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| 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). | | [[Image:Prostatelead.jpg|thumb|right|200px|The prostate gland and its surrounding structures. (WC/NCI)]] |
| | The '''prostate gland''' adds juice to the sperm. In old men it creates a lot of problems... [[nodular hyperplasia]] (commonly called BPH or [[benign prostatic hyperplasia]]) and cancer (usually adenocarcinoma). |
| | |
| | [[Prostate cancer]] is such a big topic it is dealt with in its own article. |
| | |
| | The female homologue of the prostate gland is considered to be Skene's gland.<ref name=pmid8522254>{{Cite journal | last1 = Dodson | first1 = MK. | last2 = Cliby | first2 = WA. | last3 = Pettavel | first3 = PP. | last4 = Keeney | first4 = GL. | last5 = Podratz | first5 = KC. | title = Female urethral adenocarcinoma: evidence for more than one tissue of origin? | journal = Gynecol Oncol | volume = 59 | issue = 3 | pages = 352-7 | month = Dec | year = 1995 | doi = 10.1006/gyno.1995.9963 | PMID = 8522254 }}</ref> |
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| =Normal prostate gland= | | =Normal prostate gland= |
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| **Second cell layer may be difficult to see (like in breast). | | **Second cell layer may be difficult to see (like in breast). |
| *Epithelium in glands is "folded" or "tufted". | | *Epithelium in glands is "folded" or "tufted". |
| **Very important - helps on differentiate from Gleason pattern 3. | | **Very important - helps to differentiate from Gleason pattern 3. |
| *Luminal epithelium often clear cytoplasm. | | *Luminal epithelium often clear cytoplasm. |
| *Single nucleus. | | *Single nucleus. |
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| Notes: | | Notes: |
| *Tufted epithelium is a strong indicator of benignancy; however two uncommon prostate cancer typically have tufted epithelium: | | *Tufted epithelium is a strong indicator of benignancy; however two uncommon prostate cancer variants typically have tufted epithelium: |
| **Pseudohyperplastic adenocarcinoma. | | **[[Pseudohyperplastic adenocarcinoma]]. |
| **Foamy gland carcinoma. | | **[[Foamy gland carcinoma]]. |
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| Images: | | ====Images==== |
| *[http://commons.wikimedia.org/wiki/File:Corpora_amylacea_low_mag.jpg Benign prostate with corpora amylacea - low mag. (WC)].
| | <gallery> |
| *[http://commons.wikimedia.org/wiki/File:Corpora_amylacea_high_mag.jpg Benign prostate with corpora amylacea - high mag. (WC)].
| | Image:Corpora_amylacea_low_mag.jpg | Benign prostate with corpora amylacea - low mag. (WC/Nephron) |
| | Image:Corpora_amylacea_high_mag.jpg | Benign prostate with corpora amylacea - high mag. (WC/Nephron) |
| | </gallery> |
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| ==IHC of normal prostate== | | ==IHC of normal prostate== |
| Normal prostate: | | Normal prostate: |
| *AMACR -ve (mark epithelial cells). | | *[[AMACR]] -ve (mark epithelial cells). |
| *CK5/6 +ve,<ref name=pmid19605815>{{Cite journal | last1 = Trpkov | first1 = K. | last2 = Bartczak-McKay | first2 = J. | last3 = Yilmaz | first3 = A. | title = Usefulness of cytokeratin 5/6 and AMACR applied as double sequential immunostains for diagnostic assessment of problematic prostate specimens. | journal = Am J Clin Pathol | volume = 132 | issue = 2 | pages = 211-20; quiz 307 | month = Aug | year = 2009 | doi = 10.1309/AJCPGFJP83IXZEUR | PMID = 19605815 }}</ref> p63 +ve, HMWCK +ve (mark basal cells). | | *[[CK5/6]] +ve,<ref name=pmid19605815>{{Cite journal | last1 = Trpkov | first1 = K. | last2 = Bartczak-McKay | first2 = J. | last3 = Yilmaz | first3 = A. | title = Usefulness of cytokeratin 5/6 and AMACR applied as double sequential immunostains for diagnostic assessment of problematic prostate specimens. | journal = Am J Clin Pathol | volume = 132 | issue = 2 | pages = 211-20; quiz 307 | month = Aug | year = 2009 | doi = 10.1309/AJCPGFJP83IXZEUR | PMID = 19605815 }}</ref> p63 +ve, HMWCK +ve (mark basal cells). |
| *PSA (prostate-specific antigen) +ve, PSAP (prostatic-specific acid phosphatase) +ve. | | *PSA ([[prostate-specific antigen]]) +ve, PSAP ([[prostatic-specific acid phosphatase]]) +ve. |
| | |
| | ==Sign out== |
| | ===Staining slightly abnormal - morphology not definitely abnormal=== |
| | <pre> |
| | COMMENT: |
| | Very focal AMACR staining is seen; this is interpreted as negative, in the |
| | context of no definite cytologic changes. The basal cells appear to be |
| | preserved in all of the tissue sampled. |
| | </pre> |
| | |
| | ===Compatible with previous biopsy=== |
| | <pre> |
| | COMMENT: |
| | Siderophages are seen in several cores; this is compatible with the history |
| | of a previous biopsy. |
| | </pre> |
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| =Other accessory glands= | | =Other accessory glands= |
| ==Bulbourethral gland== | | ==Bulbourethral gland== |
| *[[AKA]] ''Cowper's gland''. | | *[[AKA]] ''Cowper's gland''. |
| ===General===
| | {{Main|Bulbourethral gland}} |
| *Mucinous glands at the apex of the prostate.
