Neuroendocrine cells of the verumontanum: a comparative immunohistochemical study

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Abstract
To define the distribution of neuroendocrine (NE) cells in the different compartments of the verumontanum (utricle, ejaculatory ducts, main prostatic ducts) in relation to other areas of the prostate. A retrospective study was conducted of 30 radical prostatectomy specimens processed in toto as whole-mount sections. Among these cases, 15 patients had received a preoperative short course of total androgen blockade. The distribution and number of NE cells in the prostatic utricle and in normal areas of the prostate were analysed using chromogranin A (CgA) and serotonin immunohistochemistry; prostate-specific antigen (PSA) immunostaining was performed systematically on a consecutive section. Six cases of endometrioid carcinomas were also investigated using these methods. The vascularization of the verumontanum was assessed by factor VIII immunohistochemistry and examined in relation to vascular endothelial growth factor (VEGF) immunohistochemistry. There were significantly more NE cells in the prostatic utricle than in the main prostatic ducts of the verumontanum and the peripheral prostatic acini. In the ejaculatory ducts. there were NE cells only in the extreme distal portion. Cells immunoreactive for PSA were present at the level of the utricle and the extreme distal portion of the ejaculatory ducts. The distribution, number and shape of NE cells were unaltered by hormonal treatment. NE cells of the verumontanum were positive for VEGF expression. Factor VIII detected more vessels around the utricle and ejaculatory ducts. NE cells (positive for CgA and serotonin) were observed in three cases of endometrioid carcinoma. The high concentration of NE cells found in the prostatic utricle suggests a possible role for these cells in human fertility. Moreover, neuroendocrine differentiation in endometrioid (large duct) carcinoma, documented for the first time, supports the concept that this cancer type is a variant of a conventional adenocarcinoma.