Difference between revisions of "Atypical small acinar proliferation"

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#redirect [[Prostate_gland#Atypical_small_acinar_proliferation]]
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Atypical small acinar proliferation - alt -- intermed mag.jpg
| Width      =
| Caption    = Atypical small acinar proliferation - top-left of image. [[H&E stain]].
| Synonyms  = suspicious for prostate carcinoma
| Micro      = morphology of prostate carcinoma but less than 6 glands (major criteria for prostate carcinoma: abnormal architecture (increased gland density, usu. small circular glands, "infiltrative growth" pattern), basal cells lost, cytological abnormalities (nuclear enlargement, nucleoli); minor criteria for prostate carcinoma: nuclear hyperchromasia, wispy blue mucin, pink amorphous secretions, intraluminal crystalloid, amphophilic cytoplasm, adjacent HGPIN, mitoses)
| Subtypes  =
| LMDDx      = [[prostate adenocarcinoma]], benign prostate
| Stains    =
| IHC        = AMACR +ve, [[CK34betaE12]] -ve, p63 -ve, PSA +ve
| EM        =
| Molecular  =
| IF        =
| Gross      =
| Grossing  =
| Site      = [[prostate gland]]
| Assdx      =
| Syndromes  =
| Clinicalhx =
| Signs      =
| Symptoms  =
| Prevalence = ~3-5% of prostate biopsies
| Bloodwork  = +/-PSA elevated
| Rads      =
| Endoscopy  =
| Prognosis  = increased risk of prostate carcinoma
| Other      = [[waffle diagnosis]] - used only on biopsy
| ClinDDx    =
| Tx        = re-biopsy, close follow-up
}}
'''Atypical small acinar proliferation''', abbreviated '''ASAP''', is a small number of [[prostate gland|prostate glands]] that are abnormal and suspicious for [[prostate carcinoma|carcinoma]].
 
It is also known as '''suspicious for carcinoma'''.<ref name=THvdK>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.
 
==General==
*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>
**Analogous to ''[[ASCUS]]'' on a pap test.
*ASAP should be used sparingly.
**One benchmark is < 3-5% of biopsies.<ref name=THvdK>THvdK. 19 June 2010.</ref>
*Never diagnosed on excision, i.e. prostatectomy specimen.
*Cancers diagnosed in biopsies after ASAP are not more frequently clinically significant than cancers diagnosed after a diagnosis of benign or HGPIN.<ref name=pmid28888752>{{Cite journal  | last1 = Wiener | first1 = S. | last2 = Haddock | first2 = P. | last3 = Cusano | first3 = J. | last4 = Staff | first4 = I. | last5 = McLaughlin | first5 = T. | last6 = Wagner | first6 = J. | title = Incidence of Clinically Significant Prostate Cancer After a Diagnosis of Atypical Small Acinar Proliferation, High-grade Prostatic Intraepithelial Neoplasia, or Benign Tissue. | journal = Urology | volume = 110 | issue =  | pages = 161-165 | month = Dec | year = 2017 | doi = 10.1016/j.urology.2017.08.040 | PMID = 28888752 }}</ref>
 
===Association with adenocarcinoma===
*On a subsequent biopsy the chance of finding [[adenocarcinoma]] is approximately 40%; this is higher than if there is [[high-grade prostatic intraepithelial neoplasia]] (HGPIN).<ref name=pmid18568243>{{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 generally considered an indication for re-biopsy;<ref name=pmid16831049>{{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 study<ref name=pmid15223967>{{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 urologists considered it a sufficient reason to re-biopsy.
 
==Microscopic==
Features:
*Atypical appearing acini - see criteria for ''[[prostate adenocarcinoma]]''.
*Limited extent - '''key feature'''.
**Less than six glands.†
 
Note:
*Deeper cuts didn't yield anything - '''important'''.
*† There is no agreed upon minimum number of glands; however, one paper suggests that agreement among experts is low with 5 or less glands.<ref name=pmid20061936>{{Cite journal  | last1 = Van der Kwast | first1 = TH. | last2 = Evans | first2 = A. | last3 = Lockwood | first3 = G. | last4 = Tkachuk | first4 = D. | last5 = Bostwick | first5 = DG. | last6 = Epstein | first6 = JI. | last7 = Humphrey | first7 = PA. | last8 = Montironi | first8 = R. | last9 = Van Leenders | first9 = GJ. | title = Variability in diagnostic opinion among pathologists for single small atypical foci in prostate biopsies. | journal = Am J Surg Pathol | volume = 34 | issue = 2 | pages = 169-77 | month = Feb | year = 2010 | doi = 10.1097/PAS.0b013e3181c7997b | PMID = 20061936 }}</ref>
 
DDx:
*[[Prostatic adenocarcinoma]].
*Benign prostate.
**Adenosis of the prostate.
**Sclerosing adenosis of the prostate.
 
===Images===
<gallery>
Image: Atypical small acinar proliferation -- low mag.jpg | ASAP - low mag.
Image: Atypical small acinar proliferation -- intermed mag.jpg | ASAP - intermed. mag.
Image: Atypical small acinar proliferation - alt -- intermed mag.jpg | ASAP - intermed. mag.
Image: Atypical small acinar proliferation -- high mag.jpg | ASAP - high mag.
Image: Atypical small acinar proliferation -- very high mag.jpg | ASAP - very high mag.
</gallery>
 
==IHC==
Usually stains like cancer:
*AMACR +ve.
*CK34betaE12 -ve.
*p63 -ve.
 
