Difference between revisions of "Prostate gland"

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Images:
Images:
*[http://path.upmc.edu/cases/case203.html Prostatic ductal adenocarcinoma - several images (upmc.edu)].
*[http://path.upmc.edu/cases/case203.html Prostatic ductal adenocarcinoma - several images (upmc.edu)].
*[http://path.upmc.edu/cases/case711.html Prostatei ductal adenocarcinoma - another case - several images (upmc.edu)].


===PIN-like prostatic ductal adenocarcinoma===
===PIN-like prostatic ductal adenocarcinoma===

Revision as of 03:10, 3 February 2012

The prostate gland adds juice to the sperm. In old men it creates lotsa problems... nodular hyperplasia (commonly called BPH or benign prostatic hyperplasia) and cancer (adenocarcinoma).

Normal

Prostate

  • Glands have two cell layers (similar to glands in breast).
    • Second cell layer may be difficult to see (like in breast).
  • Epithelium in glands is "folded" or "tufted".
    • Very important - helps on differentiate from Gleason pattern 3.
  • Luminal epithelium often clear cytoplasm.
  • Single nucleus.

Benign normal:

  • Corpora amylacea.
    • Round/ovoid-eosinophilic bodies -- with laminations (layered appearance).
    • In gland lumina.
    • Usually in benign glands - but cannot be used to exclude cancer.[1]
    • Very common.
    • These should be differentiated from eosinophilic proteinaceous debris - which is associated with cancer.

Image: Two corpora amylacea (WC).

Negatives:

  • No nucleoli present (if you see nuclei think: cancer, HGPIN, reactive changes, basal cell hyperplasia).
  • No mitoses - these are uncommon... even in high grade prostate cancer.

Notes:

  • Tufted epithelium is a strong indicator of benignancy; however two uncommon prostate cancer typically have tufted epithelium:
    • Pseudohyperplastic adenocarcinoma.
    • Foamy gland carcinoma.

IHC of normal prostate

Normal prostate:

  • AMACR -ve (mark epithelial cells).
  • CK5/6 +ve,[2] p63 +ve, HMWCK +ve (mark basal cells).
  • PSA +ve, PSAP +ve.

Other accessory glands

Bulbourethral gland

  • AKA Cowper's gland.
  • Mucinous glands at the apex of the prostate.

Image: Mucinous/serous salivary gland (duke.edu).

Seminal vesicles

  • Fern-like architecture - epithelial component clustered closely, looks like it connects.
    • Epithelium surrounded by a thick layer of muscle (>10 cells across ~80 microns).
  • Lipofuscin (coarse cytoplasmic yellow granules approximately 1-2 micrometers) - key feature.
  • Nucleoli - common.
  • Nuclear inclusions - common.

Notes:

  • The ejaculatory ducts have the same epithelium as the seminal vesicles.[4]

Images:

Common diagnoses

  • Benign.
    • Atrophy - may resemble adenocarcinoma - typically not reported.
    • Adenosis - may resemble adenocarcinoma - typically not reported.
  • Prostate adenocarcinoma.
    • Most common Grade is 3+3=6.
  • HGPIN (high-grade prostatic intraepithelial neoplasia) - prostate adenocarcinoma precursor lesion.
  • ASAP (atypical small acinar proliferation) - used if you have a few abnormal appearing glands... but can't decide between prostate adenocarcinoma & benign.
  • Chronic inflammation.
  • Acute inflammation - can result in an elevated PSA and may have prompted the biopsy you're looking at.
  • Nodular hyperplasia of the prostate; AKA benign prostatic hypertrophy (BPH).
    • Not diagnosed on needle biopsies.
    • BPH is technically incorrect -- the process is a hyperplasia.
      • Hyperplasia = proliferation of cells, hypertrophy = enlargement of cells.
        • How to remember? A. Prostate... hyperPlasia.

Clinical history

  • PSA (serum).
    • >10 ng/mL worrisome for prostate cancer.
    • Normal is age dependent - increases with age, usu. cut-off ~ 4 ng/mL.
  • HIFU = High Intensity Focused Ultrasound - an ablation procedure for prostate cancer.[5]

Prostatic nodular hyperplasia

  • AKA nodular hyperplasia of the prostate, AKA benign prostatic hyperplasia (abbreviated BPH).

General

  • Very common.
  • Incidence increases with age.

Clinical - mnemonic I WISH 2p:[6]

  • Intermittency.
  • Weak stream.
  • Incomplete emptying.
  • Straining.
  • Hesitancy.
  • Post-void dribbling.
  • Prolonged voiding.

Microscopic

Features:

  • Stromal and/or glandular hyperplasia.

Image: Prostatic nodular hyperplasia (WC).

Acute inflammation

General

  • A may lead to an increase in the PSA and prompt biopsy.

