Histopathologic diagnosis of prostate cancer: Difference between revisions
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A '''[[histopathology|histopathologic]] diagnosis of [[prostate cancer]]''' is the discernment of whether there is a [[cancer]] in the [[prostate]], as well as specifying any subdiagnosis of prostate cancer if possible. 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 |
A '''[[histopathology|histopathologic]] diagnosis of [[prostate cancer]]''' is the discernment of whether there is a [[cancer]] in the [[prostate]], as well as specifying any subdiagnosis of prostate cancer if possible. 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 }}</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=1999-768X|doi=10.5001/omj.2015.36 |pmid=26171121 |pmc=4459157 |doi-access=free}}</ref> The most common form of acinar adenocarcinoma, in turn, is "adenocarcinoma, not otherwise specified", also termed conventional, or usual acinar adenocarcinoma.<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|access-date=2019-10-30|archive-date=2019-09-11|archive-url=https://web.archive.org/web/20190911145728/http://surgpathcriteria.stanford.edu/prostate/adenocarcinoma/classification-lists.html|url-status=dead}}</ref> |
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==Sampling== |
==Sampling== |
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[[File:Prostate cutting.png|thumb|Example histopathologic preparation after prostatectomy.]] |
[[File:Prostate cutting.png|thumb|Example histopathologic preparation after prostatectomy.]] |
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The main sources of tissue sampling are [[prostatectomy]] and [[prostate biopsy]]. |
The main sources of tissue sampling are [[prostatectomy]] and [[prostate biopsy]].{{cn|date=May 2021}} |
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==Subdiagnoses - overview== |
==Subdiagnoses - overview== |
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[[File:Prostate cancer types.png|thumb|300px|Pie chart of subdiagnoses.<ref group="notes" name="mixed">At least where noted, the numbers include cases where the pattern is found admixed with usual acinar adenocarcinoma.</ref>]] |
[[File:Prostate cancer types.png|thumb|300px|left|Pie chart of subdiagnoses.<ref group="notes" name="mixed">At least where noted, the numbers include cases where the pattern is found admixed with usual acinar adenocarcinoma.</ref>]] |
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{|class="wikitable" |
{|class="wikitable" |
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!colspan=2 rowspan=2| |
!colspan=2 rowspan=2| Subdiagnosis !!colspan=2| Relative incidence !!rowspan=2| Image !!rowspan=2| Microscopic characteristics !!rowspan=2| [[Immunohistochemistry]] !!rowspan=2| [[Gleason score|Gleason scoring]] |
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! [[prostate biopsy|Core<br>biopsy]] !! Radical [[prostatectomy]] |
! [[prostate biopsy|Core<br>biopsy]] !! Radical [[prostatectomy]] |
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!rowspan=6| Acinar adenocarcinoma<br>- 93%<ref name="BaigHamid2015"/> !! Adenocarcinoma <br>(not otherwise specified/<br>conventional/<br>usual acinar)<ref name=Stanford-list/> |
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| 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]] |
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*Collagenous micronodules<ref name="CruzSantana2016"/> |
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*Glomerulations<ref name="CruzSantana2016"/> |
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''Further information in [[#Acinar_adenocarcinoma|section below]]'' |
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*May be mixed with other subdiagnoses. |
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| Tumorous glands: |
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*34βE12- and p63-<ref name="BaigHamid2015"/> (+ in adjacent benign glands)<ref name="BaigHamid2015"/> |
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*[[Alpha-methylacyl-CoA racemase|AMACR]]+ (- in adjacent benign glands)<ref name="BaigHamid2015"/> |
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*[[Prostate-specific antigen|PSA]]+ (>10 ng/ml) in 60% of cases<ref name="BaigHamid2015"/> |
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| As usual |
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! Foamy gland carcinoma |
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| Foamy gland carcinoma || 17%<ref name="Humphrey2018"/><ref group="notes" name="mixed"/> || 13–23%<ref name="Humphrey2018"/><ref group="notes" name="mixed"/> || Based on architecture, discounting foamy cytoplasms<ref name=Wang2016/> |
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| 17%<ref name="Humphrey2018"/><ref group="notes" name="mixed"/> || 13–23%<ref name="Humphrey2018"/><ref group="notes" name="mixed"/> || <!--Image--> |
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*Abundant foamy cytoplasm<ref name=Wang2016/> |
