Difference between revisions of "Prostate gland"

Jump to navigation Jump to search

Prostate gland (view source)

Revision as of 16:43, 15 October 2012

30,431 bytes removed ,  16:43, 15 October 2012
→‎Prostatic adenocarcinoma: remove ---> moved to prostate cancer
Line 470: Line 470:
Features - basal cells present:
Features - basal cells present:
*HMWK +ve.
*HMWK +ve.
==Prostatic adenocarcinoma==
*[[AKA]] ''adenocarcinoma of the prostate''.
*[[AKA]] ''prostatic carcinoma''.
===General===
*Very common.
*Increasing incidence with age - the age in years is an approximation of the percentage of men with prostate cancer.
*Usually an indolent course - most old men die with prostate cancer ''not'' from prostate cancer.
====Management====
The management changes between Gleason 6, 7 & 8; typically, the implications are:
* Gleason 6: watchful waiting ''or'' radioactive seeds; surgery if patient wants.
* Gleason 7: do something - often surgery.
* Gleason 8+: bad cancer - do something quickly!
Bottom line:
*You want to be sure when you call something Gleason pattern 4.
===Microscopic===
====Criteria as a list====
Major criteria (the ABCs of prostate pathology):<ref name=pmid17213347>{{cite journal |author=Humphrey PA |title=Diagnosis of adenocarcinoma in prostate needle biopsy tissue |journal=J. Clin. Pathol. |volume=60 |issue=1 |pages=35–42 |year=2007 |month=January |pmid=17213347 |pmc=1860598 |doi=10.1136/jcp.2005.036442 |url=http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1860598/?tool=pubmed}}</ref>
#Architecture.
#*Increased gland density.
#*Small circular glands.
#**In rare subtypes - large branching glands.
#*"Infiltrative growth" pattern - malignant glands between benign ones.
#**Image: [http://www.nature.com/modpathol/journal/v17/n3/fig_tab/3800050f1.html#figure-title Infiltrative growth pattern (nature.com)].
#Basal cells lacking.
#Cytological abnormalities:
#*Nuclear enlargement.
#*Nucleoli.
Minor criteria:<ref name=pmid17213347/>
#Nuclear hyperchromasia.
#Wispy blue mucin.
#*Image: [http://www.nature.com/modpathol/journal/v17/n3/fig_tab/3800050f3.html#figure-title Wispy blue mucin (nature.com)] - from Epstein.<ref name=pmid14739905>{{cite journal |author=Epstein JI |title=Diagnosis and reporting of limited adenocarcinoma of the prostate on needle biopsy |journal=Mod. Pathol. |volume=17 |issue=3 |pages=307–15 |year=2004 |month=March |pmid=14739905 |doi=10.1038/modpathol.3800050 |url=http://www.nature.com/modpathol/journal/v17/n3/full/3800050a.html}}</ref>
#Pink amorphous secretions.
#*Image: [http://www.nature.com/modpathol/journal/v17/n3/fig_tab/3800050f11.html Pink amorphous secretions (nature.com)] - from Epstein.<ref name=pmid14739905>{{cite journal |author=Epstein JI |title=Diagnosis and reporting of limited adenocarcinoma of the prostate on needle biopsy |journal=Mod. Pathol. |volume=17 |issue=3 |pages=307–15 |year=2004 |month=March |pmid=14739905 |doi=10.1038/modpathol.3800050 |url=http://www.nature.com/modpathol/journal/v17/n3/full/3800050a.html}}</ref>
#Intraluminal crystalloid.
#*Image: [http://www.nature.com/modpathol/journal/v17/n3/fig_tab/3800050f4.html#figure-title Intraluminal crystalloid (nature.com)] - from Epstein.<ref name=pmid14739905/>
#Amphophilic cytoplasm.
#*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].
#Adjacent [[HGPIN]].
#Mitoses - quite rare.
Extent/quantity criteria:
*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/>
====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).