Microscopic

Features:

  • Neutrophils within the glands, between the epithelial cells or within the stroma - key feature.

Note:

  • "Prostatitis" is considered a clinical diagnosis.
    • Cases are signed-out as "acute inflammation".
      • Some pathologists do not comment on the presence (or absence) of inflammation.

Image:

Chronic inflammation

Chronic inflammation not otherwise specified

Common

  • Non-specific.
  • Etiology usu. not apparent on histomorphology.

Microscopic

Features:

  • Lymphocytes within the glands, between the epithelial cells or within the stroma - key feature.

Image:

Granulomatous inflammation

General

  • Common.
  • Usu. secondary to BCG treatment of bladder cancer.
  • Several classifications exist[7] - the most commonly used is by Epstein & Hutchins.
Epstein & Hutchins classification

The groupings:[8]

  1. Non-specific.
    • No cause identified, usu. incidentally discovered.
    • Most common.
  2. After TURP.
  3. Specific.
    • Identifiable infectious agent, usu. BCG (in the context of treating bladder cancer), rarely tuberculosis and even more rarely various fungi and syphilis.
  4. Allergic granulomatous prostatitis.

Microscopic

Features:

Images:

Atrophy

General

  • Small glands (may mimic Gleason score 3 pattern).

Microscopic

Features:

  • Glands often have a jagged edges/prows (in cancer the glands tend to have round edges) - key feature.
    • Prow = forward most part of a ship's bow that cuts through the water.[9]
      • You may have come across prow in the context of breast cancer, i.e. tubular carcinoma.
  • Gland density is usually lower than in prostate carcinoma, i.e. glands are not back-to-back - key feature.
  • Atrophic glands are often hyperchromatic.[10]
  • Scant cytoplasm - usually.

Negatives:

  • Nuclei like normal, i.e. nucleoli uncommon.
  • Should have two cell layers, i.e. epithelial and myoepithelial (may be difficult to see).

Atrophy vs. cancer

Atrophy Cancer
Glandular architecture/
arrangement 		angulated glands, may
look like they originate
from one large duct 		round glands,
often back-to-back
Nuclear
hyperchromasia 		marked moderate
Cytoplasm scant/minimal moderate, may
be amphophilic
Basal cells may be visible absent
Nucleoli absent present
Secretions in
glands 		no yes - eosinophilic
or blue

Prostatic infarction

General

Microscopic

Features:

  • Classic findings of necrosis:
    • Karyolysis (loss of nuclei), karyorrhexis (frag. of nuclei), pyknosis (small shrunken nuclei).
  • +/-Squamous metaplasia of prostate gland epithelium.

Notes:

  • Corpora amylacea - help... call it benign.
  • Glands maintain normal spacing.

Image:

Basal cell hyperplasia of the prostate

General

  • Atypical appearing glands - typically in transition zone.[12]
  • May have nucleoli.
  • Benign lesion that can be misdiagnosed as cancer.[13]

Differentiating between diagnoses

Basal cell hyperplasia vs. cancer:[14]

  • Low power gland architecture near normal.[15][16]
    • Glands not as small as cancer.
    • Folds in gland lumina.
    • No hyperchromasia.
    • Two cell layers (as in normal prostate glands).

High-grade prostatic intraepithelial neoplasia

  • Abbreviated as HGPIN.

General

  • Thought to be a precursor lesion for prostate adenocarcinoma; however, HGPIN does not appear to be associated with increased risk for prostate cancer on re-biopsy at one year (if the initial biopsy had 8 or more cores).[17]

Low-grade PIN:

  • Not reported and generally believed to be irrelevant biologically/clinically.
    • PIN not otherwise specified refers to HGPIN.
    • Low-grade PIN has the architecture of HGPIN but lacks the nuclear atypia.

Microscopic

Features:

  • Diagnosed on basis of nuclear changes.
    • Hyperchromatic nuclei.
    • Nucleoli present - key (high power) feature.
    • Often increased N/C ratio.
    • Nuclear enlargement.
  • Different architectures (e.g. micropapillary).
  • Usually epithelial hyperplasia.

Note:

  • Nucleoli should be visible with the 20x objective.
    • If one uses the 40x objective... one over calls.

HGPIN architecture

There are several forms:[18][19]

  • Flat - uncommon.
  • Tufting - common.
  • Micropapillary - common.
  • Cribriform - rare.

Note:

  • The architectural pattern is NOT thought to have any prognostic significance -- may, however, be useful for picking it out from benign prostate.

Images:

Differentiating between diagnoses

HGPIN vs. adenocarcinoma:

  • Glands with HGPIN have two or more distinct cells layers.

HGPIN vs. normal:

  • HPGIN has nuclear changes.

May need IHC (especially for cancer vs. HGPIN).

