Ductal adenocarcinoma of the prostate gland

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Ductal adenocarcinoma of the prostate gland, also prostatic ductal adenocarcinoma, is relatively common variant of prostate cancer.

Ductal adenocarcinoma of the prostate gland
Diagnosis in short

Ductal adenocarcinoma of prostate. H&E stain. (WC)
Synonyms prostatic ductal adenocarcinoma, endometrioid adenocarcinoma (use discouraged), papillary adenocarcinoma of prostate (old term)
Subtypes (subtype of prostate carcinoma)
LM DDx acinar adenocarcinoma of prostate, prostatic-type polyp, adenocarcinoma of the urinary bladder, metastatic adenocarcinoma
IHC chromogranin A +ve, p53 +ve, PSA +ve
Grossing notes prostate biopsy, prostate chips, radical prostatectomy
Staging prostate cancer staging
Site prostate gland - esp. central zone, see prostate cancer
Prevalence uncommon - though considered most common non-acinar prostate carcinoma
Prognosis poor

It is also known as prostatic adenocarcinoma, large duct type.

It should not be confused with intraductal carcinoma of the prostate gland.

General

  • Sometimes it is referred to as endometrioid or endometrial adenocarcinoma; both terms are discouraged.[1]
  • In older literature it is referred to as papillary adenocarcinoma of the prostate.[2][3]
  • Not completely uncontroversial - may represent acinar adenocarcinoma with periurethral ducts involvement.[4]
  • More aggressive than conventional (acinar) prostate carcinoma.

Microscopic

Features:[5]

  1. Pseudostratified (crowded appearing) columnar (or cigar-shaped) nuclei - key feature.
  2. Compatible architecture:
  3. >= 50% of tumour.[6] ‡‡
    • If ductal component <50%, it is a conventional (acinar) adenocarcinoma with a ductal component.

Notes:

  • Proportion of ductal component should be quantified:
    • <10% ductal component of no prognostic significance.[6]
  • ‡‡ Mahul Amin advocates that >=80% should be ductal morphology to call ductal adenocarcinoma.[7]

DDx:

Images

  • DAP - low mag.

  • DAP - intermed. mag.

  • DAP - high mag.

  • DAP - very high mag.

www

IHC

Features:[8]

  • p53 +ve in ~ 75% of cases.
  • Ki-67 high in ~ 70% of cases.
  • Chromogranin A +ve (cytoplasm) in ~ 70% of cases.

Others:[9]

  • PSA +ve.

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Comment about small amount of ductal adenocarcinoma

A small amount of ductal-type adenocarcinoma of the prostate is seen; it represents approximately 5% of the tumour by volume and is of no particular prognostic significance. As the volume of the ductal-type adenocarcinoma is small, the case is classified as acinar adenocarcinoma.

See also

References

  1. ↑ 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.
  2. ↑ Miki, J.; Ikemoto, I.; Shimomura, T.; Kiyota, H.; Oisi, Y.; Kondo, I.; Madarame, J.; Endo, K. et al. (Jan 2003). "[Papillary adenocarcinoma of the prostate: report of 4 cases].". Hinyokika Kiyo 49 (1): 21-4. PMID 12629776.
  3. ↑ Wernert, N.; Lüchtrath, H.; Seeliger, H.; Schäfer, M.; Goebbels, R.; Dhom, G. (1987). "Papillary carcinoma of the prostate, location, morphology, and immunohistochemistry: the histogenesis and entity of so-called endometrioid carcinoma.". Prostate 10 (2): 123-31. PMID 2436204.
  4. ↑ Bock, BJ.; Bostwick, DG. (Jul 1999). "Does prostatic ductal adenocarcinoma exist?". Am J Surg Pathol 23 (7): 781-5. PMID 10403300.
  5. ↑ 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.
  6. ↑ 6.0 6.1 Amin, A.; Epstein, JI. (Apr 2011). "Pathologic stage of prostatic ductal adenocarcinoma at radical prostatectomy: effect of percentage of the ductal component and associated grade of acinar adenocarcinoma.". Am J Surg Pathol 35 (4): 615-9. doi:10.1097/PAS.0b013e31820eb25b. PMID 21383610.
  7. ↑ Amin, Mahul B. (2010). Diagnostic Pathology: Genitourinary (1st ed.). Amirsys. pp. 3-102. ISBN 978-1931884280.
  8. ↑ Tarján, M.; Lenngren, A.; Hellberg, D.; Tot, T. (Jun 2012). "Immunohistochemical verification of ductal differentiation in prostate cancer.". APMIS 120 (6): 510-8. doi:10.1111/j.1600-0463.2011.02862.x. PMID 22583364.
  9. ↑ Kumar, A.; Mukherjee, SD. (Apr 2010). "Metastatic ductal carcinoma of the prostate: a rare variant responding to a common treatment.". Can Urol Assoc J 4 (2): E50-4. PMID 20368883.
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