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*Nuclei may be small and pyknotic - benign-looking<ref name=Wang2016/> |
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*Infiltrative pattern |
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*Foamy cells: |
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*PSA+ and CD68− <ref name=Wang2016/> |
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*AMACR+ in 68% of cases<ref name=Wang2016/> |
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| Based on architecture, discounting foamy cytoplasms<ref name=Wang2016/> |
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! Atrophic carcinoma |
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| 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"/> || As usual<ref name=Wang2016/> |
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| 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--> || |
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*Glands lined by cells with scant cytoplasm, resembling atrophy<ref name=Wang2016/> |
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*Infiltrative growth<ref name=Wang2016/> |
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*Usually admixed with non-atrophic components<ref name=Wang2016/> |
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| Tumorous glands: |
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*34βE12- and p63- <ref name=Wang2016/> |
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*AMACR+ in 70% of cases<ref name=Wang2016/> |
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| As usual<ref name=Wang2016/> |
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! Pseudohyperplastic carcinoma |
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| 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"/> || 3+3=6<ref name=Wang2016/> |
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| 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|pmid=29297496 |doi-access=free}}</ref> || 11%<ref name="Humphrey2018"/> || <!--Image--> |
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*Large-sized or dilated glands<ref name=Wang2016/> |
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:*Branching and papillary infolding<ref name=Wang2016/> |
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*Tall columnar cells<ref name=Wang2016/> |
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:*Abundant pale to slight granular luminal cytoplasm<ref name=Wang2016/> |
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*Nuclei towards basement membrane<ref name=Wang2016/> |
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| Tumorous glands: |
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*34βE12- and p63- <ref name=Wang2016/> |
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*AMACR+ in 70–83% of cases<ref name=Wang2016/> |
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| 3+3=6<ref name=Wang2016/> |
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! Microcystic carcinoma |
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| || 11%<ref name="Humphrey2018"/> || <!--Image--> |
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*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|pmid=20216381 |s2cid=24149412 }}</ref> |
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*Lined by flat cells<ref name="YaskivCao2010"/> |
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*Intraluminal crystalloids, and wispy blue intraluminal mucin<ref name="YaskivCao2010"/> |
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*34βE12- and p63-<ref name="YaskivCao2010"/> |
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*AMACR+<ref name="YaskivCao2010"/> |
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| On (usually) adjacent acinar adeocarcinoma<ref name="YaskivCao2010"/> |
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! [[Prostatic intraepithelial neoplasia|PIN]]-like |
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| 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> || || Not recommended<ref name=Wang2016/> |
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| 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|pmid=29297491 |doi-access=free}}</ref> || |
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| <!--Image--> |
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*Glands lined by ≥2 layers of malignant cells<ref name=Wang2016/> |
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*May resemble flat or tufted [[high-grade prostatic intraepithelial neoplasia|high-grade PIN]], but lacks basal cells<ref name=Wang2016/> |
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| Tumorous glands: |
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*34βE12- and p63- <ref name=Wang2016/> |
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| Not recommended<ref name=Wang2016/> |
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!rowspan=7| Non acinar<br>(or mixed acinar/<br>non-acinar)<br> adenocarcinoma !! Ductal adenocarcinoma |
