Difference between revisions of "Prostate gland"

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Prostate gland (view source)

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=Specific conditions=
=Specific conditions=
==Prostatic nodular hyperplasia==
==Prostatic nodular hyperplasia==
*[[AKA]] ''nodular hyperplasia of the prostate'', AKA ''benign prostatic hyperplasia'' (abbreviated BPH).
*[[AKA]] ''nodular hyperplasia of the prostate''.
*AKA ''benign prostatic hyperplasia'' (abbreviated BPH).
*AKA ''benign prostatic hypertrophy''.
**This is a misnomer. It is ''not'' a hypertrophy.


===General===
===General===
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====General====
====General====
*Common.
*Common.
*Usu. secondary to BCG treatment of bladder cancer.
*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''.
*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''.


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*[http://commons.wikimedia.org/wiki/File:Granulomatous_inflammation_of_bladder_neck_high_mag.jpg Granulomatous inflammation of the prostate/bladder neck - high 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)].


==Atrophy==
==Atrophy of the prostate==
*[[AKA]] ''atrophy''.
===General===
===General===
*Small glands (may mimic Gleason score 3 pattern).
*Small glands (may mimic Gleason score 3 pattern).
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*Nuclei like normal, i.e. nucleoli uncommon.
*Nuclei like normal, i.e. nucleoli uncommon.
*Should have two cell layers, i.e. epithelial and myoepithelial (may be difficult to see).
*Should have two cell layers, i.e. epithelial and myoepithelial (may be difficult to see).
Notes:
*Atrophic glands may be scattered with non-atrophic ones.
*IHC may be misleading - basal cell loss.
DDx:
*[[Atrophic prostate carcinoma]].


===Atrophy versus cancer===
===Atrophy versus cancer===
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==Prostatic infarct==
==Prostatic infarct==
*[[AKA]] ''prostatic infarction''.
*[[AKA]] ''prostatic [[infarction]]''.
===General===
===General===
*Rare < 0.1% of core biopsies.<ref name=pmid11023099>{{Cite journal  | last1 = Milord | first1 = RA. | last2 = Kahane | first2 = H. | last3 = Epstein | first3 = JI. | title = Infarct of the prostate gland: experience on needle biopsy specimens. | journal = Am J Surg Pathol | volume = 24 | issue = 10 | pages = 1378-84 | month = Oct | year = 2000 | doi =  | PMID = 11023099 }}</ref>
*Rare < 0.1% of core biopsies.<ref name=pmid11023099>{{Cite journal  | last1 = Milord | first1 = RA. | last2 = Kahane | first2 = H. | last3 = Epstein | first3 = JI. | title = Infarct of the prostate gland: experience on needle biopsy specimens. | journal = Am J Surg Pathol | volume = 24 | issue = 10 | pages = 1378-84 | month = Oct | year = 2000 | doi =  | PMID = 11023099 }}</ref>
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===Microscopic===
===Microscopic===
Features:
Features:
*Classic findings of necrosis:
*Classic findings of [[necrosis]]:
**Karyolysis (loss of nuclei), karyorrhexis (frag. of nuclei), pyknosis (small shrunken nuclei).
**Karyolysis (loss of nuclei), karyorrhexis (frag. of nuclei), pyknosis (small shrunken nuclei).
*+/-Squamous metaplasia of prostate gland epithelium.
*+/-Squamous metaplasia of prostate gland epithelium.
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*[[AKA]] ''[[basal cell hyperplasia]]''.
*[[AKA]] ''[[basal cell hyperplasia]]''.
===General===
===General===
*Atypical appearing glands - typically in transition zone.<ref>URL: [http://pathologyoutlines.com/prostate.html#bch http://pathologyoutlines.com/prostate.html#bch]. Accessed on: 19 June 2010.</ref>
*May have nucleoli.
*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>
*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>


===Differentiating between diagnoses===
===Microscopic===
Basal cell hyperplasia vs. cancer:<ref>URL: [http://pathologyoutlines.com/prostate.html#bch http://pathologyoutlines.com/prostate.html#bch]. Accessed on: 28 June 2010.</ref>
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>
*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.
**Glands ''not'' as small as cancer.
**Folds in gland lumina.
**Folds in gland lumina.
**No hyperchromasia.
*No hyperchromasia.
**Two cell populations (as in normal prostate glands).
*Two cell populations (as in normal prostate glands).
*May have nucleoli.
 
