Prostate cancer
This article deals with prostate cancer.
The vast majority of prostate cancers are carcinomas and could be labelled prostatic carcinoma. Most prostatic carcinomas are gland forming; thus, they can be labelled prostatic adenocarcinoma or adenocarcinoma of the prostate.
Benign pathology of the prostate gland, and prostate histology and anatomy are dealt with in the prostate gland article.
Conventional prostate cancer
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):[1]
- Architecture.
- Increased gland density.
- Small circular glands.
- In rare subtypes - large branching glands.
- "Infiltrative growth" pattern - malignant glands between benign ones.
- Basal cells lacking.
- Cytological abnormalities:
- Nuclear enlargement.
- Nucleoli.
Minor criteria:[1]
- Nuclear hyperchromasia.
- Wispy blue mucin.
- Image: Wispy blue mucin (nature.com) - from Epstein.[2]
- Pink amorphous secretions.
- Image: Pink amorphous secretions (nature.com) - from Epstein.[2]
- Intraluminal crystalloid.
- Image: Intraluminal crystalloid (nature.com) - from Epstein.[2]
- Amphophilic cytoplasm.
- Amphopilic is said to be bluish-red[3] -- though might also be described as blue-grey.
- 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.[4]
- Thus, it has been suggested that six or more glands should be present to diagnose cancer.[4]
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.
- May be difficult to see - especially if light intensity is low.
- 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:[5]
| 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 | 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 (???) | Sclerosing adenosis (webpathology.com) |
| Atrophy | sharp angulation of gland | nuclear hyperchromasia, scant cytoplasm | may appear right beside non-atrophic tissue | Atrophy (webpathology.com), Partial atrophy (webpathology.com) Sclerotic atrophy (webpathology.com) |
| 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 | BCH (webpathology.com) |
| Bulbourethral gland | no nuclear atypia | clear cytoplasm | apex of prostate | 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 | SV - high mag. (WC), 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 | Radiation changes (webpathology.com), 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 | 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- | 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.[6]
- 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).[6]
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/.
- It was studied in a paper by Kronz et al.[7]
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.[8]
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.[8]
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:
- Gleason pattern 4 - cribriform (WC).
- Gleason pattern 4 - small glands & Gleason pattern 5 - single cells (WC).
- 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).
- May be confused with stromal/lymphocytic infiltration.
- Cords.
- Nests of cells with necrosis at centre.
Image: Gleason pattern 4 - small glands & Gleason pattern 5 - single cells (WC).
Special types
Special types of prostate cancer have set Gleason scores:[9]
| Special type | Gleason pattern | Comment |
|---|---|---|
| Ductal carcinoma | 4 | may be graded 3 or 5[10] |
| Mucinous carcinoma | 4 | |
| Sarcomatoid carcinoma | 5 | glands graded separately |
| Signet ring cell carcinoma | 5 | |
| Small cell carcinoma | not graded | may be graded 5[10] |
| 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 Lung carcinomas (Urothelial carcinoma, Lymphoepithelioma-like carcinoma):
- Small cell carcinoma.
- Squamous cell carcinoma.
- Adenosquamous carcinoma.
- Adenoid cystic carcinoma.
Staging parameters and margins
Surgical margins
Main article: Surgical margins
- Positive is tumour touching ink.[11]
- "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).[12]
- France: 13-17%.[13]
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).[14]
- Weaker impact than stage and Gleason score.[15]
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.[16]
- The prostate does NOT have a well defined capsule.
- 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 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 in prostate biopsy if:
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.[19][20]
Notes:
- Invasion of the adventitia (only) would quality as EPE; this is, usually, T3a.
IHC
Benign prostate versus neoplastic prostate
- AMACR +ve.
- AR +ve -- in prostate confined cancer.
- Usu. -ve in LN +ve disease.[21]
- PSA +ve.
- PSAP +ve.
- May be positive in hindgut neuroendocrine tumours.[22]
- p63 -ve.
- HMWCK (34betaE12) -ve.
Combination immunostains:
Prostate versus urothelium
- Prostate: PSA +ve, CK20 -ve, CK7 -ve.
- Urothelial: CK20 +ve, CK7 +ve, PSA -ve.
Note:
Molecular changes in prostate cancer
A fusion gene between TMPRSS2 and ERG is described.[27][28]
- Both genes are on chromosome 21.
- Currently not used diagnostically.
- Fusion gene seen in approximately 50% of prostate cancer.[28]
- A subset of TMPRSS2-ERG known as 2+Edel (seen in ~7% of all prostate cancer cases) predicts poor survival.[29]
Sign out
Prostatectomy specimens
See: CAP checklist.