**Sharp transition between gland border and lumen.
***Loss of epithelial folding at the epithelium-gland lumen interface - "punched-out" appearance.
**Eosinophilic debris within the gland lumen (pink amorphous secretions, intraluminal crystalloid).
**Blue-tinged acellular material within the gland lumen (mucin) -- uncommon.
**"Infiltrative": small round/oval (malignant) glands (approx. 5 cells across) interspersed with larger (benign) glands that are 2-3 times larger.
====High power features====
*Nuclei.
**Hyperchromatic nuclei (like in HGPIN).
**Nuclear enlargement.
***Difficult to appreciate (if cancer isn't side-by-side with normal prostate).
***Difficult to see if not on high power.
*Nucleoli visible on high power (200x or 100X)
**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 overcalling something benign).
**If I see three good nucleoli in a gland I'm usually confident it is 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.
Notes:
*Mitoses are not a common feature - don't waste time looking for them.
====Mimics====
Mimics of prostate adenocarcinoma:<ref>{{Ref TPoSP|100-3}}</ref>
{| class="wikitable sortable"
! Entity
! Key feature
! Detailed microscopic
! Other
! Image
|-
| Adenosis ([[AKA]] ''atypical adenomatous hyperplasia'')
| gradual transition between normal & small gland (NOT two populations)
| many small glands, lack nuclear size variation, basal layer present
| nucleoli may be present; may need to do p63 or 34betaE12 to find basal layer
| [http://webpathology.com/image.asp?case=21&n=3 AAH (webpathology.com)]
|-
| Sclerosing adenosis
| gradual transition between normal & small gland (NOT two populations), fibrosis
| many small glands, lack nuclear size variation, basal layer present
| analogous to sclerosing adenosis of breast (???)
| [http://webpathology.com/image.asp?case=21&n=8 Sclerosing adenosis (webpathology.com)]
|-
| [[atrophy of the prostate|Atrophy]]
| sharp angulation of gland
| nuclear hyperchromasia, scant cytoplasm
| may appear right beside non-atrophic tissue
| [http://webpathology.com/image.asp?case=16&n=7 Atrophy (webpathology.com)], [http://webpathology.com/image.asp?case=16&n=5 Partial atrophy (webpathology.com)] [http://webpathology.com/image.asp?case=16&n=6 Sclerotic atrophy (webpathology.com)]
|-
| [[Basal cell hyperplasia of the prostate|Basal cell hyperplasia]]
| two distinct cell populations (in epithelial component)
| abundant epithelial cells; nucleoli in pale ('blue') nuclei of basal cells, glandular cell nuclei darker ('purple')
| vaguely similar to epithelial hyperplasia of usual type (EHUT) in breast
| [http://webpathology.com/image.asp?case=18&n=1 BCH (webpathology.com)]
|-
| [[Bulbourethral gland]]
| no nuclear atypia
| clear cytoplasm
| apex of prostate
| [http://webpathology.com/image.asp?case=21&n=4 Cowper gland (webpathology.com)]
|-
| Seminal vesicles / ejaculatory ducts
| lipofuscin (yellow granular material in cytoplasm), smudge cells (smeared appearance + hyperchromatic)
| 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.; 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)]
|-
| Radiation effect
| marked nuclear size variation
| increased stroma (fibrosis), lack nucleoli ???
| history of Rx; uniform nuc. size with Hx of Rx should raise susp. of cancer
| [http://webpathology.com/image.asp?case=97&n=6 Radiation changes (webpathology.com)], [http://webpathology.com/image.asp?case=97&n=7 Radiation changes (webpathology.com)]
|-
| Prostatitis
| inflammatory cells (lymphocytes, plasma cells, PMNs)
| no nuclear atypia, normal gland arch.
