Difference between revisions of "Prostate gland"

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Prostate gland (view source)

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The '''prostate gland''' adds juice to the sperm.  In old men it creates lotsa problems... [[nodular hyperplasia]] (commonly called BPH or [[benign prostatic hyperplasia]]) and cancer (adenocarcinoma).   
[[Image:Prostatelead.jpg|thumb|right|200px|The prostate gland and its surrounding structures. (WC/NCI)]]
The '''prostate gland''' adds juice to the sperm.  In old men it creates a lot of problems... [[nodular hyperplasia]] (commonly called BPH or [[benign prostatic hyperplasia]]) and cancer (usually adenocarcinoma).   


[[Prostate cancer]] is such a big topic it is dealt with in its own article.
[[Prostate cancer]] is such a big topic it is dealt with in its own article.
 
The female homologue of the prostate gland is considered to be Skene's gland.<ref name=pmid8522254>{{Cite journal  | last1 = Dodson | first1 = MK. | last2 = Cliby | first2 = WA. | last3 = Pettavel | first3 = PP. | last4 = Keeney | first4 = GL. | last5 = Podratz | first5 = KC. | title = Female urethral adenocarcinoma: evidence for more than one tissue of origin? | journal = Gynecol Oncol | volume = 59 | issue = 3 | pages = 352-7 | month = Dec | year = 1995 | doi = 10.1006/gyno.1995.9963 | PMID = 8522254 }}</ref>


=Normal prostate gland=
=Normal prostate gland=
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**Second cell layer may be difficult to see (like in breast).
**Second cell layer may be difficult to see (like in breast).
*Epithelium in glands is "folded" or "tufted".
*Epithelium in glands is "folded" or "tufted".
**Very important - helps on differentiate from Gleason pattern 3.
**Very important - helps to differentiate from Gleason pattern 3.
*Luminal epithelium often clear cytoplasm.
*Luminal epithelium often clear cytoplasm.
*Single nucleus.
*Single nucleus.
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Notes:
Notes:
*Tufted epithelium is a strong indicator of benignancy; however two uncommon prostate cancer typically have tufted epithelium:
*Tufted epithelium is a strong indicator of benignancy; however two uncommon prostate cancer variants typically have tufted epithelium:
**[[Pseudohyperplastic adenocarcinoma]].
**[[Pseudohyperplastic adenocarcinoma]].
**[[Foamy gland carcinoma]].
**[[Foamy gland carcinoma]].
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==IHC of normal prostate==
==IHC of normal prostate==
Normal prostate:  
Normal prostate:  
*AMACR -ve (mark epithelial cells).  
*[[AMACR]] -ve (mark epithelial cells).  
*CK5/6 +ve,<ref name=pmid19605815>{{Cite journal  | last1 = Trpkov | first1 = K. | last2 = Bartczak-McKay | first2 = J. | last3 = Yilmaz | first3 = A. | title = Usefulness of cytokeratin 5/6 and AMACR applied as double sequential immunostains for diagnostic assessment of problematic prostate specimens. | journal = Am J Clin Pathol | volume = 132 | issue = 2 | pages = 211-20; quiz 307 | month = Aug | year = 2009 | doi = 10.1309/AJCPGFJP83IXZEUR | PMID = 19605815 }}</ref> p63 +ve, HMWCK +ve (mark basal cells).
*[[CK5/6]] +ve,<ref name=pmid19605815>{{Cite journal  | last1 = Trpkov | first1 = K. | last2 = Bartczak-McKay | first2 = J. | last3 = Yilmaz | first3 = A. | title = Usefulness of cytokeratin 5/6 and AMACR applied as double sequential immunostains for diagnostic assessment of problematic prostate specimens. | journal = Am J Clin Pathol | volume = 132 | issue = 2 | pages = 211-20; quiz 307 | month = Aug | year = 2009 | doi = 10.1309/AJCPGFJP83IXZEUR | PMID = 19605815 }}</ref> p63 +ve, HMWCK +ve (mark basal cells).
*PSA (prostate-specific antigen) +ve, PSAP (prostatic-specific acid phosphatase) +ve.
*PSA ([[prostate-specific antigen]]) +ve, PSAP ([[prostatic-specific acid phosphatase]]) +ve.
 
