Template:Prostate screening method - Revision history

Mikael Häggström: /* Precancerous lesions */ Seminal vesicle

2024-06-14T17:02:19Z

Precancerous lesions: Seminal vesicle

← Older revision		Revision as of 13:02, 14 June 2024
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	Picture above compares a PIN-4 immunohistochemistry of benign gland (left) and adenocarcinoma (right) using PIN-4. The adenocarcinoma lacks the basal epithelial cells (stained dark brown by p63 and HMWK). Also, in PIN-4 stained samples, adenocarcinoma cells generally display red cytoplasms (stained by AMACR, also known as P504S), while benign glands do not.		Picture above compares a PIN-4 immunohistochemistry of benign gland (left) and adenocarcinoma (right) using PIN-4. The adenocarcinoma lacks the basal epithelial cells (stained dark brown by p63 and HMWK). Also, in PIN-4 stained samples, adenocarcinoma cells generally display red cytoplasms (stained by AMACR, also known as P504S), while benign glands do not.
	<~~br clear~~=~~all~~>		<gallery mode=packed heights=180>
	[[File:Histology of prostate atrophy.jpg~~\|thumb\|left\|370px~~\|'''Atrophy''' is a differential diagnosis to prostate cancer. This example shows gradually increasing simple atrophy from left to right, H&E stain. Crowding and angulation may mimic that of adenocarcinoma, but there is nuclear basophilia rather than atypia, and occasional basal cells can still be seen.]]		File:Histology of prostate atrophy.jpg\|'''Atrophy''' is a differential diagnosis to prostate cancer. This example shows gradually increasing simple atrophy from left to right, H&E stain. Crowding and angulation may mimic that of adenocarcinoma, but there is nuclear basophilia rather than atypia, and occasional basal cells can still be seen.
	<~~br clear~~=~~all~~><noinclude>		File:Histology of seminal vesicle glands on H&E stain.jpg\|Also, '''seminal vesicle''' glands may mimic prostatic adenocarcinoma by crowded glands with enlarged hyperchromatic and irregular nuclei, but will have inconspicuous nucleoli and coarse refractile golden brown lipofuscin granules.<ref>Image by Mikael Häggström, MD. Reference for findings: {{cite web\|url=https://www.pathologyoutlines.com/topic/prostateseminalves.html\|title=Anatomy & histology-seminal vesicles / ejaculatory duct\|website=Pathology Outlines\|author=Faryal Shoaib, M.D., Chinedum Okafor, M.D., Y. Albert Yeh, M.D., Ph.D.}} Last staff update: 20 November 2023</ref>
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Mikael Häggström: /* Precancerous lesions */ +Atrophy

2024-06-14T13:23:07Z

Precancerous lesions: +Atrophy

← Older revision		Revision as of 09:23, 14 June 2024
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	Picture above compares a PIN-4 immunohistochemistry of benign gland (left) and adenocarcinoma (right) using PIN-4. The adenocarcinoma lacks the basal epithelial cells (stained dark brown by p63 and HMWK). Also, in PIN-4 stained samples, adenocarcinoma cells generally display red cytoplasms (stained by AMACR, also known as P504S), while benign glands do not.		Picture above compares a PIN-4 immunohistochemistry of benign gland (left) and adenocarcinoma (right) using PIN-4. The adenocarcinoma lacks the basal epithelial cells (stained dark brown by p63 and HMWK). Also, in PIN-4 stained samples, adenocarcinoma cells generally display red cytoplasms (stained by AMACR, also known as P504S), while benign glands do not.
	<br clear=all>		<br clear=all>
	<noinclude>		[[File:Histology of prostate atrophy.jpg\|thumb\|left\|370px\|'''Atrophy''' is a differential diagnosis to prostate cancer. This example shows gradually increasing simple atrophy from left to right, H&E stain. Crowding and angulation may mimic that of adenocarcinoma, but there is nuclear basophilia rather than atypia, and occasional basal cells can still be seen.]]
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Mikael Häggström: /* Characteristics of adenocarcinoma */ d