| |
| | |
| ===Microscopic===
| |
| Features:<ref name=pmid9158679>{{Cite journal | last1 = Cina | first1 = SJ. | last2 = Silberman | first2 = MA. | last3 = Kahane | first3 = H. | last4 = Epstein | first4 = JI. | title = Diagnosis of Cowper's glands on prostate needle biopsy. | journal = Am J Surg Pathol | volume = 21 | issue = 5 | pages = 550-5 | month = May | year = 1997 | doi = | PMID = 9158679 }}</ref>
| |
| *Resemble (mucinous) [[salivary gland]]s.
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| | |
| DDx:
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| *[[Foamy gland carcinoma]].
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| *Mucinous metaplasia of the prostate.
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| Images:
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| *[http://pathology.mc.duke.edu/research/histo_course/mixed_saliv.jpg Mucinous/serous salivary gland (duke.edu)].
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| *[http://webpathology.com/image.asp?case=21&n=4 Cowper gland (webpathology.com)].
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| ===Stains===
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| *[[Mucicarmine]] +ve.
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| *[[PAS-D]] +ve.
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| | |
| ===IHC===
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| Features:<ref name=pmid9158679/>
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| *PSAP -ve.
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| *PSA +ve.
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| *HMWCK +ve.
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| ==Seminal vesicles== | | ==Seminal vesicles== |
| *Fern-like architecture - epithelial component clustered closely, looks like it connects.
| | {{Main|Seminal vesicles}} |
| **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.
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| *Nuclear inclusions - common.
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| Notes:
| | =Specimens= |
| *The ''ejaculatory ducts'' have the same epithelium as the seminal vesicles.<ref name=pmid12657938>{{cite journal |author=Leroy X, Ballereau C, Villers A, ''et al.'' |title=MUC6 is a marker of seminal vesicle-ejaculatory duct epithelium and is useful for the differential diagnosis with prostate adenocarcinoma |journal=Am. J. Surg. Pathol. |volume=27 |issue=4 |pages=519–21 |year=2003 |month=April |pmid=12657938 |doi= |url=}}</ref> | | *[[Prostate core biopsy]] - done transrectal. |
| | *[[Prostate chips]] (from a ''transurethral resection of the prostate'', abbreviated ''TURP'') - usu. done for [[nodular hyperplasia of the prostate gland]]; may be done in the context of obstructing cancer. |
| | *[[Radical prostatectomy]] - includes the [[seminal vesicles]]. |
| | *[[Radical cystoprostatectomy]] - includes the [[urinary bladder]] and [[seminal vesicles]].<ref>URL: [http://www.cancer.gov/dictionary?cdrid=446218 http://www.cancer.gov/dictionary?cdrid=446218]. Accessed on: 23 February 2012.</ref> |
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| Images:
| | =Approach= |
| *[http://commons.wikimedia.org/wiki/File:Seminal_vesicle_low_mag.jpg SV - showing fern-like architecture (WC)]. | | *Know the common diagnoses well. |
| *[http://commons.wikimedia.org/wiki/File:Seminal_vesicle_high_mag.jpg SV - looking vaguely like to prostate adenocarcinoma (WC)].
| | *Core biopsies - scan the slides with the 10x objective. |
| *[http://commons.wikimedia.org/wiki/File:Seminal_vesicle_intermed_mag.jpg SV - looks a bit like prostate but lumina too big (WC)]. | |
| *[http://dspace.udel.edu:8080/dspace/bitstream/19716/2016/1/cmrsvlm3.GIF SV (udel.edu)].