| clinical mimic of cancer (elevated PSA); usu. not a problem for the pathologist
| [http://commons.wikimedia.org/wiki/File:Inflammation_of_prostate.jpg Prostatic inflammation (WC)]
|-
| [[Vasitis nodosa]]
| sperm within ducts, clinical history (usu. post-vasectomy)
| small tubules, nucleoli common, mild atypia, may "invade" vessels, track along nerves
| mimics metastatic prostate carcinoma, IHC stains: PSA-, PSAP-
| [http://www.webpathology.com/image.asp?n=11&Case=40 VN (webpathology.com)]
|}
Memory device: '''AAABBRS''' = atrophy, adenosis, adenosis (sclerosing), basal cell hyperplasia, bulbourethral gland, radiation, seminal vesicles.
====Gleason grading system====
Overview:
*This system is only one any one talks about.
*Score range: 6-10.
**Technically 2-10... but almost no one uses 2-5.
*Reported as on biopsy as: (primary pattern) + (secondary pattern ''or'' tertiary pattern with the highest grade) = sum.
**e.g. ''Gleason score 3+4=7'' means: pattern 3 is present and dominant, pattern 4 is the remainder of the tumour - but present in a lesser amount than pattern 3.
*Reported as on prostatectomies as: (primary pattern) + (secondary pattern) = sum, (tertiary pattern)
*Tertiary Gleason pattern - definition: a pattern that is seen in than 5% of the tumour (volume), that is higher grade than the two dominant patterns.<ref name=Ref_GUP72>{{Ref GUP|72}}</ref>
**The presence of a tertiary patterns adversely affect the prognosis; however, the prognosis is not as bad as when the tertiary pattern is the secondary pattern, i.e. 3+4 tertiary 5 has a better prognosis than 3+5 (with some small amount of pattern 4).<ref name=Ref_GUP72>{{Ref GUP|72}}</ref>
Examples:
*A biopsy has 80% pattern 4, 16% pattern 3 and 4% pattern 5... it would be reported as: 4+5=9.
*A prostatectomy has 80% pattern 4, 16% pattern 3 and 4% pattern 5... it would be reported as: 4+3=7 with tertiary pattern 5.
Testing yourself:
*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>
=====Gleason pattern 1 & 2=====
*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=====
*Glands smaller than normal prostate glands + loss of epithelial folding.
*Can draw a line around each gland.
*May have ''gland branching''.
**Glands have a X, U, V or Y shape.
Notes:
*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=====
*Loss of gland lumina.
*Gland fusion.
*Benign looking cords ('hypernephroid pattern').
*Cribriform.
*Glomeruloid pattern - resembles a glomerulus.
Notes:
*One gland is not enough to call Gleason 4.
Images:
*[http://commons.wikimedia.org/wiki/File:Prostate_cancer_with_Gleason_pattern_4_low_mag.jpg Gleason pattern 4 - cribriform (WC)].
*[http://commons.wikimedia.org/wiki/File:Gleason_4_and_5_intermed_mag.jpg Gleason pattern 4 - small glands & Gleason pattern 5 - single cells (WC)].
*[http://www.nature.com/modpathol/journal/v17/n3/fig_tab/3800050f9.html#figure-title Glomeruloid pattern (nature.com)].
=====Gleason pattern 5=====
*Sheets.
**Must be differentiated from intraductal growth (which like in the breast are well circumscribed nests).
*Single cells.
**May be confused with stromal/lymphocytic infiltration.
***Look for nucleoli, cells should be round (prostatic stroma cells are spindle cells).
*Cords.
*Nests of cells with [[necrosis]] at centre.
Image: [http://commons.wikimedia.org/wiki/File:Gleason_4_and_5_intermed_mag.jpg Gleason pattern 4 - small glands & Gleason pattern 5 - single cells (WC)].
