Difference between revisions of "Prostate cancer"

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Prostate cancer (view source)

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This article deals with '''prostate cancer'''.  The vast majority of prostate cancers are carcinomas, i.e. '''prostatic adenocarcinoma''' ([[AKA]] '''adenocarcinoma of the prostate''', '''prostatic carcinoma''').  Benign pathology of the prostate gland is dealt with in the ''[[prostate gland]]'' article.
This article deals with '''prostate cancer'''.  The vast majority of prostate cancers are carcinomas, i.e. '''prostatic adenocarcinoma''' ([[AKA]] '''adenocarcinoma of the prostate''', '''prostatic carcinoma''').  Benign pathology of the prostate gland is dealt with in the ''[[prostate gland]]'' article.


=Conventional prostate cancer=
==General==
==General==
*Very common.
*Very common.
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- ADDITIONAL FINDINGS: HIGH-GRADE PROSTATIC INTRAEPITHELIAL NEOPLASIA, CHRONIC INFLAMMATION (FOCAL).
- ADDITIONAL FINDINGS: HIGH-GRADE PROSTATIC INTRAEPITHELIAL NEOPLASIA, CHRONIC INFLAMMATION (FOCAL).
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=Unusual forms of prostate cancer=
==Prostatic ductal adenocarcinoma==
*[[AKA]] ''ductal adenocarcinoma of the prostate''.
*[[AKA]] ''prostatic adenocarcinoma, large duct type''.
===General===
*Sometimes it is referred to as ''endometrioid'' or ''endometrial'' adenocarcinoma; both terms are discouraged.<ref name=pmid18773743>{{Cite journal  | last1 = Samaratunga | first1 = H. | last2 = Delahunt | first2 = B. | title = Ductal adenocarcinoma of the prostate: current opinion and controversies. | journal = Anal Quant Cytol Histol | volume = 30 | issue = 4 | pages = 237-46 | month = Aug | year = 2008 | doi =  | PMID = 18773743 }}</ref>
*Not completely uncontroversial - may represent ''acinar adenocarcinoma'' with periurethral ducts involvement.<ref name=pmid10403300>{{Cite journal  | last1 = Bock | first1 = BJ. | last2 = Bostwick | first2 = DG. | title = Does prostatic ductal adenocarcinoma exist? | journal = Am J Surg Pathol | volume = 23 | issue = 7 | pages = 781-5 | month = Jul | year = 1999 | doi =  | PMID = 10403300 }}</ref>
*More aggressive than conventional (acinar) prostate carcinoma.
===Microscopic===
Features:<ref name=Ref_GUP88>{{Ref GUP|88}}</ref>
*Pseudostratified (crowded appearing) columnar (or cigar-shaped) nuclei - '''key feature'''.
**Vaguely resembles [[colonic adenocarcinoma]].
*Variable architecture:
**Papillary.
**Cribriform.
**Single gland (large glands).
**Endometrioid - vaguely looks like endometrial carcinoma (with back-to-back glands).
Notes:
*Usually seen in association with conventional (acinar) prostate adenocarcinoma.
**Proportion of ductal component should be quantified:
***<10% ductal component of no prognostic significance.<ref name=pmid21383610>{{Cite journal  | last1 = Amin | first1 = A. | last2 = Epstein | first2 = JI. | title = Pathologic stage of prostatic ductal adenocarcinoma at radical prostatectomy: effect of percentage of the ductal component and associated grade of acinar adenocarcinoma. | journal = Am J Surg Pathol | volume = 35 | issue = 4 | pages = 615-9 | month = Apr | year = 2011 | doi = 10.1097/PAS.0b013e31820eb25b | PMID = 21383610 }}</ref>
Images:
*[http://path.upmc.edu/cases/case203.html Prostatic ductal adenocarcinoma - several images (upmc.edu)].
*[http://path.upmc.edu/cases/case711.html Prostatic ductal adenocarcinoma - another case - several images (upmc.edu)].
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3024288/figure/F1/ Prostatic ductal adenocarcinoma - F1 (nih.gov)].
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3024288/figure/F2/ Prostatic ductal adenocarcinoma - F2 (nih.gov)].
*[http://www.webpathology.com/image.asp?n=13&Case=23 Prostatic ductal adenocarcinoma (webpathology.com)].