Biopsy specimens
Important elements - a list:[1]
- 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.[30]
Completely negative
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.
No glands
F. PROSTATE, RIGHT MEDIAL MIDZONE, BIOPSY: - BENIGN FIBROMUSCULAR TISSUE; - NO PROSTATIC GLANDULAR TISSUE PRESENT.
Inflammation
G. PROSTATE, LEFT LATERAL SUPERIOR, BIOPSY: - BENIGN PROSTATE TISSUE; - FOCAL CHRONIC INFLAMMATION.
F. PROSTATE, RIGHT MEDIAL MIDZONE, BIOPSY: - BENIGN PROSTATE TISSUE; - CHRONIC INFLAMMATION.
F. PROSTATE, RIGHT MEDIAL MIDZONE, BIOPSY: - BENIGN PROSTATE TISSUE; - ACUTE AND CHRONIC INFLAMMATION.
Positive
F. PROSTATE, RIGHT MEDIAL INFERIOR, BIOPSY: - ADENOCARCINOMA, GLEASON SCORE 6/10 (3+3); - 1/1 CORE INVOLVED; APPROXIMATELY 5% OF TISSUE INVOLVED.
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.
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.
H. PROSTATE, LEFT MEDIAL SUPERIOR, BIOPSY: - ADENOCARCINOMA, GLEASON SCORE 8/10 (4+4); - 1/1 CORE INVOLVED; APPROXIMATELY 15% OF TISSUE INVOLVED.
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.
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).
Intraductal spread of prostate cancer
Intraductal carcinoma of the prostate
- AKA intraductal carcinoma.
- AKA intraductal prostate carcinoma.
General
- Associated with a poor prognosis.[31]
- Strong association with aggressive invasive carcinomas on prostatectomy when identified in isolation on biopsy.[32]
Microscopic
Features:
- Malignant cells in glands with basal cells - key feature.
- Two cell populations:
- Obviously malignant cells with enlarged nuclei, granular chromatin, hyperchromasia and nucleoli.
- Cells with pale cytoplasm and smaller nuclei.
- Two cell populations:
DDx:
IHC
Features - basal cells present:
- HMWK +ve.
Unusual forms of prostate cancer
Prostatic ductal adenocarcinoma
General
- Sometimes it is referred to as endometrioid or endometrial adenocarcinoma; both terms are discouraged.[33]
- Not completely uncontroversial - may represent acinar adenocarcinoma with periurethral ducts involvement.[34]
- More aggressive than conventional (acinar) prostate carcinoma.
Microscopic
Features:[35]
- 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.[36][citation needed]
- 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.[36]
Images:
- Prostatic ductal adenocarcinoma - several images (upmc.edu).
- Prostatic ductal adenocarcinoma - another case - several images (upmc.edu).
- Prostatic ductal adenocarcinoma - F1 (nih.gov).
- Prostatic ductal adenocarcinoma - F2 (nih.gov).
- Prostatic ductal adenocarcinoma (webpathology.com).
IHC
Features:[37]
- p53 +ve in ~ 75% of cases.
- Ki-67 high in ~ 70% of cases.
- Chromogranin A +ve (cytoplasm) in ~ 70% of cases.
Others:[38]
- PSA +ve.
PIN-like prostatic ductal adenocarcinoma
General
- Recently described.[39][40]
- May be confused with prostatic intraepithelial neoplasia (PIN).
Microscopic
Features:[39]
- Stratified malignant epithelium.
Note:
- Vaguely similar to a tubular adenoma of the colon.
DDx:
Image:
Foamy gland carcinoma
General
- Rare.
- Usually low grade, i.e. Gleason score 6/10.[41]
Microscopic
Features:
- Increased glandular density.
- Tufted glandular border.
- Abundant eosinophilic (or hyperchromatic) cytoplasm - key feature.
- Gland size larger than "typical" prostate cancer.
Note:
DDx:
Image:
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.[42]
Microscopic
Features:
- Scant cytoplasm.
- Nuclear features of conventional prostate cancer (nucleoli, nuclear enlargement).
- Increased gland density.
DDx:
Image: Atrophic carcinoma (nature.com).
Mucinous prostate carcinoma
General
- Rare.
Microscopic
Features:
- Cytologically malignant cells floating in mucin.
- > 25% of tumour mucinous.[9]
- One study suggests >= 25%.[43]
DDx:
- Metastatic mucinous carcinoma.
Notes:
- Mucinous carcinoma - percentage required to call varies by site.
Pseudohyperplastic prostatic adenocarcinoma
General
- Rare.
