Difference between revisions of "Prostate cancer"

Jump to navigation Jump to search

Prostate cancer (view source)

Revision as of 20:29, 24 May 2020

29,797 bytes removed ,  20:29, 24 May 2020
m
vauthors
m (vauthors)
 
(72 intermediate revisions by 2 users not shown)
Line 14: Line 14:
| Gross      = usu. posterior aspect of the prostate - often not apparent at gross
| Gross      = usu. posterior aspect of the prostate - often not apparent at gross
| Grossing  = [[prostate biopsy]], [[prostate chips]], [[radical prostatectomy]]
| Grossing  = [[prostate biopsy]], [[prostate chips]], [[radical prostatectomy]]
| Staging    = [[prostate cancer staging]]
| Site      = [[prostate gland]]
| Site      = [[prostate gland]]
| Assdx      =
| Assdx      =
Line 24: Line 25:
| Rads      = hypoechoic areas, no apparent abnormality
| Rads      = hypoechoic areas, no apparent abnormality
| Endoscopy  =
| Endoscopy  =
| Prognosis  = good-to-poor (depends on [[Gleason score]] and [[stage]])
| Prognosis  = good-to-poor (depends on [[prostate cancer grading|grade (Gleason score)]] and [[stage]])
| Other      =
| Other      =
| ClinDDx    = [[prostatitis]], [[nodular hyperplasia of the prostate]]
| ClinDDx    = [[prostatitis]], [[nodular hyperplasia of the prostate]]
Line 47: Line 48:
===Management===
===Management===
====Dirty first approximation====
====Dirty first approximation====
*The management changes between [[Gleason score]] 6, 7 and 8.
*The management changes between [[Gleason score]] 6, 7 (3+4), 7 (4+3) and 8.


Typically, the implications are:
Typically, the implications are:
* Gleason 6: observation ''or'' radioactive seeds; surgery if patient wants.
* Gleason 6: observation ''or'' radioactive seeds; surgery if patient wants.
* Gleason 7: do something -- surgery ''or'' radiation therapy.
* Gleason 7 with a bit of Gleason pattern 4 and a low tumour volume: it is reasonable to watch ''or'' do something. ‡
* Gleason 7 with a lot of Gleason pattern 4 ''or'' a high tumour volume: do something -- surgery ''or'' radiation therapy.
* Gleason 8+: bad cancer -- do something quickly!
* Gleason 8+: bad cancer -- do something quickly!
Note:
* ‡ It has been said that ''Gleason score 7 with a bit of Gleason pattern 4 is the new Gleason score 6''.


Bottom line:  
Bottom line:  
Line 78: Line 83:
Clinical criteria:
Clinical criteria:
*PSA <= 10 ng/mL.<ref name=pmid22314081/>
*PSA <= 10 ng/mL.<ref name=pmid22314081/>
*Negative DRE.


==Gross==
==Gross==
Line 93: Line 99:


===Cytoprostatectomy grossing===
===Cytoprostatectomy grossing===
{{Main|Cystoprostatectomy grossing}}
*Limited sampling of the prostate may lead to undersampling error.<ref name=pmid11182038>{{Cite journal  | last1 = Cindolo | first1 = L. | last2 = Benincasa | first2 = G. | last3 = Autorino | first3 = R. | last4 = Domizio | first4 = S. | last5 = De Rosa | first5 = G. | last6 = Testa | first6 = G. | last7 = D'Armiento | first7 = M. | last8 = Altieri | first8 = V. | title = Prevalence of silent prostatic adenocarcinoma in 165 patients undergone cystoprostatectomy: a retrospective study. | journal = Oncol Rep | volume = 8 | issue = 2 | pages = 269-71 | month =  | year =  | doi =  | PMID = 11182038 }}</ref>
*Limited sampling of the prostate may lead to undersampling error.<ref name=pmid11182038>{{Cite journal  | last1 = Cindolo | first1 = L. | last2 = Benincasa | first2 = G. | last3 = Autorino | first3 = R. | last4 = Domizio | first4 = S. | last5 = De Rosa | first5 = G. | last6 = Testa | first6 = G. | last7 = D'Armiento | first7 = M. | last8 = Altieri | first8 = V. | title = Prevalence of silent prostatic adenocarcinoma in 165 patients undergone cystoprostatectomy: a retrospective study. | journal = Oncol Rep | volume = 8 | issue = 2 | pages = 269-71 | month =  | year =  | doi =  | PMID = 11182038 }}</ref>


Line 127: Line 134:
**Thus, it has been suggested that six or more glands should be present to diagnose cancer.<ref name=pmid20061936/>
**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>
Features considered pathognomonic for prostate carcinoma by some authorities:<ref name=pmid16613324>{{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><ref name=pmid10435561>{{Cite journal  | last1 = Baisden | first1 = BL. | last2 = Kahane | first2 = H. | last3 = Epstein | first3 = JI. | title = Perineural invasion, mucinous fibroplasia, and glomerulations: diagnostic features of limited cancer on prostate needle biopsy. | journal = Am J Surg Pathol | volume = 23 | issue = 8 | pages = 918-24 | month = Aug | year = 1999 | doi =  | PMID = 10435561 }}</ref>
#Perineural invasion.
#Perineural invasion.
#*Must be circumferential (>95% of circumference{{fact}}).  
#*Must be circumferential (>95% of circumference{{fact}}).  
#Glomeruloid bodies.
#Glomeruloid bodies.
#Collagenous micronodules.
#[[Collagenous micronodules]] also known as ''mucinous fibroplasia''.