==Sign out==
===Staining slightly abnormal - morphology not definitely abnormal===
<pre>
COMMENT:
Very focal AMACR staining is seen; this is interpreted as negative, in the
context of no definite cytologic changes.  The basal cells appear to be
preserved in all of the tissue sampled.
</pre>
 
===Compatible with previous biopsy===
<pre>
COMMENT:
Siderophages are seen in several cores; this is compatible with the history
of a previous biopsy.
</pre>


=Other accessory glands=
=Other accessory glands=
==Bulbourethral gland==
==Bulbourethral gland==
*[[AKA]] ''Cowper's gland''.
*[[AKA]] ''Cowper's gland''.
===General===
{{Main|Bulbourethral gland}}
*Mucinous glands at the apex of the prostate.
 
===Microscopic===
Features:<ref name=pmid9158679>{{Cite journal  | last1 = Cina | first1 = SJ. | last2 = Silberman | first2 = MA. | last3 = Kahane | first3 = H. | last4 = Epstein | first4 = JI. | title = Diagnosis of Cowper's glands on prostate needle biopsy. | journal = Am J Surg Pathol | volume = 21 | issue = 5 | pages = 550-5 | month = May | year = 1997 | doi =  | PMID = 9158679 }}</ref>
*Lobular glands with abundant pale cytoplasm.
**Resemble (mucinous) [[salivary gland]]s.
*Often assocatiated with skeletal muscle.<ref>URL: [http://webpathology.com/image.asp?case=21&n=4 http://webpathology.com/image.asp?case=21&n=4]. Accessed on: 3 June 2013.</ref>
 
DDx:
*[[Foamy gland carcinoma]].
*Mucinous metaplasia of the prostate.
 
Images:
*[http://pathology.mc.duke.edu/research/histo_course/mixed_saliv.jpg Mucinous/serous salivary gland (duke.edu)].
*[http://webpathology.com/image.asp?case=21&n=4 Cowper gland (webpathology.com)].
 
===Stains===
*[[Mucicarmine]] +ve.
*[[PAS-D]] +ve.
 
===IHC===
Features:<ref name=pmid9158679/>
*PSAP -ve.
*PSA +ve.
*HMWCK +ve.


==Seminal vesicles==
==Seminal vesicles==
===General===
{{Main|Seminal vesicles}}
*Seen in radical prostatectomies and occasionally in core biopsies.
 
===Microscopic===
*Fern-like architecture - epithelial component clustered closely, looks like it connects.
**Epithelium surrounded by a thick layer of muscle (>10 cells across ~80 microns).
*Lipofuscin (coarse cytoplasmic yellow granules approximately 1-2 micrometers) - '''key feature'''.
*Nucleoli - common.
*Nuclear inclusions - common.<ref>URL: [http://surgpathcriteria.stanford.edu/prostate/adenocarcinoma/benign-vs-carcinoma.html http://surgpathcriteria.stanford.edu/prostate/adenocarcinoma/benign-vs-carcinoma.html]. Accessed on: 10 January 2013.</ref>
 
Notes:
*The ''ejaculatory ducts'' have the same epithelium as the seminal vesicles.<ref name=pmid12657938>{{cite journal |author=Leroy X, Ballereau C, Villers A, ''et al.'' |title=MUC6 is a marker of seminal vesicle-ejaculatory duct epithelium and is useful for the differential diagnosis with prostate adenocarcinoma |journal=Am. J. Surg. Pathol. |volume=27 |issue=4 |pages=519–21 |year=2003 |month=April |pmid=12657938 |doi= |url=}}</ref>
 
====Images====
<gallery>
Image:Seminal_vesicle_low_mag.jpg | SV - showing fern-like architecture. (WC/Nephron)
Image:Seminal_vesicle_high_mag.jpg | SV - looking vaguely like to prostate adenocarcinoma. (WC/Nephron)
Image:Seminal_vesicle_intermed_mag.jpg | SV - looks a bit like prostate but lumina too big. (WC/Nephron)
</gallery>
www:
*[http://dspace.udel.edu:8080/dspace/bitstream/19716/2016/1/cmrsvlm3.GIF SV (udel.edu)].
 
