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===Characteristics===
===Characteristics===
;Specific but relatively rare:<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'''<ref name="CruzSantana2016"/>
*'''Collagenous micronodules''' for acinar adenocarcinoma (the most common subdiagnosis)<ref name="CruzSantana2016"/>  
*'''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/>  
*'''Glomerulations''', for acinar adenocarcinoma,<ref name="CruzSantana2016"/> consisting of epithelial proliferations into one or more gland lumina, typically a cribriform tuft with a single attachment to the gland wall.<ref name=Stanford/>  
<gallery>
<gallery>
File:Micrograph of prostate adenocarcinoma with a glomeruloid gland.jpg|Glomerulation.
File:Micrograph of prostate adenocarcinoma with a glomeruloid gland.jpg|Glomerulation.
Line 38: Line 38:


In uncertain cases, a diagnosis of malignancy can be discarded by immunohistochemical detection of basal cells.<ref name="CruzSantana2016"/>
In uncertain cases, a diagnosis of malignancy can be discarded by immunohistochemical detection of basal cells.<ref name="CruzSantana2016"/>
===Subdiagnoses===
The histopathologic subdiagnosis of prostate cancer has implications for the possibility and methodology of any subsequent [[Gleason score|Gleason scoring]].<ref name=Wang2016>{{cite journal |vauthors=Li J, Wang Z |title=The pathology of unusual subtypes of prostate cancer |journal=Chin. J. Cancer Res. |volume=28 |issue=1 |pages=130–43 |date=February 2016 |pmid=27041935 |pmc=4779761 |doi=10.3978/j.issn.1000-9604.2016.01.06 |url=}}</ref> The most common histopathological subdiagnosis of prostate cancer is acinar adenocarcinoma, constituting 93% of prostate cancers.<ref name="BaigHamid2015">{{cite journal|last1=Baig|first1=Faraz A.|last2=Hamid|first2=Amna|last3=Mirza|first3=Talat|last4=Syed|first4=Serajuddaula|title=Ductal and Acinar Adenocarcinoma of Prostate: Morphological and Immunohistochemical Characterization|journal=Oman Medical Journal|volume=30|issue=3|year=2015|pages=162–166|issn=1999768X|doi=10.5001/omj.2015.36}}</ref> The most common form of acinar adenocarcinoma, in turn, is "adenocarcinoma, not otherwise specified", also termed conventional, or usual acinar.<ref name=Stanford-list>{{cite web|url=http://surgpathcriteria.stanford.edu/prostate/adenocarcinoma/classification-lists.html|title=Prostatic Adenocarcinoma|website=Stanford University School of Medicine|accessdate=2019-10-30}}</ref>
{|class="wikitable"
!colspan=2 rowspan=2| Subtype !!colspan=2| Relative incidence !!rowspan=2| Image !!rowspan=2| Microscopic characteristics !!rowspan=2| [[Immunohistochemistry]] !!rowspan=2| Gleason scoring
|-
! [[prostate biopsy|Core<br>biopsy]] !! Radical [[prostatectomy]]
|-
!rowspan=6| Acinar adenocarcinoma<br>- 93%<ref name="BaigHamid2015"/> !! Adenocarcinoma <br>(not otherwise specified/<br>conventional/<br>usual acinar)<ref name=Stanford-list/>