IHC patterns:

  • Cancer: AMACR +ve, p63 -ve, HMWCK -ve.
  • HGPIN: AMACR +ve, p63 +ve, HMWCK +ve.
  • Normal: AMACR -ve, p63 +ve, HMWCK ve+.

Atypical small acinar proliferation

  • Abbreviated ASAP.

General

  • It is a waffle diagnosis, i.e. it is not considered an entity with a distinct pathobiology.[20]
    • It is the same as suspicious for carcinoma.[21]
      • ASAP is preferred as it does not contain the word carcinoma and, thus, cannot be misread as carcinoma, i.e. positive for malignancy.
    • Analogous to ASCUS on a pap test.
    • ASAP should be used sparingly.
      • One benchmark is < 3-5% of biopsies.[22]
  • Never diagnosed on excision, i.e. prostatectomy specimen.

Histologic characteristics

  • Atypical appearing acini.
  • Limited extent, e.g. 2-3 glands.
  • IHC not contributory.
  • Deeper cuts didn't yield anything.

Association with adenocarcinoma

Management

  • ASAP is considered an indication for re-biopsy;[24] in one survey of urologists[25] 41/42 (~98%) of respondents considered it a sufficient reason to re-biopsy.

Intraductal carcinoma

General

  • Associated with a poor prognosis.[26]

Microscopic

Features:

  • Malignant cells in glands with basal cells - key feature.
    • Two cell populations:
      1. Obviously malignant cells with enlarged nuclei, granular chromatin, hyperchromasia and nucleoli.
      2. Cells with pale cytoplasm and smaller nuclei.

Prostatic adenocarcinoma

  • AKA adenocarcinoma of the prostate.

Criteria as a list

Major criteria (the ABCs of prostate pathology):[27]

  1. Architecture.
    • Increased gland density.
    • Small circular glands.
      • In rare subtypes - large branching glands.
    • "Infiltrative growth" pattern - malignant glands between benign ones.
  2. Basal cells lacking.
  3. Cytological abnormalities:
    • Nuclear enlargement.
    • Nucleoli.

Minor criteria:[27]

  1. Nuclear hyperchromasia.
  2. Wispy blue mucin.
  3. Pink amorphous secretions.
  4. Intraluminal crystalloid.
  5. Amphophilic cytoplasm.
  6. Adjacent HGPIN.
  7. Mitoses - quite rare.

Extent/quantity criteria:

  • There is no agreed upon minimum number of glands; however, one paper suggests that agreement among experts is low with 5 or less glands.[30]
    • Thus, it has been suggested that six or more glands should be present to diagnose cancer.[30]

Low power features

  • Architecture is the key to diagnosing low grade cancer.
    • Back-to-back glands or crowding of glands -- think low grade cancer (Gleason pattern 3).
    • Sharp transition between gland border and lumen.
      • Loss of epithelial folding at the epithelium-gland lumen interface - "punched-out" appearance.
    • Eosinophilic debris within the gland lumen (pink amorphous secretions, intraluminal crystalloid).
    • Blue-tinged acellular material within the gland lumen (mucin) -- uncommon.
    • "Infiltrative": small round/oval (malignant) glands (approx. 5 cells across) interspersed with larger (benign) glands that are 2-3 times larger.

High power features

  • Nuclei.
    • Hyperchromatic nuclei (like in HGPIN).
    • Nuclear enlargement.
      • Difficult to appreciate (if cancer isn't side-by-side with normal prostate).
      • Difficult to see if not on high power.
  • Nucleoli visible on high power (200x or 100X)
    • May be difficult to see - especially if light intensity is low.
      • One should not use 400x to look for nucleoli (it is a waste of time + you risk overcalling something benign).
    • If I see three good nucleoli in a gland I'm usually confident it is cancer.
  • Loss of basal cells - diagnostic feature.
    • Like in breast pathology (where one looks for loss of myoepithelial cells) - this may be difficult to see.

Notes:

  • Mitoses are not a common feature - don't waste time looking for them.

IHC

  • AMACR +ve.
  • AR +ve -- in prostate confined cancer.
    • Usu. -ve in LN +ve disease.[31] *PSA +ve.
  • PSAP +ve.
  • p63 -ve.
  • HMWCK (34betaE12) -ve.

Combination immunostains:

  • PIN-4 -- consists of: CK5 + CK14 + p63 + P504S (AMACR).[32][33][34]
    • AKA PIN.
    • AKA CAP.
      • Why CAP?
        • A. CAncer of the Prostate.