<gallery>
<gallery>
Image: Intraluminal eosinophilic crystalloid of prostate gland - high mag.jpg| Intraluminal eosinophilic crystalloid - high mag. (WC)
Image: Intraluminal eosinophilic crystalloid of prostate gland - high mag.jpg| Intraluminal eosinophilic crystalloid - high mag. (WC)
Image: Prostate carcinoma with blue mucin -- very high mag.jpg | Whispy blue mucin - very high mag. (WC)
Image: Prostate carcinoma with blue mucin - a1 -- intermed mag.jpg | Whispy blue mucin - intermed. mag. (WC)
</gallery>
</gallery>


Line 180: Line 189:
| many small glands, lack nuclear size variation, basal layer present
| 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
| 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)]
| [[Image:Adenosis of prostate_--_intermed_mag.jpg|thumb|150px|center| Adenosis of prostate. (WC)]]
|-
|-
| Sclerosing adenosis
| Sclerosing adenosis
Line 186: Line 195:
| many small glands, lack nuclear size variation, basal layer present
| many small glands, lack nuclear size variation, basal layer present
| analogous to [[sclerosing adenosis of the breast]]{{fact}}
| analogous to [[sclerosing adenosis of the breast]]{{fact}}
| [http://webpathology.com/image.asp?case=21&n=8 Sclerosing adenosis (webpathology.com)]
| [http://webpathology.com/image.asp?case=21&n=40 Sclerosing adenosis (webpathology.com)]
|-
|-
| [[atrophy of the prostate|Atrophy]]
| [[atrophy of the prostate|Atrophy]]
Line 198: Line 207:
| abundant epithelial cells; nucleoli in pale ('blue') nuclei of basal cells, glandular cell nuclei darker ('purple')
| 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
| vaguely similar to epithelial hyperplasia of usual type (EHUT) in breast
| [[Image:Basal_cell_hyperplasia_of_the_prostate_--_high_mag.jpg|thumb|150px|center| Prostatic BCH. (WC)]]
| [[Image:Basal_cell_hyperplasia_of_prostate_-_high_mag.jpg|thumb|150px|center| Prostatic BCH. (WC)]]
|-
|-
| [[Bulbourethral gland]]
| [[Bulbourethral gland]]
Line 215: Line 224:
| marked nuclear size variation
| marked nuclear size variation
| increased stroma (fibrosis), lack nucleoli ???
| increased stroma (fibrosis), lack nucleoli ???
| history of Rx; uniform nuc. size with Hx of Rx should raise susp. of cancer
| history of Rx; uniform nuc. size with Hx of Rx should raise susp. of [[postradiation prostatic carcinoma|postradiation 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)]
| [[Image:Prostate_with_radiation_changes_--_high_mag.jpg|thumb|150px|center|Radiation change. (WC)]]
|-
|-
| Prostatitis
| Prostatitis
Line 232: Line 241:
Memory device: '''AAABBRS''' = atrophy, adenosis, adenosis (sclerosing), basal cell hyperplasia, bulbourethral gland, radiation, seminal vesicles.
Memory device: '''AAABBRS''' = atrophy, adenosis, adenosis (sclerosing), basal cell hyperplasia, bulbourethral gland, radiation, seminal vesicles.


===Gleason grading system===
===Situations where prostate adenocarcinoma may be missed===
====Overview====
Key reasons for false negative prostate samples<ref>{{cite journal |authors=Yang C, Humphrey PA |title=False-Negative Histopathologic Diagnosis of Prostatic Adenocarcinoma |journal=Arch. Pathol. Lab. Med. |volume=144 |issue=3 |pages=326–334 |date=March 2020 |pmid=31729886 |doi=10.5858/arpa.2019-0456-RA |url=}}</ref>:
*This system is only one any one talks about and there is consensus on how it is done.<ref name=pmid16096414>{{Cite journal | last1 = Epstein | first1 = JI. | last2 = Allsbrook | first2 = WC. | last3 = Amin | first3 = MB. | last4 = Egevad | first4 = LL. | title = The 2005 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma. | journal = Am J Surg Pathol | volume = 29 | issue = 9 | pages = 1228-42 | month = Sep | year = 2005 | doi = | PMID = 16096414 }}</ref>
*Tissue artefacts (try levels and/or IHC):
*Score range: 6-10.
**Crush artefact
**Technically 2-10... but almost no one uses 2-5.
**Thick sections
*Reported on biopsy (and [[TURP]]) as: (primary pattern) + (secondary pattern ''or'' tertiary pattern with the highest grade) = sum.
**Aberrant H&E staining
**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.
**Freezing artefact
*Reported as on prostatectomies as: (primary pattern) + (secondary pattern) = sum, (tertiary pattern)
**Cautery
 
*Minimal adenocarcinoma (less than 1mm long or involving less than 5% of a core biopsy):
*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>
*Prostatic adenocarcinoma variants that mimic benign:
**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>
**[[Atrophic prostate carcinoma]]
 
**[[Pseudohyperplastic adenocarcinoma]]
Testing yourself:
**[[Foamy gland adenocarcinoma]]
*There is a nice test-yourself quiz from Johns Hopkins: [http://162.129.103.34/prostate/ http://162.129.103.34/prostate/].
**[[PIN-like adenocarcinoma]]
**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>
**Microcystic adenocarcinoma
 
*Single cells of Gleason 5 adenocarcinoma (missed or mistaken for lymphocytes; try IHC for cytokeratins, prostatic and/or hematologic markers)
====Examples====
*Treatment effect (check clinical information and look for treatment effect in benign glands)
*A biopsy with 80% pattern 4, 16% pattern 3 and 4% pattern 5... would be reported as: 4+5=9.
*A biopsy with 92% pattern 4, and 8% pattern 3... would be reported as: 4+3=7.
*A biopsy with 98% pattern 4, and 2% pattern 3... would be reported as: 4+4=8.
*A prostatectomy with 80% pattern 4, 16% pattern 3 and 4% pattern 5... would be reported as: 4+3=7 with tertiary pattern 5.
 
