Prostate adenocarcinoma: Difference between revisions

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[[File:Micrograph of histopathological criteria for prostate cancer.jpg|thumb|Illustrative images of some morphological criteria for the diagnosis of prostate cancer:<br>A) blue mucin (arrow) in acinar adenocarcinoma.<br>B) Multiple nucleoli (arrow) in acinar adenocarcinoma.<br>C) two mitoses (arrow) in reactive epithelium<br>D) double and marginated nucleoli (arrows) in acinar adenocarcinoma.<ref name="CruzSantana2016"/>]]
[[File:Micrograph of histopathological criteria for prostate cancer.jpg|thumb|Illustrative images of some morphological criteria for the diagnosis of prostate cancer:<br>A) blue mucin (arrow) in acinar adenocarcinoma.<br>B) Multiple nucleoli (arrow) in acinar adenocarcinoma.<br>C) two mitoses (arrow) in reactive epithelium<br>D) double and marginated nucleoli (arrows) in acinar adenocarcinoma.<ref name="CruzSantana2016"/>]]


;Specific but relatively rare:<ref name="CruzSantana2016"/><ref group="notes">"Rare" here refers to prevalence at least in core biopsies.(Cruz 2016)</ref>
;Specific but relatively rare:<ref group="notes">"Rare" here refers to prevalence at least in core biopsies.(Cruz 2016)</ref>
*Collagenous micronodules
*'''Collagenous micronodules'''<ref name="CruzSantana2016"/>
*Glomerulations
*'''Glomerulations''',<ref name="CruzSantana2016"/> epithelial proliferations into one or more gland lumina, typically a cribriform tuft with a single attachment to the gland wall.<ref name=Stanford/>
*Perineural invasion
*Perineural invasion.<ref name="CruzSantana2016"/> It should be circumferential<ref name=Stanford>{{cite web|url=http://surgpathcriteria.stanford.edu/prostate/adenocarcinoma/|title=Prostatic Adenocarcinoma|website=Stanford Medical School|author=Robert V Rouse MD}} Last update 2/2/16</ref><ref group="notes>Glands adjacent to and indenting nerves is not sufficient as a diagnostic criterion by itself. (Stanford)</ref>
*Angiolymphatic invasion
*Angiolymphatic invasion<ref name="CruzSantana2016"/>
*Extraprostatic extension  
*Extraprostatic extension <ref name="CruzSantana2016"/>
;Relatively common and highly specific :<ref name="CruzSantana2016"/>
;Relatively common and highly specific :<ref name="CruzSantana2016"/>
*Multiple nucleoli
*Multiple nucleoli

Revision as of 07:57, 30 October 2019

Authors: Mikael Häggström; Authors of integrated Creative Commons article[1] [note 1]

Gross processing

As prostatectomy or biopsy.

Microscopic evaluation

Characteristics

File:Micrograph of histopathological criteria for prostate cancer.jpg
Illustrative images of some morphological criteria for the diagnosis of prostate cancer:
A) blue mucin (arrow) in acinar adenocarcinoma.
B) Multiple nucleoli (arrow) in acinar adenocarcinoma.
C) two mitoses (arrow) in reactive epithelium
D) double and marginated nucleoli (arrows) in acinar adenocarcinoma.[1]
Specific but relatively rare
[notes 1]
  • Collagenous micronodules[1]
  • Glomerulations,[1] epithelial proliferations into one or more gland lumina, typically a cribriform tuft with a single attachment to the gland wall.[2]
  • Perineural invasion.[1] It should be circumferential[2][notes 2]
  • Angiolymphatic invasion[1]
  • Extraprostatic extension [1]
Relatively common and highly specific
[1]
  • Multiple nucleoli
  • Eccentric nucleoli[1]
Less specific findings.

In uncertain cases, a diagnosis of malignancy can be discarded by immunohistochemical detection of basal cells.[1]

Gleason scoring

File:Gleasonscore.jpg
File:Invasive cribriform prostate carcinoma.jpg
Cribriform pattern: Gleason grade 4

Rate the dominant, or most common cell morphology (scored 1—5), in addition to the non-dominant cell pattern with the highest grade (scored 1—5).

Staging

Depending on sample type:

  • Multiple biopsy specimens: Adenocarcinoma presence in how many of the biopsies
  • Prostatectomy: Stage by TNM:

From the AJCC 7th edition[3] and International Union Against Cancer (UICC) 7th edition.[4]

Evaluation of the (primary) tumor ('T')
  • TX: cannot evaluate the primary tumor
  • T0: no evidence of tumor
  • T1: tumor present, but not detectable clinically or with imaging
    • T1a: tumor was incidentally found in 5% or less of prostate tissue resected (for other reasons)
    • T1b: tumor was incidentally found in greater than 5% of prostate tissue resected
    • T1c: tumor was found in a needle biopsy performed due to an elevated serum PSA
  • T2: the tumor can be felt (palpated) on examination, but has not spread outside the prostate
    • T2a: the tumor is in half or less than half of one of the prostate gland's two lobes
    • T2b: the tumor is in more than half of one lobe, but not both
    • T2c: the tumor is in both lobes but within the prostatic capsule
  • T3: the tumor has spread through the prostatic capsule (if it is only part-way through, it is still T2)
    • T3a: the tumor has spread through the capsule on one or both sides
    • T3b: the tumor has invaded one or both seminal vesicles
  • T4: the tumor has invaded other nearby structures
Evaluation of the regional lymph nodes ('N')
  • NX: cannot evaluate the regional lymph nodes
  • N0: there has been no spread to the regional lymph nodes
  • N1: there has been spread to the regional lymph nodes
Evaluation of distant metastasis ('M')
  • MX: cannot evaluate distant metastasis
  • M0: there is no distant metastasis
  • M1: there is distant metastasis
    • M1a: the cancer has spread to lymph nodes beyond the regional ones
    • M1b: the cancer has spread to bone
    • M1c: the cancer has spread to other sites (regardless of bone involvement)

Report

  • Diagnosis
  • Gleason score
  • Stage, or number of biopsies where tumor is found.
  • Any perineural or angiolymphatic invasion.

  See also: General notes on reporting


Notes

  1. ↑ "Rare" here refers to prevalence at least in core biopsies.(Cruz 2016)
  2. ↑ Glands adjacent to and indenting nerves is not sufficient as a diagnostic criterion by itself. (Stanford)
  1. ↑ For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.

Main page

References

  1. ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 Initially largely copied from: Cruz, Andrea O.; Santana, Amanda L. S.; Santos, Andréia C.; Athanazio, Daniel A. (2016). "Frequency of the morphological criteria of prostate adenocarcinoma in 387 consecutive prostate needle biopsies: emphasis on the location and number of nucleoli ". Jornal Brasileiro de Patologia e Medicina Laboratorial. doi:10.5935/1676-2444.20160018. ISSN 1676-2444. 
  2. ↑ 2.0 2.1 Robert V Rouse MD. Prostatic Adenocarcinoma. Stanford Medical School. Last update 2/2/16
  3. ↑ American Joint Committee on Cancer. Edge, Stephen B, ed. (2010). AJCC cancer staging manual. (7th ed.). New York: Springer. p. 457–468. ISBN 9780387884400. 
  4. ↑ . TNM | UICC (in en). Union for International Cancer Control. Retrieved on 11 November 2017.

Image sources


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