2024-01-08T19:39:21Z

Characteristics of adenocarcinoma: d

← Older revision		Revision as of 15:39, 8 January 2024
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	*'''Collagenous micronodules''' for acinar adenocarcinoma<ref name="CruzSantana2016"/>		*'''Collagenous micronodules''' for acinar adenocarcinoma<ref name="CruzSantana2016"/>
	*'''Angiolymphatic''' invasion<ref name="CruzSantana2016"/>		*'''Angiolymphatic''' invasion<ref name="CruzSantana2016"/>
	*'''Extraprostatic''' extension,<ref name="CruzSantana2016"/> which in biopsies can be ~~diagnoses~~ when tumor cells are located in fatty tissue.		*'''Extraprostatic''' extension,<ref name="CruzSantana2016"/> which in biopsies can be diagnosed when tumor cells are located in fatty tissue.
	;Less specific findings:		;Less specific findings:
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Mikael Häggström: /* Precancerous lesions */ heights

2023-12-20T22:13:44Z

Precancerous lesions: heights

← Older revision		Revision as of 18:13, 20 December 2023
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	An '''ASAP''' is a lesion that is probably carcinoma but either lacks definitive diagnostic features, or is too small to be certain (see image below).<ref name=stanford-asap>{{cite web\|url=http://surgpathcriteria.stanford.edu/prostate/adenocarcinoma/atypical-small-acinar-proliferation-asap.html\|title=Prostatic Adenocarcinoma - Atypical Small Acinar Proliferation (ASAP)\|website=Stanford Medical School\|accessdate=2020-09-14}}</ref> It should not be used for benign lesions that are just unusual looking.<ref name=stanford-asap/> In uncertain cases, a diagnosis of adenocarcinoma can be excluded by immunohistochemical detection of basal cells (or confirmed by absence thereof),<ref name="CruzSantana2016"/> such as using the '''PIN-4''' cocktail of stains (which consists of P504S, p63 and high-molecular-weight keratins (HMWK) such as CK5 and CK14).		An '''ASAP''' is a lesion that is probably carcinoma but either lacks definitive diagnostic features, or is too small to be certain (see image below).<ref name=stanford-asap>{{cite web\|url=http://surgpathcriteria.stanford.edu/prostate/adenocarcinoma/atypical-small-acinar-proliferation-asap.html\|title=Prostatic Adenocarcinoma - Atypical Small Acinar Proliferation (ASAP)\|website=Stanford Medical School\|accessdate=2020-09-14}}</ref> It should not be used for benign lesions that are just unusual looking.<ref name=stanford-asap/> In uncertain cases, a diagnosis of adenocarcinoma can be excluded by immunohistochemical detection of basal cells (or confirmed by absence thereof),<ref name="CruzSantana2016"/> such as using the '''PIN-4''' cocktail of stains (which consists of P504S, p63 and high-molecular-weight keratins (HMWK) such as CK5 and CK14).
	<gallery mode=packed>		<gallery mode=packed heights=200>
	File:Histopathology of small acinar cell proliferation (annotated).jpg\|'''Small acinar cell proliferation''', with acinar cells with large nuclei, prominent nucleoli (arrows marking two of them) and no certain basal cell lining.		File:Histopathology of small acinar cell proliferation (annotated).jpg\|'''Small acinar cell proliferation''', with acinar cells with large nuclei, prominent nucleoli (arrows marking two of them) and no certain basal cell lining.
	File:PIN-4 staining of benign prostate gland and adenocarcinoma.jpg\|PIN-4 staining of benign prostate gland and adenocarcinoma		File:PIN-4 staining of benign prostate gland and adenocarcinoma.jpg\|PIN-4 staining of benign prostate gland and adenocarcinoma