====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=====
<gallery>
Image:Prostate_cancer_with_Gleason_pattern_4_low_mag.jpg | Gleason pattern 4 - cribriform. (WC)
Image:Gleason_4_and_5_intermed_mag.jpg | Gleason pattern 4 - small glands & Gleason pattern 5 - single cells. (WC)
</gallery>
www:
*[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 carcinoma of the prostate|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 (strands).
**Line of cells.
**Should not be intermixed with clumps of cells (pattern 4).
*Nests of cells with [[necrosis]] (at the centre) (comedonecrosis) ''or'' (intraluminal) necrosis in a cribriform pattern.<ref name=pmid16096414/>
**Necrosis:
***Nuclear changes:
****Karyorrhexis (nuclear fragmentation).
****Pynosis (nuclear shrinkage).
****Karyolysis (nuclear dissolution).
***Cell ghosts (cells without a nucleus).
 
Notes:
*Pattern 5 may be under-diagnosed.
*Single cells is the most commonly missed pattern.<ref name=pmid21997691>{{Cite journal  | last1 = Fajardo | first1 = DA. | last2 = Miyamoto | first2 = H. | last3 = Miller | first3 = JS. | last4 = Lee | first4 = TK. | last5 = Epstein | first5 = JI. | title = Identification of Gleason pattern 5 on prostatic needle core biopsy: frequency of underdiagnosis and relation to morphology. | journal = Am J Surg Pathol | volume = 35 | issue = 11 | pages = 1706-11 | month = Nov | year = 2011 | doi = 10.1097/PAS.0b013e318228571d | PMID = 21997691 }}
</ref>


=====Images=====
===Prostate cancer grading===
<gallery>
{{Main|Prostate cancer grading}}
Image:Gleason_4_and_5_intermed_mag.jpg | Gleason pattern 4 - small glands (left) & Gleason pattern 5 - single cells (right). (WC)
It covers the ''Gleason grading system'' and the (new) ''prognostic grade groupings''.
</gallery>
www:
*[http://www.webpathology.com/image.asp?n=17&Case=20 Gleason pattern 5 - sheeting (webpathology.com)].
 
====Special types====
Special types of prostate cancer have suggested Gleason patterns:<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
| 3 or 4 - dependent on morphology<ref name=pmid18487999>{{Cite journal  | last1 = Osunkoya | first1 = AO. | last2 = Adsay | first2 = NV. | last3 = Cohen | first3 = C. | last4 = Epstein | first4 = JI. | last5 = Smith | first5 = SL. | title = MUC2 expression in primary mucinous and nonmucinous adenocarcinoma of the prostate: an analysis of 50 cases on radical prostatectomy. | journal = Mod Pathol | volume = 21 | issue = 7 | pages = 789-94 | month = Jul | year = 2008 | doi = 10.1038/modpathol.2008.47 | PMID = 18487999 }}</ref><ref name=pmid18300802>{{Cite journal  | last1 = Osunkoya | first1 = AO. | last2 = Nielsen | first2 = ME. | last3 = Epstein | first3 = 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 | month = Mar | year = 2008 | doi = 10.1097/PAS.0b013e3181589f72 | PMID = 18300802 }}</ref>
| some advocate grade 4<ref name=pmid14976541/>
|-
|Sarcomatoid carcinoma
| 5
| glands graded separately
|-
|Signet ring cell carcinoma
| 5
|
|-
|Small cell carcinoma
| not graded
| may be graded 5<ref name=bostwicklabs/>
|-
|[[Adenosquamous carcinoma|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.
 
====Biopsy-prostatectomy concordance of Gleason score====
*Discordance is common.
**Upgrade on prostatectomy: 25-40%.
**Downgrade on prostatectomy: 5-15%.
 
Selected studies on concordance:
{| class="wikitable sortable"  style="margin-left:auto;margin-right:auto"
! Study
! Upgrade
! Downgrade
! Notes
|-
| Sfoungaristos et al.<ref name=pmid22277633>{{Cite journal  | last1 = Sfoungaristos | first1 = S. | last2 = Perimenis | first2 = P. | title = Clinical and pathological variables that predict changes in tumour grade after radical prostatectomy in patients with prostate cancer. | journal = Can Urol Assoc J | volume =  | issue =  | pages = 1-5 | month = Jan | year = 2012 | doi = 10.5489/cuaj.11067 | PMID = 22277633 }}</ref>
| 42.1%
| 13.7%
| high volume of tumour predicts upgrade
|-
| Thomas et al.<ref name=pmid21592293>{{Cite journal  | last1 = Thomas | first1 = C. | last2 = Pfirrmann | first2 = K. | last3 = Pieles | first3 = F. | last4 = Bogumil | first4 = A. | last5 = Gillitzer | first5 = R. | last6 = Wiesner | first6 = C. | last7 = Thüroff | first7 = JW. | last8 = Melchior | first8 = SW. | title = Predictors for clinically relevant Gleason score upgrade in patients undergoing radical prostatectomy. | journal = BJU Int | volume = 109 | issue = 2 | pages = 214-9 | month = Jan | year = 2012 | doi = 10.1111/j.1464-410X.2011.10187.x | PMID = 21592293 }}</ref>
| 38.1%
| 4.7%
|
|-
| Truesdale et al.<ref name=pmid20840549>{{Cite journal  | last1 = Truesdale | first1 = MD. | last2 = Cheetham | first2 = PJ. | last3 = Turk | first3 = AT. | last4 = Sartori | first4 = S. | last5 = Hruby | first5 = GW. | last6 = Dinneen | first6 = EP. | last7 = Benson | first7 = MC. | last8 = Badani | first8 = KK. | title = Gleason score concordance on biopsy-confirmed prostate cancer: is pathological re-evaluation necessary prior to radical prostatectomy? | journal = BJU Int | volume = 107 | issue = 5 | pages = 749-54 | month = Mar | year = 2011 | doi = 10.1111/j.1464-410X.2010.09570.x | PMID = 20840549 }}</ref>
| 23%
| 11%
|
|}
 
