Vasitis nodosa and related lesions

a modern immunohistochemical staining profile with special emphasis on novel diagnostic dilemmas

Brie E. Kezlarian, Liang Cheng, Nilesh S. Gupta, Sean R. Williamson

Research output: Contribution to journalArticle

Abstract

Vasitis nodosa is a benign proliferation of vas deferens epithelium, thought to be a response to trauma or obstruction, usually vasectomy. Although histologic features mimic malignancy, diagnosis is usually straightforward due to the clinical context. We analyzed 21 specimens with vasitis or epididymitis nodosa with antibodies to PAX8, CD10, p63, α-methyl-acyl-coA-racemase (AMACR), GATA3, prostein, NKX3.1, and prostate-specific antigen (PSA). Two diagnostically problematic cases included (1) florid bladder muscle involvement after prostatectomy and (2) involvement of the ampulla and ejaculatory duct in a radical prostatectomy specimen. Vasitis nodosa was excluded in 3 additional histologic mimics (2 post-treatment prostate cancers and 1 bladder cancer). PAX8 yielded consistent positive (100%) nuclear staining in the proliferative glands of vasitis nodosa, often stronger and more uniform than native vas deferens. CD10 labeling was common but also labeled secretions and other structures. Labeling for p63 was often basally located in glands with a multilayered appearance, but often markedly attenuated or lacking in the proliferative glands compared to native epithelium. AMACR positivity was variable but often present (19/21). PSA, prostein, and NKX3.1 were consistently negative. Rare problematic cases of vasitis nodosa include “invasion” of the ejaculatory duct at the prostate and involvement of bladder muscle after prostatectomy. The proliferative vasitis nodosa glands often have a prostate cancer–like staining pattern with variable AMACR positivity and negative or patchy p63. However, reliable positivity for PAX8, patchy GATA3, and negative staining for PSA, NKX3.1, and prostein aid in distinguishing from prostate cancer and tubular variants of bladder cancer.

Original languageEnglish (US)
Pages (from-to)164-170
Number of pages7
JournalHuman Pathology
Volume73
DOIs
StatePublished - Mar 1 2018

Fingerprint

Prostate-Specific Antigen
Prostatectomy
Ejaculatory Ducts
Urinary Bladder Neoplasms
Vas Deferens
Staining and Labeling
Prostate
Prostatic Neoplasms
Urinary Bladder
Epithelium
Epididymitis
Racemases and Epimerases
Vasectomy
Negative Staining
Muscles
Antibodies
Wounds and Injuries
prostein
Neoplasms
Therapeutics

Keywords

  • GATA3
  • Immunohistochemistry
  • NKX3.1
  • PAX8
  • Prostate cancer
  • Vasitis nodosa

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

Cite this

Vasitis nodosa and related lesions : a modern immunohistochemical staining profile with special emphasis on novel diagnostic dilemmas. / Kezlarian, Brie E.; Cheng, Liang; Gupta, Nilesh S.; Williamson, Sean R.

In: Human Pathology, Vol. 73, 01.03.2018, p. 164-170.

Research output: Contribution to journalArticle

@article{b4ca2303624f46e1ae217820ad31dd49,
title = "Vasitis nodosa and related lesions: a modern immunohistochemical staining profile with special emphasis on novel diagnostic dilemmas",
abstract = "Vasitis nodosa is a benign proliferation of vas deferens epithelium, thought to be a response to trauma or obstruction, usually vasectomy. Although histologic features mimic malignancy, diagnosis is usually straightforward due to the clinical context. We analyzed 21 specimens with vasitis or epididymitis nodosa with antibodies to PAX8, CD10, p63, α-methyl-acyl-coA-racemase (AMACR), GATA3, prostein, NKX3.1, and prostate-specific antigen (PSA). Two diagnostically problematic cases included (1) florid bladder muscle involvement after prostatectomy and (2) involvement of the ampulla and ejaculatory duct in a radical prostatectomy specimen. Vasitis nodosa was excluded in 3 additional histologic mimics (2 post-treatment prostate cancers and 1 bladder cancer). PAX8 yielded consistent positive (100{\%}) nuclear staining in the proliferative glands of vasitis nodosa, often stronger and more uniform than native vas deferens. CD10 labeling was common but also labeled secretions and other structures. Labeling for p63 was often basally located in glands with a multilayered appearance, but often markedly attenuated or lacking in the proliferative glands compared to native epithelium. AMACR positivity was variable but often present (19/21). PSA, prostein, and NKX3.1 were consistently negative. Rare problematic cases of vasitis nodosa include “invasion” of the ejaculatory duct at the prostate and involvement of bladder muscle after prostatectomy. The proliferative vasitis nodosa glands often have a prostate cancer–like staining pattern with variable AMACR positivity and negative or patchy p63. However, reliable positivity for PAX8, patchy GATA3, and negative staining for PSA, NKX3.1, and prostein aid in distinguishing from prostate cancer and tubular variants of bladder cancer.",
keywords = "GATA3, Immunohistochemistry, NKX3.1, PAX8, Prostate cancer, Vasitis nodosa",
author = "Kezlarian, {Brie E.} and Liang Cheng and Gupta, {Nilesh S.} and Williamson, {Sean R.}",
year = "2018",
month = "3",
day = "1",
doi = "10.1016/j.humpath.2017.12.001",
language = "English (US)",
volume = "73",
pages = "164--170",
journal = "Human Pathology",
issn = "0046-8177",
publisher = "W.B. Saunders Ltd",