===IHC===
Features:<ref name=pmid22583364>{{Cite journal  | last1 = Tarján | first1 = M. | last2 = Lenngren | first2 = A. | last3 = Hellberg | first3 = D. | last4 = Tot | first4 = T. | title = Immunohistochemical verification of ductal differentiation in prostate cancer. | journal = APMIS | volume = 120 | issue = 6 | pages = 510-8 | month = Jun | year = 2012 | doi = 10.1111/j.1600-0463.2011.02862.x | PMID = 22583364 }}</ref>
*p53 +ve in ~ 75% of cases.
*Ki-67 high in ~ 70% of cases.
*Chromogranin A +ve (cytoplasm) in ~ 70% of cases.
Others:<ref name=pmid20368883>{{Cite journal  | last1 = Kumar | first1 = A. | last2 = Mukherjee | first2 = SD. | title = Metastatic ductal carcinoma of the prostate: a rare variant responding to a common treatment. | journal = Can Urol Assoc J | volume = 4 | issue = 2 | pages = E50-4 | month = Apr | year = 2010 | doi =  | PMID = 20368883 }}</ref>
*PSA +ve.
==PIN-like prostatic ductal adenocarcinoma==
===General===
*Recently described.<ref name=pmid16607376>{{Cite journal  | last1 = Hameed | first1 = O. | last2 = Humphrey | first2 = PA. | title = Stratified epithelium in prostatic adenocarcinoma: a mimic of high-grade prostatic intraepithelial neoplasia. | journal = Mod Pathol | volume = 19 | issue = 7 | pages = 899-906 | month = Jul | year = 2006 | doi = 10.1038/modpathol.3800601 | PMID = 16607376 }}</ref><ref name=pmid20438402>{{Cite journal  | last1 = Lee | first1 = TK. | last2 = Miller | first2 = JS. | last3 = Epstein | first3 = JI. | title = Rare histological patterns of prostatic ductal adenocarcinoma. | journal = Pathology | volume = 42 | issue = 4 | pages = 319-24 | month = Jun | year = 2010 | doi = 10.3109/00313021003767314 | PMID = 20438402 }}</ref>
*May be confused with [[prostatic intraepithelial neoplasia]] (PIN).
===Microscopic===
Features:<ref name=pmid16607376>{{Cite journal  | last1 = Hameed | first1 = O. | last2 = Humphrey | first2 = PA. | title = Stratified epithelium in prostatic adenocarcinoma: a mimic of high-grade prostatic intraepithelial neoplasia. | journal = Mod Pathol | volume = 19 | issue = 7 | pages = 899-906 | month = Jul | year = 2006 | doi = 10.1038/modpathol.3800601 | PMID = 16607376 }}</ref>
*Stratified malignant epithelium.
Note:
*Vaguely similar to a tubular adenoma of the colon.
DDx:
*[[HGPIN]].
Image:
*[http://www.nature.com/modpathol/journal/v19/n7/fig_tab/3800601f1.html#figure-title PIN-like adenocarcinoma (nature.com)].
==Foamy gland carcinoma==
===General===
*Rare.
===Microscopic===
Features:
*Tufted glandular border.
*Abundant eosinophilic (or hyperchromatic) cytoplasm - '''key feature'''.
*Gland size larger than "typical" prostate cancer.
Image: [http://www.nature.com/modpathol/journal/v17/n3/fig_tab/3800050f11.html#figure-title Foamy gland carcinoma (nature.com)].
==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===
Features:
*Scant cytoplasm.
*Nuclear features of conventional prostate cancer (nucleoli, nuclear enlargement).
*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)].
==Mucinous prostate carcinoma==
===General===
*Rare.
===Microscopic===
Features:
*Cytologically malignant cells floating in mucin.
*> 25% of tumour mucinous.<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>
**One study suggests '''>=''' 25%.<ref>{{cite journal |author=Osunkoya AO, Nielsen ME, Epstein JI |title=Prognosis of mucinous adenocarcinoma of the prostate treated by radical prostatectomy: a study of 47 cases |journal=Am. J. Surg. Pathol. |volume=32 |issue=3 |pages=468–72 |year=2008 |month=March |pmid=18300802 |doi=10.1097/PAS.0b013e3181589f72 |url=}}</ref>
DDx:
*Metastatic [[mucinous carcinoma]].