| 77%<ref group="notes" name="nonmixed">Numbers for usual acinar adenocarcinoma do not include mixed patterns with other types.</ref> || 54%<ref group="notes" name="nonmixed"/> || [[File:Micrograph of prostate cancer with Gleason score 8 (4+4) with glomeruloid glands.jpg|190px]]
|
*Collagenous micronodules<ref name="CruzSantana2016"/>
*Glomerulations<ref name="CruzSantana2016"/>
*May be mixed with other patterns.
| Tumorous glands:
*34βE12- and p63-<ref name="BaigHamid2015">{{cite journal|last1=Baig|first1=Faraz A.|last2=Hamid|first2=Amna|last3=Mirza|first3=Talat|last4=Syed|first4=Serajuddaula|title=Ductal and Acinar Adenocarcinoma of Prostate: Morphological and Immunohistochemical Characterization|journal=Oman Medical Journal|volume=30|issue=3|year=2015|pages=162–166|issn=1999768X|doi=10.5001/omj.2015.36}}</ref> (+ in adjacent benign glands)<ref name="BaigHamid2015"/>
*Alpha-methylacyl-CoA racemase (AMACR) + (- in adjacent benign glands)<ref name="BaigHamid2015"/>
*PSA+ (>10 ng/ml) in 60% of cases<ref name="BaigHamid2015"/>
| As usual
|-
! Foamy gland carcinoma
| 17%<ref name="Humphrey2018"/><ref group="notes" name="mixed"/>At least where noted, the numbers include cases where the pattern is found admixed with usual acinar adenocarcinoma.</ref> || 13–23%<ref name="Humphrey2018"/><ref group="notes" name="mixed"/> || <!--Image-->
|
*Abundant foamy cytoplasm<ref name=Wang2016/>
*Nuclei may be small and pyknotic - benign-looking<ref name=Wang2016/>
*Infiltrative pattern
|
*Foamy cells:
*PSA+ and CD68− <ref name=Wang2016/>
*AMACR+ in 68% of cases<ref name=Wang2016/>
| Based on architecture, discounting foamy cytoplasms<ref name=Wang2016/>
|-
! Atrophic carcinoma
| 2%<ref name="Humphrey2018"/><ref group="notes" name="atrophic">Number refers to sporadic atrophic pattern adenocarcinoma.</ref> || 16%<ref name="Humphrey2018"/><ref group="notes" name="atrophic"/> || <!--Image--> ||
*Glands lined by cells with scant cytoplasm, resembling atrophy<ref name=Wang2016/>
*Infiltrative growth<ref name=Wang2016/>
*Usually admixed with non-atrophic components<ref name=Wang2016/>
| Tumorous glands:
*34βE12- and p63- <ref name=Wang2016/>
*AMACR+ in 70% of cases<ref name=Wang2016/>
| As usual<ref name=Wang2016/>
|-
! Pseudohyperplastic carcinoma
| 2%<ref name="Humphrey2018">{{cite journal|last1=Humphrey|first1=Peter A|title=Variants of acinar adenocarcinoma of the prostate mimicking benign conditions|journal=Modern Pathology|volume=31|issue=S1|year=2018|pages=64–70|issn=0893-3952|doi=10.1038/modpathol.2017.137}}</ref> || 11%<ref name="Humphrey2018"/> || <!--Image-->
|
*Large-sized or dilated glands<ref name=Wang2016/>
:*Branching and papillary infolding<ref name=Wang2016/>
*Tall columnar cells<ref name=Wang2016/>
:*Abundant pale to slight granular luminal cytoplasm<ref name=Wang2016/>
*Nuclei towards basement membrane<ref name=Wang2016/>
| Tumorous glands:
*34βE12- and p63- <ref name=Wang2016/>
*AMACR+ in 70–83% of cases<ref name=Wang2016/>
| 3+3=6<ref name=Wang2016/>
|-
! Microcystic carcinoma