===IHC===
*PSA -ve.<ref name=pmid22895132>{{Cite journal  | last1 = Itami | first1 = Y. | last2 = Nagai | first2 = Y. | last3 = Kobayashi | first3 = Y. | last4 = Shimizu | first4 = N. | last5 = Yamamoto | first5 = Y. | last6 = Minami | first6 = T. | last7 = Hayashi | first7 = T. | last8 = Nozawa | first8 = M. | last9 = Yoshimura | first9 = K. | title = [A case of prostatic cancer with a low PSA level accompanied with cystic formation requiring differentiation from adenocarcinoma of the seminal vesicle]. | journal = Hinyokika Kiyo | volume = 58 | issue = 7 | pages = 349-53 | month = Jul | year = 2012 | doi =  | PMID = 22895132 }}</ref>
*CK7 +ve.<ref name=pmid19468449>{{Cite journal  | last1 = Tarján | first1 = M. | last2 = Ottlecz | first2 = I. | last3 = Tot | first3 = T. | title = Primary adenocarcinoma of the seminal vesicle. | journal = Indian J Urol | volume = 25 | issue = 1 | pages = 143-5 | month = Jan | year = 2009 | doi = 10.4103/0970-1591.45557 | PMID = 19468449 }}</ref><ref name=pmid22076175>{{Cite journal  | last1 = Terada | first1 = T. | title = Monstrous epithelial cell clusters in the seminal vesicle. | journal = Int J Clin Exp Pathol | volume = 4 | issue = 7 | pages = 727-30 | month =  | year = 2011 | doi =  | PMID = 22076175 }}</ref>
*CK20 -ve.<ref name=pmid19468449/>
*p63 +ve.<ref name=pmid22076175/>
*CK34betaE12 -ve.<ref name=pmid22076175/>
*AMACR -ve.<ref name=pmid22076175/>
 
===Sign out===
<pre>
B. PROSTATE, RIGHT MEDIAL SUPERIOR, BIOPSY:
- BENIGN PROSTATE TISSUE.
- BENIGN SEMINAL VESICLE/EJACULATORY DUCT.
</pre>


=Specimens=
=Specimens=
*Prostate core biopsy - done transrectal.
*[[Prostate core biopsy]] - done transrectal.
*Prostate chips (from a ''transurethral resection of the prostate'', abbreviated ''TURP'') - usu. done for [[nodular hyperplasia of the prostate gland]]; may be done in the context of obstructing cancer.
*[[Prostate chips]] (from a ''transurethral resection of the prostate'', abbreviated ''TURP'') - usu. done for [[nodular hyperplasia of the prostate gland]]; may be done in the context of obstructing cancer.
*Radical prostatectomy - includes the [[seminal vesicles]].
*[[Radical prostatectomy]] - includes the [[seminal vesicles]].
*Radical cystoprostatectomy - includes the [[urinary bladder]] and [[seminal vesicles]].<ref>URL: [http://www.cancer.gov/dictionary?cdrid=446218 http://www.cancer.gov/dictionary?cdrid=446218]. Accessed on: 23 February 2012.</ref>
*[[Radical cystoprostatectomy]] - includes the [[urinary bladder]] and [[seminal vesicles]].<ref>URL: [http://www.cancer.gov/dictionary?cdrid=446218 http://www.cancer.gov/dictionary?cdrid=446218]. Accessed on: 23 February 2012.</ref>