=====Sign out=====
=====Upgrading=====
<pre>
Gleason score upgrading on prostatectomy is considered relatively common; it is reported
to occur in 23% to 42.1% of cases.[1][2]
 
1. BJU Int. 2011 107 (5): 749-54.
2. Can Urol Assoc J. 2012 Jan 24:1-5.
</pre>
 
=====Downgrading=====
<pre>
Gleason score downgrading on prostatectomy is considered uncommon; however, it is reported
in 4.7% to 13.7% of cases.[1][2]
 
1. BJU Int. 2012 Jan; 109(2):214-9.
2. Can Urol Assoc J. 2012 Jan; 24;1-5.
</pre>
 
=====Order of Gleason score components changed=====
<pre>
COMMENT:
The change in the order of the Gleason score components (3+4 on prostatectomy
versus 4+3 on core biopsy) may be explained by sampling.
</pre>


===Staging parameters, margins and more===
===Staging parameters, margins and more===
====Surgical margins====
====Surgical margins====
{{Main|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>
*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 (<0.1 mm) have an increased recurrence risk.<ref name=pmid22578729/>
**"Close" margins (<0.1 mm) have an increased recurrence risk.<ref name=pmid22578729/>


Line 454: Line 289:


=====Bladder neck margin=====
=====Bladder neck margin=====
{{Main|Bladder neck invasion}}
:[[AKA]] ''invasion of the bladder neck''.<ref name=pmid19914651/>
:[[AKA]] ''invasion of the bladder neck''.<ref name=pmid19914651/>
*Bladder neck margin positivity typically is '''pT3a'''.<ref name=pmid23225909>{{Cite journal  | last1 = Chung | first1 = MS. | last2 = Lee | first2 = SH. | last3 = Lee | first3 = DH. | last4 = Chung | first4 = BH. | title = Evaluation of the 7th American Joint Committee on cancer TNM staging system for prostate cancer in point of classification of bladder neck invasion. | journal = Jpn J Clin Oncol | volume = 43 | issue = 2 | pages = 184-8 | month = Feb | year = 2013 | doi = 10.1093/jjco/hys196 | PMID = 23225909 }</ref>
*Bladder neck margin positivity typically is '''pT3a'''.<ref name=pmid23225909>{{Cite journal  | last1 = Chung | first1 = MS. | last2 = Lee | first2 = SH. | last3 = Lee | first3 = DH. | last4 = Chung | first4 = BH. | title = Evaluation of the 7th American Joint Committee on cancer TNM staging system for prostate cancer in point of classification of bladder neck invasion. | journal = Jpn J Clin Oncol | volume = 43 | issue = 2 | pages = 184-8 | month = Feb | year = 2013 | doi = 10.1093/jjco/hys196 | PMID = 23225909 }}</ref>
*Seen in approximately 1% of prostatectomies.<ref name=pmid19914651>{{Cite journal  | last1 = Pierorazio | first1 = PM. | last2 = Epstein | first2 = JI. | last3 = Humphreys | first3 = E. | last4 = Han | first4 = M. | last5 = Walsh | first5 = PC. | last6 = Partin | first6 = AW. | title = The significance of a positive bladder neck margin after radical prostatectomy: the American Joint Committee on Cancer Pathological Stage T4 designation is not warranted. | journal = J Urol | volume = 183 | issue = 1 | pages = 151-7 | month = Jan | year = 2010 | doi = 10.1016/j.juro.2009.08.138 | PMID = 19914651 }}</ref>
*Seen in approximately 1% of prostatectomies.<ref name=pmid19914651>{{Cite journal  | last1 = Pierorazio | first1 = PM. | last2 = Epstein | first2 = JI. | last3 = Humphreys | first3 = E. | last4 = Han | first4 = M. | last5 = Walsh | first5 = PC. | last6 = Partin | first6 = AW. | title = The significance of a positive bladder neck margin after radical prostatectomy: the American Joint Committee on Cancer Pathological Stage T4 designation is not warranted. | journal = J Urol | volume = 183 | issue = 1 | pages = 151-7 | month = Jan | year = 2010 | doi = 10.1016/j.juro.2009.08.138 | PMID = 19914651 }}</ref>


====Extraprostatic extension====
====Extraprostatic extension====
:Abbreviated ''EPE''.
:Abbreviated ''EPE''.
 
