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).
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).


==Normal==  
=Normal=
===Prostate===
==Prostate==
*Glands have two cell layers (similar to glands in breast).
*Glands have two cell layers (similar to glands in breast).
**Second cell layer may be difficult to see (like in breast).
**Second cell layer may be difficult to see (like in breast).
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**Foamy gland carcinoma.
**Foamy gland carcinoma.


====IHC of normal prostate====
===IHC of normal prostate===
Normal prostate:  
Normal prostate:  
*AMACR -ve (mark epithelial cells).  
*AMACR -ve (mark epithelial cells).  
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*PSA +ve, PSAP +ve.
*PSA +ve, PSAP +ve.


===Other accessory glands===
==Other accessory glands==
====Bulbourethral gland====
===Bulbourethral gland===
*AKA ''Cowper's gland''.
*AKA ''Cowper's gland''.
*Mucinous glands at the apex of the prostate.
*Mucinous glands at the apex of the prostate.
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Image: [http://pathology.mc.duke.edu/research/histo_course/mixed_saliv.jpg Mucinous/serous salivary gland (duke.edu)].
Image: [http://pathology.mc.duke.edu/research/histo_course/mixed_saliv.jpg Mucinous/serous salivary gland (duke.edu)].
====Seminal vesicles====
===Seminal vesicles===
*Fern-like architecture - epithelial component clustered closely, looks like it connects.
*Fern-like architecture - epithelial component clustered closely, looks like it connects.
**Epithelium surrounded by a thick layer of muscle (>10 cells across ~80 microns).
**Epithelium surrounded by a thick layer of muscle (>10 cells across ~80 microns).
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*[http://dspace.udel.edu:8080/dspace/bitstream/19716/2016/1/cmrsvlm3.GIF SV (udel.edu)].
*[http://dspace.udel.edu:8080/dspace/bitstream/19716/2016/1/cmrsvlm3.GIF SV (udel.edu)].


==Common diagnoses==
=Common diagnoses=
*Benign.
*Benign.
**Atrophy - may resemble adenocarcinoma - typically not reported.
**Atrophy - may resemble adenocarcinoma - typically not reported.
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****How to remember? A. '''P'''rostate... hyper'''P'''lasia.
****How to remember? A. '''P'''rostate... hyper'''P'''lasia.


==Clinical history==
=Clinical history=
*PSA (serum).
*PSA (serum).
** >10 ng/mL worrisome for prostate cancer.
** >10 ng/mL worrisome for prostate cancer.
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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=
==Prostatic nodular hyperplasia==
==Prostatic nodular hyperplasia==
*[[AKA]] ''nodular hyperplasia of the prostate'', AKA ''benign prostatic hyperplasia'' (abbreviated BPH).
*[[AKA]] ''nodular hyperplasia of the prostate'', AKA ''benign prostatic hyperplasia'' (abbreviated BPH).
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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].