=====Special types=====
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"
! Special type
! Gleason pattern
! Comment
|-
|Ductal carcinoma
| 4
| may be graded 3 or 5<ref name=bostwicklabs>URL: [https://www.bostwicklaboratories.com/global/physicians/medical-library/articles/gleason-grading.aspx https://www.bostwicklaboratories.com/global/physicians/medical-library/articles/gleason-grading.aspx]. Accessed on: 26 November 2011.</ref>
|-
|Mucinous carcinoma
| 4
|
|-
|Sarcomatoid carcinoma
| 5
| glands graded separately
|-
|Signet ring cell carcinoma
| 5
|
|-
|Small cell carcinoma
| not graded
| may be graded 5<ref name=bostwicklabs/>
|-
|Adenosquamous and squamous carcinoma
| not graded
|
|-
|Lymphoepithelioma-like carcinoma
| not graded
|
|-
|Adenoid cystic carcinoma
| not graded
|
|-
|Urothelial carcinoma
| not graded
|
|-
|Undifferentiated carcinoma, NOS
| not graded
|
|}
How to remember the ones that aren't graded - think of '''Ur''' '''L'''ung carcinomas ('''Ur'''othelial carcinoma, '''L'''ymphoepithelioma-like carcinoma):
*Small cell carcinoma.
*Squamous cell carcinoma.
*Adenosquamous carcinoma.
*Adenoid cystic carcinoma.
====Staging parameters and margins====
=====Surgical margins=====
{{Main|Surgical margins}}
*Positive is ''tumour touching ink''.<ref name=pmid22578729>{{Cite journal  | last1 = Lu | first1 = J. | last2 = Wirth | first2 = GJ. | last3 = Wu | first3 = S. | last4 = Chen | first4 = J. | last5 = Dahl | first5 = DM. | last6 = Olumi | first6 = AF. | last7 = Young | first7 = RH. | last8 = McDougal | first8 = WS. | last9 = Wu | first9 = CL. | title = A close surgical margin after radical prostatectomy is an independent predictor of recurrence. | journal = J Urol | volume = 188 | issue = 1 | pages = 91-7 | month = Jul | year = 2012 | doi = 10.1016/j.juro.2012.02.2565 | PMID = 22578729 }}</ref>
**"Close" margins have an increase recurrence risk.
Notes:
*Surgical margin - where the surgeon cut.
**It is possible to have EPE without a positive margin.
**It is possible to have a positive margin without EPE.
======Rates and implication======
Positivity rate varies substantially (13-44%):
*Norway: 26% -- strong dependence on surgeon volume (18% high case load vs. 44% low case load).<ref name=pmid22860630>{{Cite journal  | last1 = Steinsvik | first1 = EA. | last2 = Axcrona | first2 = K. | last3 = Angelsen | first3 = A. | last4 = Beisland | first4 = C. | last5 = Dahl | first5 = A. | last6 = Eri | first6 = LM. | last7 = Haug | first7 = ES. | last8 = Svindland | first8 = A. | last9 = Fosså | first9 = S. | title = Does a surgeon's annual radical prostatectomy volume predict the risk of positive surgical margins and urinary incontinence at one-year follow-up? - Findings from a prospective national study. | journal = Scand J Urol Nephrol | volume =  | issue =  | pages =  | month = Aug | year = 2012 | doi = 10.3109/00365599.2012.707684 | PMID = 22860630 }}</ref>
*France: 13-17%.<ref name=pmid22860572>{{Cite journal  | last1 = Koutlidis | first1 = N. | last2 = Mourey | first2 = E. | last3 = Champigneulle | first3 = J. | last4 = Mangin | first4 = P. | last5 = Cormier | first5 = L. | title = Robot-assisted or pure laparoscopic nerve-sparing radical prostatectomy: What is the optimal procedure for the surgical margins? A single center experience. | journal = Int J Urol | volume =  | issue =  | pages =  | month = Jul | year = 2012 | doi = 10.1111/j.1442-2042.2012.03102.x | PMID = 22860572 }}</ref>
Note:
*There is likely a strong dependence on stage and grade of cancer, i.e. surgeons that operate more on high grade cancers will probably have a higher margin positive rates.
