Histopathological Analysis of Prostate Cancer Growth Patterns and Role of Immunohistochemistry in Grading and Identifying Rare Histological Variants

Background- Prostate cancer comprises a heterogenous group of tumors having a range of clinical outcomes. Histopathological examination is the gold standard for accurately assessing them, but nevertheless sometimes diagnosing can be challenging particularly when rare variants are encountered. In such scenarios immunohistochemistry plays an immense aid in exact categorisation of the lesions. This study aims to Aimunderstand the histological patterns of prostate carcinoma and the value that immunohistochemistry adds in establishing a diagnosis and grading, with special emphasis on rare variants. Department of Pathology. Prospective observational study. Setting And Design- Material And MethodsAn institutional based prospective observational study was conducted on 31 TURP chippings positive for prostate cancer for a period of 1 year (June 2023-May 2024). Gleason score was assigned and relevant immunohistochemistry panel was used. Sensitivity and specificity of AMACR was calculated. The expression of serum PSA was correlated with ki-67 expression. Data was gathered Statistical Analysis- and entered in Microsoft excel spreadsheet, tabulated, and calculated using suitable software. the most common age Results- of presentation was in the 7th decade. Mean PSA level was 20.2129±4.997 ng/ml in the 31 primary prostate cancer cases. Prostatic acinar adenocarcinoma accounted for 92.322% cases and the others comprised primary urothelial carcinoma, sarcomatoid carcinoma and primary prostate lymphoma. Gleason score 7 emerged as the most common score. AMACR sensitivity and specificity was 92.86% and 100% respectively. Majority (90.32%) of the cases showed positive expression of ki67. The association between increased serum PSA value and Ki-67 index was not statistically significant. Conclusion- As an adjunct to histopathology, the judicious use of immunomarkers adds a diagnostic value and helps alleviate diagnostic challenges.