Mikael Häggström: /* Precancerous lesions */ Organized

2023-12-20T22:12:33Z

Precancerous lesions: Organized

← Older revision		Revision as of 18:12, 20 December 2023
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	===Precancerous lesions===		===Precancerous lesions===
	[[File:Histopathology of high-grade prostatic intraepithelial neoplasia (HGPIN), annotated.jpg\|thumb\|300px\|High-grade prostatic intraepithelial neoplasia (HGPIN) with typical features, H&E stain.<ref>Image by Mikael Häggström, MD. Reference for features:<br>- {{cite web\|url=https://www.pathologyoutlines.com/topic/prostateHGPIN.html\|title=High grade prostatic intraepithelial neoplasia (HGPIN)\|author=Margaret Sanders, M.B.B.Ch., Murali Varma, M.B.B.S.\|website=Pathology Outlines}} Last author update: 23 February 2021</ref>]]		[[File:Histopathology of high-grade prostatic intraepithelial neoplasia (HGPIN), annotated.jpg\|thumb\|300px\|High-grade prostatic intraepithelial neoplasia (HGPIN) with typical features, H&E stain.<ref>Image by Mikael Häggström, MD. Reference for features:<br>- {{cite web\|url=https://www.pathologyoutlines.com/topic/prostateHGPIN.html\|title=High grade prostatic intraepithelial neoplasia (HGPIN)\|author=Margaret Sanders, M.B.B.Ch., Murali Varma, M.B.B.S.\|website=Pathology Outlines}} Last author update: 23 February 2021</ref>]]
	[[File:Histopathology of small acinar cell proliferation (annotated).jpg\|thumb\|210px\|Histopathology of a '''small acinar cell proliferation''', with acinar cells with large nuclei, prominent nucleoli (arrows marking two of them) and no certain basal cell lining.]]
	In case of only less specific findings, consider a '''Prostatic intraepithelial neoplasia''' ('''PIN''') or an '''atypical small acinar proliferation''' ('''ASAP''').		In case of only less specific findings, consider a '''Prostatic intraepithelial neoplasia''' ('''PIN''') or an '''atypical small acinar proliferation''' ('''ASAP''').

	A '''PIN''' is where acini are architecturally benign, but individual cells display atypia. In high-grade PIN (HGPIN), the changes are similar to those of prostate cancer, whereas in low-grade (LGPIN) the changes are milder. Most pathologists do not report the presence of LGPIN.<ref>{{cite web\|url=https://emedicine.medscape.com/article/447780-overview\|title=Precancerous Lesions of the Prostate\|author=Stanley A Brosman, MD\|website=Medscape}} Updated: Feb 26, 2020</ref>		A '''PIN''' is where acini are architecturally benign, but individual cells display atypia. In high-grade PIN (HGPIN), the changes are similar to those of prostate cancer, whereas in low-grade (LGPIN) the changes are milder. Most pathologists do not report the presence of LGPIN.<ref>{{cite web\|url=https://emedicine.medscape.com/article/447780-overview\|title=Precancerous Lesions of the Prostate\|author=Stanley A Brosman, MD\|website=Medscape}} Updated: Feb 26, 2020</ref>