Note:
*Often ''not'' contributory.
 
===Images===
<gallery>
Image: Atypical small acinar proliferation - AMACR-CK34betaE12 -- intermed mag.jpg | ASAP - intermed. mag.
Image: Atypical small acinar proliferation - AMACR-CK34betaE12 -- high mag.jpg | ASAP - high mag.
Image: Atypical small acinar proliferation - AMACR-CK34betaE12 -- very high mag.jpg | ASAP - very high mag.
Image: Atypical small acinar proliferation - AMACR-CK34betaE12 - alt -- very high mag.jpg | ASAP - very high mag.
</gallery>
 
==Sign out==
<pre>
C. Prostate, Left Base:
- Atypical prostatic glands, suspicious for microfocus of adenocarcinoma.
</pre>
 
===Block letters===
<pre>
K. PROSTATE, LEFT LATERAL INTERIOR, BIOPSY:
- ATYPICAL SMALL ACINAR PROLIFERATION.
</pre>
 
==See also==
*[[Waffle diagnosis]].
*[[Prostate gland]].
*[[Atypical intraductal proliferation]].
 
==References==
{{Reflist|2}}


[[Category:Diagnosis]]
[[Category:Diagnosis]]

Latest revision as of 03:28, 12 October 2022

Atypical small acinar proliferation
Diagnosis in short

Atypical small acinar proliferation - top-left of image. H&E stain.
Synonyms suspicious for prostate carcinoma
LM morphology of prostate carcinoma but less than 6 glands (major criteria for prostate carcinoma: abnormal architecture (increased gland density, usu. small circular glands, "infiltrative growth" pattern), basal cells lost, cytological abnormalities (nuclear enlargement, nucleoli); minor criteria for prostate carcinoma: nuclear hyperchromasia, wispy blue mucin, pink amorphous secretions, intraluminal crystalloid, amphophilic cytoplasm, adjacent HGPIN, mitoses)
LM DDx prostate adenocarcinoma, benign prostate
IHC AMACR +ve, CK34betaE12 -ve, p63 -ve, PSA +ve
Site prostate gland
Prevalence ~3-5% of prostate biopsies
Blood work +/-PSA elevated
Prognosis increased risk of prostate carcinoma
Other waffle diagnosis - used only on biopsy
Treatment re-biopsy, close follow-up

Atypical small acinar proliferation, abbreviated ASAP, is a small number of prostate glands that are abnormal and suspicious for carcinoma.

It is also known as suspicious for carcinoma.[1] ASAP is preferred as it does not contain the word carcinoma and, thus, cannot be misread as carcinoma, i.e. positive for malignancy.

General

  • It is a waffle diagnosis, i.e. it is not considered an entity with a distinct pathobiology.[2]
    • Analogous to ASCUS on a pap test.
  • ASAP should be used sparingly.
    • One benchmark is < 3-5% of biopsies.[1]
  • Never diagnosed on excision, i.e. prostatectomy specimen.
  • Cancers diagnosed in biopsies after ASAP are not more frequently clinically significant than cancers diagnosed after a diagnosis of benign or HGPIN.[3]

Association with adenocarcinoma

Management

  • ASAP is generally considered an indication for re-biopsy;[5] in one study[6] 41/42 (~98%) of urologists considered it a sufficient reason to re-biopsy.

Microscopic

Features:

  • Atypical appearing acini - see criteria for prostate adenocarcinoma.
  • Limited extent - key feature.
    • Less than six glands.†

Note:

  • Deeper cuts didn't yield anything - important.
  • † There is no agreed upon minimum number of glands; however, one paper suggests that agreement among experts is low with 5 or less glands.[7]

DDx:

Images

  • ASAP - low mag.

  • ASAP - intermed. mag.

  • ASAP - intermed. mag.

  • ASAP - high mag.

  • ASAP - very high mag.

IHC

Usually stains like cancer:

  • AMACR +ve.
  • CK34betaE12 -ve.
  • p63 -ve.

Note:

  • Often not contributory.

Images

  • ASAP - intermed. mag.

  • ASAP - high mag.

  • ASAP - very high mag.

  • ASAP - very high mag.

Sign out

C. Prostate, Left Base:
- Atypical prostatic glands, suspicious for microfocus of adenocarcinoma.

Block letters

K. PROSTATE, LEFT LATERAL INTERIOR, BIOPSY:
- ATYPICAL SMALL ACINAR PROLIFERATION.

See also

References

  1. ↑ 1.0 1.1 THvdK. 19 June 2010.
  2. ↑ 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.
  3. ↑ Wiener, S.; Haddock, P.; Cusano, J.; Staff, I.; McLaughlin, T.; Wagner, J. (Dec 2017). "Incidence of Clinically Significant Prostate Cancer After a Diagnosis of Atypical Small Acinar Proliferation, High-grade Prostatic Intraepithelial Neoplasia, or Benign Tissue.". Urology 110: 161-165. doi:10.1016/j.urology.2017.08.040. PMID 28888752.
  4. ↑ 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.
  5. ↑ 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.
  6. ↑ 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.
  7. ↑ Van der Kwast, TH.; Evans, A.; Lockwood, G.; Tkachuk, D.; Bostwick, DG.; Epstein, JI.; Humphrey, PA.; Montironi, R. et al. (Feb 2010). "Variability in diagnostic opinion among pathologists for single small atypical foci in prostate biopsies.". Am J Surg Pathol 34 (2): 169-77. doi:10.1097/PAS.0b013e3181c7997b. PMID 20061936.
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