Immunohistochemical expression of Ets‑related gene‑transcriptional factor in adenocarcinoma prostate and its correlation with Gleason score.
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Date
2016-10
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Abstract
Background: Prostate carcinoma is the second leading cause of cancer‑related
deaths in males worldwide. The burden is expected to grow 1.7 million new cases
and 499,000 new deaths by 2030. In developing countries such as India, prostate
carcinoma will show an increase by 140% in the next few years. Although the
diagnosis of prostate carcinoma can usually be made on histological features,
now a days many immunohistochemical (IHC) markers are used to distinguish
it from benign mimickers as well as in predicting prognosis and treatment. Out
of these markers, Ets‑related gene (ERG product) is a proto‑oncogene which
participates in chromosomal translocations and is frequently over expressed
in prostate carcinoma which harbors ERG‑transmembrane protease, serine 2
fusion. Materials and Methods: Fifty cases of carcinoma prostate diagnosed in
needle biopsies and prostatic chips, in the Department of Pathology of a tertiary
care teaching hospital in Punjab, India, were included in the present study. The
slides were observed under the light microscope, and Gleason scoring was
done using the 2005 International Society of Urological Pathology modified
Gleason system. IHC study for ERG expression was done on all the cases, for
which anti‑ERG monoclonal rabbit clone antibody EP111 (Dako, Denmark) was
used. Lymphocytes and endothelial cells were taken as in built positive controls
for staining. The intensity of ERG positivity was scored as no staining (0), weak
staining (+1), moderate staining (+2) and intense staining (+3). The H score was
then calculated by multiplying the intensity of the stain with the percentage (0–100)
of the cells showing that staining intensity. The H‑score has a range of 0–300.
The relationship between IHC expression and clinico‑pathological parameters
was compared and analyzed using Chi-square test. P < 0.05 was considered
statistically significant. Results: Majority of patients included in the study were in
the age group of 61–80 (84% of the total). When ERG expression was studied
with age‑specific rates, it was not found to be statistically significant. The most
common pattern noted in the present study was 4 + 3, constituting 36% of total,
followed by 3 + 4 constituting 32%. Calculating the score, the majority of patients
had a Gleason score of 5–8, constituting 76% of total. Out of the total fifty cases
of prostate carcinoma, ERG was positive in 29 cases (58%) and negative in
21 cases (42%). Fourteen out of 21 (48%) of the ERG positive cases had an
intensity score of 3. When the ERG intensity was correlated with the Gleason score
group, it was seen that patients having Gleason score 7–8 showed ERG positivity
in 19 out of 38 cases (50%), with 11/19 (57%) cases showing an ERG intensity
score of 3. The Gleason score group 9–10 showed ERG positivity in 83% (10/12)
cases, 20% (2/10) cases showing intensity score of 3. This correlation was found
to be statistically significant. Conclusion: ERG immunostaining was performed
in a small Indian cohort of prostate cancer patients, diagnosed in trucut biopsy
specimens and prostatic chips. ERG expression was found in 58% patients. An increase in the ERG expression was
observed with an increase in Gleason
score. The intensity of ERG expression,
however, decreased with an increasing
Gleason score.
Description
Keywords
Carcinoma prostate, Ets‑related gene transcription factor, Expression, Immunohistochemistry, India
Citation
Mannan Rahul, Bhasin Tejinder Singh, Manjari Mridu, Singh Gagandeep, Bhatia Puneet Kaur, Sharma Sonam. Immunohistochemical expression of Ets‑related gene‑transcriptional factor in adenocarcinoma prostate and its correlation with Gleason score. Indian Journal of Pathology & Microbiology. 2016 Oct-Dec 59(4): 489-495.