The impact of positive margins:
*Significant modest negative affect on long-term outcome in node negative cancers (pT2-4 pN0).<ref name=pmid22901983>{{Cite journal  | last1 = Mauermann | first1 = J. | last2 = Fradet | first2 = V. | last3 = Lacombe | first3 = L. | last4 = Dujardin | first4 = T. | last5 = Tiguert | first5 = R. | last6 = Tetu | first6 = B. | last7 = Fradet | first7 = Y. | title = The Impact of Solitary and Multiple Positive Surgical Margins on Hard Clinical End Points in 1712 Adjuvant Treatment-Naive pT2-4 N0 Radical Prostatectomy Patients. | journal = Eur Urol | volume =  | issue =  | pages =  | month = Aug | year = 2012 | doi = 10.1016/j.eururo.2012.08.002 | PMID = 22901983 }}</ref>
*Weaker impact than stage and Gleason score.<ref>{{Cite journal  | last1 = Chalfin | first1 = HJ. | last2 = Dinizo | first2 = M. | last3 = Trock | first3 = BJ. | last4 = Feng | first4 = Z. | last5 = Partin | first5 = AW. | last6 = Walsh | first6 = PC. | last7 = Humphreys | first7 = E. | last8 = Han | first8 = M. | title = Impact of surgical margin status on prostate-cancer-specific mortality. | journal = BJU Int | volume =  | issue =  | pages =  | month = Jul | year = 2012 | doi = 10.1111/j.1464-410X.2012.11371.x | PMID = 22788795 }}</ref>
=====Extraprostatic extension=====
:Abbreviated ''EPE''.
General:
*Extraprostatic extension (EPE) is difficult to assess (in prostatectomy specimens) as there is no consensus definition.
**The prostate does NOT have a well defined capsule.
***Intraobserver agreement for EPE is fair-moderate and lower than for the surgical margin.<ref name=pmid18708939>{{Cite journal  | last1 = Evans | first1 = AJ. | last2 = Henry | first2 = PC. | last3 = Van der Kwast | first3 = TH. | last4 = Tkachuk | first4 = DC. | last5 = Watson | first5 = K. | last6 = Lockwood | first6 = GA. | last7 = Fleshner | first7 = NE. | last8 = Cheung | first8 = C. | last9 = Belanger | first9 = EC. | last10 = Amin | first10 = MB. | last11 = Boccon-Gibod | first11 = L. | last12 = Bostwick | first12 = DG. | last13 = Egevad | first13 = L. | last14 = Epstein | first14 = JI. | last15 = Grignon | first15 = DJ. | last16 = Jones | first16 = EC. | last17 = Montironi | first17 = R. | last18 = Moussa | first18 = M. | last19 = Sweet | first19 = JM. | last20 = Trpkov | first20 = K. | last21 = Wheeler | first21 = TM. | last22 = Srigley | first22 = JR. | title = Interobserver variability between expert urologic pathologists for extraprostatic extension and surgical margin status in radical prostatectomy specimens. | journal = Am J Surg Pathol | volume = 32 | issue = 10 | pages = 1503-12 | month = Oct | year = 2008 | doi = 10.1097/PAS.0b013e31817fb3a0 | PMID = 18708939 }}</ref>
*EPE, typically, upstages tumours from T2x to T3a.
Prostatectomy specimens - EPE is present if there is either:
#A "significant bulge" in the contour of the prostate at low power ''and'' no fibromuscular tissue surrounding the malignant cells.
#Malignant cells directly adjacent to peri-prostatic adipose tissue.
Note:
*The prostate, at the apex, may have some skeletal muscle. Thus, it is difficult to define extention... ergo EPE not called at the apex.