Notes:
*[[Mucinous carcinoma]] - percentage required to call varies by site.
==Pseudohyperplastic prostatic adenocarcinoma==
===General===
*Rare.
===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>
*Medium to large glands with an atypical morphology - '''key low power feature''':
**Papillary or pseudopapillary infoldings, luminal undulations, branching or cystic dilatation.
*Nuclear features of conventional prostate cancer (nucleoli, nuclear enlargement).
Image: [http://www.nature.com/modpathol/journal/v17/n3/fig_tab/3800050f13.html Pseudohyperplastic prostatic adenocarcinoma (nature.com)].
Notes:
*Usually associated with conventional (acinar) prostate adenocarcinoma.
*Pale abundant cytoplasm - similar to normal prostate.
==Prostatic signet ring cell carcinoma==
{{Main|Signet ring cell carcinoma}}
===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>
*Criteria vary - percentage of SRCs required for Dx varies from 20% to 50%.<ref name=pmid21123640/>
===Microscopic===
Features:
*Signet ring cells - see ''[[basics]]'' article.
Image:
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2996149/figure/F1/ Prostatic SRC (nih.gov)].
==Sarcomatoid prostate carcinoma==
*[[AKA]] ''carcinosarcoma''.
===General===
*Rare.
===Microscopic===
Features:<ref name=Ref_GUP80>{{Ref GUP|77 & 80}}</ref>
*Biphasic tumour:
*#Spindle cells (sarcomatous component).
*#*May include components of: [[osteosarcoma]], [[chondrosarcoma]] and/or [[rhabdomyosarcoma]].
*#Glandular component (like conventional prostate carcinoma).
===IHC===
Features - typical:<ref name=Ref_GUP80>{{Ref GUP|77 & 80}}</ref>
*PSA +ve.
*Keratin +ve.
==Small cell carcinoma of the prostate gland==
{{Main|Small cell carcinoma}}
===General===
*Rare.
===Microscopic===
Features:
*Nuclear moulding.
*Stippled chromatin.
*High [[NC ratio]].
*Small cells.
Notes:
*Similar to [[small cell carcinoma of the lung]].
*High-grade squamoid component favours metastatic [[urothelial carcinoma]].
**UCC usu. HWCK +ve.
==Adenoid cystic/basal cell carcinoma of the prostate==
*Abbreviated ''ACBCC''.
===General===
*Rare.
*Typically indolent - may be aggressive.<ref name=pmid14657711>{{Cite journal  | last1 = Iczkowski | first1 = KA. | last2 = Ferguson | first2 = KL. | last3 = Grier | first3 = DD. | last4 = Hossain | first4 = D. | last5 = Banerjee | first5 = SS. | last6 = McNeal | first6 = JE. | last7 = Bostwick | first7 = DG. | title = Adenoid cystic/basal cell carcinoma of the prostate: clinicopathologic findings in 19 cases. | journal = Am J Surg Pathol | volume = 27 | issue = 12 | pages = 1523-9 | month = Dec | year = 2003 | doi =  | PMID = 14657711 }}</ref>
===Microscopic===
Features:
*[[Adenoid cystic carcinoma]]-like and [[basal cell adenoma]]-like:
**Nests of cells that have round spaces filled by whispy blue mucin.
**Dense collagenous stroma.
Images:
*[http://www.webpathology.com/image.asp?case=23&n=15 Adenoid basal cell tumour (webpathology.com)].
*[http://www.webpathology.com/image.asp?case=23&n=16 Adenoid basal cell tumour (webpathology.com)].
===IHC===
*HER2/neu +ve (strong).<ref name=pmid17142577>{{Cite journal  | last1 = Iczkowski | first1 = KA. | last2 = Montironi | first2 = R. | title = Adenoid cystic/basal cell carcinoma of the prostate strongly expresses HER-2/neu. | journal = J Clin Pathol | volume = 59 | issue = 12 | pages = 1327-30 | month = Dec | year = 2006 | doi = 10.1136/jcp.2005.035147 | PMID = 17142577 }}</ref>


=See also=
=See also=
Michael
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