==Molecular changes in prostate cancer==
===Molecular changes in prostate cancer===
A fusion gene between ''TMPRSS2'' and ''ERG'' is described.<ref name=pmid20478527>{{cite journal | author = Yu J, Yu J, Mani RS, Cao Q, Brenner CJ, Cao X, Wang X, Wu L, Li J, Hu M, Gong Y, Cheng H, Laxman B, Vellaichamy A, Shankar S, Li Y, Dhanasekaran SM, Morey R, Barrette T, Lonigro RJ, Tomlins SA, Varambally S, Qin ZS, Chinnaiyan AM | title = An Integrated Network of Androgen Receptor, Polycomb, and TMPRSS2-ERG Gene Fusions in Prostate Cancer Progression | journal = Cancer Cell | volume = 17 | issue = 5 | pages = 443–54 | year = 2010 | month = May | pmid = 20478527 | pmc = 2874722 | doi = 10.1016/j.ccr.2010.03.018 | url =  }}</ref><ref name=omim602060>{{OMIM|602060}}</ref>
A fusion gene between ''TMPRSS2'' and ''ERG'' is described.<ref name=pmid20478527>{{cite journal | author = Yu J, Yu J, Mani RS, Cao Q, Brenner CJ, Cao X, Wang X, Wu L, Li J, Hu M, Gong Y, Cheng H, Laxman B, Vellaichamy A, Shankar S, Li Y, Dhanasekaran SM, Morey R, Barrette T, Lonigro RJ, Tomlins SA, Varambally S, Qin ZS, Chinnaiyan AM | title = An Integrated Network of Androgen Receptor, Polycomb, and TMPRSS2-ERG Gene Fusions in Prostate Cancer Progression | journal = Cancer Cell | volume = 17 | issue = 5 | pages = 443–54 | year = 2010 | month = May | pmid = 20478527 | pmc = 2874722 | doi = 10.1016/j.ccr.2010.03.018 | url =  }}</ref><ref name=omim602060>{{OMIM|602060}}</ref>
*Both genes are on chromosome 21.
*Both genes are on chromosome 21.
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*A subset of ''TMPRSS2-ERG'' known as ''2+Edel'' (seen in ~7% of all prostate cancer cases) predicts poor survival.<ref name=pmid17637754>{{Cite journal  | last1 = Attard | first1 = G. | last2 = Clark | first2 = J. | last3 = Ambroisine | first3 = L. | last4 = Fisher | first4 = G. | last5 = Kovacs | first5 = G. | last6 = Flohr | first6 = P. | last7 = Berney | first7 = D. | last8 = Foster | first8 = CS. | last9 = Fletcher | first9 = A. | title = Duplication of the fusion of TMPRSS2 to ERG sequences identifies fatal human prostate cancer. | journal = Oncogene | volume = 27 | issue = 3 | pages = 253-63 | month = Jan | year = 2008 | doi = 10.1038/sj.onc.1210640 | PMID = 17637754 }}</ref>
*A subset of ''TMPRSS2-ERG'' known as ''2+Edel'' (seen in ~7% of all prostate cancer cases) predicts poor survival.<ref name=pmid17637754>{{Cite journal  | last1 = Attard | first1 = G. | last2 = Clark | first2 = J. | last3 = Ambroisine | first3 = L. | last4 = Fisher | first4 = G. | last5 = Kovacs | first5 = G. | last6 = Flohr | first6 = P. | last7 = Berney | first7 = D. | last8 = Foster | first8 = CS. | last9 = Fletcher | first9 = A. | title = Duplication of the fusion of TMPRSS2 to ERG sequences identifies fatal human prostate cancer. | journal = Oncogene | volume = 27 | issue = 3 | pages = 253-63 | month = Jan | year = 2008 | doi = 10.1038/sj.onc.1210640 | PMID = 17637754 }}</ref>


==Unusual forms of prostate cancer==
=Unusual forms of prostate cancer=
===Prostatic ductal adenocarcinoma===
==Prostatic ductal adenocarcinoma==
*[[AKA]] ''ductal adenocarcinoma of the prostate''.
*[[AKA]] ''ductal adenocarcinoma of the prostate''.
*[[AKA]] ''prostatic adenocarinoma, large duct type''.
*[[AKA]] ''prostatic adenocarinoma, large duct type''.
===General===
*Sometimes it is referred to as ''endometrioid'' or ''endometrial'' adenocarcinoma; both terms are discouraged.<ref name=pmid18773743>{{Cite journal  | last1 = Samaratunga | first1 = H. | last2 = Delahunt | first2 = B. | title = Ductal adenocarcinoma of the prostate: current opinion and controversies. | journal = Anal Quant Cytol Histol | volume = 30 | issue = 4 | pages = 237-46 | month = Aug | year = 2008 | doi =  | PMID = 18773743 }}</ref>
*Sometimes it is referred to as ''endometrioid'' or ''endometrial'' adenocarcinoma; both terms are discouraged.<ref name=pmid18773743>{{Cite journal  | last1 = Samaratunga | first1 = H. | last2 = Delahunt | first2 = B. | title = Ductal adenocarcinoma of the prostate: current opinion and controversies. | journal = Anal Quant Cytol Histol | volume = 30 | issue = 4 | pages = 237-46 | month = Aug | year = 2008 | doi =  | PMID = 18773743 }}</ref>