Prostate biopsy - EPE is present if:
*Tumour touches adipose tissue.<ref name=pmid17707261>{{Cite journal  | last1 = Epstein | first1 = JI. | last2 = Srigley | first2 = J. | last3 = Grignon | first3 = D. | last4 = Humphrey | first4 = P. | title = Recommendations for the reporting of prostate carcinoma. | journal = Hum Pathol | volume = 38 | issue = 9 | pages = 1305-9 | month = Sep | year = 2007 | doi = 10.1016/j.humpath.2007.05.015 | PMID = 17707261 }}</ref><ref>Evans, A. 4 June 2010.</ref>
=====Seminal vesicle invasion=====
General:
*Typically upstages to T3b.
Microscopic:
*Tumour '''must''' be in the muscle surrounding the epithelial component; tumour in the adventitia (the loose connective tissue surrounding the seminal vesicles) does not count.<ref name=Ref_Lester3_409>{{Ref Lester3|409}}</ref><ref name=pmid20818343>{{Cite journal  | last1 = Berney | first1 = DM. | last2 = Wheeler | first2 = TM. | last3 = Grignon | first3 = DJ. | last4 = Epstein | first4 = JI. | last5 = Griffiths | first5 = DF. | last6 = Humphrey | first6 = PA. | last7 = van der Kwast | first7 = T. | last8 = Montironi | first8 = R. | last9 = Delahunt | first9 = B. | title = International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 4: seminal vesicles and lymph nodes. | journal = Mod Pathol | volume = 24 | issue = 1 | pages = 39-47 | month = Jan | year = 2011 | doi = 10.1038/modpathol.2010.160 | PMID = 20818343 }}</ref>
Notes:
*Invasion of the adventitia (only) would quality as EPE; this is, usually, T3a.
===IHC===
*AMACR +ve.
*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.
*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>
*p63 -ve.
*HMWCK (34betaE12) -ve.
Combination immunostains:
*''PIN-4'' -- consists of: CK5 + CK14 + p63 + P504S (AMACR).<ref>URL: [http://biocare.net/wp-content/uploads/225DS.pdf http://biocare.net/wp-content/uploads/225DS.pdf]. Accessed on: 18 October 2011.</ref><ref>URL: [http://www.antibodies-online.com/antibody/308235/anti-PIN-4+p63+Cytokeratin+HMW+p504S++AMACR/ http://www.antibodies-online.com/antibody/308235/anti-PIN-4+p63+Cytokeratin+HMW+p504S++AMACR/]. Accessed on: 18 October 2011.</ref><ref>URL: [http://www.webpathology.com/image.asp?case=96&n=5 http://www.webpathology.com/image.asp?case=96&n=5]. Accessed on: 18 October 2011.</ref>
**[[AKA]] ''PIN''.
**[[AKA]] ''CAP''.
***Why '''CAP'''?
****A. '''CA'''ncer of the '''P'''rostate.
===Molecular changes in prostate cancer===
A fusion gene between ''TMPRSS2'' and ''ERG'' is described.<ref name=pmid20478527>{{cite journal | author = Yu J, Yu J, Mani RS, Cao Q, Brenner CJ, Cao X, Wang X, Wu L, Li J, Hu M, Gong Y, Cheng H, Laxman B, Vellaichamy A, Shankar S, Li Y, Dhanasekaran SM, Morey R, Barrette T, Lonigro RJ, Tomlins SA, Varambally S, Qin ZS, Chinnaiyan AM | title = An Integrated Network of Androgen Receptor, Polycomb, and TMPRSS2-ERG Gene Fusions in Prostate Cancer Progression | journal = Cancer Cell | volume = 17 | issue = 5 | pages = 443–54 | year = 2010 | month = May | pmid = 20478527 | pmc = 2874722 | doi = 10.1016/j.ccr.2010.03.018 | url =  }}</ref><ref name=omim602060>{{OMIM|602060}}</ref>
*Both genes are on chromosome 21.
*Currently ''not'' used diagnostically.