|  || 11%<ref name="Humphrey2018"/> || <!--Image-->
|
*Cystic dilatation and rounded expansion of malignant glands<ref name="YaskivCao2010">{{cite journal|last1=Yaskiv|first1=Oksana|last2=Cao|first2=Dengfeng|last3=Humphrey|first3=Peter A.|title=Microcystic Adenocarcinoma of the Prostate: A Variant of Pseudohyperplastic and Atrophic Patterns|journal=The American Journal of Surgical Pathology|volume=34|issue=4|year=2010|pages=556–561|issn=0147-5185|doi=10.1097/PAS.0b013e3181d2a549}}</ref>
*Lined by flat cells<ref name="YaskivCao2010"/>
*Intraluminal crystalloids, and wispy blue intraluminal mucin<ref name="YaskivCao2010"/>
| 
*34βE12- and p63-<ref name="YaskivCao2010"/>
*AMACR+<ref name="YaskivCao2010"/>
| On (usually) adjacent acinar adeocarcinoma<ref name="YaskivCao2010"/>
|-
! [[Prostatic intraepithelial neoplasia|PIN]]-like
| 1.3%<ref name="Zhou2018">{{cite journal|last1=Zhou|first1=Ming|title=High-grade prostatic intraepithelial neoplasia, PIN-like carcinoma, ductal carcinoma, and intraductal carcinoma of the prostate|journal=Modern Pathology|volume=31|issue=S1|year=2018|pages=71–79|issn=0893-3952|doi=10.1038/modpathol.2017.138}}</ref> ||
| <!--Image-->
|
*Glands lined by ≥2 layers of malignant cells<ref name=Wang2016/>
*May resemble flat or tufted [[high-grade prostatic intraepithelial neoplasia|high-grade PIN]], but lacks basal cells<ref name=Wang2016/>
| Tumorous glands:
*34βE12- and p63- <ref name=Wang2016/>
| Not recommended<ref name=Wang2016/>
|-
!rowspan=7| Non acinar<br>(or mixed acinar/<br>non-acinar)<br> adenocarcinoma !! Ductal adenocarcinoma
|colspan=2| 3% to 12.7%<ref>{{cite journal |vauthors=Liu T, Wang Y, Zhou R, Li H, Cheng H, Zhang J |title=The update of prostatic ductal adenocarcinoma |journal=Chin. J. Cancer Res. |volume=28 |issue=1 |pages=50–7 |date=February 2016 |pmid=27041926 |pmc=4779765 |doi=10.3978/j.issn.1000-9604.2016.02.02 |url=}}</ref><ref group="notes" name="mixed"/> || [[File:Micrograph of typical ductal adenocarcinoma of the prostate.jpg|190px]]
|
*Large glands and papillary formations, lined by tall columnar cells, often pseudostratified<ref name=Wang2016/>
*Papillary, cribriform, individual glands, or solid variants<ref name=Wang2016/>
*Cytoplasm usually amphophilic<ref name=Wang2016/>
*Nuclei are large and hyperchromatic, with prominent nucleoli<ref>{{cite web|url=http://surgpathcriteria.stanford.edu/prostate/ductal-adenocarcinoma/|title=Prostatic Ductal Adenocarcinoma|author=Robert V Rouse|website=Stanford University School of Medicine|date=2012-01-06}}</ref>
|
*AMACR+ in 77% of cases<ref name=Wang2016/>
*Usually negative for basal cells stains<ref name=Wang2016/>
||
|-
! Intraductal adenocarcinoma
| 2.8%<ref name="MagersKunju2015">{{cite journal|last1=Magers|first1=Martin|last2=Kunju|first2=Lakshmi Priya|last3=Wu|first3=Angela|title=Intraductal Carcinoma of the Prostate: Morphologic Features, Differential Diagnoses, Significance, and Reporting Practices|journal=Archives of Pathology & Laboratory Medicine|volume=139|issue=10|year=2015|pages=1234–1241|issn=0003-9985|doi=10.5858/arpa.2015-0206-RA}}</ref> || ||  [[File:Micrograph of intraductal carcinoma of the prostate with an infiltrative growth pattern.jpg|190px]]<br>H&E and CK5/6