DDx:
*[[HGPIN]].
*[[Prostatic adenocarcinoma]].


Image:
Image:
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*May be referred to as ''prostatic intraepithelial neoplasia'', abbreviated ''PIN''.
*May be referred to as ''prostatic intraepithelial neoplasia'', abbreviated ''PIN''.
===General===
===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).<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>
*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:
Low-grade prostatic intraepithelial neoplasia:
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Features:
Features:
*Diagnosed on basis of nuclear changes.
*Diagnosed on basis of nuclear changes.
**Hyperchromatic nuclei.
**Hyperchromatic nuclei - '''key (low power) feature'''.
**Nucleoli present - '''key (high power) feature'''.
**Nucleoli present - '''key (high power) feature'''.
**Often increased N/C ratio.
**Often increased N/C ratio.
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*Usually epithelial hyperplasia.
*Usually epithelial hyperplasia.


Note:
Notes:
*Nucleoli should be visible with the 20x objective.
*Nucleoli should be visible with the 20x objective.
**If one uses the 40x objective... one over calls.
**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====
====HGPIN architecture====
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Note:  
Note:  
*The architectural pattern is NOT thought to have any prognostic significance -- may, however, be useful for picking it out from benign prostate.
*The architectural pattern is NOT thought to have any prognostic significance; however, it may be useful for differentiating it from benign prostate.


Images:
Images:
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*[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_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)].
*[http://commons.wikimedia.org/wiki/File:High-grade_prostatic_intraepithelial_neoplasia_high_mag.jpg HGPIN - high mag. (WC)].
====Differentiating between the 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===
===IHC===
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==Atypical small acinar proliferation==
==Atypical small acinar proliferation==
*Abbreviated ''ASAP''.
*Abbreviated ''ASAP''.
*[[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.
===General===
===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>
*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>
**It is the same as ''suspicious for carcinoma''.<ref>THvdK. 19 June 2010.</ref>
**Analogous to ''[[ASCUS]]'' on a pap test.
***''ASAP'' is preferred as it does not contain the word ''carcinoma'' and, thus, cannot be misread as ''carcinoma'', i.e. positive for malignancy.
*ASAP should be used sparingly.
**Analogous to ''ASCUS'' on a pap test.
**One benchmark is < 3-5% of biopsies.<ref>THvdK. 19 June 2010.</ref>
**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.
*Never diagnosed on excision, i.e. prostatectomy specimen.


===Histologic characteristics===
====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.
*Atypical appearing acini.
*Limited extent, e.g. 2-3 glands.
*Limited extent, e.g. 2-3 glands.
Notes:
*IHC not contributory.
*IHC not contributory.
*Deeper cuts didn't yield anything.
*Deeper cuts didn't yield anything - '''important'''.


===Association with adenocarcinoma===
DDx:
*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>
*[[Prostatic adenocarcinoma]].


===Management===
==Intraductal carcinoma of the prostate==
*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.
*[[AKA]] ''intraductal carcinoma''.
 
*[[AKA]] ''intraductal prostate carcinoma''.
==Intraductal carcinoma==
===General===
===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>
*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===
===Microscopic===
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**#Obviously malignant cells with enlarged nuclei, granular chromatin, hyperchromasia and nucleoli.
**#Obviously malignant cells with enlarged nuclei, granular chromatin, hyperchromasia and nucleoli.
**#Cells with pale cytoplasm and smaller nuclei.
**#Cells with pale cytoplasm and smaller nuclei.
DDx:
*[[HGPIN]].
===IHC===
Features - basal cells present:
*HMWK +ve.