===Microscopic===
Features:<ref name=Ref_GUP88>{{Ref GUP|88}}</ref>
Features:<ref name=Ref_GUP88>{{Ref GUP|88}}</ref>
*Pseudostratified (crowded appearing) columnar (or cigar-shaped) nuclei - '''key feature'''.
*Pseudostratified (crowded appearing) columnar (or cigar-shaped) nuclei - '''key feature'''.
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*[http://path.upmc.edu/cases/case711.html Prostatei ductal adenocarcinoma - another case - several images (upmc.edu)].
*[http://path.upmc.edu/cases/case711.html Prostatei ductal adenocarcinoma - another case - several images (upmc.edu)].


===PIN-like prostatic ductal adenocarcinoma===
==PIN-like prostatic ductal adenocarcinoma==
*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>
*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>
*May be confused with [[prostatic intraepithelial neoplasia]] (PIN).
*May be confused with [[prostatic intraepithelial neoplasia]] (PIN).


===Microscopic===
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>
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>
*Stratified malignant epithelium.
*Stratified malignant epithelium.
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*[http://www.nature.com/modpathol/journal/v19/n7/fig_tab/3800601f1.html#figure-title PIN-like adenocarcinoma (nature.com)].
*[http://www.nature.com/modpathol/journal/v19/n7/fig_tab/3800601f1.html#figure-title PIN-like adenocarcinoma (nature.com)].


===Foamy gland carcinoma===
==Foamy gland carcinoma==
 
===Microscopic===
Features:
Features:
*Tufted glandular border.
*Tufted glandular border.
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Image: [http://www.nature.com/modpathol/journal/v17/n3/fig_tab/3800050f11.html#figure-title Foamy gland carcinoma (nature.com)].
Image: [http://www.nature.com/modpathol/journal/v17/n3/fig_tab/3800050f11.html#figure-title Foamy gland carcinoma (nature.com)].


===Atrophic carcinoma===
==Atrophic carcinoma==
===Microscopic===
Features:
Features:
*Scant cytoplasm.
*Scant cytoplasm.
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Image: [http://www.nature.com/modpathol/journal/v17/n3/fig_tab/3800050f12.html#figure-title Atrophic carcinoma (nature.com)].
Image: [http://www.nature.com/modpathol/journal/v17/n3/fig_tab/3800050f12.html#figure-title Atrophic carcinoma (nature.com)].


===Mucinous prostate carcinoma===
==Mucinous prostate carcinoma==
Definition:
===General===
*Rare.
 
===Microscopic===
Features:
*Cytologically malignant cells floating in mucin.
*Cytologically malignant cells floating in mucin.
*> 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>  
*> 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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*[[Mucinous carcinoma]] - percentage required to call varies by site.
*[[Mucinous carcinoma]] - percentage required to call varies by site.