|
*Carcinoma cells spanning entire lumen of ducts and acini<ref name="RobertsZhou2013">{{cite journal|last1=Roberts|first1=Jordan A.|last2=Zhou|first2=Ming|last3=Park|first3=Yong Wok|last4=Ro|first4=Jae Y.|title=Intraductal Carcinoma of Prostate: A Comprehensive and Concise Review|journal=Korean Journal of Pathology|volume=47|issue=4|year=2013|pages=307|issn=1738-1843|doi=10.4132/KoreanJPathol.2013.47.4.307}}</ref>
*At least focal preservation of the basal cell layer<ref name="RobertsZhou2013"/>
|
*PSA+<ref name="MagersKunju2015"/>
*AMACR+<ref name="MagersKunju2015"/>
*Basal cell markers+<ref name="MagersKunju2015"/>
|
|-
! Urothelial carcinoma
|colspan=2| 0.7 to 2.8%<ref name="Grignon2004">{{cite journal|last1=Grignon|first1=David J|title=Unusual subtypes of prostate cancer|journal=Modern Pathology|volume=17|issue=3|year=2004|pages=316–327|issn=0893-3952|doi=10.1038/modpathol.3800052}}</ref>
| [[File:Urothelial carcinoma in the prostatic urethra, low mag.jpg|190px]]
|
*Umbrella cells are usually present in low-grade tumors<ref name=stanford-urothelial>{{cite web|url=http://surgpathcriteria.stanford.edu/bladder/tcc-papillary-transitional-urothelial-carcinoma/|title=Papillary Urothelial (Transitional Cell) Carcinoma|website=Stanford University School of Medicine|author=Robert V Rouse}} Original posting/updates: 10/20/12, 12/29/12</ref>
*Frequently branching fibrovascular cores<ref name=stanford-urothelial/>
*Frequently fusing of papillae<ref name=stanford-urothelial/>
| 
| Not recommended<ref name=Wang2016/>
|-
! Small-cell carcinoma
|colspan=2| 0.3–2%<ref>0.3%-1%: [https://books.google.se/books?id=S96CDwAAQBAJ&pg=PA77 Page 77] in:{{cite book | last=Beltran | first=Antonio | title=Pathology of the prostate : an algorithmic approach | publisher=Cambridge University Press | publication-place=Cambridge, United Kingdom New York, NY | year=2017 | isbn=978-1-108-18565-3 | oclc=1011514854 | ref=harv}}</ref><ref name="KumarAhmed2018">0.5-2%: {{cite journal|last1=Kumar|first1=Kishore|last2=Ahmed|first2=Rafeeq|last3=Chukwunonso|first3=Chime|last4=Tariq|first4=Hassan|last5=Niazi|first5=Masooma|last6=Makker|first6=Jasbir|last7=Ihimoyan|first7=Ariyo|title=Poorly Differentiated Small-Cell-Type Neuroendocrine Carcinoma of the Prostate: A Case Report and Literature Review|journal=Case Reports in Oncology|volume=11|issue=3|year=2018|pages=676–681|issn=1662-6575|doi=10.1159/000493255}}</ref><ref group="notes" name="mixed"/> || [[File:Micrograph of small-cell carcinoma of the prostate.jpg|190px]]
|
*Small blue cells with scant cytoplasm<ref name=Wang2016/>
*High nucleus/cytoplasm ratio<ref name=Wang2016/>
*"salt and pepper" chromatin<ref name=Wang2016/>
*Nuclear molding<ref name=Wang2016/>