==Prostatic adenocarcinoma==
==Prostatic adenocarcinoma==
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#*Amphopilic is said to be ''bluish-red''<ref>URL: [http://pancreaticcancer2000.com/page1.htm http://pancreaticcancer2000.com/page1.htm]. Accessed on: 3 June 2010.</ref> -- though might also be described as ''blue-grey''.  
#*Amphopilic is said to be ''bluish-red''<ref>URL: [http://pancreaticcancer2000.com/page1.htm http://pancreaticcancer2000.com/page1.htm]. Accessed on: 3 June 2010.</ref> -- though might also be described as ''blue-grey''.  
#**Image: [http://www.webpathology.com/image.asp?n=4&Case=20 Amphophilic cytoplasm is prostate carcinoma].
#**Image: [http://www.webpathology.com/image.asp?n=4&Case=20 Amphophilic cytoplasm is prostate carcinoma].
#Adjacent HGPIN.
#Adjacent [[HGPIN]].
#Mitoses - quite rare.
#Mitoses - quite rare.


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*AMACR +ve.
*AMACR +ve.
*AR +ve -- in prostate confined cancer.
*AR +ve -- in prostate confined cancer.
**Usu. -ve in LN +ve disease.<ref name=pmid20878946>{{Cite journal  | last1 = Fleischmann | first1 = A. | last2 = Rocha | first2 = C. | last3 = Schobinger | first3 = S. | last4 = Seiler | first4 = R. | last5 = Wiese | first5 = B. | last6 = Thalmann | first6 = GN. | title = Androgen receptors are differentially expressed in Gleason patterns of prostate cancer and down-regulated in matched lymph node metastases. | journal = Prostate | volume = 71 | issue = 5 | pages = 453-60 | month = Apr | year = 2011 | doi = 10.1002/pros.21259 | PMID = 20878946 }}</ref> *PSA +ve.  
**Usu. -ve in LN +ve disease.<ref name=pmid20878946>{{Cite journal  | last1 = Fleischmann | first1 = A. | last2 = Rocha | first2 = C. | last3 = Schobinger | first3 = S. | last4 = Seiler | first4 = R. | last5 = Wiese | first5 = B. | last6 = Thalmann | first6 = GN. | title = Androgen receptors are differentially expressed in Gleason patterns of prostate cancer and down-regulated in matched lymph node metastases. | journal = Prostate | volume = 71 | issue = 5 | pages = 453-60 | month = Apr | year = 2011 | doi = 10.1002/pros.21259 | PMID = 20878946 }}</ref>  
*PSA +ve.  
*PSAP +ve.
*PSAP +ve.
**May be positive in hindgut [[neuroendocrine tumour]]s.<ref name=pmid>{{Cite journal  | last1 = Azumi | first1 = N. | last2 = Traweek | first2 = ST. | last3 = Battifora | first3 = H. | title = Prostatic acid phosphatase in carcinoid tumors. Immunohistochemical and immunoblot studies. | journal = Am J Surg Pathol | volume = 15 | issue = 8 | pages = 785-90 | month = Aug | year = 1991 | doi =  | PMID = 1712549 }}</ref>
**May be positive in hindgut [[neuroendocrine tumour]]s.<ref name=pmid>{{Cite journal  | last1 = Azumi | first1 = N. | last2 = Traweek | first2 = ST. | last3 = Battifora | first3 = H. | title = Prostatic acid phosphatase in carcinoid tumors. Immunohistochemical and immunoblot studies. | journal = Am J Surg Pathol | volume = 15 | issue = 8 | pages = 785-90 | month = Aug | year = 1991 | doi =  | PMID = 1712549 }}</ref>
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| '''Image'''
| '''Image'''
|-
|-
| Seminal vesicles
| Seminal vesicles / ejaculatory ducts
| lipofuscin (yellow granular material in cytoplasm), smudge cells (smeared appearance + hyperchromatic)
| lipofuscin (yellow granular material in cytoplasm), smudge cells (smeared appearance + hyperchromatic)
| fern-like arrangement of epithelium (low power), nucleoli, surrounded by muscle, +/- nuclear inclusions
| 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.
| involvement by cancer changes staging, lipofuscin may be present in prostate, often has marked nuc. size var.; location: usu. base of prostate
| [http://commons.wikimedia.org/wiki/File:Seminal_vesicle_high_mag.jpg SV - high mag. (WC)], [http://commons.wikimedia.org/wiki/File:Seminal_vesicle_low_mag.jpg SV - low mag. (WC)]
| [http://commons.wikimedia.org/wiki/File:Seminal_vesicle_high_mag.jpg SV - high mag. (WC)], [http://commons.wikimedia.org/wiki/File:Seminal_vesicle_low_mag.jpg SV - low mag. (WC)]
|-
|-
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===Grading===
===Grading===
There is only one grading system that any one talks about...
There is only one grading system that any one talks about - the Gleason system.