=Approach=
=Approach=
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==Common diagnoses==
==Common diagnoses==
*Benign.
*Benign.
**[[atrophy of the prostate|Atrophy]] - may resemble adenocarcinoma - typically not reported.
**[[Atrophy of the prostate|Atrophy]] - may resemble adenocarcinoma - typically not reported.
**Adenosis - may resemble adenocarcinoma - typically not reported.
**[[Adenosis of the prostate|Adenosis]] - may resemble adenocarcinoma - typically not reported.
*[[Prostate adenocarcinoma]].  
*[[Prostate adenocarcinoma]].  
**Most common Grade is 3+3=6.
*[[HGPIN]] (high-grade prostatic intraepithelial neoplasia) - prostate adenocarcinoma precursor lesion.
*[[HGPIN]] (high-grade prostatic intraepithelial neoplasia) - prostate adenocarcinoma precursor lesion.
*[[ASAP]] (atypical small acinar proliferation) - used if you have a few abnormal appearing glands... but can't decide between prostate adenocarcinoma & benign.
*[[ASAP]] (atypical small acinar proliferation) - used if you have a few abnormal appearing glands... but can't decide between prostate adenocarcinoma & benign.
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=Clinical history=
=Clinical history=
*PSA (serum).
{{Main|Prostate specific antigen}}
*[[PSA]] (serum).
** >10 ng/mL worrisome for prostate cancer.
** >10 ng/mL worrisome for prostate cancer.
** Normal is age dependent - increases with age, usu. cut-off ~ 4 ng/mL.
** Normal is age dependent - increases with age, usu. cut-off ~ 4 ng/mL.
*HIFU = ''High Intensity Focused Ultrasound'' - an ablation procedure for prostate cancer.<ref>URL: [http://www.internationalhifu.com/what-is-hifu-mainmenu-132.html http://www.internationalhifu.com/what-is-hifu-mainmenu-132.html]. Accessed on: 15 June 2010.</ref>
*HIFU = ''High Intensity Focused Ultrasound'' - an ablation procedure for prostate cancer.<ref>URL: [http://www.internationalhifu.com/what-is-hifu-mainmenu-132.html http://www.internationalhifu.com/what-is-hifu-mainmenu-132.html]. Accessed on: 15 June 2010.</ref>


=Specific conditions=
=Benign changes and remnants=
==Adenosis of the prostate gland==
*[[AKA]] ''atypical adenomatous hyperplasia of the prostate gland'' (or ''atypical adenomatous hyperplasia'').
{{Main|Adenosis of the prostate gland}}
 
==Basal cell hyperplasia of the prostate==
{{Main|Basal cell hyperplasia of the prostate}}
 
==Atrophy of the prostate==
*[[AKA]] ''atrophy''.
*[[AKA]] ''prostatic atrophy''.
*[[AKA]] ''atrophy of the prostate gland''.
{{Main|Atrophy of the prostate gland}}
 
==Mesonephric remnant of the prostate gland==
{{Main|Mesonephric remnant of the prostate gland}}
 
=Benign conditions=
==Prostatic nodular hyperplasia==
==Prostatic nodular hyperplasia==
*[[AKA]] ''nodular hyperplasia of the prostate''.
*[[AKA]] ''nodular hyperplasia of the prostate''.
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*AKA ''benign prostatic hypertrophy''.
*AKA ''benign prostatic hypertrophy''.
**This is a misnomer. It is ''not'' a hypertrophy.
**This is a misnomer. It is ''not'' a hypertrophy.
 
{{Main|Nodular hyperplasia of the prostate}}
===General===
*Very common.
*Incidence increases with age.
 
Clinical - mnemonic ''I WISH 2p'':<ref>{{Ref TN2006| U5}}</ref>
*Intermittency.
*Weak stream.
*Incomplete emptying.
*Straining.
*Hesitancy.
*Post-void dribbling.
*Prolonged voiding.
 
Treatment:
*Medications.
*Transurethral resection of the prostate (TURP).
 
===Microscopic===
Features:
*Stromal and/or glandular hyperplasia.
 
Note:
*Should '''not''' be diagnosed on core biopsy!
 
DDx:
*[[Urothelial carcinoma]] - significant nuclear atypia.
 
====Images====
<gallery>
Image:Nodular_hyperplasia_of_the_prostate.jpg | Prostatic nodular hyperplasia. (WC/Nephron)
Image:Urethral_urothelial_cell_carcinoma.jpg | UCC. (WC/Nephron)
</gallery>
 
===Sign out===
====Urothelium present====
<pre>
PROSTATE TISSUE, TRANSURETHRAL RESECTION OF THE PROSTATE (TURP):
- BENIGN PROSTATIC TISSUE WITH GLANDULAR AND STROMAL PROLIFERATION.
- UROTHELIAL MUCOSA WITH A MILD LYMPHOCYTIC INFILTRATE.
- NEGATIVE FOR MALIGNANCY.
</pre>
 