}

TY - JOUR

T1 - Vasitis nodosa and related lesions

T2 - a modern immunohistochemical staining profile with special emphasis on novel diagnostic dilemmas

AU - Kezlarian, Brie E.

AU - Cheng, Liang

AU - Gupta, Nilesh S.

AU - Williamson, Sean R.

PY - 2018/3/1

Y1 - 2018/3/1

N2 - Vasitis nodosa is a benign proliferation of vas deferens epithelium, thought to be a response to trauma or obstruction, usually vasectomy. Although histologic features mimic malignancy, diagnosis is usually straightforward due to the clinical context. We analyzed 21 specimens with vasitis or epididymitis nodosa with antibodies to PAX8, CD10, p63, α-methyl-acyl-coA-racemase (AMACR), GATA3, prostein, NKX3.1, and prostate-specific antigen (PSA). Two diagnostically problematic cases included (1) florid bladder muscle involvement after prostatectomy and (2) involvement of the ampulla and ejaculatory duct in a radical prostatectomy specimen. Vasitis nodosa was excluded in 3 additional histologic mimics (2 post-treatment prostate cancers and 1 bladder cancer). PAX8 yielded consistent positive (100%) nuclear staining in the proliferative glands of vasitis nodosa, often stronger and more uniform than native vas deferens. CD10 labeling was common but also labeled secretions and other structures. Labeling for p63 was often basally located in glands with a multilayered appearance, but often markedly attenuated or lacking in the proliferative glands compared to native epithelium. AMACR positivity was variable but often present (19/21). PSA, prostein, and NKX3.1 were consistently negative. Rare problematic cases of vasitis nodosa include “invasion” of the ejaculatory duct at the prostate and involvement of bladder muscle after prostatectomy. The proliferative vasitis nodosa glands often have a prostate cancer–like staining pattern with variable AMACR positivity and negative or patchy p63. However, reliable positivity for PAX8, patchy GATA3, and negative staining for PSA, NKX3.1, and prostein aid in distinguishing from prostate cancer and tubular variants of bladder cancer.

AB - Vasitis nodosa is a benign proliferation of vas deferens epithelium, thought to be a response to trauma or obstruction, usually vasectomy. Although histologic features mimic malignancy, diagnosis is usually straightforward due to the clinical context. We analyzed 21 specimens with vasitis or epididymitis nodosa with antibodies to PAX8, CD10, p63, α-methyl-acyl-coA-racemase (AMACR), GATA3, prostein, NKX3.1, and prostate-specific antigen (PSA). Two diagnostically problematic cases included (1) florid bladder muscle involvement after prostatectomy and (2) involvement of the ampulla and ejaculatory duct in a radical prostatectomy specimen. Vasitis nodosa was excluded in 3 additional histologic mimics (2 post-treatment prostate cancers and 1 bladder cancer). PAX8 yielded consistent positive (100%) nuclear staining in the proliferative glands of vasitis nodosa, often stronger and more uniform than native vas deferens. CD10 labeling was common but also labeled secretions and other structures. Labeling for p63 was often basally located in glands with a multilayered appearance, but often markedly attenuated or lacking in the proliferative glands compared to native epithelium. AMACR positivity was variable but often present (19/21). PSA, prostein, and NKX3.1 were consistently negative. Rare problematic cases of vasitis nodosa include “invasion” of the ejaculatory duct at the prostate and involvement of bladder muscle after prostatectomy. The proliferative vasitis nodosa glands often have a prostate cancer–like staining pattern with variable AMACR positivity and negative or patchy p63. However, reliable positivity for PAX8, patchy GATA3, and negative staining for PSA, NKX3.1, and prostein aid in distinguishing from prostate cancer and tubular variants of bladder cancer.

KW - GATA3

KW - Immunohistochemistry

KW - NKX3.1

KW - PAX8

KW - Prostate cancer

KW - Vasitis nodosa

UR - http://www.scopus.com/inward/record.url?scp=85041840197&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85041840197&partnerID=8YFLogxK

U2 - 10.1016/j.humpath.2017.12.001

DO - 10.1016/j.humpath.2017.12.001

M3 - Article

VL - 73

SP - 164

EP - 170

JO - Human Pathology

JF - Human Pathology

SN - 0046-8177

ER -