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|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 }}</ref><ref group="notes" name="mixed"/> || [[File:Micrograph of typical ductal adenocarcinoma of the prostate.jpg|190px]] |
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*Large glands and papillary formations, lined by tall columnar cells, often pseudostratified<ref name=Wang2016/> |
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*Papillary, cribriform, individual glands, or solid variants<ref name=Wang2016/> |
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*Cytoplasm usually amphophilic<ref name=Wang2016/> |
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*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> |
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*AMACR+ in 77% of cases<ref name=Wang2016/> |
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*Usually negative for basal cells stains<ref name=Wang2016/> |
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! Intraductal adenocarcinoma |
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| 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 |
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| 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|pmid=26414467 |doi-access=free}}</ref> || || [[File:Micrograph of intraductal carcinoma of the prostate with an infiltrative growth pattern.jpg|190px]]<br>H&E and CK5/6 |
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*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=307–315|issn=1738-1843|doi=10.4132/KoreanJPathol.2013.47.4.307|pmid=24009625 | pmc=3759629|doi-access=free}}</ref> |
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*At least focal preservation of the basal cell layer<ref name="RobertsZhou2013"/> |
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*PSA+<ref name="MagersKunju2015"/> |
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*AMACR+<ref name="MagersKunju2015"/> |
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*Basal cell markers+<ref name="MagersKunju2015"/> |
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! Urothelial carcinoma |
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| 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> || |
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|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|pmid=14976541 |doi-access=}}</ref> |
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| [[File:Urothelial carcinoma in the prostatic urethra, low mag.jpg|190px]] |
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*[[Umbrella cell]]s 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> |
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*Frequently branching fibrovascular cores<ref name=stanford-urothelial/> |
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*Frequently fusing of papillae<ref name=stanford-urothelial/> |
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| Not recommended<ref name=Wang2016/> |
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! Small-cell carcinoma |
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| 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"/> || |
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|colspan=2| 0.3–2%<ref>0.3–1%: [https://books.google.com/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><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|pmid=30483097 |pmc=6243899 |doi-access=free}}</ref><ref group="notes" name="mixed"/> || [[File:Micrograph of small-cell carcinoma of the prostate.jpg|190px]] |
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*Small blue cells with scant cytoplasm<ref name=Wang2016/> |
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*High nucleus/cytoplasm ratio<ref name=Wang2016/> |
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*"salt and pepper" chromatin<ref name=Wang2016/> |
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*Nuclear molding<ref name=Wang2016/> |
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*Necrosis of single cells, or geographic<ref name=Wang2016/> |
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*Smearing artifacts<ref name=Wang2016/> |
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Half of cases have usual acinar components<ref name=Wang2016/> |
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! Mucinous adenocarcinoma |
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| Mucinous adenocarcinoma ||colspan=2| 0.2%<ref name="Grignon2004"/> || 4+4=8 for irregular cribriform glands floating in mucin.<ref name=Wang2016/> || [[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]] |
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|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]] |
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*≥25% of tumor shows extracellular mucin<ref name=Wang2016/> |