	An '''ASAP''' is a lesion that is probably carcinoma but either lacks definitive diagnostic features, or is too small to be certain.<ref name=stanford-asap>{{cite web\|url=http://surgpathcriteria.stanford.edu/prostate/adenocarcinoma/atypical-small-acinar-proliferation-asap.html\|title=Prostatic Adenocarcinoma - Atypical Small Acinar Proliferation (ASAP)\|website=Stanford Medical School\|accessdate=2020-09-14}}</ref> It should not be used for benign lesions that are just unusual looking.<ref name=stanford-asap/> In uncertain cases, a diagnosis of adenocarcinoma can be excluded by immunohistochemical detection of basal cells (or confirmed by absence thereof),<ref name="CruzSantana2016"/> such as using the '''PIN-4''' cocktail of stains (which consists of P504S, p63 and high-molecular-weight keratins (HMWK) such as CK5 and CK14).		An '''ASAP''' is a lesion that is probably carcinoma but either lacks definitive diagnostic features, or is too small to be certain (see image below).<ref name=stanford-asap>{{cite web\|url=http://surgpathcriteria.stanford.edu/prostate/adenocarcinoma/atypical-small-acinar-proliferation-asap.html\|title=Prostatic Adenocarcinoma - Atypical Small Acinar Proliferation (ASAP)\|website=Stanford Medical School\|accessdate=2020-09-14}}</ref> It should not be used for benign lesions that are just unusual looking.<ref name=stanford-asap/> In uncertain cases, a diagnosis of adenocarcinoma can be excluded by immunohistochemical detection of basal cells (or confirmed by absence thereof),<ref name="CruzSantana2016"/> such as using the '''PIN-4''' cocktail of stains (which consists of P504S, p63 and high-molecular-weight keratins (HMWK) such as CK5 and CK14).
			<gallery mode=packed>
	[[File:PIN-4 staining of benign prostate gland and adenocarcinoma.jpg\|~~left\|220px]]~~		File:Histopathology of small acinar cell proliferation (annotated).jpg\|'''Small acinar cell proliferation''', with acinar cells with large nuclei, prominent nucleoli (arrows marking two of them) and no certain basal cell lining.
	Picture ~~at left~~ compares a PIN-4 immunohistochemistry of benign gland (left) and adenocarcinoma (right) using PIN-4. The adenocarcinoma lacks the basal epithelial cells (stained dark brown by p63 and HMWK). Also, in PIN-4 stained samples, adenocarcinoma cells generally display red cytoplasms (stained by AMACR, also known as P504S), while benign glands do not.		File:PIN-4 staining of benign prostate gland and adenocarcinoma.jpg\|PIN-4 staining of benign prostate gland and adenocarcinoma
			</gallery>
			Picture above compares a PIN-4 immunohistochemistry of benign gland (left) and adenocarcinoma (right) using PIN-4. The adenocarcinoma lacks the basal epithelial cells (stained dark brown by p63 and HMWK). Also, in PIN-4 stained samples, adenocarcinoma cells generally display red cytoplasms (stained by AMACR, also known as P504S), while benign glands do not.
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Mikael Häggström: /* Precancerous lesions */ +Image

2023-12-20T22:09:48Z

Precancerous lesions: +Image

← Older revision		Revision as of 18:09, 20 December 2023
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	===Precancerous lesions===		===Precancerous lesions===
			[[File:Histopathology of high-grade prostatic intraepithelial neoplasia (HGPIN), annotated.jpg\|thumb\|300px\|High-grade prostatic intraepithelial neoplasia (HGPIN) with typical features, H&E stain.<ref>Image by Mikael Häggström, MD. Reference for features:<br>- {{cite web\|url=https://www.pathologyoutlines.com/topic/prostateHGPIN.html\|title=High grade prostatic intraepithelial neoplasia (HGPIN)\|author=Margaret Sanders, M.B.B.Ch., Murali Varma, M.B.B.S.\|website=Pathology Outlines}} Last author update: 23 February 2021</ref>]]
	[[File:Histopathology of small acinar cell proliferation (annotated).jpg\|thumb\|210px\|Histopathology of a '''small acinar cell proliferation''', with acinar cells with large nuclei, prominent nucleoli (arrows marking two of them) and no certain basal cell lining.]]		[[File:Histopathology of small acinar cell proliferation (annotated).jpg\|thumb\|210px\|Histopathology of a '''small acinar cell proliferation''', with acinar cells with large nuclei, prominent nucleoli (arrows marking two of them) and no certain basal cell lining.]]
	In case of only less specific findings, consider a '''Prostatic intraepithelial neoplasia''' ('''PIN''') or an '''atypical small acinar proliferation''' ('''ASAP''').		In case of only less specific findings, consider a '''Prostatic intraepithelial neoplasia''' ('''PIN''') or an '''atypical small acinar proliferation''' ('''ASAP''').