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| =Specimens= | | ==Common diagnoses== |
| *Prostate core biopsy - done transrectal.
| |
| *Prostate chips (from a ''transurethral resection of the prostate'', abbreviated ''TURP'') - usu. done for [[nodular hyperplasia of the prostate gland]]; may be done in the context of obstructing cancer.
| |
| *Radical prostatectomy - includes the seminal vesicles.
| |
| *Radical cystoprostatectomy - includes the urinary bladder and seminal vesicles.<ref>URL: [http://www.cancer.gov/dictionary?cdrid=446218 http://www.cancer.gov/dictionary?cdrid=446218]. Accessed on: 23 February 2012.</ref>
| |
| | |
| =Common diagnoses= | |
| *Benign. | | *Benign. |
| **Atrophy - may resemble adenocarcinoma - typically not reported. | | **[[Atrophy of the prostate|Atrophy]] - may resemble adenocarcinoma - typically not reported. |
| **Adenosis - may resemble adenocarcinoma - typically not reported. | | **[[Adenosis of the prostate|Adenosis]] - may resemble adenocarcinoma - typically not reported. |
| *Prostate adenocarcinoma. | | *[[Prostate adenocarcinoma]]. |
| **Most common Grade is 3+3=6. | | *[[HGPIN]] (high-grade prostatic intraepithelial neoplasia) - prostate adenocarcinoma precursor lesion. |
| *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. |
| *ASAP (atypical small acinar proliferation) - used if you have a few abnormal appearing glands... but can't decide between prostate adenocarcinoma & benign. | |
| *Chronic inflammation. | | *Chronic inflammation. |
| *Acute inflammation - can result in an elevated PSA and may have prompted the biopsy you're looking at. | | *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). | | *[[Nodular hyperplasia of the prostate]]; [[AKA]] ''benign prostatic hypertrophy'' (BPH). |
| **Not diagnosed on needle biopsies. | | **Not diagnosed on needle biopsies. |
| **''BPH'' is technically incorrect -- the process is a hyperplasia. | | **''BPH'' is technically incorrect -- the process is a hyperplasia. |
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| =Clinical history= | | =Clinical history= |
| *PSA (serum). | | {{Main|Prostate specific antigen}} |
| | *[[PSA]] (serum). |
| ** >10 ng/mL worrisome for prostate cancer. | | ** >10 ng/mL worrisome for prostate cancer. |
| ** Normal is age dependent - increases with age, usu. cut-off ~ 4 ng/mL. | | ** Normal is age dependent - increases with age, usu. cut-off ~ 4 ng/mL. |
| *HIFU = ''High Intensity Focused Ultrasound'' - an ablation procedure for prostate cancer.<ref>URL: [http://www.internationalhifu.com/what-is-hifu-mainmenu-132.html http://www.internationalhifu.com/what-is-hifu-mainmenu-132.html]. Accessed on: 15 June 2010.</ref> | | *HIFU = ''High Intensity Focused Ultrasound'' - an ablation procedure for prostate cancer.<ref>URL: [http://www.internationalhifu.com/what-is-hifu-mainmenu-132.html http://www.internationalhifu.com/what-is-hifu-mainmenu-132.html]. Accessed on: 15 June 2010.</ref> |
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| =Specific conditions= | | =Benign changes and remnants= |
| | ==Adenosis of the prostate gland== |
| | *[[AKA]] ''atypical adenomatous hyperplasia of the prostate gland'' (or ''atypical adenomatous hyperplasia''). |
| | {{Main|Adenosis of the prostate gland}} |
| | |
| | ==Basal cell hyperplasia of the prostate== |
| | {{Main|Basal cell hyperplasia of the prostate}} |
| | |
| | ==Atrophy of the prostate== |
| | *[[AKA]] ''atrophy''. |
| | *[[AKA]] ''prostatic atrophy''. |
| | *[[AKA]] ''atrophy of the prostate gland''. |
| | {{Main|Atrophy of the prostate gland}} |
| | |
| | ==Mesonephric remnant of the prostate gland== |
| | {{Main|Mesonephric remnant of the prostate gland}} |
| | |
| | =Benign conditions= |
| ==Prostatic nodular hyperplasia== | | ==Prostatic nodular hyperplasia== |
| *[[AKA]] ''nodular hyperplasia of the prostate''. | | *[[AKA]] ''nodular hyperplasia of the prostate''. |
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| *AKA ''benign prostatic hypertrophy''. | | *AKA ''benign prostatic hypertrophy''. |
| **This is a misnomer. It is ''not'' a hypertrophy. | | **This is a misnomer. It is ''not'' a hypertrophy. |
| | {{Main|Nodular hyperplasia of the prostate}} |
|
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| | ==Acute inflammation of the prostate gland== |
| | {{ Infobox external links |
| | | Name = {{PAGENAME}} |
| | | EHVSC = 10176 |
| | | pathprotocols = |
| | | wikipedia = |
| | | pathoutlines = |
| | }} |
| | *[[AKA]] ''prostate gland with acute inflammation''. |
| ===General=== | | ===General=== |
| *Very common. | | *A may lead to an increase in the PSA and prompt biopsy. |
| *Incidence increases with age.