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:*Intraluminal mucinous material does not qualify<ref name=Wang2016/> |
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*No extraprostatic origin found<ref name=Wang2016/> |
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| Tumorous glands: |
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*34βE12- and p63-<ref name=Wang2016/> |
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*PSA+ and CK8/18+<ref name=Wang2016/> |
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| 4+4=8 for irregular cribriform glands floating in mucin.<ref name=Wang2016/> |
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! Signet-ring adenocarcinoma |
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| 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> || Not recommended<ref name=Wang2016/> |
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|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|pmid=22110982 |pmc=3216005|doi-access=free}}</ref> |
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| [[File:Micrograph of signet-ring adenocarcinoma of the prostate.jpg|190px]] |
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*≥25% of tumor shows signet-ring cells (widely infiltrative cells with optically clear vacuoles displacing the nuclei)<ref name=Wang2016/> |
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| Tumorous glands: |
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*34βE12- and p63-<ref name=Wang2016/> |
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*PSA+<ref name=Wang2016/> |
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| Not recommended<ref name=Wang2016/> |
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! Basal-cell carcinoma |
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| 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> || Not recommended.<ref name=Wang2016/> |
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|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|doi-access=free}}</ref> |
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| <!--Image--> |
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| Basaloid tumor: |
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*Scant cytoplasm<ref name=Wang2016/> |
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*High nucleus/cytoplasm ratio<ref name=Wang2016/> |
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*Irregular or angulated nuclei<ref name=Wang2016/> |
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*[[Euchromatin|Euchromatic]]<ref name=Wang2016/> |
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*May have nuclear and cytoplasmic micro-vacuolation<ref name=Wang2016/> |
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*Infiltration of adjacent parenchyma<ref name=Wang2016/> |
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BCC-pattern: |
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*Variably sized solid nests, cords, or trabeculae<ref name=Wang2016/> |
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*Peripheral [[Palisade (pathology)|palisading]]<ref name=Wang2016/> |
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*p63+ <ref name=Wang2016/> |
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*HMCK(34βE12)+<ref name=Wang2016/> |
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*Typically CK20−/CK7+, but CK7− in pure solid basal cell nests<ref name=Wang2016/> |
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*Bcl-2+, strongly and diffusely<ref name=Wang2016/> |
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*Ki-67 nuclear staining in >20%<ref name=Wang2016/> |
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| Not recommended.<ref name=Wang2016/> |
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[[File:PIN-4 staining of benign prostate gland and adenocarcinoma, annotated.jpg|thumb|200px|PIN-4 staining of a benign gland (left) and prostate adenocarcinoma (right) using the PIN-4 cocktail. The adenocarcinoma lacks the basal epithelial cells (stained dark brown by [[TP63|p63]], [[Keratin 5|CK-5]] and [[Keratin 14|CK-14]]). Also, in PIN-4 stained samples, adenocarcinoma cells generally display red cytoplasms (stained by [[Alpha-methylacyl-CoA racemase|AMACR]]).]] |
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In uncertain cases, a diagnosis of malignancy 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 targets [[TP63|p63]], [[Keratin 5|CK-5]], [[Keratin 14|CK-14]] and [[Alpha-methylacyl-CoA racemase|AMACR]] (latter also known as P504S). |
|||
[[Prostate cancer#Tumor markers| |
Other [[Prostate cancer#Tumor markers|prostate cancer tumor markers]] may be necessary in cases that remain uncertain after [[microscopy]]. |
||
==Acinar adenocarcinoma== |
==Acinar adenocarcinoma== |
||
These constitute 93% of prostate cancers.<ref name="BaigHamid2015"/> |
These constitute 93% of prostate cancers.<ref name="BaigHamid2015"/> |
||
===Microscopic characteristics=== |
===Microscopic characteristics=== |
||