*Fusion gene seen in approximately 50% of prostate cancer.<ref name=omim602060>{{OMIM|602060}}</ref>
*A subset of ''TMPRSS2-ERG'' known as ''2+Edel'' (seen in ~7% of all prostate cancer cases) predicts poor survival.<ref name=pmid17637754>{{Cite journal  | last1 = Attard | first1 = G. | last2 = Clark | first2 = J. | last3 = Ambroisine | first3 = L. | last4 = Fisher | first4 = G. | last5 = Kovacs | first5 = G. | last6 = Flohr | first6 = P. | last7 = Berney | first7 = D. | last8 = Foster | first8 = CS. | last9 = Fletcher | first9 = A. | title = Duplication of the fusion of TMPRSS2 to ERG sequences identifies fatal human prostate cancer. | journal = Oncogene | volume = 27 | issue = 3 | pages = 253-63 | month = Jan | year = 2008 | doi = 10.1038/sj.onc.1210640 | PMID = 17637754 }}</ref>
===Sign out===
====Prostatectomy specimens====
See: [http://www.cap.org/apps/cap.portal?_nfpb=true&cntvwrPtlt_actionOverride=/portlets/contentViewer/show&_windowLabel=cntvwrPtlt&cntvwrPtlt{actionForm.contentReference}=committees/cancer/cancer_protocols/protocols_index.html&_pageLabel=cntvwr CAP checklist].
====Biopsy specimens====
Important elements - a list:<ref name=pmid17213347/>
#Type of cancer, e.g. "prostatic adenocarcinoma, acinar type".
#Gleason score including primary and secondary pattern, e.g. "Gleason score 3+4=7".
#Number of cores and number involved, e.g. "2/3 cores involved by cancer".
#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".
#Presence of [[perineural invasion]].
#Presence of extension into fat (extraprostatic extension).
Notes:
*"Percent area involved" may seem like an odd thing to request 'cause it is sampling dependent, i.e. if the radiologist sticks the biopsy needle deeper into the lesion more of the core is positive, but urologists think it is important -- more important than perineural invasion.<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>
=====Completely negative=====
<pre>
A. PROSTATE, RIGHT LATERAL SUPERIOR, BIOPSY:
- BENIGN PROSTATE TISSUE.
B. PROSTATE, RIGHT MEDIAL SUPERIOR, BIOPSY:
- BENIGN PROSTATE TISSUE.
C. PROSTATE, RIGHT LATERAL MIDZONE, BIOPSY:
- BENIGN PROSTATE TISSUE.
D. PROSTATE, RIGHT MEDIAL MIDZONE, BIOPSY:
- BENIGN PROSTATE TISSUE.
E. PROSTATE, RIGHT LATERAL INTERIOR, BIOPSY:
- BENIGN PROSTATE TISSUE.
F. PROSTATE, RIGHT MEDIAL INFERIOR, BIOPSY:
- BENIGN PROSTATE TISSUE.
G. PROSTATE, LEFT LATERAL SUPERIOR, BIOPSY:
- BENIGN PROSTATE TISSUE.
H. PROSTATE, LEFT MEDIAL SUPERIOR, BIOPSY:
- BENIGN PROSTATE TISSUE.
I. PROSTATE, LEFT LATERAL MIDZONE, BIOPSY:
- BENIGN PROSTATE TISSUE.
J. PROSTATE, LEFT MEDIAL MIDZONE, BIOPSY:
- BENIGN PROSTATE TISSUE.
K. PROSTATE, LEFT LATERAL INTERIOR, BIOPSY:
- BENIGN PROSTATE TISSUE.
L. PROSTATE, LEFT MEDIAL INFERIOR, BIOPSY:
- BENIGN PROSTATE TISSUE.
</pre>
=====No glands=====
<pre>
F. PROSTATE, RIGHT MEDIAL MIDZONE, BIOPSY:
- BENIGN FIBROMUSCULAR TISSUE;
- NO PROSTATIC GLANDULAR TISSUE PRESENT.
