P504s (also known as AMACR or alpha-methylacyl-CoA racemase) is an essential enzyme in the β-oxidation of branched-chain fatty acids. P504s over-expression has been demonstrated in several cancers including colorectal, prostate, bladder, renal cell carcinomas, and lymphoma. Staining with the antibody to this enzyme has been useful in identifying prostate carcinoma and high-grade intraepithelial neoplasia in formalin-fixed, paraffin embedded tissue. Cytoplasmic P504s staining, combined with absence of basal cell markers, has shown great value in establishing an identification of prostate carcinoma on small needle biopsy foci. However, P504s is of limited utility as a single marker in differential identification of prostate carcinoma from benign mimics of prostate carcinoma, such as glandular and partial atrophy and adenosis. A panel of antibodies including P504s, HMWCK, and p63 is recommended.
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