{{Main|Prostate cancer staging#Extraprostatic extension}}
=====General=====
*Extraprostatic extension (EPE) is difficult to assess in prostatectomy specimens.<ref name=pmid20802467>{{Cite journal  | last1 = Magi-Galluzzi | first1 = C. | last2 = Evans | first2 = AJ. | last3 = Delahunt | first3 = B. | last4 = Epstein | first4 = JI. | last5 = Griffiths | first5 = DF. | last6 = van der Kwast | first6 = TH. | last7 = Montironi | first7 = R. | last8 = Wheeler | first8 = TM. | last9 = Srigley | first9 = JR. | title = International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 3: extraprostatic extension, lymphovascular invasion and locally advanced disease. | journal = Mod Pathol | volume = 24 | issue = 1 | pages = 26-38 | month = Jan | year = 2011 | doi = 10.1038/modpathol.2010.158 | PMID = 20802467 }}</ref>
**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 in a prostatectomy 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 apex of the prostate gland may have some skeletal muscle. Thus, it is difficult to define extension at this site. EPE is not called at the apex by some pathologists; however, it is generally believed to exist.<ref name=pmid20802467/>
 
=====Prostate biopsy=====
EPE is present in prostate biopsy 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>
 
======Images======
<gallery>
Image: Prostate carcinoma with extraprostatic extension -- intermed mag.jpg | EPE - intermed. mag.
Image: Prostate carcinoma with extraprostatic extension -- high mag.jpg | EPE - high mag.
</gallery>


====Seminal vesicle invasion====
====Seminal vesicle invasion====
:Abbreviated ''SVI''.
:Abbreviated ''SVI''.
General:
{{Main|Prostate cancer staging#Seminal vesicle invasion}}
*Typically upstages to pT3b.
*Associations:<ref name=pmid23194127>{{Cite journal  | last1 = Sapre | first1 = N. | last2 = Pedersen | first2 = J. | last3 = Hong | first3 = MK. | last4 = Harewood | first4 = L. | last5 = Peters | first5 = J. | last6 = Costello | first6 = AJ. | last7 = Hovens | first7 = CM. | last8 = Corcoran | first8 = NM. | title = Re-evaluating the biological significance of seminal vesicle invasion (SVI) in locally advanced prostate cancer. | journal = BJU Int | volume = 110 Suppl 4 | issue =  | pages = 58-63 | month = Dec | year = 2012 | doi = 10.1111/j.1464-410X.2012.11477.x | PMID = 23194127 }}</ref>
**Most SVI is by direct extension ~90%.
**Approximately 20% of patients with pT3x have SVI.
**Usually associated with a large tumour volume (22% versus 12%).
 
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.
*Immunostains useful to separate prostate carcinoma from [[SV]] are discussed in the ''[[seminal vesicle]]'' article.
*It is not possible to differentiate the ''seminal vesicles'' and ''ejaculatory ducts'' based only on histology; thus, on biopsy one can generally comment only on ''seminal vesicle/ejaculatory duct invasion''.
 
====Lymph node metastases====
{{Main|Lymph node metastasis}}
*Essentially never happens in Gleason score 6 cancers.
**A study of over 14,000 Gleason score <=6 cases found 22 cases with lymph node metastases -- all of the 19 cases available for review were determined to have a higher Gleason score and some Gleason pattern 4 or 5.<ref name=pmid22531173>{{Cite journal  | last1 = Ross | first1 = HM. | last2 = Kryvenko | first2 = ON. | last3 = Cowan | first3 = JE. | last4 = Simko | first4 = JP. | last5 = Wheeler | first5 = TM. | last6 = Epstein | first6 = JI. | title = Do adenocarcinomas of the prostate with Gleason score (GS) ≤6 have the potential to metastasize to lymph nodes? | journal = Am J Surg Pathol | volume = 36 | issue = 9 | pages = 1346-52 | month = Sep | year = 2012 | doi = 10.1097/PAS.0b013e3182556dcd | PMID = 22531173 }}</ref>


====Perineural invasion====
====Perineural invasion====
Line 524: Line 319:


===Prostate markers===
===Prostate markers===
*PSA (prostate specific antigen) +ve.  
*[[PSA]] (prostate specific antigen) +ve.  
*PSAP (prostatic specific acid phosphatase) +ve. †
*[[PSAP]] (prostatic specific acid phosphatase) +ve. †
*P501S +ve. ‡
*P501S +ve. ‡
*NKX3.1 +ve. ‡
*[[NKX3.1]] +ve. ‡


Notes:
Notes:
Line 552: Line 347:
Other IHC stains:
Other IHC stains:
*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>  
**Usually -ve in lymph node +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>
 
Note:
*Bcl-2 marks basal cells in prostate cancer.<ref name=pmid20189848>{{Cite journal  | last1 = Boran | first1 = C. | last2 = Kandirali | first2 = E. | last3 = Yilmaz | first3 = F. | last4 = Serin | first4 = E. | last5 = Akyol | first5 = M. | title = Reliability of the 34βE12, keratin 5/6, p63, bcl-2, and AMACR in the diagnosis of prostate carcinoma. | journal = Urol Oncol | volume = 29 | issue = 6 | pages = 614-23 | month =  | year =  | doi = 10.1016/j.urolonc.2009.11.013 | PMID = 20189848 }}</ref>