===Pseudohyperplastic prostatic adenocarcinoma===
==Pseudohyperplastic prostatic adenocarcinoma==
===Microscopic===
Features:<ref name=Ref_GUP77>{{Ref GUP|77}}</ref><ref name=pmid14688829>{{cite journal |author=Arista-Nasr J, Martinez-Benitez B, Valdes S, Hernández M, Bornstein-Quevedo L |title=Pseudohyperplastic prostatic adenocarcinoma in transurethral resections of the prostate |journal=Pathol. Oncol. Res. |volume=9 |issue=4 |pages=232–5 |year=2003 |pmid=14688829 |doi=PAOR.2003.9.4.0232 |url=}}</ref>
Features:<ref name=Ref_GUP77>{{Ref GUP|77}}</ref><ref name=pmid14688829>{{cite journal |author=Arista-Nasr J, Martinez-Benitez B, Valdes S, Hernández M, Bornstein-Quevedo L |title=Pseudohyperplastic prostatic adenocarcinoma in transurethral resections of the prostate |journal=Pathol. Oncol. Res. |volume=9 |issue=4 |pages=232–5 |year=2003 |pmid=14688829 |doi=PAOR.2003.9.4.0232 |url=}}</ref>
*Medium to large glands with an atypical morphology - '''key low power feature''':  
*Medium to large glands with an atypical morphology - '''key low power feature''':  
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*Pale abundant cytoplasm - similar to normal prostate.
*Pale abundant cytoplasm - similar to normal prostate.


===Prostatic signet ring cell carcinoma===
==Prostatic signet ring cell carcinoma==
*Very rare - 9 cases in a series of 29,783 prostate cancer cases.<ref name=pmid21123640>{{Cite journal  | last1 = Warner | first1 = JN. | last2 = Nakamura | first2 = LY. | last3 = Pacelli | first3 = A. | last4 = Humphreys | first4 = MR. | last5 = Castle | first5 = EP. | title = Primary signet ring cell carcinoma of the prostate. | journal = Mayo Clin Proc | volume = 85 | issue = 12 | pages = 1130-6 | month = Dec | year = 2010 | doi = 10.4065/mcp.2010.0463 | PMID = 21123640 }}</ref>
*Very rare - 9 cases in a series of 29,783 prostate cancer cases.<ref name=pmid21123640>{{Cite journal  | last1 = Warner | first1 = JN. | last2 = Nakamura | first2 = LY. | last3 = Pacelli | first3 = A. | last4 = Humphreys | first4 = MR. | last5 = Castle | first5 = EP. | title = Primary signet ring cell carcinoma of the prostate. | journal = Mayo Clin Proc | volume = 85 | issue = 12 | pages = 1130-6 | month = Dec | year = 2010 | doi = 10.4065/mcp.2010.0463 | PMID = 21123640 }}</ref>
*Criteria vary - percentage of SRCs required for Dx varies from 20% to 50%.<ref name=pmid21123640/>
*Criteria vary - percentage of SRCs required for Dx varies from 20% to 50%.<ref name=pmid21123640/>
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*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2996149/figure/F1/ Prostatic SRC (nih.gov)].
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2996149/figure/F1/ Prostatic SRC (nih.gov)].


===Sarcomatoid prostate carcinoma===
==Sarcomatoid prostate carcinoma==
*[[AKA]] ''carcinosarcoma''.
*[[AKA]] ''carcinosarcoma''.


===Microscopic===
Features:<ref name=Ref_GUP80>{{Ref GUP|77 & 80}}</ref>
Features:<ref name=Ref_GUP80>{{Ref GUP|77 & 80}}</ref>
*Biphasic tumour:
*Biphasic tumour:
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*#*Typically stains PSA +ve, keratin +ve.
*#*Typically stains PSA +ve, keratin +ve.


===Small cell carcinoma===
==Small cell carcinoma of the prostate==
{{Main|Small cell carcinoma}}
{{Main|Small cell carcinoma}}
Features:
Features:
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**UCC usu. HWCK +ve.
**UCC usu. HWCK +ve.


==See also==
=See also=
*[[Urothelium]].
*[[Urothelium]].
*[[Genitourinary pathology]].
*[[Genitourinary pathology]].


==References==
=References=
{{reflist|2}}
{{reflist|2}}


==External links==
=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 check list] - cap.org.
*[http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2006/prostate06_ckw.pdf CAP prostate protocol] - cap.org.
*[http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2006/prostate06_ckw.pdf CAP prostate protocol] - cap.org.
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