Mimics

Mimics of prostate adenocarcinoma:[35]

Entity Key feature Detailed microscopic Other Image
Adenosis (AKA atypical adenomatous hyperplasia) gradual transition between normal & small gland (NOT two populations) many small glands, lack nuclear size variation, basal layer present nucleoli may be present; may need to do p63 or 34betaE12 to find basal layer Image
Sclerosing adenosis gradual transition between normal & small gland (NOT two populations), fibrosis many small glands, lack nuclear size variation, basal layer present analogous to sclerosing adenosis of breast (???) Image
Atrophy sharp angulation of gland nuclear hyperchromasia, scant cytoplasm may appear right beside non-atrophic tissue Image
Basal cell hyperplasia two distinct cell populations (in epithelial component) abundant epithelial cells; nucleoli in pale ('blue') nuclei of basal cells, glandular cell nuclei darker ('purple') vaguely similar to epithelial hyperplasia of usual type (EHUT) in breast Image
Bulbourethral gland no nuclear atypia clear cytoplasm apex of prostate Image
Seminal vesicles lipofuscin (yellow granular material in cytoplasm), smudge cells (smeared appearance + hyperchromatic) fern-like arrangement of epithelium (low power), nucleoli, surrounded by muscle, +/- nuclear inclusions involvement by cancer changes staging, lipofuscin may be present in prostate, often has marked nuc. size var. SV - high mag. (WC), SV - low mag. (WC)
Radiation effect marked nuclear size variation increased stroma (fibrosis), lack nucleoli ??? history of Rx; uniform nuc. size with Hx of Rx should raise susp. of cancer Image
Prostatitis inflammatory cells (lymphocytes, plasma cells, PMNs) no nuclear atypia, normal gland arch. clinical mimic of cancer (elevated PSA); usu. not a problem for the pathologist (WC)
Vasitis nodosa sperm within ducts, clinical history (usu. post-vasectomy) small tubules, nucleoli common, mild atypia, may "invade" vessels, track along nerves mimics metastatic prostate carcinoma, IHC stains: PSA-, PSAP- VN (webpathology.com)

Memory device: AAABBRS = atrophy, adenosis, adenosis (sclerosing), basal cell hyperplasia, bulbourethral gland, radiation, seminal vesicles.

Grading

There is only one grading system that any one talks about...

Gleason grading system

  • Score range: 2-10.
  • Reported as on biopsy as: (primary pattern) + (secondary pattern or tertiary pattern with the highest grade) = sum.
    • e.g. Gleason grade 3+4=7 means: pattern 3 is present and dominant, pattern 4 is the remainder of the tumour - but present in a lesser amount than pattern 3.
  • Reported as on prostatectomies as: (primary pattern) + (secondary pattern) = sum, (tertiary pattern)
  • Tertiary Gleason pattern - definition: a pattern that is seen in than 5% of the tumour (volume), that is higher grade than the two dominant patterns.[36]
    • The presence of a tertiary patterns adversely affect the prognosis; however, the prognosis is not as bad as when the tertiary pattern is the secondary pattern, i.e. 3+4 tertiary 5 has a better prognosis than 3+5 (with some small amount of pattern 4).[36]

Examples:

  • A biopsy has 80% pattern 4, 15.1% pattern 3 and 4.9% pattern 5... it would be reported as: 4+5=9.
  • A prostatectomy has 80% pattern 4, 15.1% pattern 3 and 4.9% pattern 5... it would be reported as: 4+3=7 with tertiary pattern 5.

Testing yourself:

Gleason pattern 1 & 2

  • Academic thing - you can forget about 'em.

Gleason pattern 3

  • Glands smaller than normal prostate glands + loss of epithelial folding.
  • Can draw a line around each gland.

Notes:

  • All cribriform is now classified as Gleason pattern 4.[38]

Gleason pattern 4

  • Loss of gland lumina.
  • Gland fusion.
  • Benign looking cords ('hypernephroid pattern').
  • Cribriform.
  • Glomeruloid pattern - resembles a glomerulus.

Notes:

  • One gland is not enough to call Gleason 4.

Images:

Gleason pattern 5

  • Sheets.
    • Must be differentiated from intraductal growth (which like in the breast are well circumscribed nests).
  • Single cells.
    • May be confused with stromal/lymphocytic infiltration.
      • Look for nucleoli, cells should be round (prostatic stroma cells are spindle cells).
  • Cords.
  • Nests of cells with necrosis at centre.

Image: Gleason pattern 4 - small glands & Gleason pattern 5 - single cells (WC).

Special types

Special types of prostate cancer have set Gleason scores:[39]

Special type Gleason pattern Comment
Ductal carcinoma 4 may be graded 3 or 5[40]
Mucinous carcinoma 4
Sarcomatoid carcinoma 5 glands graded separately
Signet ring cell carcinoma 5
Small cell carcinoma not graded may be graded 5[40]
Adenosquamous and squamous carcinoma not graded
Lymphoepithelioma-like carcinoma not graded
Adenoid cystic carcinoma not graded
Urothelial carcinoma not graded
Undifferentiated carcinoma, NOS not graded

Management

The management changes between Gleason 6, 7 & 8; typically, the implications are:

  • Gleason 6: watchful waiting or radioactive seeds, surgery if patient wants.
  • Gleason 7: do something.
  • Gleason 8+: bad cancer - do something quickly!