;Specific but relatively rare:<ref group="notes">"Rare" here refers to prevalence at least in core biopsies.<br>-{{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}}</ref> |
;Specific but relatively rare:<ref group="notes">"Rare" here refers to prevalence at least in core biopsies.<br>-{{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|doi-access=free}}</ref> |
||
*'''Collagenous micronodules'''<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}}</ref> |
*'''Collagenous micronodules'''<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|doi-access=free}}</ref> |
||
*'''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''',<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.<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. Glands partially surrounding a nerve is an indication of carcinoma.<br>- {{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> |
*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. Glands partially surrounding a nerve is an indication of carcinoma.<br>- {{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> |
||
Line 71: | Line 204: | ||
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"/> |
||
<gallery mode=packed> |
|||
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. |
|||
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> |
|||
</gallery> |
|||
==Intraductal carcinoma== |
==Intraductal carcinoma== |
||
[[File:Micrograph of intraductal carcinoma of the prostate with definitions of enlarged nucleus.jpg|thumb|This case could meet the criterion of six times normal nuclear size for intraductal carcinoma of the prostate if size is defined as nuclear area but not if defined as nuclear diameter (blue dot: size of normal nucleus, green dot: size six times normal area and red dot: size six times normal diameter).<ref name="Varma2019/>]] |
[[File:Micrograph of intraductal carcinoma of the prostate with definitions of enlarged nucleus.jpg|thumb|This case could meet the criterion of six times normal nuclear size for intraductal carcinoma of the prostate if size is defined as nuclear area but not if defined as nuclear diameter (blue dot: size of normal nucleus, green dot: size six times normal area and red dot: size six times normal diameter).<ref name="Varma2019"/>]] |
||
Intraductal carcinoma of the prostate gland (IDCP), which is now categorised as a distinct entity by WHO 2016, includes two biologically distinct diseases. IDCP associated with invasive carcinoma (IDCP-inv) generally represents a growth pattern of invasive prostatic adenocarcinoma while the rarely encountered pure IDCP is a precursor of prostate cancer.<ref name="Varma2019>{{cite journal|last1=Varma|first1=Murali|last2=Delahunt|first2=Brett|last3=Egevad|first3=Lars|last4=Samaratunga|first4=Hemamali|last5=Kristiansen|first5=Glen|title=Intraductal carcinoma of the prostate: a critical re-appraisal|journal=Virchows Archiv|volume=474|issue=5|year=2019|pages=525–534|issn=0945-6317|doi=10.1007/s00428-019-02544-6}} |
Intraductal carcinoma of the prostate gland (IDCP), which is now categorised as a distinct entity by WHO 2016, includes two biologically distinct diseases. IDCP associated with invasive carcinoma (IDCP-inv) generally represents a growth pattern of invasive prostatic adenocarcinoma while the rarely encountered pure IDCP is a precursor of prostate cancer.<ref name="Varma2019">{{cite journal|last1=Varma|first1=Murali|last2=Delahunt|first2=Brett|last3=Egevad|first3=Lars|last4=Samaratunga|first4=Hemamali|last5=Kristiansen|first5=Glen|title=Intraductal carcinoma of the prostate: a critical re-appraisal|journal=Virchows Archiv|volume=474|issue=5|year=2019|pages=525–534|issn=0945-6317|doi=10.1007/s00428-019-02544-6|pmid=30825003 |pmc=6505500 |doi-access=free}} |
||
*"This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/)," |
*"This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/)," |
||
</ref> The diagnostic criterion of nuclear size at least 6 times normal is ambiguous as size could refer to either nuclear area or diameter. If area, then this criterion could be re-defined as nuclear diameter at least three times normal as it is difficult to visually compare area of nuclei.<ref name="Varma2019/> It is also unclear whether IDCP could also include tumors with ductal morphology.<ref name="Varma2019/> There is no consensus whether pure IDCP in needle biopsies should be managed with re-biopsy or radical therapy. A pragmatic approach would be to recommend radical therapy only for extensive pure IDCP that is morphologically unequivocal for high-grade prostate cancer.<ref name="Varma2019/> Active surveillance is not appropriate when low-grade invasive cancer is associated with IDCP, as such patients usually have unsampled high-grade prostatic adenocarcinoma.<ref name="Varma2019/> It is generally |