====Gleason grading system====
====Gleason grading system====
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Testing yourself:
Testing yourself:
*There is a nice test-yourself quiz from Johns Hopkins: [http://162.129.103.34/prostate/ http://162.129.103.34/prostate/].
*There is a nice test-yourself quiz from Johns Hopkins: [http://162.129.103.34/prostate/ http://162.129.103.34/prostate/].
**It was studied in a paper by Kronz et al..<ref name=pmid11014569>{{Cite journal  | last1 = Kronz | first1 = JD. | last2 = Silberman | first2 = MA. | last3 = Allsbrook | first3 = WC. | last4 = Bastacky | first4 = SI. | last5 = Burks | first5 = RT. | last6 = Cina | first6 = SJ. | last7 = Mills | first7 = SE. | last8 = Ross | first8 = JS. | last9 = Sakr | first9 = WA. | last10 = Tomaszewski | first10 = JE. | last11 = True | first11 = LD. | last12 = Ulbright | first12 = TM. | last13 = Weinstein | first13 = MW. | last14 = Yantiss | first14 = RK. | last15 = Young | first15 = RH. | last16 = Epstein | first16 = JI. | title = Pathology residents' use of a Web-based tutorial to improve Gleason grading of prostate carcinoma on needle biopsies. | journal = Hum Pathol | volume = 31 | issue = 9 | pages = 1044-50 | month = Sep | year = 2000 | doi = 10.1053/hupa.2000.16278 | PMID = 11014569 }}</ref>
**It was studied in a paper by Kronz et al.<ref name=pmid11014569>{{Cite journal  | last1 = Kronz | first1 = JD. | last2 = Silberman | first2 = MA. | last3 = Allsbrook | first3 = WC. | last4 = Bastacky | first4 = SI. | last5 = Burks | first5 = RT. | last6 = Cina | first6 = SJ. | last7 = Mills | first7 = SE. | last8 = Ross | first8 = JS. | last9 = Sakr | first9 = WA. | last10 = Tomaszewski | first10 = JE. | last11 = True | first11 = LD. | last12 = Ulbright | first12 = TM. | last13 = Weinstein | first13 = MW. | last14 = Yantiss | first14 = RK. | last15 = Young | first15 = RH. | last16 = Epstein | first16 = JI. | title = Pathology residents' use of a Web-based tutorial to improve Gleason grading of prostate carcinoma on needle biopsies. | journal = Hum Pathol | volume = 31 | issue = 9 | pages = 1044-50 | month = Sep | year = 2000 | doi = 10.1053/hupa.2000.16278 | PMID = 11014569 }}</ref>


=====Gleason pattern 1 & 2=====  
=====Gleason pattern 1 & 2=====  
*Academic thing - you can forget about 'em.
*Use strongly discouraged by a number of GU pathology experts.
 
Notes:
*Gleason pattern 1 - probably represents what today would be called ''adenosis''.
**Should never be used.
*Gleason pattern 2 - used by few GU pathology experts occasionally.
**Generally, should '''not''' be diagnosed on core biopsies.<ref name=pmid20006878>{{Cite journal  | last1 = Epstein | first1 = JI. | title = An update of the Gleason grading system. | journal = J Urol | volume = 183 | issue = 2 | pages = 433-40 | month = Feb | year = 2010 | doi = 10.1016/j.juro.2009.10.046 | PMID = 20006878 }}</ref>


=====Gleason pattern 3=====
=====Gleason pattern 3=====
*Glands smaller than normal prostate glands + loss of epithelial folding.
*Glands smaller than normal prostate glands + loss of epithelial folding.
*Can draw a line around each gland.
*Can draw a line around each gland.
*May have ''gland branching''.
**Glands have a X, U, V or Y shape.