Bottom line: You want to be sure when you call something Gleason pattern 4.

Note:

  • The usual caveats apply to the above; if the patient is moribund-- nothing is done, if the patient refuses treatment... nothing is done et cetera.

Margins + Extension

Definitions:

  • Extraprostatic extension (EPE) is difficult to assess (in prostatectomy specimens) as there is no consensus definition.
    • The prostate does NOT have a well defined capsule.
      • Intraobserver agreement for EPE is fair-moderate and lower than for the surgical margin.[41]
  • Surgical margin - where the surgeon cut.
    • It is possible to have EPE without a positive margin.
    • It is possible to have a positive margin without EPE.

Important:

  • EPE cannot be called on a biopsy unless the tumour is next to adipose tissue.[42]

Extraprostatic extension (EPE)

  • Prostatectomy specimens: EPE is present if there is either:
    1. A "significant bulge" in the contour of the prostate at low power and no fibromuscular tissue surrounding the malignant cells.
    2. Malignant cells directly adjacent to peri-prostatic adipose tissue.
  • Prostate biopsy: EPE is present if tumour touches adipose tissue.[43]
    • The prostate, at the apex, may have some skeletal muscle. Thus, it is difficult to define extention... ergo EPE not called at the apex.

Reporting prostate cancer

Elements of a prostate biopsy report with cancer

Important elements:[27]

  1. Type of cancer, e.g. "prostatic adenocarcinoma, acinar type".
  2. Gleason score including primary and secondary pattern, e.g. "Gleason score 3+4=7".
  3. Number of cores and number involved, e.g. "2/3 cores involved by cancer".
  4. Percent area involved, i.e. how much of the core is cancer, e.g. "75% of specimen is tumour".
  5. Percent area involved that is Gleason pattern 4 or 5, e.g. "25% of the tumour is Gleason pattern 4 or 5".
  6. Presence of perineural invasion.
  7. Presence of extension into fat (extraprostatic extension).

Notes:

  • "Percent area involved" may seem like an odd thing to request 'cause it is sampling dependent, i.e. if the radiologist sticks the biopsy needle deeper into the lesion more of the core is positive, but urologists think it is important -- more important than perineural invasion.[44]

Prostatectomy specimens

See: CAP checklist.

Molecular changes in prostate cancer

A fusion gene between TMPRSS2 and ERG is described.[45][46]

  • Both genes are on chromosome 21.
  • Currently not used diagnostically.
  • Fusion gene seen in approx. 50% of prostate cancer.[46]
  • A subset of TMPRSS2-ERG known as 2+Edel (seen in ~7% of all prostate cancer cases) predicts poor survival.[47]

Unusual forms of prostate cancer

Prostatic ductal adenocarcinoma

  • AKA ductal adenocarcinoma of the prostate.
  • AKA prostatic adenocarinoma, large duct type.
  • Sometimes it is referred to as endometrioid or endometrial adenocarcinoma; both terms are discouraged.[48]

Features:[49]

  • Pseudostratified (crowded appearing) columnar (or cigar-shaped) nuclei - key feature.
    • Vaguely resembles colonic adenocarcinoma.
  • Variable architecture:
    • Papillary.
    • Cribriform.
    • Single gland (large glands).
    • Endometrioid - vaguely looks like endometrial carcinoma (with back-to-back glands).

Notes:

  • Usually seen in association with conventional (acinar) prostate adenocarcinoma.

Images:

PIN-like prostatic ductal adenocarcinoma

Features:[50]

  • Stratified malignant epithelium.

Note:

  • Vaguely similar to a tubular adenoma of the colon.

Image:

Foamy gland carcinoma

Features:

  • Tufted glandular border.
  • Abundant eosinophilic (or hyperchromatic) cytoplasm - key feature.
  • Gland size larger than "typical" prostate cancer.

Image: Foamy gland carcinoma (nature.com).

Atrophic carcinoma

Features:

  • Scant cytoplasm.
  • Nuclear features of conventional prostate cancer (nucleoli, nuclear enlargement).
  • Increased gland density.

Image: Atrophic carcinoma (nature.com).

Mucinous prostate carcinoma

Definition:

  • Cytologically malignant cells floating in mucin.
  • > 25% of tumour mucinous.[39]
    • One study suggests >= 25%.[52]

Notes:

Pseudohyperplastic prostatic adenocarcinoma

Features:[53][54]

  • Medium to large glands with an atypical morphology - key low power feature:
    • Papillary or pseudopapillary infoldings, luminal undulations, branching or cystic dilatation.
  • Nuclear features of conventional prostate cancer (nucleoli, nuclear enlargement).

Image: Pseudohyperplastic prostatic adenocarcinoma (nature.com).