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|
| |
|
| Clinical - mnemonic ''I WISH 2p'':<ref>TN06 U5</ref>
| | Note: |
| *Intermittency. | | *"[[Prostatitis]]" is considered a clinical diagnosis. |
| *Weak stream. | | **Cases are signed out as "acute inflammation". |
| *Incomplete emptying.
| | ***Some pathologists do not comment on the presence (or absence) of inflammation. |
| *Straining.
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| *Hesitancy.
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| *Post-void dribbling. | |
| *Prolonged voiding. | |
| | |
| Treatment:
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| *Medications. | |
| *Transurethral resection of the prostate (TURP). | |
|
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| ===Microscopic=== | | ===Microscopic=== |
| Features: | | Features: |
| *Stromal and/or glandular hyperplasia. | | *[[Neutrophil]]s within the glands, between the epithelial cells ''or'' within the stroma - '''key feature'''. |
| | *+/-Chronic inflammation (lymphocytes) within the surrounding stroma. |
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| Note:
| | DDx: |
| *Should '''not''' be diagnosed on core biopsy!
| | *[[Prostatic infarction]]. |
| | |
| Image:
| |
| *[http://commons.wikimedia.org/wiki/File:Nodular_hyperplasia_of_the_prostate.jpg Prostatic nodular hyperplasia (WC)]. | |
|
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|
| | ====Image==== |
| | <gallery> |
| | Image:Acute_inflammation_of_prostate.jpg| Prostate with acute inflammation. (WC/Nephron) |
| | </gallery> |
| ===Sign out=== | | ===Sign out=== |
| <pre> | | <pre> |
| PROSTATE GLAND, TRANSURETHRAL RESECTION OF THE PROSTATE (TURP): | | G. PROSTATE, LEFT LATERAL SUPERIOR, BIOPSY: |
| - BENIGN PROSTATIC TISSUE WITH GLANDULAR AND STROMAL PROLIFERATION. | | - BENIGN PROSTATE TISSUE; |
| | - FOCAL ACUTE INFLAMMATION. |
| </pre> | | </pre> |
|
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| ==Acute inflammation==
| | <pre> |
| ===General===
| | G. PROSTATE, LEFT LATERAL SUPERIOR, BIOPSY: |
| *A may lead to an increase in the PSA and prompt biopsy.
| | - BENIGN PROSTATE TISSUE; |
| | | - FOCAL ACUTE AND CHRONIC INFLAMMATION. |
| ===Microscopic===
| | </pre> |
| Features:
| |
| *[[Neutrophil]]s within the glands, between the epithelial cells ''or'' within the stroma - '''key feature'''.
| |
| | |
| Note:
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| *"Prostatitis" is considered a clinical diagnosis.
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| **Cases are signed-out as "acute inflammation".
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| ***Some pathologists do not comment on the presence (or absence) of inflammation.
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| | |
| Image:
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| *[http://commons.wikimedia.org/wiki/File:Acute_inflammation_of_prostate.jpg Prostate with acute inflammation (WC)].
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| ==Chronic inflammation not otherwise specified== | | ==Chronic inflammation not otherwise specified== |
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| *Lymphocytes within the glands, between the epithelial cells ''or'' within the stroma - '''key feature'''. | | *Lymphocytes within the glands, between the epithelial cells ''or'' within the stroma - '''key feature'''. |
|
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|
| Image:
| | Notes: |
| *[http://commons.wikimedia.org/wiki/File:Inflammation_of_prostate.jpg Prostate with chronic inflammation (WC)]. | | *Rare scattered lymphocytes are common, especially in the central portion of the gland. |
| | *"Focal" one field with a 2.2 mm diameter involved. |
|
| |
|
| | ====Image==== |
| | <gallery> |
| | Image:Inflammation_of_prostate.jpg | Prostate with chronic inflammation. (WC/Nephron) |
| | </gallery> |
| ===Sign out=== | | ===Sign out=== |
| <pre> | | <pre> |
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| ==Granulomatous prostatitis== | | ==Granulomatous prostatitis== |
| *[[AKA]] ''prostatic granuloma''.
| | {{Main|Granulomatous prostatitis}} |
| *[[AKA]] ''prostate gland granuloma''.
| |
| ===General===
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| *Common.