====Prostate carcinoma versus urothelial carcinoma====
====Prostate carcinoma versus urothelial carcinoma====
Line 566: Line 364:
*AMACR not useful; it is positive in ~50% of [[UCC]].<ref name=pmid16315020>{{Cite journal  | last1 = Langner | first1 = C. | last2 = Rupar | first2 = G. | last3 = Leibl | first3 = S. | last4 = Hutterer | first4 = G. | last5 = Chromecki | first5 = T. | last6 = Hoefler | first6 = G. | last7 = Rehak | first7 = P. | last8 = Zigeuner | first8 = R. | title = Alpha-methylacyl-CoA racemase (AMACR/P504S) protein expression in urothelial carcinoma of the upper urinary tract correlates with tumour progression. | journal = Virchows Arch | volume = 448 | issue = 3 | pages = 325-30 | month = Mar | year = 2006 | doi = 10.1007/s00428-005-0129-6 | PMID = 16315020 }}</ref>
*AMACR not useful; it is positive in ~50% of [[UCC]].<ref name=pmid16315020>{{Cite journal  | last1 = Langner | first1 = C. | last2 = Rupar | first2 = G. | last3 = Leibl | first3 = S. | last4 = Hutterer | first4 = G. | last5 = Chromecki | first5 = T. | last6 = Hoefler | first6 = G. | last7 = Rehak | first7 = P. | last8 = Zigeuner | first8 = R. | title = Alpha-methylacyl-CoA racemase (AMACR/P504S) protein expression in urothelial carcinoma of the upper urinary tract correlates with tumour progression. | journal = Virchows Arch | volume = 448 | issue = 3 | pages = 325-30 | month = Mar | year = 2006 | doi = 10.1007/s00428-005-0129-6 | PMID = 16315020 }}</ref>
*CK7 and CK20 are typically negative in prostate carcinoma, and classically positive in urothelial carcinoma.
*CK7 and CK20 are typically negative in prostate carcinoma, and classically positive in urothelial carcinoma.
*CK34betaE12 may be positive in prostate cancer; 43% of cases in one small series of cases with lymph node metastases.<ref name=pmid9024071>{{Cite journal  | last1 = Googe | first1 = PB. | last2 = McGinley | first2 = KM. | last3 = Fitzgibbon | first3 = JF. | title = Anticytokeratin antibody 34 beta E12 staining in prostate carcinoma. | journal = Am J Clin Pathol | volume = 107 | issue = 2 | pages = 219-23 | month = Feb | year = 1997 | doi =  | PMID = 9024071 }}</ref>


===Rate of utilization===
===Rate of utilization===
Line 597: Line 396:


===Transurethral resection of prostate===
===Transurethral resection of prostate===
<pre>
Prostate Tissue, Transurethral Resection of Prostate (TURP):
- ADENOCARCINOMA, Gleason score 6/10 (3+3);
-- Approximately 2% of tissue involved;
-- Please see tumour summary.
Comment:
The World Health Organization (WHO) grade is: 1 out of 5.
</pre>
<pre>
Prostate Tissue, Transurethral Resection of Prostate (TURP):
- ADENOCARCINOMA, Gleason score 7/10 (3+4);
-- Approximately 4% of tissue involved;
-- Please see tumour summary.
- Benign inflamed urothelium.
Comment:
The World Health Organization (WHO) grade is: 2 out of 5. Gleason pattern 3 represents 90% of the tumour, and Gleason pattern 4 represents 10% of the tumour.
</pre>
====Block letters====
<pre>
<pre>
PROSTATE TISSUE, TRANSURETHRAL RESECTION OF PROSTATE (TURP):
PROSTATE TISSUE, TRANSURETHRAL RESECTION OF PROSTATE (TURP):
Line 633: Line 454:
- APPROXIMATELY 5% OF TISSUE INVOLVED;
- APPROXIMATELY 5% OF TISSUE INVOLVED;
- PLEASE SEE TUMOUR SUMMARY.
- PLEASE SEE TUMOUR SUMMARY.
</pre>
<pre>
Prostate Tissue, Transurethral Resection of Prostate (TURP):
- Adenocarcinoma, Gleason score 7 (3+4)
- Approximately 3% of sampled tissue involved
- Please see tumour summary
Tumour summary:
Procedure: Transurethral resection of prostate
Specimen weight: 11.7 g
Histologic type: Adenocarcinoma, acinar type
Histologic grade:
Primary pattern: 3
Secondary pattern: 4 (<15% of tumor)
Total Gleason score: 7/10 (3+4)
Tumor volume: 3% of tissue
Periprostate fat invasion: Periprostatic fat not identified
Seminal vesicle invasion: Seminal vesicle not identified
Lymphovascular inasion: Not identified
Perineural invasion: Not identified
Additional findings:
Glandular and stromal hyperplasia
Mild chronic inflammation
</pre>
</pre>


Line 815: Line 664:
*[[AKA]] ''[[intraductal carcinoma]]''.
*[[AKA]] ''[[intraductal carcinoma]]''.
*[[AKA]] ''intraductal prostate carcinoma''.
*[[AKA]] ''intraductal prostate carcinoma''.
===General===
{{Main|Intraductal carcinoma of the prostate}}
*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===
====Major criteria====
Required major criteria:<ref name=pmid22692290>{{Cite journal  | last1 = Shah | first1 = RB. | last2 = Zhou | first2 = M. | title = Atypical cribriform lesions of the prostate: clinical significance, differential diagnosis and current concept of intraductal carcinoma of the prostate. | journal = Adv Anat Pathol | volume = 19 | issue = 4 | pages = 270-8 | month = Jul | year = 2012 | doi = 10.1097/PAP.0b013e31825c6c0e | PMID = 22692290 }}</ref><ref name=pmid17616999>{{Cite journal  | last1 = Cohen | first1 = RJ. | last2 = Wheeler | first2 = TM. | last3 = Bonkhoff | first3 = H. | last4 = Rubin | first4 = MA. | title = A proposal on the identification, histologic reporting, and implications of intraductal prostatic carcinoma. | journal = Arch Pathol Lab Med | volume = 131 | issue = 7 | pages = 1103-9 | month = Jul | year = 2007 | doi = 10.1043/1543-2165(2007)131[1103:APOTIH]2.0.CO;2 | PMID = 17616999 }}</ref>
#Glands 2x normal (peripheral zone) glands.
#Basal cells present (proven by IHC).
#"Cytologically malignant cells" = nuclear hyperchromasia, nuclear enlargement, nucleoli.
#Fills the lumen ("expansile") but does not have to be "solid".
#*Solid = no spaces between the cells.
 