Microscopic
- 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: 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 article: Signet ring cell carcinoma
General
- Very rare - 9 cases in a series of 29,783 prostate cancer cases.[46]
- Criteria vary - percentage of SRCs required for Dx varies from 20% to 50%.[46]
Microscopic
Features:
- Signet ring cells - see basics article.
Image:
Sarcomatoid prostate carcinoma
- AKA carcinosarcoma.
General
- Rare.
Microscopic
Features:[47]
- Biphasic tumour:
- Spindle cells (sarcomatous component).
- May include components of: osteosarcoma, chondrosarcoma and/or rhabdomyosarcoma.
- Glandular component (like conventional prostate carcinoma).
- Spindle cells (sarcomatous component).
IHC
Features - typical:[47]
- PSA +ve.
- Keratin +ve.
Small cell carcinoma of the prostate gland
Main article: 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.[48]
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:
IHC
- HER2/neu +ve (strong).[49]
See also
References
- ↑ 1.0 1.1 1.2 Humphrey PA (January 2007). "Diagnosis of adenocarcinoma in prostate needle biopsy tissue". J. Clin. Pathol. 60 (1): 35–42. doi:10.1136/jcp.2005.036442. PMC 1860598. PMID 17213347. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1860598/?tool=pubmed.
- ↑ 2.0 2.1 2.2 Epstein JI (March 2004). "Diagnosis and reporting of limited adenocarcinoma of the prostate on needle biopsy". Mod. Pathol. 17 (3): 307–15. doi:10.1038/modpathol.3800050. PMID 14739905. http://www.nature.com/modpathol/journal/v17/n3/full/3800050a.html.
- ↑ URL: http://pancreaticcancer2000.com/page1.htm. Accessed on: 3 June 2010.
- ↑ 4.0 4.1 Van der Kwast, TH.; Evans, A.; Lockwood, G.; Tkachuk, D.; Bostwick, DG.; Epstein, JI.; Humphrey, PA.; Montironi, R. et al. (Feb 2010). "Variability in diagnostic opinion among pathologists for single small atypical foci in prostate biopsies.". Am J Surg Pathol 34 (2): 169-77. doi:10.1097/PAS.0b013e3181c7997b. PMID 20061936.
- ↑ Weedman Molavi, Diana (2008). The Practice of Surgical Pathology: A Beginner's Guide to the Diagnostic Process (1st ed.). Springer. pp. 100-3. ISBN 978-0387744858.
- ↑ 6.0 6.1 Zhou, Ming; Magi-Galluzzi, Cristina (2006). Genitourinary Pathology: A Volume in Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 72. ISBN 978-0443066771.
- ↑ Kronz, JD.; Silberman, MA.; Allsbrook, WC.; Bastacky, SI.; Burks, RT.; Cina, SJ.; Mills, SE.; Ross, JS. et al. (Sep 2000). "Pathology residents' use of a Web-based tutorial to improve Gleason grading of prostate carcinoma on needle biopsies.". Hum Pathol 31 (9): 1044-50. doi:10.1053/hupa.2000.16278. PMID 11014569.
- ↑ 8.0 8.1 Epstein, JI. (Feb 2010). "An update of the Gleason grading system.". J Urol 183 (2): 433-40. doi:10.1016/j.juro.2009.10.046. PMID 20006878. Cite error: Invalid
<ref>tag; name "pmid20006878" defined multiple times with different content - ↑ 9.0 9.1 Grignon DJ (March 2004). "Unusual subtypes of prostate cancer". Mod. Pathol. 17 (3): 316–27. doi:10.1038/modpathol.3800052. PMID 14976541.
- ↑ 10.0 10.1 URL: https://www.bostwicklaboratories.com/global/physicians/medical-library/articles/gleason-grading.aspx. Accessed on: 26 November 2011.
- ↑ Lu, J.; Wirth, GJ.; Wu, S.; Chen, J.; Dahl, DM.; Olumi, AF.; Young, RH.; McDougal, WS. et al. (Jul 2012). "A close surgical margin after radical prostatectomy is an independent predictor of recurrence.". J Urol 188 (1): 91-7. doi:10.1016/j.juro.2012.02.2565. PMID 22578729.
- ↑ Steinsvik, EA.; Axcrona, K.; Angelsen, A.; Beisland, C.; Dahl, A.; Eri, LM.; Haug, ES.; Svindland, A. et al. (Aug 2012). "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.". Scand J Urol Nephrol. doi:10.3109/00365599.2012.707684. PMID 22860630.
- ↑ Koutlidis, N.; Mourey, E.; Champigneulle, J.; Mangin, P.; Cormier, L. (Jul 2012). "Robot-assisted or pure laparoscopic nerve-sparing radical prostatectomy: What is the optimal procedure for the surgical margins? A single center experience.". Int J Urol. doi:10.1111/j.1442-2042.2012.03102.x. PMID 22860572.