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| *Usually secondary to BCG treatment of [[urinary bladder cancer|bladder cancer]].
| |
| *Several classifications exist<ref name=pmid17092284>{{Cite journal | last1 = Uzoh | first1 = CC. | last2 = Uff | first2 = JS. | last3 = Okeke | first3 = AA. | title = Granulomatous prostatitis. | journal = BJU Int | volume = 99 | issue = 3 | pages = 510-2 | month = Mar | year = 2007 | doi = 10.1111/j.1464-410X.2006.06585.x | PMID = 17092284 | URL = http://onlinelibrary.wiley.com/doi/10.1111/j.1464-410X.2006.06585.x/full }}</ref> - the most commonly used is by ''Epstein & Hutchins''.
| |
| | |
| ====Epstein & Hutchins classification====
| |
| The groupings:<ref name=pmid6432674>{{Cite journal | last1 = Epstein | first1 = JI. | last2 = Hutchins | first2 = GM. | title = Granulomatous prostatitis: distinction among allergic, nonspecific, and post-transurethral resection lesions. | journal = Hum Pathol | volume = 15 | issue = 9 | pages = 818-25 | month = Sep | year = 1984 | doi = | PMID = 6432674 }}</ref>
| |
| #Non-specific.
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| #*No cause identified, usu. incidentally discovered.
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| #*Most common.
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| #Post-[[TURP]].
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| #*Palisading [[granuloma]] with necrotic core (histology similar to a [[rheumatoid nodule]]<ref name=pmid6703198>{{Cite journal | last1 = Mies | first1 = C. | last2 = Balogh | first2 = K. | last3 = Stadecker | first3 = M. | title = Palisading prostate granulomas following surgery. | journal = Am J Surg Pathol | volume = 8 | issue = 3 | pages = 217-21 | month = Mar | year = 1984 | doi = | PMID = 6703198 }}</ref><ref>URL: [http://www.humpath.com/spip.php?article18010 http://www.humpath.com/spip.php?article18010]. Accessed on: 26 September 2012.</ref>) +/- eosinophils.
| |
| #Specific.
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| #*Identifiable infectious agent, usu. BCG (in the context of treating bladder cancer), rarely [[tuberculosis]] and even more rarely various [[fungi]] and [[syphilis]].
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| #Allergic granulomatous prostatitis.
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| #*Usually associated with eosinophils.
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| #*Examples:
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| #*#[[Wegener granulomatosis]].
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| #*#[[Churg-Strauss syndrome]].
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| ===Microscopic===
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| Features:
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| *[[Granulomas]] in the prostate - '''key feature'''.
| |
| **Palisading granulomas with a necrotic core (similar to a [[rheumatoid nodule]]) consistent a prior TURP.<ref name=pmid6703198/>
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| *+/-Eosinophils.
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| | |
| Images:
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| *[http://commons.wikimedia.org/wiki/File:Granulomatous_inflammation_of_bladder_neck.jpg Granulomatous inflammation of the prostate/bladder neck - low mag. (WC)].
| |
| *[http://commons.wikimedia.org/wiki/File:Granulomatous_inflammation_of_bladder_neck_high_mag.jpg Granulomatous inflammation of the prostate/bladder neck - high mag. (WC)].
| |
| | |
| ===Stains===
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| *[[GMS stain]].
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| *[[Ziehl-Neelsen stain]].
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| | |
| Note:
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| *Stains are indicated when there is a suspicion of an infective etiology based on histomorphology or clinical information (e.g. immunosuppression).
| |
| | |
| ===Sign out===
| |
| <pre>
| |
| PROSTATE GLAND, TRANSURETHRAL RESECTION OF THE PROSTATE (TURP):
| |
| - BENIGN PROSTATIC TISSUE WITH GLANDULAR AND STROMAL PROLIFERATION.
| |
| - PALISADING GRANULOMA WITH NECROTIC CORE, SEE COMMENT.
| |
| | |
| COMMENT:
| |
| This is morphologically consistent with a post-TURP granuloma.
| |
| </pre>
| |
| | |
| ==Atrophy of the prostate==
| |
| *[[AKA]] ''atrophy''.
| |
| *[[AKA]] ''prostatic atrophy''.
| |
| ===General===
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| *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.<ref>[http://en.wikipedia.org/wiki/Prow http://en.wikipedia.org/wiki/Prow]</ref>
| |
| ***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.<ref>SN. June 3, 2009.</ref>
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| *Scant cytoplasm - usually.
