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1:
Alpha methylacyl CoA racemase (AMACR) in Prostate Cancer
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Comments: AMACR is an enzyme with a role in the beta oxidation of branched-chain fatty acids and fatty acid derivatives. It has proven to be a useful marker for the diagnosis of small foci of adenocarcinoma in prostate needle biopsies (Z. Jiang et al. Am J Clin Pathol 2004; 122:275-289). The photomicrograph shows a small focus of adenocarcinoma with strong immunoreactivity for AMACR. For H&E stained section, see next image.
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3:
AMACR in post-radiation prostate cancer
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Comments: This photomicrograph shows expression of AMACR in recurrent adenocarcinoma following radioactive seed implantation (brachytherapy). For H&E stained section, see next image. AMACR has been found to be overexpressed in post-radiation and post-hormonal therapy treated cases and in many unusual morphologic patterns or variants of prostate cancer.
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4:
Prostate cancer post-radiation therapy
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Comments: Prostate cancer following radiation shows paucity of cancer glands, poorly-formed glands, or single tumor cells with abundant vacuolated cytoplasm and fibrosis in the surrounding stroma.
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5:
PIN-4 cocktail in Prostate Cancer
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Comments: Since small foci of atypical glands often don’t persist on deeper levels in needle biopsies, antibody cocktails have been devised that combine basal cell markers such as high molecular weight cytokeratin (HMW-CK) and p63 with AMACR (PIN-4 cocktail). The benign glands in the middle of the core in this image are positive for HMW-CK and p63 (brown stain) and show weak immunoreactivity for racemase (red stain). The malignant glands on either side lack basal cells and show strong AMACR positivity.
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6:
PIN-4 cocktail in Prostate Cancer
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Comments: This image shows higher magnification view of previous case. Note the apical staining pattern of AMACR in the malignant glands on the left. The benign glands on the right show basal cells and weak immunoreactivity for racemase.
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7:
AMACR in HGPIN
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Comments: AMACR expression is not specific for prostate cancer. It has been seen in the majority of cases of high-grade prostatic intraepithelial neoplasia and in small percentage of cases of atypical adenomatous hyperplasia (adenosis), and even morphologically benign glands.
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