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Atypical small acinar proliferation (view source)
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'''Atypical small acinar proliferation''', abbreviated ''ASAP'', is a small number of [[prostate gland|prostate glands]] that are abnormal and suspicious for [[prostate carcinoma|carcinoma]]. | |||
It is also known as '''suspicious for carcinoma'''.<ref>THvdK. 19 June 2010.</ref> ASAP is preferred as it does not contain the word ''carcinoma'' and, thus, cannot be misread as ''carcinoma'', i.e. positive for malignancy. | |||
==General== | |||
*It is a [[waffle diagnosis]], i.e. it is not considered an entity with a distinct pathobiology.<ref name=pmid17378841>{{cite journal |author=Flury SC, Galgano MT, Mills SE, Smolkin ME, Theodorescu D |title=Atypical small acinar proliferation: biopsy artefact or distinct pathological entity |journal=BJU International |volume=99 |issue=4 |pages=780-5 |year=2007 |month=January |pmid= 17378841 |doi= |url=http://www3.interscience.wiley.com/journal/118508438/abstract}}</ref> | |||
**Analogous to ''[[ASCUS]]'' on a pap test. | |||
*ASAP should be used sparingly. | |||
**One benchmark is < 3-5% of biopsies.<ref>THvdK. 19 June 2010.</ref> | |||
*Never diagnosed on excision, i.e. prostatectomy specimen. | |||
===Association with adenocarcinoma=== | |||
*On subsequent [[biopsy]] - chance of finding [[adenocarcinoma]] is approximately 40%; this is higher than if there is [[high-grade prostatic intraepithelial neoplasia]] (HGPIN).<ref>{{cite journal |author=Leite KR, Camara-Lopes LH, Cury J, Dall'oglio MF, Sañudo A, Srougi M |title=Prostate cancer detection at rebiopsy after an initial benign diagnosis: results using sextant extended prostate biopsy |journal=Clinics |volume=63 |issue=3 |pages=339–42 |year=2008 |month=June |pmid=18568243 |doi= |url=http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1807-59322008000300009&lng=en&nrm=iso&tlng=en}}</ref> | |||
===Management=== | |||
*ASAP is considered an indication for re-biopsy;<ref>{{cite journal |author=Bostwick DG, Meiers I |title=Atypical small acinar proliferation in the prostate: clinical significance in 2006 |journal=Arch. Pathol. Lab. Med. |volume=130 |issue=7 |pages=952–7 |year=2006 |month=July |pmid=16831049 |doi= |url=http://journals.allenpress.com/jrnlserv/?request=get-abstract&issn=0003-9985&volume=130&page=952}}</ref> in one survey of [[urologist]]s<ref>{{cite journal |author=Rubin MA, Bismar TA, Curtis S, Montie JE |title=Prostate needle biopsy reporting: how are the surgical members of the Society of Urologic Oncology using pathology reports to guide treatment of prostate cancer patients? |journal=Am. J. Surg. Pathol. |volume=28 |issue=7 |pages=946–52 |year=2004 |month=July |pmid=15223967 |doi= |url=}}</ref> 41/42 (~98%) of respondents considered it a sufficient reason to re-biopsy. | |||
==Microscopic== | |||
Features: | |||
*Atypical appearing acini. | |||
*Limited extent - '''key feature'''. | |||
**Less than six glands. | |||
Note: | |||
*Deeper cuts didn't yield anything - '''important'''. | |||
DDx: | |||
*[[Prostatic adenocarcinoma]]. | |||
*Benign prostate. | |||
**Adenosis of the prostate. | |||
**Sclerosing adenosis of the prostate. | |||
==IHC== | |||
*Generally ''not'' contributory. | |||
Usually stains like cancer: | |||
*AMACR +ve. | |||
*CK34betaE12 -ve. | |||
*p63 -ve. | |||
==See also== | |||
*[[Waffle diagnosis]]. | |||
*[[Prostate gland]]. | |||
==References== | |||
{{Reflist|2}} | |||
[[Category:Diagnosis]] | [[Category:Diagnosis]] | ||