Difference between revisions of "Prostate gland"

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Prostate gland (view source)

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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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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==
==Sign out==
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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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*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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==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''.
{{Main|Atrophy of the prostate gland}}


==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]].
*[[Adenoid cystic/basal cell carcinoma of the prostate]] - for the adenoid cystic-like pattern of BCH.<ref name=pmid15371944>{{Cite journal  | last1 = McKenney | first1 = JK. | last2 = Amin | first2 = MB. | last3 = Srigley | first3 = JR. | last4 = Jimenez | first4 = RE. | last5 = Ro | first5 = JY. | last6 = Grignon | first6 = DJ. | last7 = Young | first7 = RH. | title = Basal cell proliferations of the prostate other than usual basal cell hyperplasia: a clinicopathologic study of 23 cases, including four carcinomas, with a proposed classification. | journal = Am J Surg Pathol | volume = 28 | issue = 10 | pages = 1289-98 | month = Oct | year = 2004 | doi =  | PMID = 15371944 }}</ref>
 
====Images====
<gallery>
Image: Basal cell hyperplasia of the prostate -- high mag.jpg | BCH - high mag. (WC)
Image: Basal cell hyperplasia of the prostate -- very high mag.jpg | BCH - very high mag. (WC)
</gallery>
www:
*[http://webpathology.com/image.asp?case=18&n=1 Basal cell hyperplasia of the prostate (webpathology.com)].
 
===Sign out===
*Usually not reported.
 
==High-grade prostatic intraepithelial neoplasia==
==High-grade prostatic intraepithelial neoplasia==
*Abbreviated as ''HGPIN''.
*Abbreviated as ''HGPIN''.
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**''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}}
{{Main|Atypical small acinar proliferation}}
==Mesonephric remnant of the prostate gland==
{{Main|Mesonephric remnant of the prostate gland}}


=Prostate cancer=
=Prostate cancer=
Alessandro
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