*Necrosis of single cells, or geographic<ref name=Wang2016/>
*Smearing artifacts<ref name=Wang2016/>
Half of cases have usual acinar components<ref name=Wang2016/>
|  ||
|-
! Mucinous adenocarcinoma
|colspan=2| 0.2%<ref name="Grignon2004"/> || [[File:Micrograph of mucinous adenocarcinoma of the prostate with Gleason score 7 (3 + 4) with individual well-formed glands and minor component of cribriform glands floating in extracellular mucin.jpg|190px]]
|
*≥25% of tumor shows extracellular mucin<ref name=Wang2016/>
:*Intraluminal mucinous material does not qualify<ref name=Wang2016/>
*No extraprostatic origin found<ref name=Wang2016/>
| Tumorous glands:
*34βE12- and p63-<ref name=Wang2016/>
*PSA+ and CK8/18+<ref name=Wang2016/>
| 4+4=8 for irregular cribriform glands floating in mucin.<ref name=Wang2016/>
|-
! Signet-ring adenocarcinoma
|colspan=2| 0.02%<ref name="WangWang2011">{{cite journal|last1=Wang|first1=Jue|last2=Wang|first2=Fen Wei|last3=Hemstreet|first3=George P.|title=Younger Age Is an Independent Predictor for Poor Survival in Patients with Signet Ring Prostate Carcinoma|journal=Prostate Cancer|volume=2011|year=2011|pages=1–8|issn=2090-3111|doi=10.1155/2011/216169}}</ref>
| [[File:Micrograph of signet-ring adenocarcinoma of the prostate.jpg|190px]]
|
*≥25% of tumor shows signet-ring cells (widely infiltrative cells with optically clear vacuoles displacing the nuclei)<ref name=Wang2016/>
| Tumorous glands:
*34βE12- and p63-<ref name=Wang2016/>
*PSA+<ref name=Wang2016/>
| Not recommended<ref name=Wang2016/>
|-
! Basal-cell carcinoma
|colspan=2| 0.01%<ref name="NinomiyaKawahara2018">{{cite journal|last1=Ninomiya|first1=Sahoko|last2=Kawahara|first2=Takashi|last3=Iwashita|first3=Hiromichi|last4=Iwamoto|first4=Genta|last5=Takamoto|first5=Daiji|last6=Mochizuki|first6=Taku|last7=Kuroda|first7=Shinnosuke|last8=Takeshima|first8=Teppei|last9=Izumi|first9=Koji|last10=Teranishi|first10=Jun-ichi|last11=Yumura|first11=Yasushi|last12=Miyoshi|first12=Yasuhide|last13=Asai|first13=Takuo|last14=Uemura|first14=Hiroji|title=Prostate Basal Cell Carcinoma: A Case Report|journal=Case Reports in Oncology|volume=11|issue=1|year=2018|pages=138–142|issn=1662-6575|doi=10.1159/000487389}}</ref>
| <!--Image-->
| Basaloid tumor:
*Scant cytoplasm<ref name=Wang2016/>
*High nucleus/cytoplasm ratio<ref name=Wang2016/>
*Irregular or angulated nuclei<ref name=Wang2016/>
*Euchromatic<ref name=Wang2016/>
*May have nuclear and cytoplasmic micro-vacuolation<ref name=Wang2016/>
*Infiltration of adjacent parenchyma<ref name=Wang2016/>
BCC-pattern:
*Variably sized solid nests, cords, or trabeculae<ref name=Wang2016/>
*Peripheral palisading<ref name=Wang2016/>
|
*p63+ <ref name=Wang2016/>
*HMCK(34βE12)+<ref name=Wang2016/>
*Typically CK20−/CK7+, but CK7− in pure solid basal cell nests<ref name=Wang2016/>
*Bcl-2+, strongly and diffusely<ref name=Wang2016/>
*Ki-67 nuclear staining in >20%<ref name=Wang2016/>
| Not recommended.<ref name=Wang2016/>
|}