</pre>
=====Inflammation=====
<pre>
G. PROSTATE, LEFT LATERAL SUPERIOR, BIOPSY:
- BENIGN PROSTATE TISSUE;
- FOCAL CHRONIC INFLAMMATION.
</pre>
<pre>
F. PROSTATE, RIGHT MEDIAL MIDZONE, BIOPSY:
- BENIGN PROSTATE TISSUE;
- CHRONIC INFLAMMATION.
</pre>
<pre>
F. PROSTATE, RIGHT MEDIAL MIDZONE, BIOPSY:
- BENIGN PROSTATE TISSUE;
- ACUTE AND CHRONIC INFLAMMATION.
</pre>
=====Positive=====
<pre>
F. PROSTATE, RIGHT MEDIAL INFERIOR, BIOPSY:
- ADENOCARCINOMA, GLEASON SCORE 6/10 (3+3);
- 1/1 CORE INVOLVED; APPROXIMATELY 5% OF TISSUE INVOLVED.
</pre>
<pre>
F. PROSTATE, RIGHT MEDIAL INFERIOR, BIOPSY:
- ADENOCARCINOMA, GLEASON SCORE 6/10 (3+3);
- 1/1 CORE INVOLVED; APPROXIMATELY 25% OF TISSUE INVOLVED;
- PERINEURAL INVASION PRESENT.
</pre>
<pre>
G. PROSTATE, LEFT LATERAL SUPERIOR, BIOPSY:
- ADENOCARCINOMA, GLEASON SCORE 7/10 (4+3);
- 1/1 CORE INVOLVED; APPROXIMATELY 5% OF TISSUE INVOLVED;
- PERINEURAL INVASION PRESENT.
</pre>
<pre>
H. PROSTATE, LEFT MEDIAL SUPERIOR, BIOPSY:
- ADENOCARCINOMA, GLEASON SCORE 8/10 (4+4);
- 1/1 CORE INVOLVED; APPROXIMATELY 15% OF TISSUE INVOLVED.
</pre>
<pre>
H. PROSTATE, LEFT MEDIAL SUPERIOR, BIOPSY:
- ADENOCARCINOMA, GLEASON SCORE 8/10 (4+4);
- 1/1 CORE INVOLVED; APPROXIMATELY 15% OF TISSUE INVOLVED;
- PERINEURAL INVASION PRESENT.
</pre>
<pre>
TUMOUR SUMMARY - PROSTATE CORE BIOPSIES:
- HISTOLOGIC TYPE: ADENOCARCINOMA (ACINAR, NOT OTHERWISE SPECIFIED).
- TOTAL GLEASON SCORE: 7.
- PRIMARY PATTERN: 4.
- SECONDARY PATTERN: 3.
- PERCENT OF TUMOUR WITH PATTERN HIGHER THAN GRADE 3: 75%.
- NUMBER OF CORES POSITIVE: 10.
- TOTAL NUMBER OF CORES: 12.
- TOTAL LINEAR MILLIMETERS OF NEEDLE CORE TISSUE: 152 MM.
- PERCENT OF NEEDLE CORE TISSUE THAT IS TUMOUR: 44%.
- PERIPROSTATIC FAT INVASION: NOT IDENTIFIED.
- SEMINAL VESICLE INVASION: SEMINAL VESICLE NOT IDENTIFIED.
- LYMPHOVASCULAR INVASION: NOT IDENTIFIED.
- PERINEURAL INVASION: PRESENT.
- ADDITIONAL FINDINGS: HIGH-GRADE PROSTATIC INTRAEPITHELIAL NEOPLASIA, CHRONIC INFLAMMATION (FOCAL).
</pre>


=Unusual forms of prostate cancer=
=Unusual forms of prostate cancer=
Michael
48,830

edits

Retrieved from "https://librepathology.org/wiki/Special:MobileDiff/18048"

Navigation menu