Additional (major) criterion:<ref name=pmid22692290/>
*Comedo[[necrosis]].
 
====Minor criteria====
Minor criteria:<ref name=pmid22692290/>
#Branching of ducts at right angles.
#Rounded/smooth gland outlines.
#Two cell populations:
#*Malignant population (enlarged nuclei with hyperchromasia and nucleoli) = peripheral location in gland.
#*Benign population (smaller nuclei, no nucleoli) = central location in gland.
 
DDx:
*[[High-grade prostatic intraepithelial neoplasia]] (HGPIN).
*Invasive [[prostate adenocarcinoma]].
 
===IHC===
Features - basal cells present:
*CK34betaE12 +ve.
*p63 +ve.


=Unusual forms of prostate cancer=
=Unusual forms of prostate cancer=
Line 852: Line 670:
*[[AKA]] ''ductal adenocarcinoma of the prostate''.
*[[AKA]] ''ductal adenocarcinoma of the prostate''.
*[[AKA]] ''prostatic adenocarcinoma, large duct type''.
*[[AKA]] ''prostatic adenocarcinoma, large duct type''.
===General===
{{Main|Ductal adenocarcinoma of the prostate gland}}
*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]].
#Compatible architecture:
#*Papillary.
#*Cribriform.
#*Single gland (large glands).
#*Endometrioid - vaguely looks like [[endometrioid endometrial carcinoma]] (with back-to-back glands).
#>= 50% of tumour.<ref name=pmid21383610/>{{fact}}
#*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.<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?case=23&n=6 Prostatic ductal adenocarcinoma (webpathology.com)].
*[http://www.webpathology.com/image.asp?n=7&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==
==PIN-like prostatic ductal adenocarcinoma==
===General===
{{Main|High-grade prostatic intraepithelial neoplasia-like ductal adenocarcinoma of the prostate}}
*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==
==Foamy gland carcinoma==
Line 917: Line 684:


==Mucinous prostate carcinoma==
==Mucinous prostate carcinoma==
===General===
{{Main|Mucinous adenocarcinoma of the prostate}}
*Rare.
*Most often Gleason 3+4 ~ 80% in one series of 47 cases.<ref name=pmid18300802>{{Cite journal  | last1 = Osunkoya | first1 = AO. | last2 = Nielsen | first2 = ME. | last3 = Epstein | first3 = 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 | month = Mar | year = 2008 | doi = 10.1097/PAS.0b013e3181589f72 | PMID = 18300802 }}</ref>
 
Gleason pattern:
*In the past, it has been suggested that the mucinous component be assigned ''Gleason pattern 4''.<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>
*The prognosis is similar or may be better than the conventional type of prostate cancer in a large series;<ref name=pmid18300802/> thus, it seems reasonable to grade based on the pattern (as advocated by some experts<ref name=pmid18487999>{{Cite journal  | last1 = Osunkoya | first1 = AO. | last2 = Adsay | first2 = NV. | last3 = Cohen | first3 = C. | last4 = Epstein | first4 = JI. | last5 = Smith | first5 = SL. | title = MUC2 expression in primary mucinous and nonmucinous adenocarcinoma of the prostate: an analysis of 50 cases on radical prostatectomy. | journal = Mod Pathol | volume = 21 | issue = 7 | pages = 789-94 | month = Jul | year = 2008 | doi = 10.1038/modpathol.2008.47 | PMID = 18487999 }}</ref>).
 
===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>
**Two studies 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><ref name=pmid23060063>{{Cite journal  | last1 = Bohman | first1 = KD. | last2 = Osunkoya | first2 = AO. | title = Mucin-producing tumors and tumor-like lesions involving the prostate: a comprehensive review. | journal = Adv Anat Pathol | volume = 19 | issue = 6 | pages = 374-87 | month = Nov | year = 2012 | doi = 10.1097/PAP.0b013e318271a361 | PMID = 23060063 }}</ref>
 
Notes:
*[[Mucinous carcinoma]] - percentage required to call varies by site.
 
DDx:
*Metastatic [[mucinous carcinoma]].
*Mucinous adenocarcinoma of the prostatic urethra - analogous to the mucinous adenocarcinoma of the [[urinary bladder]].<ref name=pmid23060063/>


==Pseudohyperplastic prostatic adenocarcinoma==
==Pseudohyperplastic prostatic adenocarcinoma==
*[[AKA]] ''pseudohyperplastic adenocarcinoma''.
*[[AKA]] ''pseudohyperplastic adenocarcinoma''.
===General===
{{Main|Pseudohyperplastic prostatic adenocarcinoma}}
*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).
 