===Gleason scoring===
===Gleason scoring===

Revision as of 08:35, 31 October 2019

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

Gross processing

As prostatectomy or biopsy.

Microscopic evaluation

Characteristics

Specific but relatively rare
[notes 1]
  • Collagenous micronodules for acinar adenocarcinoma (the most common subdiagnosis)[1]
  • Glomerulations, for acinar adenocarcinoma,[1] consisting of epithelial proliferations into one or more gland lumina, typically a cribriform tuft with a single attachment to the gland wall.[2]
  • Glomerulation.
    Glomerulation.
  • 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]

Subdiagnoses

The histopathologic subdiagnosis of prostate cancer has implications for the possibility and methodology of any subsequent Gleason scoring.[3] The most common histopathological subdiagnosis of prostate cancer is acinar adenocarcinoma, constituting 93% of prostate cancers.[4] The most common form of acinar adenocarcinoma, in turn, is "adenocarcinoma, not otherwise specified", also termed conventional, or usual acinar.[5]

Subtype Relative incidence Image Microscopic characteristics Immunohistochemistry Gleason scoring
Core
biopsy		 Radical prostatectomy
Acinar adenocarcinoma
- 93%[4]		 Adenocarcinoma
(not otherwise specified/
conventional/
usual acinar)[5] 		77%[notes 3] 54%[notes 3] File:Micrograph of prostate cancer with Gleason score 8 (4+4) with glomeruloid glands.jpg
  • Collagenous micronodules[1]
  • Glomerulations[1]
  • May be mixed with other patterns.
 Tumorous glands:
  • 34βE12- and p63-[4] (+ in adjacent benign glands)[4]
  • Alpha-methylacyl-CoA racemase (AMACR) + (- in adjacent benign glands)[4]
  • PSA+ (>10 ng/ml) in 60% of cases[4]
 As usual
Foamy gland carcinoma 17%[6][notes 4]At least where noted, the numbers include cases where the pattern is found admixed with usual acinar adenocarcinoma.</ref> 13–23%[6][notes 4]
  • Abundant foamy cytoplasm[3]
  • Nuclei may be small and pyknotic - benign-looking[3]
  • Infiltrative pattern
  • Foamy cells:
  • PSA+ and CD68− [3]
  • AMACR+ in 68% of cases[3]
 Based on architecture, discounting foamy cytoplasms[3]
Atrophic carcinoma 2%[6][notes 5] 16%[6][notes 5]
  • Glands lined by cells with scant cytoplasm, resembling atrophy[3]
  • Infiltrative growth[3]
  • Usually admixed with non-atrophic components[3]
 Tumorous glands:
  • 34βE12- and p63- [3]
  • AMACR+ in 70% of cases[3]
 As usual[3]
Pseudohyperplastic carcinoma 2%[6] 11%[6]
  • Large-sized or dilated glands[3]
  • Branching and papillary infolding[3]
  • Tall columnar cells[3]
  • Abundant pale to slight granular luminal cytoplasm[3]
  • Nuclei towards basement membrane[3]
 Tumorous glands:
  • 34βE12- and p63- [3]
  • AMACR+ in 70–83% of cases[3]
 3+3=6[3]
Microcystic carcinoma 11%[6]
  • Cystic dilatation and rounded expansion of malignant glands[7]
  • Lined by flat cells[7]
  • Intraluminal crystalloids, and wispy blue intraluminal mucin[7]
  • 34βE12- and p63-[7]
  • AMACR+[7]
 On (usually) adjacent acinar adeocarcinoma[7]
PIN-like 1.3%[8]
  • Glands lined by ≥2 layers of malignant cells[3]
  • May resemble flat or tufted high-grade PIN, but lacks basal cells[3]
 Tumorous glands:
  • 34βE12- and p63- [3]
 Not recommended[3]
Non acinar
(or mixed acinar/
non-acinar)
adenocarcinoma		 Ductal adenocarcinoma 3% to 12.7%[9][notes 4] File:Micrograph of typical ductal adenocarcinoma of the prostate.jpg
  • Large glands and papillary formations, lined by tall columnar cells, often pseudostratified[3]
  • Papillary, cribriform, individual glands, or solid variants[3]
  • Cytoplasm usually amphophilic[3]
  • Nuclei are large and hyperchromatic, with prominent nucleoli[10]
  • AMACR+ in 77% of cases[3]
  • Usually negative for basal cells stains[3]
Intraductal adenocarcinoma 2.8%[11] File:Micrograph of intraductal carcinoma of the prostate with an infiltrative growth pattern.jpg
H&E and CK5/6
  • Carcinoma cells spanning entire lumen of ducts and acini[12]
  • At least focal preservation of the basal cell layer[12]
Urothelial carcinoma 0.7 to 2.8%[13] File:Urothelial carcinoma in the prostatic urethra, low mag.jpg
  • Umbrella cells are usually present in low-grade tumors[14]
  • Frequently branching fibrovascular cores[14]
  • Frequently fusing of papillae[14]
 Not recommended[3]
Small-cell carcinoma 0.3–2%[15][16][notes 4] File:Micrograph of small-cell carcinoma of the prostate.jpg
  • Small blue cells with scant cytoplasm[3]
  • High nucleus/cytoplasm ratio[3]
  • "salt and pepper" chromatin[3]
  • Nuclear molding[3]
  • Necrosis of single cells, or geographic[3]
  • Smearing artifacts[3]

Half of cases have usual acinar components[3]