</ref> The diagnostic criterion of nuclear size at least 6 times normal is ambiguous as size could refer to either nuclear area or diameter. If area, then this criterion could be re-defined as nuclear diameter at least three times normal as it is difficult to visually compare area of nuclei.<ref name="Varma2019"/> It is also unclear whether IDCP could also include tumors with ductal morphology.<ref name="Varma2019"/> There is no consensus whether pure IDCP in needle biopsies should be managed with re-biopsy or radical therapy. A pragmatic approach would be to recommend radical therapy only for extensive pure IDCP that is morphologically unequivocal for high-grade prostate cancer.<ref name="Varma2019"/> Active surveillance is not appropriate when low-grade invasive cancer is associated with IDCP, as such patients usually have unsampled high-grade prostatic adenocarcinoma.<ref name="Varma2019"/> It is generally |
||
recommended that IDCP component of IDCP-inv should be included in tumor extent but not grade.<ref name="Varma2019/> However, there are good arguments in favor of grading IDCP associated with invasive cancer.<ref name="Varma2019/> WHO 2016 recommends that IDCP should not be graded, but it is unclear whether this applies to both pure IDCP and IDCP-inv.<ref name="Varma2019/> |
recommended that IDCP component of IDCP-inv should be included in tumor extent but not grade.<ref name="Varma2019"/> However, there are good arguments in favor of grading IDCP associated with invasive cancer.<ref name="Varma2019"/> WHO 2016 recommends that IDCP should not be graded, but it is unclear whether this applies to both pure IDCP and IDCP-inv.<ref name="Varma2019"/> |
||
<gallery mode=packed heights=220> |
<gallery mode=packed heights=220> |
||
File:Micrograph of intraductal carcinoma of the prostate with an infiltrative growth pattern, with comedonecrosis.jpg|Intraductal carcinoma of the prostate with an infiltrative growth pattern may be morphologically difficult to distinguish from invasive cancer. One focus shows comedonecrosis (arrow), morphologically suggesting Gleason pattern 5 invasive carcinoma (a haematoxylin and eosin, b CK5/6)<ref name="Varma2019/> |
File:Micrograph of intraductal carcinoma of the prostate with an infiltrative growth pattern, with comedonecrosis.jpg|Intraductal carcinoma of the prostate with an infiltrative growth pattern may be morphologically difficult to distinguish from invasive cancer. One focus shows comedonecrosis (arrow), morphologically suggesting Gleason pattern 5 invasive carcinoma (a haematoxylin and eosin, b CK5/6)<ref name="Varma2019"/> |
||
File:Micrograph of intraductal carcinoma of the prostate with very patchy basal cells.jpg|Intraductal carcinoma of the prostate with very patchy basal cells identified by immunohistochemistry. At least some of the glands lacking basal cell immunoreactivity represent intraductal rather than invasive carcinoma (a haematoxylin and eosin, b CK 5/6)<ref name="Varma2019/> |
File:Micrograph of intraductal carcinoma of the prostate with very patchy basal cells.jpg|Intraductal carcinoma of the prostate with very patchy basal cells identified by immunohistochemistry. At least some of the glands lacking basal cell immunoreactivity represent intraductal rather than invasive carcinoma (a haematoxylin and eosin, b CK 5/6)<ref name="Varma2019"/> |
||
</gallery> |
</gallery> |
||
Ductal adenocarcinoma may have a prominent cribriforming architecture, with glands appearing relatively round, and may thereby mimic intraductal adenocarcinoma, but can be distinguished by the following features:<ref name="MagersKunju2015"/> |
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{|class="wikitable" align="center" |
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|+ Differences between ductal and intraductal adenocarcinoma<ref name="MagersKunju2015"/> |
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|- |
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! Feature !! Ductal adenocarcinoma !! Intraductal adenocarcinoma |
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|- |
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! True fibrovascular cores in micropapillary architecture |
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| Present ||Usually absent |
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|- |
|||
! Cribriform lumens |
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| Lined by pseudostratified, columnar cells || Punched out lumens lined by cuboidal cells |
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|- |
|||
! Basal cell markers |
|||
| Usually negative || Usually positive |
|||
|} |
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==Further workup== |
==Further workup== |
||
Further workup of a diagnosis of prostate cancer includes mainly: |
Further workup of a diagnosis of prostate cancer includes mainly:{{cn|date=May 2021}} |
||
* [[Gleason score]] |
* [[Gleason score]] |
||
* [[Prostate cancer staging]] |
* [[Prostate cancer staging]] |
||
Line 91: | Line 244: | ||
{{reflist|group=notes}} |
{{reflist|group=notes}} |
||
== Reference list == |
|||
==References== |
|||
{{reflist}} |
{{reflist}} |
||
== Sources == |
|||
