Difference between revisions of "Prostate gland"

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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>


==Cancer==
==Atrophy==
*Small glands (may mimic Gleason score 3 pattern).
*Glands often have a jagged edges/prows (in cancer the glands tend to have round edges).
**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''.
*Atrophic glands are often hyperchromatic.<ref>SN. June 3, 2009.</ref>
 
Negatives:
*Nuclei like normal.
*Should have two cell layers, i.e. epithelial and myoepithelial (may be difficult to see).
 
===Differentiating between diagnoses===
Atrophy vs. low grade cancer (Gleason pattern 3)
*Atrophy - has two distinct cells layers in the gland.
*Atrophy - has an acinar arrangement/look like they originate from one large duct.
*Cancer - glands are back-to-back and do not look like they originate from one large duct.
*Cancer - has nucleoli (atrophy does NOT).
 
==Basal cell hyperplasia==
*Atypical appearing glands - typically in transition zone.<ref>[http://pathologyoutlines.com/prostate.html#bch]</ref>
*May have nucleoli.
 
===Differentiating between diagnoses===
Basal cell hyperplasia vs. cancer[http://pathologyoutlines.com/prostate.html#bch]
*Low power gland architecture near normal.[http://www.nature.com/modpathol/journal/v16/n6/fig_tab/3880810f1.html][http://www.nature.com/modpathol/journal/v16/n6/fig_tab/3880810f2.html]
**Glands ''not'' as small as cancer.
**Folds in gland lumina.
**No hyperchromasia.
**Two cell layers (as in normal prostate glands).
 
==HGPIN (high grade prostatic intraepithelial neoplasia)==
===General===
*Thought to be a precursor lesion for prostate adenocarcinoma.
 
===Microscopy===
*Diagnosed on basis of nuclear changes.
**Hyperchromatic nuclei.
**Nucleoli present.
**Often increased N/C ratio.
*Different architectures (e.g. papillary).
*Usually epithelial hyperplasia.
 
Note: Low grade PIN (LGPIN) is ''never'' diagnosed. It was found to be a useless diagnosis with no significant prognostic significance.
 
====HGPIN architecture====
There are several forms:<ref>WMSP P.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 -- may, however, be useful for picking it out from benign prostate.
 
===Differentiating between diagnoses===
HGPIN vs. adenocarcinoma:
*Glands with HGPIN have two or more distinct cells layers.
 
HGPIN vs. normal:
*HPGIN has nuclear changes.
 
May need IHC (especially for cancer vs. HGPIN).
 
IHC patterns:
*Cancer: AMACR +ve, p63 -ve, HMWCK -ve.
*HGPIN: AMACR +ve, p63 +ve, HMWCK +ve.
*Normal: AMACR -ve, p63 +ve, HMWCK ve+.
 
==Atypical small acinar proliferation==
===General===
*Abbreviated ''ASAP''.
*Can be considered to be a ''waffle'' diagnosis... like ''ASCUS'' is on the pap test.
*Should be used sparingly.
*Never diagnosed on excision, i.e. prostatectomy specimen.
*Some experts consider this diagnosis bogus, i.e. some don't believe it exists.<ref>{{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= |doi= |url=http://www3.interscience.wiley.com/journal/118508438/abstract}}</ref>
 
===Histologic characteristics===
*Atypical appearing acini.
*Limited extent, e.g. 2-3 glands.
*IHC not contributory.
*Deeper cuts didn't yield anything.
 
===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.
 
==Common prostate cancer==
===Criteria as a list===
===Criteria as a list===
Major criteria (the ABCs of prostate pathology):<ref name=pmid17213347>{{cite journal |author=Humphrey PA |title=Diagnosis of adenocarcinoma in prostate needle biopsy tissue |journal=J. Clin. Pathol. |volume=60 |issue=1 |pages=35–42 |year=2007 |month=January |pmid=17213347 |pmc=1860598 |doi=10.1136/jcp.2005.036442 |url=http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1860598/?tool=pubmed}}</ref>
Major criteria (the ABCs of prostate pathology):<ref name=pmid17213347>{{cite journal |author=Humphrey PA |title=Diagnosis of adenocarcinoma in prostate needle biopsy tissue |journal=J. Clin. Pathol. |volume=60 |issue=1 |pages=35–42 |year=2007 |month=January |pmid=17213347 |pmc=1860598 |doi=10.1136/jcp.2005.036442 |url=http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1860598/?tool=pubmed}}</ref>
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See: [http://www.cap.org/apps/cap.portal?_nfpb=true&cntvwrPtlt_actionOverride=/portlets/contentViewer/show&_windowLabel=cntvwrPtlt&cntvwrPtlt{actionForm.contentReference}=committees/cancer/cancer_protocols/protocols_index.html&_pageLabel=cntvwr CAP checklist].
See: [http://www.cap.org/apps/cap.portal?_nfpb=true&cntvwrPtlt_actionOverride=/portlets/contentViewer/show&_windowLabel=cntvwrPtlt&cntvwrPtlt{actionForm.contentReference}=committees/cancer/cancer_protocols/protocols_index.html&_pageLabel=cntvwr CAP checklist].