<pre>
PROSTATE TISSUE, TRANSURETHRAL RESECTION OF THE PROSTATE (TURP) AND URINARY BLADDER NECK:
- BENIGN PROSTATIC TISSUE WITH GLANDULAR AND STROMAL PROLIFERATION.
- UROTHELIUM WITH THE CHANGES OF CYSTITIS CYSTICA ET GLANDULARIS.
- NEGATIVE FOR MALIGNANCY.
</pre>
 
<pre>
PROSTATE TISSUE, TRANSURETHRAL RESECTION OF THE PROSTATE (TURP) AND URINARY BLADDER NECK:
- BENIGN PROSTATIC TISSUE WITH GLANDULAR AND STROMAL PROLIFERATION, AND FOCAL
  ACUTE AND CHRONIC INFLAMMATION.
- UROTHELIUM WITH THE CHANGES OF CYSTITIS CYSTICA ET GLANDULARIS.
- NEGATIVE FOR MALIGNANCY.
</pre>
 
====No urothelium present====
<pre>
PROSTATE GLAND, TRANSURETHRAL RESECTION OF THE PROSTATE (TURP):
- BENIGN PROSTATIC TISSUE WITH GLANDULAR AND STROMAL PROLIFERATION.
</pre>
 
====Post-TURP granuloma present====
<pre>
PROSTATE TISSUE, TRANSURETHRAL RESECTION OF THE PROSTATE (TURP):
- BENIGN PROSTATIC TISSUE WITH GLANDULAR AND STROMAL PROLIFERATION WITH
PROMINENT BLOOD VESSELS AND SQUAMOUS METAPLASIA.
- PALISADING GRANULOMA WITH NECROTIC CORE, SEE COMMENT.
- UROTHELIAL MUCOSA WITH A MILD INFLAMMATORY INFILTRATE.
- NEGATIVE FOR MALIGNANCY.
 
COMMENT:
This is morphologically consistent with a post-TURP granuloma.
</pre>


==Acute inflammation of the prostate gland==
==Acute inflammation of the prostate gland==
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==Granulomatous prostatitis==
==Granulomatous prostatitis==
{{Main|Granulomatous prostatitis}}
{{Main|Granulomatous prostatitis}}
==Atrophy of the prostate==
*[[AKA]] ''atrophy''.
*[[AKA]] ''prostatic atrophy''.
*[[AKA]] ''atrophy of the prostate gland''.
===General===
*Small glands (may mimic Gleason score 3 pattern).
===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.<ref>[http://en.wikipedia.org/wiki/Prow http://en.wikipedia.org/wiki/Prow]</ref>
***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.<ref>SN. June 3, 2009.</ref>
*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:
*[[Atrophic prostate carcinoma]].
====Atrophy versus cancer====
{| class="wikitable sortable"
! Histologic feature
! Atrophy
! Cancer
|-
|Glandular architecture/<br>arrangement
|angulated glands, may <br>look like they originate <br>from one large duct
|round glands, <br>often back-to-back
|-
|Nuclear <br>hyperchromasia
|marked
|moderate
|-
|Cytoplasm
|scant/minimal
|moderate, may <br>be amphophilic
|-
|Basal cells
|may be visible
|absent
|-
|Nucleoli
|absent
|present
|-
|Secretions in <br>glands
|no
|yes - eosinophilic <br>or blue
|}
===Sign out===
Generally, this finding is ''not'' reported; it is considered a normal finding.


==Prostatic infarct==
==Prostatic infarct==
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*[http://www.sciencephoto.com/media/258565/enlarge Prostatic thrombosis (sciencephoto.com)].
*[http://www.sciencephoto.com/media/258565/enlarge Prostatic thrombosis (sciencephoto.com)].