Notes:
Notes:
*All ''cribriform'' is now classified as Gleason pattern 4.<ref name=pmid20006878>{{cite journal |author=Epstein JI |title=An update of the Gleason grading system |journal=J. Urol. |volume=183 |issue=2 |pages=433–40 |year=2010 |month=February |pmid=20006878 |doi=10.1016/j.juro.2009.10.046 |url=}}</ref>
*Gland lumina should be seen.
*All ''cribriform'' is now, generally, classified as Gleason pattern 4.<ref name=pmid20006878>{{cite journal |author=Epstein JI |title=An update of the Gleason grading system |journal=J. Urol. |volume=183 |issue=2 |pages=433–40 |year=2010 |month=February |pmid=20006878 |doi=10.1016/j.juro.2009.10.046 |url=}}</ref>


=====Gleason pattern 4=====
=====Gleason pattern 4=====
Line 544: Line 586:
Special types of prostate cancer have set Gleason scores:<ref name=pmid14976541>{{cite journal |author=Grignon DJ |title=Unusual subtypes of prostate cancer |journal=Mod. Pathol. |volume=17 |issue=3 |pages=316–27 |year=2004 |month=March |pmid=14976541 |doi=10.1038/modpathol.3800052 |url=}}</ref>  
Special types of prostate cancer have set Gleason scores:<ref name=pmid14976541>{{cite journal |author=Grignon DJ |title=Unusual subtypes of prostate cancer |journal=Mod. Pathol. |volume=17 |issue=3 |pages=316–27 |year=2004 |month=March |pmid=14976541 |doi=10.1038/modpathol.3800052 |url=}}</ref>  
{| class="wikitable sortable"  style="margin-left:auto;margin-right:auto"
{| class="wikitable sortable"  style="margin-left:auto;margin-right:auto"
| Special type
! Special type
| Gleason pattern
! Gleason pattern
| Comment
! Comment
|-
|-
|Ductal carcinoma
|Ductal carcinoma
Line 634: Line 676:
#Percent area involved, i.e. how much of the core is cancer, e.g. "75% of specimen is tumour".
#Percent area involved, i.e. how much of the core is cancer, e.g. "75% of specimen is tumour".
#Percent area involved that is Gleason pattern 4 or 5, e.g. "25% of the tumour is Gleason pattern 4 or 5".
#Percent area involved that is Gleason pattern 4 or 5, e.g. "25% of the tumour is Gleason pattern 4 or 5".
#Presence of perineural invasion.
#Presence of [[perineural invasion]].
#Presence of extension into fat (extraprostatic extension).
#Presence of extension into fat (extraprostatic extension).


Line 686: Line 728:
Note:
Note:
*Vaguely similar to a tubular adenoma of the colon.
*Vaguely similar to a tubular adenoma of the colon.
DDx:
*[[HGPIN]].


Image:  
Image:  
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==Foamy gland carcinoma==
==Foamy gland carcinoma==
===General===
*Rare.


===Microscopic===
===Microscopic===
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Image: [http://www.nature.com/modpathol/journal/v17/n3/fig_tab/3800050f11.html#figure-title Foamy gland carcinoma (nature.com)].
Image: [http://www.nature.com/modpathol/journal/v17/n3/fig_tab/3800050f11.html#figure-title Foamy gland carcinoma (nature.com)].


==Atrophic carcinoma==
==Atrophic prostate carcinoma==
*[[AKA]] ''atrophic carcinoma''.
 
===General===
*Uncommon.
 
Note:
*An atrophic component in prostate cancer is common; one study identified it in ~15% of cases.<ref name=pmid9620026>{{Cite journal  | last1 = Kaleem | first1 = Z. | last2 = Swanson | first2 = PE. | last3 = Vollmer | first3 = RT. | last4 = Humphrey | first4 = PA. | title = Prostatic adenocarcinoma with atrophic features: a study of 202 consecutive completely embedded radical prostatectomy specimens. | journal = Am J Clin Pathol | volume = 109 | issue = 6 | pages = 695-703 | month = Jun | year = 1998 | doi =  | PMID = 9620026 }}</ref>
 
===Microscopic===
===Microscopic===
Features:
Features:
Line 706: Line 761:
*Nuclear features of conventional prostate cancer (nucleoli, nuclear enlargement).
*Nuclear features of conventional prostate cancer (nucleoli, nuclear enlargement).
*Increased gland density.
*Increased gland density.
DDx:
*[[Atrophy of the prostate]].