Notes:

  • Usually associated with conventional (acinar) prostate adenocarcinoma.
  • Pale abundant cytoplasm - similar to normal prostate.

Prostatic signet ring cell carcinoma

  • Very rare - 9 cases in a series of 29,783 prostate cancer cases.[55]
  • Criteria vary - percentage of SRCs required for Dx varies from 20% to 50%.[55]

Features:

  • Signet ring cells - see basics article.

Image:

Sarcomatoid prostate carcinoma

  • AKA carcinosarcoma.

Features:[56]

  • Biphasic tumour:
    1. Spindle cells (sarcomatous component).
      • May include components of: osteosarcoma, chondrosarcoma and/or rhabdomyosarcoma.
    2. Glandular component (like conventional prostate carcinoma).
      • Typically stains PSA +ve, keratin +ve.

Small cell carcinoma

Main article: Small cell carcinoma

Features:

  • Nuclear moulding.
  • Stippled chromatin.
  • High NC ratio.
  • Small cells.

Notes:

  • Similar to small cell carcinoma of the lung.
  • High-grade squamoid component favours metastatic urothelial carcinoma.
    • UCC usu. HWCK +ve.

See also

References

  1. ↑ Christian JD, Lamm TC, Morrow JF, Bostwick DG (January 2005). "Corpora amylacea in adenocarcinoma of the prostate: incidence and histology within needle core biopsies". Mod. Pathol. 18 (1): 36–9. doi:10.1038/modpathol.3800250.
  2. ↑ Trpkov, K.; Bartczak-McKay, J.; Yilmaz, A. (Aug 2009). "Usefulness of cytokeratin 5/6 and AMACR applied as double sequential immunostains for diagnostic assessment of problematic prostate specimens.". Am J Clin Pathol 132 (2): 211-20; quiz 307. doi:10.1309/AJCPGFJP83IXZEUR. PMID 19605815.
  3. ↑ PR. September 2009.
  4. ↑ Leroy X, Ballereau C, Villers A, et al. (April 2003). "MUC6 is a marker of seminal vesicle-ejaculatory duct epithelium and is useful for the differential diagnosis with prostate adenocarcinoma". Am. J. Surg. Pathol. 27 (4): 519–21. PMID 12657938.
  5. ↑ URL: http://www.internationalhifu.com/what-is-hifu-mainmenu-132.html. Accessed on: 15 June 2010.
  6. ↑ TN06 U5
  7. ↑ Uzoh, CC.; Uff, JS.; Okeke, AA. (Mar 2007). "Granulomatous prostatitis.". BJU Int 99 (3): 510-2. doi:10.1111/j.1464-410X.2006.06585.x. PMID 17092284.
  8. ↑ Epstein, JI.; Hutchins, GM. (Sep 1984). "Granulomatous prostatitis: distinction among allergic, nonspecific, and post-transurethral resection lesions.". Hum Pathol 15 (9): 818-25. PMID 6432674.
  9. ↑ http://en.wikipedia.org/wiki/Prow
  10. ↑ SN. June 3, 2009.
  11. ↑ 11.0 11.1 Milord, RA.; Kahane, H.; Epstein, JI. (Oct 2000). "Infarct of the prostate gland: experience on needle biopsy specimens.". Am J Surg Pathol 24 (10): 1378-84. PMID 11023099.
  12. ↑ URL: http://pathologyoutlines.com/prostate.html#bch. Accessed on: 19 June 2010.
  13. ↑ Cleary, KR.; Choi, HY.; Ayala, AG. (Dec 1983). "Basal cell hyperplasia of the prostate.". Am J Clin Pathol 80 (6): 850-4. PMID 6195916.
  14. ↑ URL: http://pathologyoutlines.com/prostate.html#bch. Accessed on: 28 June 2010.
  15. ↑ URL: http://www.nature.com/modpathol/journal/v16/n6/fig_tab/3880810f1.html. Accessed on: 28 June 2010.
  16. ↑ URL: http://www.nature.com/modpathol/journal/v16/n6/fig_tab/3880810f2.html. Accessed on: 28 June 2010.
  17. ↑ Herawi, M.; Kahane, H.; Cavallo, C.; Epstein, JI. (Jan 2006). "Risk of prostate cancer on first re-biopsy within 1 year following a diagnosis of high grade prostatic intraepithelial neoplasia is related to the number of cores sampled.". J Urol 175 (1): 121-4. doi:10.1016/S0022-5347(05)00064-9. PMID 16406886.
  18. ↑ Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 380. ISBN 978-0781765275.
  19. ↑ Bostwick, DG.; Qian, J. (Mar 2004). "High-grade prostatic intraepithelial neoplasia.". Mod Pathol 17 (3): 360-79. doi:10.1038/modpathol.3800053. PMID 14739906. http://www.nature.com/modpathol/journal/v17/n3/pdf/3800053a.pdf.
