Difference between revisions of "Prostate cancer"

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*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>

**Thus, it has been suggested that six or more glands should be present to diagnose cancer.<ref name=pmid20061936/>

Pathognomonic features of prostate carcinoma:<ref>{{Cite journal | last1 = Egevad | first1 = L. | last2 = Allsbrook | first2 = WC. | last3 = Epstein | first3 = JI. | title = Current practice of diagnosis and reporting of prostate cancer on needle biopsy among genitourinary pathologists. | journal = Hum Pathol | volume = 37 | issue = 3 | pages = 292-7 | month = Mar | year = 2006 | doi = | PMID = 16613324 }}</ref>

#Perineural invasion.

#*Must be circumferential (>95% of circumference{{fact}}).

#Glomeruloid bodies.

#Collagenous micronodules.

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</gallery>

===Low power features===

===Divided into high and low power===

====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).

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**"Infiltrative": small round/oval (malignant) glands (approx. 5 cells across) interspersed with larger (benign) glands that are 2-3 times larger.

===High power features===

====High power features====

*Nuclei.

**Hyperchromatic nuclei (like in HGPIN).

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**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 over-calling something benign).

**If I see three good nucleoli in a gland and the architecture is abnormal, I'm usually confident it is badness ([[ASAP]] or [[prostate cancer|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.

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**If you find them the lesion is probably high-grade.

**Generally, it isn't worth looking for them.

*The nucleoli should be 3 micrometres in size.{{fact}}

===Mimics===

Difference between revisions of "Prostate cancer"

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@@ Line 126: / Line 126: @@
 *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>
 **Thus, it has been suggested that six or more glands should be present to diagnose cancer.<ref name=pmid20061936/>
+Pathognomonic features of prostate carcinoma:<ref>{{Cite journal  | last1 = Egevad | first1 = L. | last2 = Allsbrook | first2 = WC. | last3 = Epstein | first3 = JI. | title = Current practice of diagnosis and reporting of prostate cancer on needle biopsy among genitourinary pathologists. | journal = Hum Pathol | volume = 37 | issue = 3 | pages = 292-7 | month = Mar | year = 2006 | doi =  | PMID = 16613324 }}</ref>
+#Perineural invasion.
+#*Must be circumferential (>95% of circumference{{fact}}).
+#Glomeruloid bodies.
+#Collagenous micronodules.
 <gallery>
@@ Line 131: / Line 137: @@
 </gallery>
-===Low power features===
+===Divided into high and low power===
+====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).
@@ Line 140: / Line 147: @@
 **"Infiltrative": small round/oval (malignant) glands (approx. 5 cells across) interspersed with larger (benign) glands that are 2-3 times larger.
-===High power features===
+====High power features====
 *Nuclei.
 **Hyperchromatic nuclei (like in HGPIN).
@@ Line 149: / Line 156: @@
 **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 over-calling something benign).
-**If I see three good nucleoli in a gland and the architecture is abnormal, I'm usually confident it is badness ([[ASAP]] or [[prostate cancer|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.
@@ Line 157: / Line 163: @@
 **If you find them the lesion is probably high-grade.
 **Generally, it isn't worth looking for them.
+*The nucleoli should be 3 micrometres in size.{{fact}}
 ===Mimics===