==Basal cell hyperplasia of the prostate==
=Preneoplastic changes and atypical changes=
*[[AKA]] ''[[basal cell hyperplasia]]''.
===General===
*Benign lesion that can be misdiagnosed as cancer.<ref name=pmid6195916>{{Cite journal  | last1 = Cleary | first1 = KR. | last2 = Choi | first2 = HY. | last3 = Ayala | first3 = AG. | title = Basal cell hyperplasia of the prostate. | journal = Am J Clin Pathol | volume = 80 | issue = 6 | pages = 850-4 | month = Dec | year = 1983 | doi =  | PMID = 6195916 }}</ref>
 
===Microscopic===
Features:<ref>URL: [http://pathologyoutlines.com/prostate.html#bch http://pathologyoutlines.com/prostate.html#bch]. Accessed on: 28 June 2010.</ref>
*Low power gland architecture near normal.<ref>URL: [http://www.nature.com/modpathol/journal/v16/n6/fig_tab/3880810f1.html http://www.nature.com/modpathol/journal/v16/n6/fig_tab/3880810f1.html]. Accessed on: 28 June 2010.</ref><ref>URL: [http://www.nature.com/modpathol/journal/v16/n6/fig_tab/3880810f2.html http://www.nature.com/modpathol/journal/v16/n6/fig_tab/3880810f2.html]. Accessed on: 28 June 2010.</ref>
**Glands ''not'' as small as cancer.
**Folds in gland lumina.
*No nuclear hyperchromasia.
*Two cell populations (as in normal prostate glands).
*Basal cells may have nucleoli.
 
DDx:
*[[High-grade prostatic intraepithelial neoplasia]] - has nuclear hyperchromasia, architecture usually different (micropapillary, tufted, cribriform or flat).
*[[Prostatic adenocarcinoma]].
 
Image:
*[http://webpathology.com/image.asp?case=18&n=1 Basal cell hyperplasia of the prostate (webpathology.com)].
 
==High-grade prostatic intraepithelial neoplasia==
==High-grade prostatic intraepithelial neoplasia==
*Abbreviated as ''HGPIN''.
*Abbreviated as ''HGPIN''.
*May be referred to as ''prostatic intraepithelial neoplasia'', abbreviated ''PIN''.
*May be referred to as ''prostatic intraepithelial neoplasia'', abbreviated ''PIN''.
===General===
{{Main|High-grade prostatic intraepithelial neoplasia}}
*Thought to be a precursor lesion for prostate adenocarcinoma.
**Multifocal HGPIN considered a risk for prostate cancer on re-biopsy.<ref name=pmid21191509>{{Cite journal  | last1 = Srigley | first1 = JR. | last2 = Merrimen | first2 = JL. | last3 = Jones | first3 = G. | last4 = Jamal | first4 = M. | title = Multifocal high-grade prostatic intraepithelial neoplasia is still a significant risk factor for adenocarcinoma. | journal = Can Urol Assoc J | volume = 4 | issue = 6 | pages = 434 | month = Dec | year = 2010 | doi =  | PMID = 21191509 }}</ref>
**A small focus of HGPIN does not appear to be associated with an increased risk for prostate cancer on re-biopsy at one year if the initial biopsy had 8 or more cores.<ref name=pmid16406886>{{Cite journal  | last1 = Herawi | first1 = M. | last2 = Kahane | first2 = H. | last3 = Cavallo | first3 = C. | last4 = Epstein | first4 = JI. | title = Risk of prostate cancer on first re-biopsy within 1 year following a diagnosis of high grade prostatic intraepithelial neoplasia is related to the number of cores sampled. | journal = J Urol | volume = 175 | issue = 1 | pages = 121-4 | month = Jan | year = 2006 | doi = 10.1016/S0022-5347(05)00064-9 | PMID = 16406886 }}</ref>
 
Low-grade prostatic intraepithelial neoplasia:
*Not reported and generally believed to be irrelevant biologically/clinically.
**''PIN'' not otherwise specified refers to ''HGPIN''.
**Low-grade PIN has the architecture of HGPIN but lacks the nuclear atypia.
 
===Microscopic===
Features:<ref name=Ref_Amin3-56>{{Ref Amin|3-56}}</ref><ref name=pmid2002502>{{Cite journal  | last1 = Chin | first1 = AI. | last2 = Dave | first2 = DS. | last3 = Rajfer | first3 = J. | title = Is repeat biopsy for isolated high-grade prostatic intraepithelial neoplasia necessary? | journal = Rev Urol | volume = 9 | issue = 3 | pages = 124-31 | month =  | year = 2007 | doi =  | PMID = 17934569 | PMC = 2002502 }}</ref>
*Medium to large glands with architectural changes - see ''HGPIN architecture'' below.
**Described as "epithelial hyperplasia".
*Diagnosed on basis of nuclear changes.
**Hyperchromatic nuclei - '''key (low power) feature'''.
**Nucleoli present - '''key (high power) feature'''.
**Often increased NC ratio.
**Nuclear enlargement.
 