====Images====
*[http://www.webpathology.com/image.asp?n=29&Case=23 Pseudohyperplastic adenocarcinoma (webpathology.com)].
*[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==
==Prostatic signet ring cell carcinoma==
Line 981: Line 714:
*[[Alcian blue stain|Alcian blue]] -- 44% of cases +ve.<ref name=pmid21123640/>
*[[Alcian blue stain|Alcian blue]] -- 44% of cases +ve.<ref name=pmid21123640/>


==Sarcomatoid prostate carcinoma==
==Sarcomatoid carcinoma of the prostate==
*[[AKA]] ''carcinosarcoma''.
{{Main|Sarcomatoid carcinoma of the prostate}}
===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==
==Small cell carcinoma of the prostate gland==
{{Main|Small cell carcinoma}}
{{Main|Small cell carcinoma of the prostate gland}}
===General===
*Very rare.<ref name=pmid22110988>{{Cite journal  | last1 = Furtado | first1 = P. | last2 = Lima | first2 = MV. | last3 = Nogueira | first3 = C. | last4 = Franco | first4 = M. | last5 = Tavora | first5 = F. | title = Review of small cell carcinomas of the prostate. | journal = Prostate Cancer | volume = 2011 | issue =  | pages = 543272 | month =  | year = 2011 | doi = 10.1155/2011/543272 | PMID = 22110988 }}</ref>
*Most common small cell carcinoma outside of the lung.<ref name=pmid22110988/>
*Poor prognosis.
 
===Microscopic===
Features:
*Small cells with:
**Nuclear moulding.
**Stippled chromatin.
**High [[NC ratio]].
*+/-High-grade acinar adenocarcinoma, i.e. conventional prostate carcinoma, seen in ~50% of cases.<ref name=pmid22110988/>
 
Notes:
*Similar to [[small cell carcinoma of the lung]].
*High-grade squamoid component favours metastatic [[urothelial carcinoma]].
**UCC usu. HWCK +ve.
 
DDx:
*[[Small cell carcinoma of the urinary bladder]].
*[[Lymphoma]], large cell.
*Other [[small round cell tumours]].
 
Images:
*[http://www.webpathology.com/image.asp?case=23&n=25 SmCC of the prostate - low mag. (webpathology.com)].
*[http://www.webpathology.com/image.asp?case=23&n=26 SmCC of the prostate - high mag. (webpathology.com)].
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3200299/figure/fig1/ SmCC of the prostate - low mag. (nih.gov)].
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3200299/figure/fig3/ SmCC of the prostate - high mag. (nih.gov)].
 
===IHC===
Features:<ref name=pmid22110988/>
*PSA weak +ve/-ve.
*Chromogranin +ve.


==Adenoid cystic/basal cell carcinoma of the prostate==
==Adenoid cystic/basal cell carcinoma of the prostate==
*Abbreviated ''ACBCC''.
*Abbreviated ''ACBCC''.
===General===
{{Main|Adenoid cystic/basal cell carcinoma of the prostate}}
*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===
==Postradiation prostate cancer==
Features:
{{Main|Postradiation prostate cancer}}
*[[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>


=Metastatic disease and other cancers of the prostate=
=Metastatic disease and other cancers of the prostate=
==Urothelial carcinoma==
==Urothelial carcinoma==
{{Main|Urothelial carcinoma}} {{Main|Urothelium}}
{{Main|Urothelial carcinoma of the urethra}}
:''Prostatic urothelial carcinoma'' redirects here.
===General===
*Spreads from the [[urinary bladder]] usually - common.<ref name=pmid22520044>{{Cite journal  | last1 = Huguet | first1 = J. | title = [Prostatic involvement by urothelial carcinoma in patients with bladder cancer and their implications in the clinical practice]. | journal = Actas Urol Esp | volume = 36 | issue = 9 | pages = 545-53 | month = Oct | year = 2012 | doi = 10.1016/j.acuro.2012.02.005 | PMID = 22520044 }}</ref>
*Identified by endoscopic loop biopsy.<ref name=pmid17338657>{{Cite journal  | last1 = Liedberg | first1 = F. | last2 = Chebil | first2 = G. | last3 = Månsson | first3 = W. | title = Urothelial carcinoma in the prostatic urethra and prostate: current controversies. | journal = Expert Rev Anticancer Ther | volume = 7 | issue = 3 | pages = 383-90 | month = Mar | year = 2007 | doi = 10.1586/14737140.7.3.383 | PMID = 17338657 }}</ref>
 
Treatment:<ref name=pmid17338657/>
*[[Cytoprostatectomy]] - stromal invasion ''or'' extensive intraductal involvement.
*Endoscopic resection and BCG - limited extent without stromal invasion.
 
===Microscopic===
Features:
*Divided into tumours with:
*#Stromal invasion.
*#Without stromal invasion.
 
Notes:
*Stromal involvement common ~ 75% of cases.<ref name=pmid23250619>{{Cite journal  | last1 = Ichihara | first1 = K. | last2 = Masumori | first2 = N. | last3 = Kitamura | first3 = H. | last4 = Hasegawa | first4 = T. | last5 = Tsukamoto | first5 = T. | title = Clinical outcomes of urothelial carcinoma of the prostate detected in radical cystectomy specimens. | journal = Int J Clin Oncol | volume =  | issue =  | pages =  | month = Dec | year = 2012 | doi = 10.1007/s10147-012-0508-3 | PMID = 23250619 }}</ref>
 
===Sign out===
<pre>
PROSTATE TISSUE, TRANSURETHRAL RESECTION:
- HIGH-GRADE UROTHELIAL CARCINOMA WITH FOCAL STROMAL INVASION, AND EXTENSIVE
  INTRADUCTAL SPREAD IN FRAGMENTS WITH BENIGN PROSTATIC GLANDS.
</pre>


=See also=
=See also=
Line 1,090: Line 739:


[[Category:Genitourinary pathology]]
[[Category:Genitourinary pathology]]
[[Category:Prostate carcinoma]]
Michael
48,790

edits

Retrieved from "https://librepathology.org/wiki/Special:MobileDiff/35534...50799"

Navigation menu