Mucinous adenocarcinoma 0.2%[13] File:Micrograph of mucinous adenocarcinoma of the prostate with Gleason score 7 (3 + 4) with individual well-formed glands and minor component of cribriform glands floating in extracellular mucin.jpg
  • ≥25% of tumor shows extracellular mucin[3]
  • Intraluminal mucinous material does not qualify[3]
  • No extraprostatic origin found[3]
 Tumorous glands:
  • 34βE12- and p63-[3]
  • PSA+ and CK8/18+[3]
 4+4=8 for irregular cribriform glands floating in mucin.[3]
Signet-ring adenocarcinoma 0.02%[17] File:Micrograph of signet-ring adenocarcinoma of the prostate.jpg
  • ≥25% of tumor shows signet-ring cells (widely infiltrative cells with optically clear vacuoles displacing the nuclei)[3]
 Tumorous glands: Not recommended[3]
Basal-cell carcinoma 0.01%[18] Basaloid tumor:
  • Scant cytoplasm[3]
  • High nucleus/cytoplasm ratio[3]
  • Irregular or angulated nuclei[3]
  • Euchromatic[3]
  • May have nuclear and cytoplasmic micro-vacuolation[3]
  • Infiltration of adjacent parenchyma[3]

BCC-pattern:

  • Variably sized solid nests, cords, or trabeculae[3]
  • Peripheral palisading[3]
  • p63+ [3]
  • HMCK(34βE12)+[3]
  • Typically CK20−/CK7+, but CK7− in pure solid basal cell nests[3]
  • Bcl-2+, strongly and diffusely[3]
  • Ki-67 nuclear staining in >20%[3]
 Not recommended.[3]

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[19] and International Union Against Cancer (UICC) 7th edition.[20]

