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Difference between revisions of "Prostate cancer"
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Clinical criteria: | Clinical criteria: | ||
*PSA <= 10 ng/mL.<ref name=pmid22314081/> | *PSA <= 10 ng/mL.<ref name=pmid22314081/> | ||
*Negative DRE. | |||
==Gross== | ==Gross== | ||
| Line 240: | 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. | ||
===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) | |||
===Prostate cancer grading=== | ===Prostate cancer grading=== | ||
| Line 253: | Line 266: | ||
====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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Prostate Tissue, Transurethral Resection of Prostate (TURP): | Prostate Tissue, Transurethral Resection of Prostate (TURP): | ||
- ADENOCARCINOMA, Gleason score 6/10 (3+3); | - ADENOCARCINOMA, Gleason score 6/10 (3+3); | ||
- Approximately 3% of tissue involved; | -- Approximately 2% of tissue involved; | ||
- Please see tumour summary. | -- 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> | </pre> | ||