, prostatitis, and trauma and even after prostatic massage. The diagnosis of limited well differentiated adenocarcinomas of prostate is one of most difficult areas of surgical pathology; [3] so there is a need of a marker which is specific, cost effective and can be useful at institutions with limited resources. Mucins are present in the tissues or are secreted by the glands. These can be stained by various methods such as periodic acid schiff (PAS), mucicarmine and alcian blue (AB). Numerous reports have claimed that because acidic mucin is absent in benign prostatic glands and is present in some prostatic adenocarcinomas, demonstration of acidic mucin may be an adjunctive aid in the diagnosis of adenocarcinomas of the prostate. [2],[4],[5],[6]


  Materials and methods Top


We studied randomly selected 100 prostatic lesions received for diagnostic and therapeutic purposes in the department of pathology during a period of April 2000-March 2005. Formalin fixed paraffin embedded tissue sections were stained for Hematoxyline and Eosin (H and E), PAS, Alcian blue (2.5 pH) and combined Alcian blue - PAS technique to study the mucin character. Histological diagnosis and grading for carcinoma prostate was done on H and E stained sections using Gleason's score. The tumor was categorized into well differentiated (score 2-4), intermediate grade (score 5-6), moderate - poorly differentiated (score 7) and high grade (score 8-10). [7]

PAS and Alcian Blue (2.5 pH) staining were performed to demonstrate the mucin character. The findings were again confirmed with combined Alcian blue-PAS (AB-PAS) technique.


  Results Top


The incidence of carcinoma prostate was found to be increasing with age with a peak incidence above the age of 70 years, whereas benign hyperplasia of prostate were most commonly seen between the age group of 61-70 years. All the cases were first categorized into benign hyperplasia and prostatic carcinoma on the basis of routine microscopy. They were then stained for mucin stains. Presence and the character of mucin whether neutral or acidic is then noted [Table 1]. Benign hyperplasia of prostate showed presence of only neutral mucins [Figure 1] whereas carcinoma prostate showed presence of both neutral as well as acidic mucins [Figure 2]. Percentage positivity for different mucins for different grades was determined [Table 2].
Figure 1: 10X, H and E showing benign hyperplasia of prostate (left), 40X, PAS benign hyperplasia of prostate showing intracytoplasmic and intraluminal positivity (right)

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Figure 2: 10X H and E (left lower) and 10X, alcian blue positivity (left upper) in carcinoma prostate. 40X, Combined AB-PAS stain showing positivity for both acidic and neutral mucins in carcinoma prostate

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Table 1: The results of mucin staining in benign hyperplasia and carcinoma prostate


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Table 2: Results of mucin staining according the grade of carcinoma prostate


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The positivity for acidic mucins in prostatic carcinoma was compared with that of benign hyperplasia and statistically analyzed using chi-square test. It was found to be statistically significant (P = 0.001).


  Discussion Top


Prostatic adenocarcinomas exhibit wide spectrum of appearances ranging from anaplastic tumors to highly differentiated neoplasms that are distinguished from non neoplastic glands with great difficulty. [7],[8] In this study we found the incidence of prostatic carcinoma to be highest above the age of 70 years. Mathur et al. reported highest incidence of prostatic cancer in the age group of 75 years and above. [2] In the present study we also found that the incidence of prostatic carcinoma increases with age. Out of 30 cases of carcinoma prostate 3(10%) were in the age group of 51-60 years, 11(36.6%) were in the age group of 61-70 years and 16(53%) were above the age of 70 years. In the present study there was no correlation of age and grade of prostatic carcinoma (P = 0.05).

Our findings of acidic mucin positivity in benign hyperplasia (0%) are in accordance with the findings of Pinder et al. (0%), and McMahon et al. (5%), whereas Arora et al. and Mathur et al. reported it as 33.3% and 16% respectively [Table 3].
Table 3: Comparison of acidic mucin positivity in various studies


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In case of prostatic malignancies positivity for acidic mucin in present study (46.66%) correlate with that of McMahon RF (50%); whereas Arora HL reported it on the higher side (60%) and Pinder et al. on the lower side (38%).

In our study positivity for acidic mucin in well differentiated prostatic carcinoma (100%) correlate best with that of McMahon et al. but no correlation was seen for moderate-poorly differentiated and high grade tumors [Table 4].
Table 4: Positivity for acidic mucin in different grades of carcinoma prostate


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Findings in the present study also correlate with the finding of Mathur et al. who in their study graded prostatic carcinoma on the basis of predominant pattern present. They found more positivity for acid mucin in well differentiating tumor decreasing significantly in high grade malignancies.

In this study, all 7 (100%) cases of well differentiated prostatic carcinoma were positive for acidic mucin with alcian blue (2.5 pH), while all the 70 (100%) cases of benign hyperplasia were negative, indicating the importance of mucin stains.


  Conclusions Top


Positivity for acidic mucins with Alcian Blue (2.5 pH) technique can be used to differentiate well differentiated adenocarcinomas of prostate from benign hyperplasia especially in those cases where prostatic lesion is a questionable malignancy either because it is so well differentiated histologically or have altered architecture so as to make it cytologically undiagnosable (P = 0.001). Though mucins are absent in high grade carcinoma histological findings of high grade carcinoma cannot be mistaken for benign lesion.

 
  References Top

1.Gittes RF. Carcinoma of the prostate. N Engl J Med 1991;324:236-45.  Back to cited text no. 1
    
2.Mathur SK, Gupta S, Marwah N, Narula A, Singh S, Arora B. Significance of mucin stain in differentiating benign and malignant lesions of prostate. Indian J Pathol Microbiol 2003;46:593-5.  Back to cited text no. 2
    
3.Epstein JI. Diagnosis and reporting of limited adenocarcinoma of the prostate on needle biopsy. Mod Pathol 2004;17:307-15.  Back to cited text no. 3
    
4.Pinder SE, McMahon RF. Mucins in prostatic carcinoma. Histopathology 1990;16:43-6.  Back to cited text no. 4
    
5.McMahon RF, McWilliam LJ, Mosley S. Evaluation of three techniques for differential diagnosis of prostatic needle biopsy specimens. J Clin Pathol 1992;45:1094-8.  Back to cited text no. 5
    
6.Arora HL. Histochemistry of mucins in various human prostatic diseases. Indian J Patholo Microbiol 1979;22:353-8.  Back to cited text no. 6
    
7.Rosai J. Male reproductive system - prostate and seminal vesicles. Rosai and Ackerman's Surgical Pathology. 10 th ed. St. Louis: Mosby; 2011. p. 1287-333.  Back to cited text no. 7
    
8.Mostofi FK, Sesterhenn IA, Davis CJ Jr. A pathologist's view of prostatic carcinoma. Cancer 1993;71:906-32.  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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Abstract
Introduction
Materials and me...
Results
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