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| | |
| Negatives:
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| *Nuclei like normal, i.e. nucleoli uncommon.
| |
| *Should have two cell layers, i.e. epithelial and myoepithelial (may be difficult to see).
| |
| | |
| Notes:
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| *Atrophic glands may be scattered with non-atrophic ones.
| |
| *IHC may be misleading - basal cell loss.
| |
| | |
| DDx:
| |
| *[[Atrophic prostate carcinoma]].
| |
| | |
| ====Atrophy versus cancer====
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| {| class="wikitable sortable"
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| ! Histologic feature
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| ! Atrophy
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| ! Cancer
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| |-
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| |Glandular architecture/<br>arrangement
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| |angulated glands, may <br>look like they originate <br>from one large duct
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| |round glands, <br>often back-to-back
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| |-
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| |Nuclear <br>hyperchromasia
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| |marked
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| |moderate
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| |-
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| |Cytoplasm
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| |scant/minimal
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| |moderate, may <br>be amphophilic
| |
| |-
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| |Basal cells
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| |may be visible
| |
| |absent
| |
| |-
| |
| |Nucleoli
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| |absent
| |
| |present
| |
| |-
| |
| |Secretions in <br>glands
| |
| |no
| |
| |yes - eosinophilic <br>or blue
| |
| |}
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| ===Sign out===
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| Generally, this finding is ''not'' reported; it is considered a normal finding.
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| ==Prostatic infarct== | | ==Prostatic infarct== |
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| *[http://www.sciencephoto.com/media/258565/enlarge Prostatic thrombosis (sciencephoto.com)]. | | *[http://www.sciencephoto.com/media/258565/enlarge Prostatic thrombosis (sciencephoto.com)]. |
|
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| ==Basal cell hyperplasia of the prostate== | | =Preneoplastic changes and atypical changes= |
| *[[AKA]] ''[[basal cell hyperplasia]]''.
| |
| ===General===
| |
| *Benign lesion that can be misdiagnosed as cancer.<ref name=pmid6195916>{{Cite journal | last1 = Cleary | first1 = KR. | last2 = Choi | first2 = HY. | last3 = Ayala | first3 = AG. | title = Basal cell hyperplasia of the prostate. | journal = Am J Clin Pathol | volume = 80 | issue = 6 | pages = 850-4 | month = Dec | year = 1983 | doi = | PMID = 6195916 }}</ref>
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| | |
| ===Microscopic===
| |
| Features:<ref>URL: [http://pathologyoutlines.com/prostate.html#bch http://pathologyoutlines.com/prostate.html#bch]. Accessed on: 28 June 2010.</ref>
| |
| *Low power gland architecture near normal.<ref>URL: [http://www.nature.com/modpathol/journal/v16/n6/fig_tab/3880810f1.html http://www.nature.com/modpathol/journal/v16/n6/fig_tab/3880810f1.html]. Accessed on: 28 June 2010.</ref><ref>URL: [http://www.nature.com/modpathol/journal/v16/n6/fig_tab/3880810f2.html http://www.nature.com/modpathol/journal/v16/n6/fig_tab/3880810f2.html]. Accessed on: 28 June 2010.</ref>
| |
| **Glands ''not'' as small as cancer.
| |
| **Folds in gland lumina.
| |
| *No hyperchromasia.
| |
| *Two cell populations (as in normal prostate glands).
| |
| *May have nucleoli.
| |
| | |
| DDx:
| |
| *[[HGPIN]].
| |
| *[[Prostatic adenocarcinoma]].
| |
| | |
| Image:
| |
| *[http://webpathology.com/image.asp?case=18&n=1 Basal cell hyperplasia of the prostate (webpathology.com)].
| |
| | |
| ==High-grade prostatic intraepithelial neoplasia== | | ==High-grade prostatic intraepithelial neoplasia== |
| *Abbreviated as ''HGPIN''. | | *Abbreviated as ''HGPIN''. |
| *May be referred to as ''prostatic intraepithelial neoplasia'', abbreviated ''PIN''. | | *May be referred to as ''prostatic intraepithelial neoplasia'', abbreviated ''PIN''. |
| ===General===
| | {{Main|High-grade prostatic intraepithelial neoplasia}} |
| *Thought to be a precursor lesion for prostate adenocarcinoma.
| |
| **Multifocal HGPIN considered a risk for prostate cancer on re-biopsy.<ref name=pmid21191509>{{Cite journal | last1 = Srigley | first1 = JR. | last2 = Merrimen | first2 = JL. | last3 = Jones | first3 = G. | last4 = Jamal | first4 = M. | title = Multifocal high-grade prostatic intraepithelial neoplasia is still a significant risk factor for adenocarcinoma. | journal = Can Urol Assoc J | volume = 4 | issue = 6 | pages = 434 | month = Dec | year = 2010 | doi = | PMID = 21191509 }}</ref>
| |
| **Small a small focus of 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.<ref name=pmid16406886>{{Cite journal | last1 = Herawi | first1 = M. | last2 = Kahane | first2 = H. | last3 = Cavallo | first3 = C. | last4 = Epstein | first4 = JI. | title = 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. | journal = J Urol | volume = 175 | issue = 1 | pages = 121-4 | month = Jan | year = 2006 | doi = 10.1016/S0022-5347(05)00064-9 | PMID = 16406886 }}</ref>
| |
| | |
| Low-grade prostatic intraepithelial neoplasia:
| |
| *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:
| |
| *Architectural changes - see below, usually tufting.