  20. ↑ Flury SC, Galgano MT, Mills SE, Smolkin ME, Theodorescu D (January 2007). "Atypical small acinar proliferation: biopsy artefact or distinct pathological entity". BJU International 99 (4): 780-5. PMID 17378841. http://www3.interscience.wiley.com/journal/118508438/abstract.
  21. ↑ THvdK. 19 June 2010.
  22. ↑ THvdK. 19 June 2010.
  23. ↑ Leite KR, Camara-Lopes LH, Cury J, Dall'oglio MF, Sañudo A, Srougi M (June 2008). "Prostate cancer detection at rebiopsy after an initial benign diagnosis: results using sextant extended prostate biopsy". Clinics 63 (3): 339–42. PMID 18568243. http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1807-59322008000300009&lng=en&nrm=iso&tlng=en.
  24. ↑ Bostwick DG, Meiers I (July 2006). "Atypical small acinar proliferation in the prostate: clinical significance in 2006". Arch. Pathol. Lab. Med. 130 (7): 952–7. PMID 16831049. http://journals.allenpress.com/jrnlserv/?request=get-abstract&issn=0003-9985&volume=130&page=952.
  25. ↑ Rubin MA, Bismar TA, Curtis S, Montie JE (July 2004). "Prostate needle biopsy reporting: how are the surgical members of the Society of Urologic Oncology using pathology reports to guide treatment of prostate cancer patients?". Am. J. Surg. Pathol. 28 (7): 946–52. PMID 15223967.
  26. ↑ Henry, PC.; Evans, AJ. (Jul 2009). "Intraductal carcinoma of the prostate: a distinct histopathological entity with important prognostic implications.". J Clin Pathol 62 (7): 579-83. doi:10.1136/jcp.2009.065003. PMID 19246509.
  27. ↑ 27.0 27.1 27.2 Humphrey PA (January 2007). "Diagnosis of adenocarcinoma in prostate needle biopsy tissue". J. Clin. Pathol. 60 (1): 35–42. doi:10.1136/jcp.2005.036442. PMC 1860598. PMID 17213347. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1860598/?tool=pubmed.
  28. ↑ 28.0 28.1 28.2 Epstein JI (March 2004). "Diagnosis and reporting of limited adenocarcinoma of the prostate on needle biopsy". Mod. Pathol. 17 (3): 307–15. doi:10.1038/modpathol.3800050. PMID 14739905. http://www.nature.com/modpathol/journal/v17/n3/full/3800050a.html.
  29. ↑ URL: http://pancreaticcancer2000.com/page1.htm. Accessed on: 3 June 2010.
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  31. ↑ Fleischmann, A.; Rocha, C.; Schobinger, S.; Seiler, R.; Wiese, B.; Thalmann, GN. (Apr 2011). "Androgen receptors are differentially expressed in Gleason patterns of prostate cancer and down-regulated in matched lymph node metastases.". Prostate 71 (5): 453-60. doi:10.1002/pros.21259. PMID 20878946.
  32. ↑ URL: http://biocare.net/wp-content/uploads/225DS.pdf. Accessed on: 18 October 2011.
  33. ↑ URL: http://www.antibodies-online.com/antibody/308235/anti-PIN-4+p63+Cytokeratin+HMW+p504S++AMACR/. Accessed on: 18 October 2011.
  34. ↑ URL: http://www.webpathology.com/image.asp?case=96&n=5. Accessed on: 18 October 2011.
  35. ↑ Weedman Molavi, Diana (2008). The Practice of Surgical Pathology: A Beginner's Guide to the Diagnostic Process (1st ed.). Springer. pp. 100-3. ISBN 978-0387744858.
  36. ↑ 36.0 36.1 Zhou, Ming; Magi-Galluzzi, Cristina (2006). Genitourinary Pathology: A Volume in Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 72. ISBN 978-0443066771.
  37. ↑ Kronz, JD.; Silberman, MA.; Allsbrook, WC.; Bastacky, SI.; Burks, RT.; Cina, SJ.; Mills, SE.; Ross, JS. et al. (Sep 2000). "Pathology residents' use of a Web-based tutorial to improve Gleason grading of prostate carcinoma on needle biopsies.". Hum Pathol 31 (9): 1044-50. doi:10.1053/hupa.2000.16278. PMID 11014569.
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  39. ↑ 39.0 39.1 Grignon DJ (March 2004). "Unusual subtypes of prostate cancer". Mod. Pathol. 17 (3): 316–27. doi:10.1038/modpathol.3800052. PMID 14976541.
