Prostate adenocarcinoma

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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]
  • 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

[File:Prostate cancer types.png|thumb|300px|Pie chart of subdiagnoses.[notes 3]]] 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 4] 54%[notes 4] 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 3] 13–23%[6][notes 3]
  • 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 3] 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 3] 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 3.2 3.3 3.4 At least where noted, the numbers include cases where the pattern is found admixed with usual acinar adenocarcinoma.
  4. ↑ 4.0 4.1 Numbers for usual acinar adenocarcinoma do not include mixed patterns with other types.
  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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