Mikael Häggström: Templated

2022-12-19T20:58:53Z

Templated

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 *Before microscopy, look at each microscopy slide by '''eye''', to plan the microscopy screening so as to not miss peripheral fragments.
 *Screen at low power, and switch to '''high power''' when encountering glandular structures that can not otherwise be cleared. Look in particular for those surrounding nerves.
-*At least if no cancer is seen, also look for '''inflammation'''.<ref name=inflammation group=notes>Inflammation can explain for example a high PSA value in the absence of adenocarcinoma, so its reporting is usually only needed in such cases.</ref><noinclude>
+*At least if no cancer is seen, also look for '''inflammation'''.<ref name=inflammation group=notes>Inflammation can explain for example a high PSA value in the absence of adenocarcinoma, so its reporting is usually only needed in such cases.</ref>
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Mikael Häggström: /* Screening method */ Specified

2021-03-24T16:26:15Z

Screening method: Specified

← Older revision		Revision as of 12:26, 24 March 2021
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	*Before microscopy, look at each microscopy slide by '''eye''', to plan the microscopy screening so as to not miss peripheral fragments.		*Before microscopy, look at each microscopy slide by '''eye''', to plan the microscopy screening so as to not miss peripheral fragments.
	*Screen at low power, and switch to '''high power''' when encountering glandular structures that can not otherwise be cleared. Look in particular for those surrounding nerves.		*Screen at low power, and switch to '''high power''' when encountering glandular structures that can not otherwise be cleared. Look in particular for those surrounding nerves.
	*At least if no cancer is seen, also look for '''inflammation'''.<ref name=inflammation group=notes>Inflammation can explain for example a high PSA value.</ref><noinclude>		*At least if no cancer is seen, also look for '''inflammation'''.<ref name=inflammation group=notes>Inflammation can explain for example a high PSA value in the absence of adenocarcinoma, so its reporting is usually only needed in such cases.</ref><noinclude>
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Mikael Häggström: /* Screening method */ Specified

2021-03-24T16:22:04Z

Screening method: Specified

← Older revision		Revision as of 12:22, 24 March 2021
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	*Before microscopy, look at each microscopy slide by '''eye''', to plan the microscopy screening so as to not miss peripheral fragments.		*Before microscopy, look at each microscopy slide by '''eye''', to plan the microscopy screening so as to not miss peripheral fragments.
	*Screen at low power, and switch to '''high power''' when encountering glandular structures that can not otherwise be cleared. Look in particular for those surrounding nerves.		*Screen at low power, and switch to '''high power''' when encountering glandular structures that can not otherwise be cleared. Look in particular for those surrounding nerves.
	*~~In addition to adenocarcinoma~~, also look for '''inflammation'''.<ref group=notes>Inflammation can explain for example a high PSA value.</ref><noinclude>		*At least if no cancer is seen, also look for '''inflammation'''.<ref name=inflammation group=notes>Inflammation can explain for example a high PSA value.</ref><noinclude>
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Mikael Häggström: /* Screening method */ Around nerves

2020-09-14T17:57:54Z

Screening method: Around nerves

← Older revision		Revision as of 13:57, 14 September 2020
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	===Screening method===		===Screening method===
	*Before microscopy, look at each microscopy slide by '''eye''', to plan the microscopy screening so as to not miss peripheral fragments.		*Before microscopy, look at each microscopy slide by '''eye''', to plan the microscopy screening so as to not miss peripheral fragments.
	*Screen at low power, and switch to '''high power''' when encountering glandular structures that can not otherwise be cleared.		*Screen at low power, and switch to '''high power''' when encountering glandular structures that can not otherwise be cleared. Look in particular for those surrounding nerves.
	*In addition to adenocarcinoma, also look for '''inflammation'''.<ref group=notes>Inflammation can explain for example a high PSA value.</ref><noinclude>		*In addition to adenocarcinoma, also look for '''inflammation'''.<ref group=notes>Inflammation can explain for example a high PSA value.</ref><noinclude>
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