| |
| *Diagnosed on basis of nuclear changes.
| |
| **Hyperchromatic nuclei - '''key (low power) feature'''.
| |
| **Nucleoli present - '''key (high power) feature'''.
| |
| **Often increased N/C ratio.
| |
| **Nuclear enlargement.
| |
| *Usually epithelial hyperplasia.
| |
| | |
| Notes:
| |
| *Nucleoli should be visible with the 20x objective.
| |
| **If one uses the 40x objective... one over calls.
| |
| *May need IHC for cancer versus HGPIN.
| |
| | |
| DDx:
| |
| *[[Basal cell hyperplasia of the prostate]].
| |
| *[[Intraductal carcinoma of the prostate]].
| |
| *[[Prostatic adenocarcinoma]] - glands with HGPIN have two or more distinct cells layers.
| |
| **[[PIN-like prostatic ductal adenocarcinoma]].
| |
| *Benign prostate - HPGIN has nuclear changes.
| |
| | |
| ====HGPIN architecture====
| |
| There are several forms:<ref name=Ref_WMSP380>{{Ref WMSP|380}}</ref><ref name=pmid14739906>{{Cite journal | last1 = Bostwick | first1 = DG. | last2 = Qian | first2 = J. | title = High-grade prostatic intraepithelial neoplasia. | journal = Mod Pathol | volume = 17 | issue = 3 | pages = 360-79 | month = Mar | year = 2004 | doi = 10.1038/modpathol.3800053 | PMID = 14739906 | url=http://www.nature.com/modpathol/journal/v17/n3/pdf/3800053a.pdf }}</ref>
| |
| *Flat - uncommon.
| |
| *Tufting - common.
| |
| *Micropapillary - common.
| |
| *Cribriform - rare.
| |
| | |
| Note:
| |
| *The architectural pattern is '''not''' thought to have any prognostic significance; however, it may be useful for differentiating it from benign prostate.
| |
| | |
| Images:
| |
| *[http://commons.wikimedia.org/wiki/File:High-grade_prostatic_intraepithelial_neoplasia_low_mag.jpg HGPIN - low mag. (WC)].
| |
| *[http://commons.wikimedia.org/wiki/File:High-grade_prostatic_intraepithelial_neoplasia_intermed_mag.jpg HGPIN - intermed. mag. (WC)].
| |
| *[http://commons.wikimedia.org/wiki/File:High-grade_prostatic_intraepithelial_neoplasia_high_mag.jpg HGPIN - high mag. (WC)].
| |
| | |
| ===IHC===
| |
| *HGPIN: AMACR +ve, p63 +ve, HMWCK +ve.
| |
| *Cancer: AMACR +ve, p63 -ve, HMWCK -ve.
| |
| *Normal: AMACR -ve, p63 +ve, HMWCK +ve.
| |
| | |
| ===Sign out===
| |
| <pre>
| |
| A. PROSTATE, RIGHT LATERAL SUPERIOR, BIOPSY:
| |
| - HIGH-GRADE PROSTATIC INTRAEPITHELIAL NEOPLASIA;
| |
| - NEGATIVE FOR MALIGNANCY.
| |
| </pre>
| |
|
| |
|
| ==Atypical small acinar proliferation== | | ==Atypical small acinar proliferation== |
Line 424: |
Line 247: |
| *[[AKA]] ''suspicious for carcinoma''.<ref>THvdK. 19 June 2010.</ref> | | *[[AKA]] ''suspicious for carcinoma''.<ref>THvdK. 19 June 2010.</ref> |
| **''ASAP'' is preferred as it does not contain the word ''carcinoma'' and, thus, cannot be misread as ''carcinoma'', i.e. positive for malignancy. | | **''ASAP'' is preferred as it does not contain the word ''carcinoma'' and, thus, cannot be misread as ''carcinoma'', i.e. positive for malignancy. |
| | {{Main|Atypical small acinar proliferation}} |
|
| |
|
| ===General===
| | =Prostate cancer= |
| *It is a [[waffle diagnosis]], i.e. it is not considered an entity with a distinct pathobiology.<ref name=pmid17378841>{{cite journal |author=Flury SC, Galgano MT, Mills SE, Smolkin ME, Theodorescu D |title=Atypical small acinar proliferation: biopsy artefact or distinct pathological entity |journal=BJU International |volume=99 |issue=4 |pages=780-5 |year=2007 |month=January |pmid= 17378841 |doi= |url=http://www3.interscience.wiley.com/journal/118508438/abstract}}</ref>
| | {{Main|Prostate cancer}} |
| **Analogous to ''[[ASCUS]]'' on a pap test.