Image: [http://www.nature.com/modpathol/journal/v17/n3/fig_tab/3800050f12.html#figure-title Atrophic carcinoma (nature.com)].
Image: [http://www.nature.com/modpathol/journal/v17/n3/fig_tab/3800050f12.html#figure-title Atrophic carcinoma (nature.com)].
Line 723: Line 781:


==Pseudohyperplastic prostatic adenocarcinoma==
==Pseudohyperplastic prostatic adenocarcinoma==
===General===
*Rare.
===Microscopic===
===Microscopic===
Features:<ref name=Ref_GUP77>{{Ref GUP|77}}</ref><ref name=pmid14688829>{{cite journal |author=Arista-Nasr J, Martinez-Benitez B, Valdes S, Hernández M, Bornstein-Quevedo L |title=Pseudohyperplastic prostatic adenocarcinoma in transurethral resections of the prostate |journal=Pathol. Oncol. Res. |volume=9 |issue=4 |pages=232–5 |year=2003 |pmid=14688829 |doi=PAOR.2003.9.4.0232 |url=}}</ref>
Features:<ref name=Ref_GUP77>{{Ref GUP|77}}</ref><ref name=pmid14688829>{{cite journal |author=Arista-Nasr J, Martinez-Benitez B, Valdes S, Hernández M, Bornstein-Quevedo L |title=Pseudohyperplastic prostatic adenocarcinoma in transurethral resections of the prostate |journal=Pathol. Oncol. Res. |volume=9 |issue=4 |pages=232–5 |year=2003 |pmid=14688829 |doi=PAOR.2003.9.4.0232 |url=}}</ref>
Line 736: Line 797:


==Prostatic signet ring cell carcinoma==
==Prostatic signet ring cell carcinoma==
{{Main|Signet ring cell carcinoma}}
===General===
===General===
*Very rare - 9 cases in a series of 29,783 prostate cancer cases.<ref name=pmid21123640>{{Cite journal  | last1 = Warner | first1 = JN. | last2 = Nakamura | first2 = LY. | last3 = Pacelli | first3 = A. | last4 = Humphreys | first4 = MR. | last5 = Castle | first5 = EP. | title = Primary signet ring cell carcinoma of the prostate. | journal = Mayo Clin Proc | volume = 85 | issue = 12 | pages = 1130-6 | month = Dec | year = 2010 | doi = 10.4065/mcp.2010.0463 | PMID = 21123640 }}</ref>
*Very rare - 9 cases in a series of 29,783 prostate cancer cases.<ref name=pmid21123640>{{Cite journal  | last1 = Warner | first1 = JN. | last2 = Nakamura | first2 = LY. | last3 = Pacelli | first3 = A. | last4 = Humphreys | first4 = MR. | last5 = Castle | first5 = EP. | title = Primary signet ring cell carcinoma of the prostate. | journal = Mayo Clin Proc | volume = 85 | issue = 12 | pages = 1130-6 | month = Dec | year = 2010 | doi = 10.4065/mcp.2010.0463 | PMID = 21123640 }}</ref>
Line 749: Line 811:
==Sarcomatoid prostate carcinoma==
==Sarcomatoid prostate carcinoma==
*[[AKA]] ''carcinosarcoma''.
*[[AKA]] ''carcinosarcoma''.
===General===
*Rare.


===Microscopic===
===Microscopic===
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==Small cell carcinoma of the prostate gland==
==Small cell carcinoma of the prostate gland==
{{Main|Small cell carcinoma}}
{{Main|Small cell carcinoma}}
===General===
*Rare.
===Microscopic===
Features:
Features:
*Nuclear moulding.
*Nuclear moulding.
Michael
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