Comedonecrosis revisited: Strong association with intraductal carcinoma of the prostate Journal Article


Authors: Fine, S. W.; Al-Ahmadie, H. A.; Chen, Y. B.; Gopalan, A.; Tickoo, S. K.; Reuter, V. E.
Article Title: Comedonecrosis revisited: Strong association with intraductal carcinoma of the prostate
Abstract: From the advent of the Gleason grading system for prostate cancer, cancer displaying intraluminal necrotic cells and/or karyorrhexis within cribriform/solid architecture, a phenomenon termed "comedonecrosis," has been assigned pattern 5. Intraductal carcinoma (IDC-P) shows morphologic overlap with high-grade cribriform/solid adenocarcinoma architecturally and cytologically and may also show central necrosis, yet due to the presence of basal cells at the duct periphery is not currently assigned a grade in clinical practice. On the basis of observations from routine clinical cases, we hypothesized that comedonecrosis was more significantly associated with IDC-P than invasive disease. From a large series of mapped radical prostatectomy specimens (n=933), we identified 125 high-grade (≥Gleason score 4+3=7), high-volume tumors with available slides for review. All slides were examined for the presence of unequivocal comedonecrosis. Standard immunohistochemistry for basal cell markers was performed to detect basal cell labeling in these foci. In total, 19 of 125 (15%) cases showed some ducts with comedonecrosis-9 cases with 1 focus and 10 cases with ≥2 foci; in all, a total of 73 foci of true comedonecrosis were evaluated. Immunohistochemical stains revealed labeling for basal cell markers in a basal cell distribution for at least some comedonecrosis foci in 18 of 19 (95%) cases, 12 with IDC-P exclusively and 6 with a mix of IDC-P and invasive carcinoma comedonecrosis foci. These results suggest that comedonecrosis is strongly associated with IDC-P and hence, the routine assignment of pattern 5 to carcinoma exhibiting comedonecrosis should be reconsidered. © 2018 Wolters Kluwer Health, Inc. All rights reserved.
Keywords: prostate cancer; prostate; intraductal carcinoma; grading; comedonecrosis
Journal Title: American Journal of Surgical Pathology
Volume: 42
Issue: 8
ISSN: 0147-5185
Publisher: Lippincott Williams & Wilkins  
Date Published: 2018-08-01
Start Page: 1036
End Page: 1041
Language: English
DOI: 10.1097/pas.0000000000001104
PROVIDER: scopus
PMCID: PMC6041141
PUBMED: 29878934
DOI/URL:
Notes: Article -- Export Date: 1 August 2018 -- Source: Scopus
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MSK Authors
  1. Satish K Tickoo
    369 Tickoo
  2. Anuradha Gopalan
    274 Gopalan
  3. Yingbei Chen
    221 Chen
  4. Samson W Fine
    316 Fine
  5. Victor Reuter
    913 Reuter