==HGPIN (high grade prostatic intraepithelial neoplasia)==
==Unusual forms of prostate cancer==
===General===
===Ductal adenocarcinoma===
*Thought to be a precursor lesion for prostate adenocarcinoma.
Features:
 
*Crowded columnar (or cigar-shaped) nuclei.
===Microscopy===
**Vaguely resembles colonic adenocarcinoma.
*Diagnosed on basis of nuclear changes.
*Usually seen in association with conventional (acinar) prostate adenocarcinoma.
**Hyperchromatic nuclei.
**Nucleoli present.
**Often increased N/C ratio.
*Different architectures (e.g. papillary).
*Usually epithelial hyperplasia.
 
Note: Low grade PIN (LGPIN) is ''never'' diagnosed. It was found to be a useless diagnosis with no significant prognostic significance.
 
====HGPIN architecture====
There are several forms:<ref>WMSP P.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 -- may, however, be useful for picking it out from benign prostate.
 
===Differentiating between diagnoses===
HGPIN vs. adenocarcinoma:
*Glands with HGPIN have two or more distinct cells layers.
 
HGPIN vs. normal:
*HPGIN has nuclear changes.
 
May need IHC (especially for cancer vs. HGPIN).
 
IHC patterns:
*Cancer: AMACR +ve, p63 -ve, HMWCK -ve.
*HGPIN: AMACR +ve, p63 +ve, HMWCK +ve.
*Normal: AMACR -ve, p63 +ve, HMWCK ve+.
 
==Atrophy==
*Small glands (may mimic Gleason score 3 pattern).
*Glands often have a jagged edges/prows (in cancer the glands tend to have round edges).
**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''.
*Atrophic glands are often hyperchromatic.<ref>SN. June 3, 2009.</ref>
 
Negatives:
*Nuclei like normal.
*Should have two cell layers, i.e. epithelial and myoepithelial (may be difficult to see).
 
===Differentiating between diagnoses===
Atrophy vs. low grade cancer (Gleason pattern 3)
*Atrophy - has two distinct cells layers in the gland.
*Atrophy - has an acinar arrangement/look like they originate from one large duct.
*Cancer - glands are back-to-back and do not look like they originate from one large duct.
*Cancer - has nucleoli (atrophy does NOT).
 
==Basal cell hyperplasia==
*Atypical appearing glands - typically in transition zone.<ref>[http://pathologyoutlines.com/prostate.html#bch]</ref>
*May have nucleoli.


===Differentiating between diagnoses===
===Foamy gland carcinoma===
Basal cell hyperplasia vs. cancer[http://pathologyoutlines.com/prostate.html#bch]
Features:
*Low power gland architecture near normal.[http://www.nature.com/modpathol/journal/v16/n6/fig_tab/3880810f1.html][http://www.nature.com/modpathol/journal/v16/n6/fig_tab/3880810f2.html]
*Tufted glandular border.
**Glands ''not'' as small as cancer.
*Abundant eosinophilic (or hyperchromatic) cytoplasm - '''key feature'''.
**Folds in gland lumina.
*Gland size larger than "typical" prostate cancer.
**No hyperchromasia.
**Two cell layers (as in normal prostate glands).
 
==Atypical small acinar proliferation==
===General===
*Abbreviated ''ASAP''.
*Can be considered to be a ''waffle'' diagnosis... like ''ASCUS'' is on the pap test.
*Should be used sparingly.
*Never diagnosed on excision, i.e. prostatectomy specimen.
*Some experts consider this diagnosis bogus, i.e. some don't believe it exists.<ref>{{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= |doi= |url=http://www3.interscience.wiley.com/journal/118508438/abstract}}</ref>
 
===Histologic characteristics===
*Atypical appearing acini.
*Limited extent, e.g. 2-3 glands.
*IHC not contributory.
*Deeper cuts didn't yield anything.
 
===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.


Ref.:[http://en.wikipedia.org/wiki/Atypical_small_acinar_proliferation ASAP (en.wikipedia.org)].
===Pseudohyperplastic prostatic adenocarcinoma===
Features:
*Usually associated with conventional (acinar) prostate adenocarcinoma.
*Pale (normal) cytoplasm).
*Pseudopapillary infolding - key feature.
*Large size glands.


==See also==
==See also==
Michael
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