  40. ↑ 40.0 40.1 URL: https://www.bostwicklaboratories.com/global/physicians/medical-library/articles/gleason-grading.aspx. Accessed on: 26 November 2011.
  41. ↑ Evans, AJ.; Henry, PC.; Van der Kwast, TH.; Tkachuk, DC.; Watson, K.; Lockwood, GA.; Fleshner, NE.; Cheung, C. et al. (Oct 2008). "Interobserver variability between expert urologic pathologists for extraprostatic extension and surgical margin status in radical prostatectomy specimens.". Am J Surg Pathol 32 (10): 1503-12. doi:10.1097/PAS.0b013e31817fb3a0. PMID 18708939.
  42. ↑ AE. 4 June 2010.
  43. ↑ Epstein, JI.; Srigley, J.; Grignon, D.; Humphrey, P. (Sep 2007). "Recommendations for the reporting of prostate carcinoma.". Hum Pathol 38 (9): 1305-9. doi:10.1016/j.humpath.2007.05.015. PMID 17707261.
  44. ↑ Rubin MA, Bismar TA, Curtis S, Montie JE (July 2004). "Prostate needle biopsy reporting: how are the surgical members of the Society of Urologic Oncology using pathology reports to guide treatment of prostate cancer patients?". Am. J. Surg. Pathol. 28 (7): 946–52. PMID 15223967.
  45. ↑ Yu J, Yu J, Mani RS, Cao Q, Brenner CJ, Cao X, Wang X, Wu L, Li J, Hu M, Gong Y, Cheng H, Laxman B, Vellaichamy A, Shankar S, Li Y, Dhanasekaran SM, Morey R, Barrette T, Lonigro RJ, Tomlins SA, Varambally S, Qin ZS, Chinnaiyan AM (May 2010). "An Integrated Network of Androgen Receptor, Polycomb, and TMPRSS2-ERG Gene Fusions in Prostate Cancer Progression". Cancer Cell 17 (5): 443–54. doi:10.1016/j.ccr.2010.03.018. PMC 2874722. PMID 20478527. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2874722/.
  46. ↑ 46.0 46.1 Online 'Mendelian Inheritance in Man' (OMIM) 602060
  47. ↑ Attard, G.; Clark, J.; Ambroisine, L.; Fisher, G.; Kovacs, G.; Flohr, P.; Berney, D.; Foster, CS. et al. (Jan 2008). "Duplication of the fusion of TMPRSS2 to ERG sequences identifies fatal human prostate cancer.". Oncogene 27 (3): 253-63. doi:10.1038/sj.onc.1210640. PMID 17637754.
  48. ↑ Samaratunga, H.; Delahunt, B. (Aug 2008). "Ductal adenocarcinoma of the prostate: current opinion and controversies.". Anal Quant Cytol Histol 30 (4): 237-46. PMID 18773743.
  49. ↑ Zhou, Ming; Magi-Galluzzi, Cristina (2006). Genitourinary Pathology: A Volume in Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 88. ISBN 978-0443066771.
  50. ↑ 50.0 50.1 Hameed, O.; Humphrey, PA. (Jul 2006). "Stratified epithelium in prostatic adenocarcinoma: a mimic of high-grade prostatic intraepithelial neoplasia.". Mod Pathol 19 (7): 899-906. doi:10.1038/modpathol.3800601. PMID 16607376.
  51. ↑ Lee, TK.; Miller, JS.; Epstein, JI. (Jun 2010). "Rare histological patterns of prostatic ductal adenocarcinoma.". Pathology 42 (4): 319-24. doi:10.3109/00313021003767314. PMID 20438402.
  52. ↑ Osunkoya AO, Nielsen ME, Epstein JI (March 2008). "Prognosis of mucinous adenocarcinoma of the prostate treated by radical prostatectomy: a study of 47 cases". Am. J. Surg. Pathol. 32 (3): 468–72. doi:10.1097/PAS.0b013e3181589f72. PMID 18300802.
  53. ↑ Zhou, Ming; Magi-Galluzzi, Cristina (2006). Genitourinary Pathology: A Volume in Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 77. ISBN 978-0443066771.
  54. ↑ Arista-Nasr J, Martinez-Benitez B, Valdes S, Hernández M, Bornstein-Quevedo L (2003). "Pseudohyperplastic prostatic adenocarcinoma in transurethral resections of the prostate". Pathol. Oncol. Res. 9 (4): 232–5. doi:PAOR.2003.9.4.0232. PMID 14688829.
  55. ↑ 55.0 55.1 Warner, JN.; Nakamura, LY.; Pacelli, A.; Humphreys, MR.; Castle, EP. (Dec 2010). "Primary signet ring cell carcinoma of the prostate.". Mayo Clin Proc 85 (12): 1130-6. doi:10.4065/mcp.2010.0463. PMID 21123640.
  56. ↑ Zhou, Ming; Magi-Galluzzi, Cristina (2006). Genitourinary Pathology: A Volume in Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 77 & 80. ISBN 978-0443066771.

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