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. Glands partially surrounding a nerve is an indication of carcinoma. (Stanford)
  3. ↑ 3.0 3.1 Numbers for usual acinar adenocarcinoma do not include mixed patterns with other types.
  4. ↑ 4.0 4.1 4.2 4.3 Cite error: Invalid <ref> tag; no text was provided for refs named mixed
  5. ↑ 5.0 5.1 Number refers to sporadic atrophic pattern adenocarcinoma.
  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 1.14 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. ↑ 3.00 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 3.09 3.10 3.11 3.12 3.13 3.14 3.15 3.16 3.17 3.18 3.19 3.20 3.21 3.22 3.23 3.24 3.25 3.26 3.27 3.28 3.29 3.30 3.31 3.32 3.33 3.34 3.35 3.36 3.37 3.38 3.39 3.40 3.41 3.42 3.43 3.44 3.45 3.46 3.47 3.48 3.49 3.50 3.51 3.52 3.53 3.54 3.55 3.56 3.57 3.58 3.59 3.60 "The pathology of unusual subtypes of prostate cancer ". Chin. J. Cancer Res. 28 (1): 130–43. February 2016. doi:10.3978/j.issn.1000-9604.2016.01.06. PMID 27041935. 
  4. ↑ 4.0 4.1 4.2 4.3 4.4 4.5 Baig, Faraz A.; Hamid, Amna; Mirza, Talat; Syed, Serajuddaula (2015). "Ductal and Acinar Adenocarcinoma of Prostate: Morphological and Immunohistochemical Characterization ". Oman Medical Journal 30 (3): 162–166. doi:10.5001/omj.2015.36. ISSN 1999768X. 
  5. ↑ 5.0 5.1 . Prostatic Adenocarcinoma. Stanford University School of Medicine. Retrieved on 2019-10-30.
  6. ↑ 6.0 6.1 6.2 6.3 6.4 6.5 6.6 Humphrey, Peter A (2018). "Variants of acinar adenocarcinoma of the prostate mimicking benign conditions ". Modern Pathology 31 (S1): 64–70. doi:10.1038/modpathol.2017.137. ISSN 0893-3952. 
  7. ↑ 7.0 7.1 7.2 7.3 7.4 7.5 Yaskiv, Oksana; Cao, Dengfeng; Humphrey, Peter A. (2010). "Microcystic Adenocarcinoma of the Prostate: A Variant of Pseudohyperplastic and Atrophic Patterns ". The American Journal of Surgical Pathology 34 (4): 556–561. doi:10.1097/PAS.0b013e3181d2a549. ISSN 0147-5185. 
  8. ↑ Zhou, Ming (2018). "High-grade prostatic intraepithelial neoplasia, PIN-like carcinoma, ductal carcinoma, and intraductal carcinoma of the prostate ". Modern Pathology 31 (S1): 71–79. doi:10.1038/modpathol.2017.138. ISSN 0893-3952. 
  9. ↑ "The update of prostatic ductal adenocarcinoma ". Chin. J. Cancer Res. 28 (1): 50–7. February 2016. doi:10.3978/j.issn.1000-9604.2016.02.02. PMID 27041926. 
  10. ↑ Robert V Rouse (2012-01-06). Prostatic Ductal Adenocarcinoma. Stanford University School of Medicine.
  11. ↑ 11.0 11.1 11.2 11.3 Magers, Martin; Kunju, Lakshmi Priya; Wu, Angela (2015). "Intraductal Carcinoma of the Prostate: Morphologic Features, Differential Diagnoses, Significance, and Reporting Practices ". Archives of Pathology & Laboratory Medicine 139 (10): 1234–1241. doi:10.5858/arpa.2015-0206-RA. ISSN 0003-9985. 
  12. ↑ 12.0 12.1 Roberts, Jordan A.; Zhou, Ming; Park, Yong Wok; Ro, Jae Y. (2013). "Intraductal Carcinoma of Prostate: A Comprehensive and Concise Review ". Korean Journal of Pathology 47 (4): 307. doi:10.4132/KoreanJPathol.2013.47.4.307. ISSN 1738-1843. 
  13. ↑ 13.0 13.1 Grignon, David J (2004). "Unusual subtypes of prostate cancer ". Modern Pathology 17 (3): 316–327. doi:10.1038/modpathol.3800052. ISSN 0893-3952. 
  14. ↑ 14.0 14.1 14.2 Robert V Rouse. Papillary Urothelial (Transitional Cell) Carcinoma. Stanford University School of Medicine. Original posting/updates: 10/20/12, 12/29/12
  15. ↑ 0.3%-1%: Page 77 in:Beltran, Antonio (2017). Pathology of the prostate : an algorithmic approach . Cambridge, United Kingdom New York, NY: Cambridge University Press. ISBN 978-1-108-18565-3. OCLC 1011514854. 
  16. ↑ 0.5-2%: Kumar, Kishore; Ahmed, Rafeeq; Chukwunonso, Chime; Tariq, Hassan; Niazi, Masooma; Makker, Jasbir; Ihimoyan, Ariyo (2018). "Poorly Differentiated Small-Cell-Type Neuroendocrine Carcinoma of the Prostate: A Case Report and Literature Review ". Case Reports in Oncology 11 (3): 676–681. doi:10.1159/000493255. ISSN 1662-6575. 
  17. ↑ Wang, Jue; Wang, Fen Wei; Hemstreet, George P. (2011). "Younger Age Is an Independent Predictor for Poor Survival in Patients with Signet Ring Prostate Carcinoma ". Prostate Cancer 2011: 1–8. doi:10.1155/2011/216169. ISSN 2090-3111. 
  18. ↑ Ninomiya, Sahoko; Kawahara, Takashi; Iwashita, Hiromichi; Iwamoto, Genta; Takamoto, Daiji; Mochizuki, Taku; Kuroda, Shinnosuke; Takeshima, Teppei; et al. (2018). "Prostate Basal Cell Carcinoma: A Case Report ". Case Reports in Oncology 11 (1): 138–142. doi:10.1159/000487389. ISSN 1662-6575. 
  19. ↑ American Joint Committee on Cancer. Edge, Stephen B, ed. (2010). AJCC cancer staging manual. (7th ed.). New York: Springer. p. 457–468. ISBN 9780387884400. 
  20. ↑ . TNM | UICC (in en). Union for International Cancer Control. Retrieved on 11 November 2017.

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