| | This is a big topic that is dealt with in its own article. |
| *ASAP should be used sparingly.
| |
| **One benchmark is < 3-5% of biopsies.<ref>THvdK. 19 June 2010.</ref>
| |
| *Never diagnosed on excision, i.e. prostatectomy specimen.
| |
| | |
| ====Association with adenocarcinoma====
| |
| *On subsequent [[biopsy]] - chance of finding [[adenocarcinoma]] is approximately 40%; this is higher than if there is [[high-grade prostatic intraepithelial neoplasia]] (HGPIN).<ref>{{cite journal |author=Leite KR, Camara-Lopes LH, Cury J, Dall'oglio MF, Sañudo A, Srougi M |title=Prostate cancer detection at rebiopsy after an initial benign diagnosis: results using sextant extended prostate biopsy |journal=Clinics |volume=63 |issue=3 |pages=339–42 |year=2008 |month=June |pmid=18568243 |doi= |url=http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1807-59322008000300009&lng=en&nrm=iso&tlng=en}}</ref>
| |
| | |
| ====Management====
| |
| *ASAP is considered an indication for re-biopsy;<ref>{{cite journal |author=Bostwick DG, Meiers I |title=Atypical small acinar proliferation in the prostate: clinical significance in 2006 |journal=Arch. Pathol. Lab. Med. |volume=130 |issue=7 |pages=952–7 |year=2006 |month=July |pmid=16831049 |doi= |url=http://journals.allenpress.com/jrnlserv/?request=get-abstract&issn=0003-9985&volume=130&page=952}}</ref> in one survey of [[urologist]]s<ref>{{cite journal |author=Rubin MA, Bismar TA, Curtis S, Montie JE |title=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? |journal=Am. J. Surg. Pathol. |volume=28 |issue=7 |pages=946–52 |year=2004 |month=July |pmid=15223967 |doi= |url=}}</ref> 41/42 (~98%) of respondents considered it a sufficient reason to re-biopsy.
| |
| | |
| ===Microscopic===
| |
| Features:
| |
| *Atypical appearing acini.
| |
| *Limited extent, e.g. 2-3 glands.
| |
| | |
| Notes:
| |
| *IHC not contributory.
| |
| *Deeper cuts didn't yield anything - '''important'''.
| |
| | |
| DDx:
| |
| *[[Prostatic adenocarcinoma]].
| |
| | |
| ==Intraductal carcinoma of the prostate==
| |
| *[[AKA]] ''intraductal carcinoma''.
| |
| *[[AKA]] ''intraductal prostate carcinoma''.
| |
| ===General===
| |
| *Associated with a poor prognosis.<ref name=pmid19246509>{{Cite journal | last1 = Henry | first1 = PC. | last2 = Evans | first2 = AJ. | title = Intraductal carcinoma of the prostate: a distinct histopathological entity with important prognostic implications. | journal = J Clin Pathol | volume = 62 | issue = 7 | pages = 579-83 | month = Jul | year = 2009 | doi = 10.1136/jcp.2009.065003 | PMID = 19246509 }}</ref>
| |
| *Strong association with aggressive invasive carcinomas on prostatectomy when identified in isolation on biopsy.<ref name=pmid20723921>{{Cite journal | last1 = Robinson | first1 = BD. | last2 = Epstein | first2 = JI. | title = Intraductal carcinoma of the prostate without invasive carcinoma on needle biopsy: emphasis on radical prostatectomy findings. | journal = J Urol | volume = 184 | issue = 4 | pages = 1328-33 | month = Oct | year = 2010 | doi = 10.1016/j.juro.2010.06.017 | PMID = 20723921 }}</ref>
| |
| | |
| ===Microscopic===
| |
| Features:
| |
| *Malignant cells in glands with basal cells - '''key feature'''.
| |
| **Two cell populations:
| |
| **#Obviously malignant cells with enlarged nuclei, granular chromatin, hyperchromasia and nucleoli.
| |
| **#Cells with pale cytoplasm and smaller nuclei.
| |
| | |
| DDx:
| |
| *[[HGPIN]].
| |
| | |
| ===IHC===
| |
| Features - basal cells present:
| |
| *HMWK +ve.
| |
|
| |
|
| =See also= | | =See also= |
Line 478: |
Line 260: |
| {{reflist|2}} | | {{reflist|2}} |
|
| |
|
| =External links=
| |
| *[http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2006/prostate06_ckw.pdf CAP prostate check list] - cap.org.
| |
| *[http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2006/prostate06_ckw.pdf CAP prostate protocol] - cap.org.
| |
| *[http://162.129.103.34/prostate/ Gleason score quiz] - Johns Hopkins Prostate Center.
| |
|
| |
|
| [[Category: Genitourinary pathology]] | | [[Category: Genitourinary pathology]] |