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Aberrant GATA3 Staining in Prostatic Adenocarcinoma: A Potential Diagnostic Pitfall
Timothy M McDonald1, Jonathan I Epstein
1Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD.
The American Journal of Surgical Pathology
|August 10, 2020
Summary
Distinguishing high-grade prostatic adenocarcinoma from urothelial carcinoma can be challenging. Rare cases of prostate cancer show strong GATA3 staining, a potential diagnostic pitfall. Use prostate-specific markers alongside GATA3 for accurate diagnosis.
Area of Science:
- Genitourinary Pathology
- Oncology
- Diagnostic Immunohistochemistry
Background:
- Differentiating high-grade prostatic adenocarcinoma from urothelial carcinoma poses diagnostic challenges, especially in the bladder neck and prostatic urethra.
- Accurate distinction is crucial due to differing prognoses and management strategies.
- GATA3 is a known marker for urothelial carcinoma, but its expression in prostate adenocarcinoma is not well-documented.
Purpose of the Study:
- To report rare cases of prostatic adenocarcinoma exhibiting aberrant GATA3 staining.
- To highlight GATA3 as a potential diagnostic pitfall in genitourinary pathology.
- To emphasize the importance of using a panel of markers for definitive diagnosis.
Main Methods:
- Retrospective review of 9 cases of prostatic adenocarcinoma with aberrant GATA3 staining from 2015-2020.
- Immunohistochemical analysis for GATA3, NKX3.1, p501s, and PSA.
- Morphological assessment of tumor characteristics.
Main Results:
- Nine cases of high-grade (Grade Group 5) prostatic adenocarcinoma showed positive GATA3 staining (diffuse, patchy, or focal).
- Tumors were located in the prostate, bladder, or prostatic urethra.
- All cases were positive for NKX3.1, with varying positivity for p501s and PSA, indicating expression of prostate-specific markers.
Conclusions:
- Rare prostatic adenocarcinomas can display strong GATA3 positivity, mimicking urothelial carcinoma.
- Relying solely on GATA3 can lead to misdiagnosis.
- A combination of GATA3 and prostate-specific markers (e.g., NKX3.1, PSA) is essential for accurate diagnosis of undifferentiated carcinomas in the prostate and bladder neck region.