Notes:
*Nucleoli should be visible with the 20x objective.
**If one uses the 40x objective... one over calls.
*May need IHC for cancer versus HGPIN.
*Nucleoli should be present in >= 10% of cells in a gland to call it HGPIN.<ref>{{Ref Amin|3-55}}</ref>
**This criterium is not required by all pathologists.
 
DDx:
*[[Basal cell hyperplasia of the prostate]].
*[[Intraductal carcinoma of the prostate]].
*[[Prostatic adenocarcinoma]] - glands with HGPIN have two or more distinct cells layers.
**[[PIN-like prostatic ductal adenocarcinoma]] - glands crowded.
*Benign prostate - HPGIN has nuclear changes.
 
====HGPIN architecture====
There are several forms:<ref name=Ref_WMSP380>{{Ref WMSP|380}}</ref><ref name=pmid14739906>{{Cite journal  | last1 = Bostwick | first1 = DG. | last2 = Qian | first2 = J. | title = High-grade prostatic intraepithelial neoplasia. | journal = Mod Pathol | volume = 17 | issue = 3 | pages = 360-79 | month = Mar | year = 2004 | doi = 10.1038/modpathol.3800053 | PMID = 14739906 | url=http://www.nature.com/modpathol/journal/v17/n3/pdf/3800053a.pdf }}</ref>
*Flat - uncommon.
*Tufting - common.
*Micropapillary - common.
*Cribriform - rare.
 
Note:
*The architectural pattern is '''not''' thought to have any prognostic significance; however, it may be useful for differentiating it from benign prostate.
 
====Images====
<gallery>
Image:High-grade_prostatic_intraepithelial_neoplasia_low_mag.jpg | HGPIN - low mag. (WC/Nephron)
Image:High-grade_prostatic_intraepithelial_neoplasia_intermed_mag.jpg | HGPIN - intermed. mag. (WC/Nephron)
Image:High-grade_prostatic_intraepithelial_neoplasia_high_mag.jpg | HGPIN - high mag. (WC/Nephron)
</gallery>
===IHC===
*HGPIN: AMACR +ve, p63 +ve, HMWCK +ve.
*Cancer: AMACR +ve, p63 -ve, HMWCK -ve.
*Normal: AMACR -ve, p63 +ve, HMWCK +ve.
 
===Sign out===
<pre>
A. PROSTATE, RIGHT LATERAL SUPERIOR, BIOPSY:
- HIGH-GRADE PROSTATIC INTRAEPITHELIAL NEOPLASIA;
- NEGATIVE FOR MALIGNANCY.
</pre>


==Atypical small acinar proliferation==
==Atypical small acinar proliferation==
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*[[AKA]] ''suspicious for carcinoma''.<ref>THvdK. 19 June 2010.</ref>
*[[AKA]] ''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.
**''ASAP'' is preferred as it does not contain the word ''carcinoma'' and, thus, cannot be misread as ''carcinoma'', i.e. positive for malignancy.
 
{{Main|Atypical small acinar proliferation}}
===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, e.g. 2-3 glands.
 
Notes:
*IHC not contributory.
*Deeper cuts didn't yield anything - '''important'''.
 
DDx:
*[[Prostatic adenocarcinoma]].


=Prostate cancer=
=Prostate cancer=
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{{reflist|2}}
{{reflist|2}}


=External links=
*[http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2006/prostate06_ckw.pdf CAP prostate check list] - cap.org.
*[http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2006/prostate06_ckw.pdf CAP prostate protocol] - cap.org.
*[http://162.129.103.34/prostate/ Gleason score quiz] - Johns Hopkins Prostate Center.


[[Category: Genitourinary pathology]]
[[Category: Genitourinary pathology]]
Alessandro
14

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