Pathology Inc. Consensus Conference
July 5th, 2006

Diagnostic Nuance and Journal Article Review #1

Dr. Mary Beth Shwayder presented a controversial article written by authors from Brigham and Women's Hospital and University of Washington (Lomo LC, etal-see below). Most of us have been taught the diagnosis of dysplasia in Barrett's esophagus should not be made if there is surface maturation even if the crypt exhibits dysplasia. This study described this change as BCDA (basal crypt-dysplasia like atypia) and compared the findings with adjacent nonatypical and nondysplastic (metaplastic) BE. Reviewing the biopsies of 206 consecutive patients, the authors analyzed p53, MIB-1 proliferation rates, molecular markers [17p(TP53) loss of heterozygosity (LOH), 9p(p16) LOH, and ploidy.

The areas of BCDA showed a significantly elevated rate of p53 positivity (60% vs. 13%, P<0.02) and a significantly elevated total crypt and basal crypt MIB-1 proliferation rate (P<0.001). Patients with BCDA showed a significantly increased rate of 17p(TP53) LOH (P=0.016), aneuploidy (P=0.004), and a trend in increased 9p(p16) LOH (P=0.08), compared with control patients without BCDA.

The overall findings suggest that BCDA is similar in profile to cases of low-grade dysplasia. The authors conclude that this change may represent a possible subtype of true dysplasia despite the morphologic appearance of surface maturation.

Diagnostic Nuance and Journal Article Review #2-Stratified Epithelium in Prostatic Adenocarcinoma

Dr. Paul Shitabata reviewed the recent journal article written by Drs. Humphrey and Hameed (see reference below) which documents the existence of an uncommon variant of prostatic adenocarcinoma exhibiting a stratified epithelial layer. Through a careful analysis of these cases, the distinction between these cases and high grade prostatic intraepithelial neoplasia is made. The authors recommend the use of triple immunoperoxidase staining for 34betaE12, p63, and AMACR as a diagnostic aid. The Power Point presentation is available for review with any web-based browser.

Journal Articles Reviewed

Crypt Dysplasia with Surface Maturation: A Clinical, Pathologic, and Molecular Study of a Barrett's Esophagus Cohort. Lomo LC, etal. Am J Surg Pathol 2006 Apr;30(4):423-435.

Stratified epithelium in prostatic adenocarcinoma: a mimic of high-grade prostatic intraepithelial neoplasia. Hameed O and Humphrey PA. Mod Pathol. 2006 Jul;19(7):899-906. Epub 2006 Apr 7.

The Doctor's Doctor-Barrett's Esophagus

The Doctor's Doctor-Prostate Cancer Histopathological Subtypes