Atrophy of the prostate gland

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Atrophy of the prostate gland, also prostatic atrophy, is a common change in the prostate gland.

Atrophy of the prostate gland
Diagnosis in short

Atrophic prostatic glands. H&E stain.
LM DDx prostate carcinoma - esp. atrophic prostate carcinoma, atypical small acinar proliferation
IHC AMACR -ve, p63 +ve (basal cells), CK34betaE12 +ve (basal cells)
Site prostate gland
Symptoms none
Prevalence very common
Prognosis benign
Treatment none

It usually is seen focally; thus, it is sometimes called partial prostatic atrophy.

General

  • Considered to be the most common mimicker of prostate carcinoma.[1]
  • Small glands (may mimic Gleason score 3 pattern).
  • Inflammatory atrophy seems to be related to HGPIN and prostate cancer;[2] however, the epidemiology is not compelling that this is a significant (clinical) association.[3]

Microscopic

Features:

  • Glands often have a jagged edges/prows (in cancer the glands tend to have round edges) - key feature.
    • Prow = forward most part of a ship's bow that cuts through the water.[4]
      • You may have come across prow in the context of breast cancer, i.e. tubular carcinoma.
  • Gland density is usually lower than in prostate carcinoma, i.e. glands are not back-to-back - key feature.
  • Atrophic glands are often hyperchromatic.[5]
  • Scant cytoplasm - usually.

Negatives:

  • Nuclei like normal, i.e. nucleoli uncommon.
  • Should have two cell layers, i.e. epithelial and myoepithelial (may be difficult to see).

Notes:

  • Atrophic glands may be scattered with non-atrophic ones.
  • IHC may be misleading - basal cell loss.

DDx:

Atrophy versus cancer

Histologic feature Atrophy Cancer
Glandular architecture/
arrangement 		angulated glands, may
look like they originate
from one large duct 		round glands,
often back-to-back
Nuclear
hyperchromasia 		marked moderate
Cytoplasm scant/minimal moderate, may
be amphophilic
Basal cells may be visible absent
Nucleoli absent present
Secretions in
glands 		no yes - eosinophilic
or blue

Images

  • APG - low mag. (WC)

  • APG - intermed. mag. (WC)

  • APG - high mag. (WC)

  • APG - very high mag. (WC)

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Generally, this finding is not reported; it is considered a normal finding.

See also

References

  1. ↑ Wang, W.; Sun, X.; Epstein, JI. (Jun 2008). "Partial atrophy on prostate needle biopsy cores: a morphologic and immunohistochemical study.". Am J Surg Pathol 32 (6): 851-7. doi:10.1097/PAS.0b013e31815a0508. PMID 18408595.
  2. ↑ De Marzo, AM.; Marchi, VL.; Epstein, JI.; Nelson, WG. (Dec 1999). "Proliferative inflammatory atrophy of the prostate: implications for prostatic carcinogenesis.". Am J Pathol 155 (6): 1985-92. doi:10.1016/S0002-9440(10)65517-4. PMID 10595928.
  3. ↑ Celma, A.; Servián, P.; Planas, J.; Placer, J.; Quilez, MT.; Arbós, MA.; de Torres, I.; Morote, J. (Mar 2014). "Clinical Significance of Proliferative Inflammatory Atrophy in Prostate Biopsy.". Actas Urol Esp 38 (2): 122-126. doi:10.1016/j.acuro.2013.04.008. PMID 24129226.
  4. ↑ http://en.wikipedia.org/wiki/Prow
  5. ↑ SN. June 3, 2009.
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