Template:Prostate screening method: Difference between revisions

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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 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>
 
===Characteristics of adenocarcinoma===
;Relatively common and highly specific findings of prostatic adenocarcinoma:<ref name="CruzSantana2016">{{cite journal|last1=Cruz|first1=Andrea O.|last2=Santana|first2=Amanda L. S.|last3=Santos|first3=Andréia C.|last4=Athanazio|first4=Daniel A.|title=Frequency of the morphological criteria of prostate adenocarcinoma in 387 consecutive prostate needle biopsies: emphasis on the location and number of nucleoli|journal=Jornal Brasileiro de Patologia e Medicina Laboratorial|year=2016|issn=1676-2444|doi=10.5935/1676-2444.20160018}}<br>[https://creativecommons.org/licenses/by/4.0/ Attribution 4.0 International (CC BY 4.0) license]</ref>
<gallery mode=packed heights=180>
File:Micrograph of acinar adenocarcinoma of the prostate with multiple nucleoli.jpg|'''Multiple nucleoli''' (Pictured in an acinar adenocarcinoma, the most common subdiagnosis of prostate adenocarcinoma)
File:Micrograph of acinar adenocarcinoma of the prostate with double and marginated nucleoli.jpg|'''Eccentric nucleoli'''<ref name="CruzSantana2016"/> (pictured example has double and eccentric nucleoli).
</gallery>
;Specific but relatively rare signs of adenocarcinoma:<ref group="notes">"Rare" here refers to prevalence at least in core biopsies.(Cruz 2016)</ref>
<gallery mode=packed heights=180>
File:Histopathology of prostatic adenocarcinoma with circumferential perineural invasion.jpg|'''Perineural invasion'''.<ref name="CruzSantana2016"/> It should be circumferential (as pictured) to count.<ref name=Stanford-prostate-adenoca>{{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>
</gallery>
On biopsies, look in particular near the tips for perineural invasion, as it is most likely seen by the capsule. 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.<ref name=Stanford-prostate-adenoca/>
*'''Collagenous micronodules''' for acinar adenocarcinoma<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.
;Less specific findings:
<gallery mode=packed heights=180>
File:Micrograph of adenocarcinoma of the prostate with two mitoses in reactive epithelium.jpg|'''Mitoses''': also seen in for example [[high-grade prostatic intraepithelial neoplasia]] (HGPIN) and [[prostate inflammation]].<ref name="CruzSantana2016"/> Picture shows adenocarcinoma with two mitoses in reactive epithelium.
File:Micrograph of acinar adenocarcinoma of the prostate with blue mucin.jpg|Intraluminal '''blue mucin'''<ref name="CruzSantana2016"/> (pictured in acinar adenocarcinoma)
File:Histopathology of prostatic adenocarcinoma with atypical eosinophilic secretions.jpg|Intraluminal '''atypical eosinophilic''' secretions.<ref name="CruzSantana2016"/>
File:Histopathology of prostatic intraluminal crystalloid.jpg|thumb|Intraluminal '''crystalloids'''.<ref name="SvatekKaram2007">{{cite journal|last1=Svatek|first1=R S|last2=Karam|first2=J A|last3=Rogers|first3=T E|last4=Shulman|first4=M J|last5=Margulis|first5=V|last6=Benaim|first6=E A|title=Intraluminal crystalloids are highly associated with prostatic adenocarcinoma on concurrent biopsy specimens|journal=Prostate Cancer and Prostatic Diseases|volume=10|issue=3|year=2007|pages=279–282|issn=1365-7852|doi=10.1038/sj.pcan.4500954}}</ref>
File:Histopathology of prostatic adenocarcinoma with uneven distribution and infiltrative pattern.jpg|'''Uneven distribution''' and '''infiltrative pattern''' of glands
File:Micrograph of prostate adenocarcinoma with a glomeruloid gland.jpg|'''Glomerulations''', for acinar adenocarcinoma, 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-prostate-adenoca/>
</gallery>
*'''Prominent nucleoli'''<ref name="CruzSantana2016"/>
*'''Nuclear enlargement'''
 
===Precancerous lesions===
[[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''').
 
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).
 
[[File:PIN-4 staining of benign prostate gland and adenocarcinoma.jpg|left|220px]]
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.
<br clear=all>
<noinclude>
{{Bottom}}
{{Bottom}}
</noinclude>
</noinclude>

Revision as of 16:58, 19 December 2022

Screening method

  • 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.[notes 1]

Characteristics of adenocarcinoma

Relatively common and highly specific findings of prostatic adenocarcinoma
[1]
Specific but relatively rare signs of adenocarcinoma
[notes 2]

On biopsies, look in particular near the tips for perineural invasion, as it is most likely seen by the capsule. 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.[2]

  • Collagenous micronodules for acinar adenocarcinoma[1]
  • Angiolymphatic invasion[1]
  • Extraprostatic extension,[1] which in biopsies can be diagnoses when tumor cells are located in fatty tissue.
Less specific findings
  • Prominent nucleoli[1]
  • Nuclear enlargement

Precancerous lesions

File:Histopathology of small acinar cell proliferation (annotated).jpg
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).

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.[4]

An ASAP is a lesion that is probably carcinoma but either lacks definitive diagnostic features, or is too small to be certain.[5] It should not be used for benign lesions that are just unusual looking.[5] In uncertain cases, a diagnosis of adenocarcinoma can be excluded by immunohistochemical detection of basal cells (or confirmed by absence thereof),[1] 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).

File:PIN-4 staining of benign prostate gland and adenocarcinoma.jpg

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.

Notes

  1. ↑ Inflammation can explain for example a high PSA value in the absence of adenocarcinoma, so its reporting is usually only needed in such cases.
  2. ↑ "Rare" here refers to prevalence at least in core biopsies.(Cruz 2016)


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 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. 
    Attribution 4.0 International (CC BY 4.0) license
  2. ↑ 2.0 2.1 2.2 Robert V Rouse MD. Prostatic Adenocarcinoma. Stanford Medical School. Last update 2/2/16
  3. ↑ Svatek, R S; Karam, J A; Rogers, T E; Shulman, M J; Margulis, V; Benaim, E A (2007). "Intraluminal crystalloids are highly associated with prostatic adenocarcinoma on concurrent biopsy specimens ". Prostate Cancer and Prostatic Diseases 10 (3): 279–282. doi:10.1038/sj.pcan.4500954. ISSN 1365-7852. 
  4. ↑ Stanley A Brosman, MD. Precancerous Lesions of the Prostate. Medscape. Updated: Feb 26, 2020
  5. ↑ 5.0 5.1 . Prostatic Adenocarcinoma - Atypical Small Acinar Proliferation (ASAP). Stanford Medical School. Retrieved on 2020-09-14.

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