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| Clinical criteria: | | Clinical criteria: |
| *PSA <= 10 ng/mL.<ref name=pmid22314081/> | | *PSA <= 10 ng/mL.<ref name=pmid22314081/> |
| | *Negative DRE. |
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| ==Gross== | | ==Gross== |
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| 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. |
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| ===Prostatic adenocarcinoma variants that mimic benign=== | | ===Situations where prostate adenocarcinoma may be missed=== |
| *[[Atrophic prostate carcinoma]]. | | 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>: |
| *[[Pseudohyperplastic adenocarcinoma]]. | | *Tissue artefacts (try levels and/or IHC): |
| *[[Foamy gland adenocarcinoma]]. | | **Crush artefact |
| *[[PIN-like adenocarcinoma]]. | | **Thick sections |
| | **Aberrant H&E staining |
| | **Freezing artefact |
| | **Cautery |
| | *Minimal adenocarcinoma (less than 1mm long or involving less than 5% of a core biopsy): |
| | *Prostatic adenocarcinoma variants that mimic benign: |
| | **[[Atrophic prostate carcinoma]] |
| | **[[Pseudohyperplastic adenocarcinoma]] |
| | **[[Foamy gland adenocarcinoma]] |
| | **[[PIN-like adenocarcinoma]] |
| | **Microcystic adenocarcinoma |
| | *Single cells of Gleason 5 adenocarcinoma (missed or mistaken for lymphocytes; try IHC for cytokeratins, prostatic and/or hematologic markers) |
| | *Treatment effect (check clinical information and look for treatment effect in benign glands) |
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| ===Prostate cancer grading=== | | ===Prostate cancer grading=== |
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| ====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/> |
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| =====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> |
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| ======Image======
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| *[http://www.nature.com/modpathol/journal/v24/n1/fig_tab/modpathol2010158f1.html Bladder neck margin (nature.com)].<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>
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| ====Extraprostatic extension==== | | ====Extraprostatic extension==== |
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| ===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): |
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| ==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>
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| *May be confused with [[prostatic intraepithelial neoplasia]] (PIN).
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| ===Microscopic===
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| 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>
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| *Stratified malignant epithelium.
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| Note:
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| *Vaguely similar to a tubular adenoma of the colon.
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| DDx:
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| *[[HGPIN]].
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| Image:
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| *[http://www.nature.com/modpathol/journal/v19/n7/fig_tab/3800601f1.html#figure-title PIN-like adenocarcinoma (nature.com)].
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| ==Foamy gland carcinoma== | | ==Foamy gland carcinoma== |
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| ==Mucinous prostate carcinoma== | | ==Mucinous prostate carcinoma== |
| ===General===
| | {{Main|Mucinous adenocarcinoma of the prostate}} |
| *Rare.
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| *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>
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| Gleason pattern:
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| *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>
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| *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>).
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| ===Microscopic===
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| Features:
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| *Cytologically malignant cells floating in mucin.
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| *> 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>
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| **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>
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| Notes:
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| *[[Mucinous carcinoma]] - percentage required to call varies by site.
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| DDx:
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| *Metastatic [[mucinous carcinoma]].
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| *Mucinous adenocarcinoma of the prostatic urethra - analogous to the mucinous adenocarcinoma of the [[urinary bladder]].<ref name=pmid23060063/>
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| ==Pseudohyperplastic prostatic adenocarcinoma== | | ==Pseudohyperplastic prostatic adenocarcinoma== |
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| =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.
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| ===General===
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| *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>
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| *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>
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| Treatment:<ref name=pmid17338657/>
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| *[[Cystoprostatectomy]] - stromal invasion ''or'' extensive intraductal involvement.
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| *Endoscopic resection and BCG - limited extent without stromal invasion.
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| ===Microscopic===
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| Features:
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| *Divided into tumours with:
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| *#Stromal invasion.
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| *#Without stromal invasion.
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| Notes:
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| *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>
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| DDx:
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| *[[Urothelial carcinoma-like prostatic carcinoma]] - may have pseudopapillae.
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| ====Images====
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| <gallery>
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| Image: Urothelial carcinoma in prostate -- low mag.jpg | UCC in prostate - low mag. (WC/Nephron)
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| Image: Urothelial carcinoma in prostate -- intermed mag.jpg | UCC in prostate - intermed. mag. (WC/Nephron)
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| Image: Urothelial carcinoma in prostate -- high mag.jpg | UCC in prostate - high mag. (WC/Nephron)
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| Image: Urothelial carcinoma in prostate - alt -- high mag.jpg | UCC in prostate - high mag. (WC/Nephron)
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| Image: Urothelial carcinoma in prostate - portrait -- intermed mag.jpg | UCC in prostate - intermed. mag. (WC/Nephron)
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| Image: Urothelial carcinoma in prostate - portrait -- high mag.jpg | UCC in prostate - high mag. (WC/Nephron)
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| Image: Urothelial carcinoma in prostate - portrait -- very high mag.jpg | UCC in prostate - very high mag. (WC/Nephron)
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| Image: Urothelial carcinoma in prostate - 2 -- intermed mag.jpg | UCC in prostate - intermed. mag. (WC/Nephron)
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| Image: Urothelial carcinoma in prostate - 2 -- high mag.jpg | UCC in prostate - high mag. (WC/Nephron)
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| Image: Urothelial carcinoma in prostate - 2 -- very high mag.jpg | UCC in prostate - very high mag. (WC/Nephron)
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| </gallery>
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| ===Sign out===
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| <pre>
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| PROSTATE TISSUE, TRANSURETHRAL RESECTION:
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| - HIGH-GRADE UROTHELIAL CARCINOMA WITH FOCAL STROMAL INVASION, AND EXTENSIVE
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| INTRADUCTAL SPREAD IN FRAGMENTS WITH BENIGN PROSTATIC GLANDS.
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| </pre>
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| =See also= | | =See also= |