- ↑ Mauermann, J.; Fradet, V.; Lacombe, L.; Dujardin, T.; Tiguert, R.; Tetu, B.; Fradet, Y. (Aug 2012). "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.". Eur Urol. doi:10.1016/j.eururo.2012.08.002. PMID 22901983.
- ↑ Chalfin, HJ.; Dinizo, M.; Trock, BJ.; Feng, Z.; Partin, AW.; Walsh, PC.; Humphreys, E.; Han, M. (Jul 2012). "Impact of surgical margin status on prostate-cancer-specific mortality.". BJU Int. doi:10.1111/j.1464-410X.2012.11371.x. PMID 22788795.
- ↑ Evans, AJ.; Henry, PC.; Van der Kwast, TH.; Tkachuk, DC.; Watson, K.; Lockwood, GA.; Fleshner, NE.; Cheung, C. et al. (Oct 2008). "Interobserver variability between expert urologic pathologists for extraprostatic extension and surgical margin status in radical prostatectomy specimens.". Am J Surg Pathol 32 (10): 1503-12. doi:10.1097/PAS.0b013e31817fb3a0. PMID 18708939.
- ↑ Epstein, JI.; Srigley, J.; Grignon, D.; Humphrey, P. (Sep 2007). "Recommendations for the reporting of prostate carcinoma.". Hum Pathol 38 (9): 1305-9. doi:10.1016/j.humpath.2007.05.015. PMID 17707261.
- ↑ Evans, A. 4 June 2010.
- ↑ Lester, Susan Carole (2010). Manual of Surgical Pathology (3rd ed.). Saunders. pp. 409. ISBN 978-0-323-06516-0.
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- ↑ Zhou, Ming; Magi-Galluzzi, Cristina (2006). Genitourinary Pathology: A Volume in Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 88. ISBN 978-0443066771.
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- ↑ Lee, TK.; Miller, JS.; Epstein, JI. (Jun 2010). "Rare histological patterns of prostatic ductal adenocarcinoma.". Pathology 42 (4): 319-24. doi:10.3109/00313021003767314. PMID 20438402.
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- ↑ Kaleem, Z.; Swanson, PE.; Vollmer, RT.; Humphrey, PA. (Jun 1998). "Prostatic adenocarcinoma with atrophic features: a study of 202 consecutive completely embedded radical prostatectomy specimens.". Am J Clin Pathol 109 (6): 695-703. PMID 9620026.
- ↑ Osunkoya AO, Nielsen ME, Epstein JI (March 2008). "Prognosis of mucinous adenocarcinoma of the prostate treated by radical prostatectomy: a study of 47 cases". Am. J. Surg. Pathol. 32 (3): 468–72. doi:10.1097/PAS.0b013e3181589f72. PMID 18300802.
- ↑ Zhou, Ming; Magi-Galluzzi, Cristina (2006). Genitourinary Pathology: A Volume in Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 77. ISBN 978-0443066771.
- ↑ Arista-Nasr J, Martinez-Benitez B, Valdes S, Hernández M, Bornstein-Quevedo L (2003). "Pseudohyperplastic prostatic adenocarcinoma in transurethral resections of the prostate". Pathol. Oncol. Res. 9 (4): 232–5. doi:PAOR.2003.9.4.0232. PMID 14688829.
- ↑ 46.0 46.1 Warner, JN.; Nakamura, LY.; Pacelli, A.; Humphreys, MR.; Castle, EP. (Dec 2010). "Primary signet ring cell carcinoma of the prostate.". Mayo Clin Proc 85 (12): 1130-6. doi:10.4065/mcp.2010.0463. PMID 21123640.
- ↑ 47.0 47.1 Zhou, Ming; Magi-Galluzzi, Cristina (2006). Genitourinary Pathology: A Volume in Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 77 & 80. ISBN 978-0443066771.
- ↑ Iczkowski, KA.; Ferguson, KL.; Grier, DD.; Hossain, D.; Banerjee, SS.; McNeal, JE.; Bostwick, DG. (Dec 2003). "Adenoid cystic/basal cell carcinoma of the prostate: clinicopathologic findings in 19 cases.". Am J Surg Pathol 27 (12): 1523-9. PMID 14657711.
- ↑ Iczkowski, KA.; Montironi, R. (Dec 2006). "Adenoid cystic/basal cell carcinoma of the prostate strongly expresses HER-2/neu.". J Clin Pathol 59 (12): 1327-30. doi:10.1136/jcp.2005.035147. PMID 17142577.