{{Free-content attribution|title= Prostate adenocarcinoma|publisher= Patholines|documentURL= https://patholines.org/Prostate adenocarcinoma|license statement URL= https://patholines.org/Patholines:Copyright|license= Creative Commons Attribution 4.0 International (CC BY 4.0) license.}} |
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[[Category:Prostate cancer]] |
[[Category:Prostate cancer]] |
Revision as of 17:01, 14 June 2024
A histopathologic diagnosis of prostate cancer is the discernment of whether there is a cancer in the prostate, as well as specifying any subdiagnosis of prostate cancer if possible. The histopathologic subdiagnosis of prostate cancer has implications for the possibility and methodology of any subsequent Gleason scoring.[1] The most common histopathological subdiagnosis of prostate cancer is acinar adenocarcinoma, constituting 93% of prostate cancers.[2] The most common form of acinar adenocarcinoma, in turn, is "adenocarcinoma, not otherwise specified", also termed conventional, or usual acinar adenocarcinoma.[3]
Sampling
![](http://upload.wikimedia.org/wikipedia/commons/thumb/1/18/Prostate_cutting.png/220px-Prostate_cutting.png)
The main sources of tissue sampling are prostatectomy and prostate biopsy.[citation needed]
Subdiagnoses - overview
![](http://upload.wikimedia.org/wikipedia/commons/thumb/f/f7/Prostate_cancer_types.png/300px-Prostate_cancer_types.png)
Subdiagnosis | Relative incidence | Image | Microscopic characteristics | Immunohistochemistry | Gleason scoring | ||
---|---|---|---|---|---|---|---|
Core biopsy |
Radical prostatectomy | ||||||
Acinar adenocarcinoma - 93%[2] |
Adenocarcinoma (not otherwise specified/ conventional/ usual acinar)[3] |
77%[notes 2] | 54%[notes 2] | ![]() |
Further information in section below
|
Tumorous glands: | As usual |
Foamy gland carcinoma | 17%[5][notes 1] | 13–23%[5][notes 1] | Based on architecture, discounting foamy cytoplasms[1] | ||||
Atrophic carcinoma | 2%[5][notes 3] | 16%[5][notes 3] | Tumorous glands: | As usual[1] | |||
Pseudohyperplastic carcinoma | 2%[5] | 11%[5] |
|
Tumorous glands: | 3+3=6[1] | ||
Microcystic carcinoma | 11%[5] | On (usually) adjacent acinar adeocarcinoma[6] | |||||
PIN-like | 1.3%[7] |
|
Tumorous glands:
|
Not recommended[1] | |||
Non acinar (or mixed acinar/ non-acinar) adenocarcinoma |
Ductal adenocarcinoma | 3% to 12.7%[8][notes 1] | ![]() |
||||
Intraductal adenocarcinoma | 2.8%[10] | ![]() H&E and CK5/6 |
|||||
Urothelial carcinoma | 0.7 to 2.8%[12] | ![]() |
|
Not recommended[1] | |||
Small-cell carcinoma | 0.3–2%[14][15][notes 1] | ![]() |
Half of cases have usual acinar components[1] |
||||
Mucinous adenocarcinoma | 0.2%[12] | ![]() |
|
Tumorous glands: | 4+4=8 for irregular cribriform glands floating in mucin.[1] | ||
Signet-ring adenocarcinoma | 0.02%[16] | ![]() |
|
Tumorous glands: | Not recommended[1] | ||
Basal-cell carcinoma | 0.01%[17] | Basaloid tumor:
BCC-pattern:
|
Not recommended.[1] |
![](http://upload.wikimedia.org/wikipedia/commons/thumb/a/af/PIN-4_staining_of_benign_prostate_gland_and_adenocarcinoma%2C_annotated.jpg/200px-PIN-4_staining_of_benign_prostate_gland_and_adenocarcinoma%2C_annotated.jpg)
In uncertain cases, a diagnosis of malignancy can be excluded by immunohistochemical detection of basal cells (or confirmed by absence thereof),[4] such as using the PIN-4 cocktail of stains, which targets p63, CK-5, CK-14 and AMACR (latter also known as P504S).
Other prostate cancer tumor markers may be necessary in cases that remain uncertain after microscopy.
Acinar adenocarcinoma
These constitute 93% of prostate cancers.[2]
Microscopic characteristics
- Specific but relatively rare
- [notes 4]
- Collagenous micronodules[4]
- Glomerulations,[4] epithelial proliferations into one or more gland lumina, typically a cribriform tuft with a single attachment to the gland wall.[18]
- Perineural invasion.[4] It should be circumferential[18][notes 5]
- Angiolymphatic invasion[4]
- Extraprostatic extension [4]
-
Glomerulation.
- Relatively common and highly specific
- [4]
- Multiple nucleoli
- Eccentric nucleoli[4]
-
Acinar adenocarcinoma with multiple nucleoli.
-
Acinar adenocarcinoma with double and eccentric nucleoli.
- Less specific findings.
- Mitoses (also seen in for example high-grade prostatic intraepithelial neoplasia (HGPIN) and prostate inflammation).[4]
- Prominent nucleoli[4]
- Intraluminal eosinophilic secretion[4]
- Intraluminal blue mucin[4]
-
Adenocarcinoma with two mitoses in reactive epithelium.
-
Acinar adenocarcinoma with intraluminal blue mucin.
In uncertain cases, a diagnosis of malignancy can be discarded by immunohistochemical detection of basal cells.[4]
-
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.
-
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.[19]
Intraductal carcinoma
![](http://upload.wikimedia.org/wikipedia/commons/thumb/3/3e/Micrograph_of_intraductal_carcinoma_of_the_prostate_with_definitions_of_enlarged_nucleus.jpg/220px-Micrograph_of_intraductal_carcinoma_of_the_prostate_with_definitions_of_enlarged_nucleus.jpg)
Intraductal carcinoma of the prostate gland (IDCP), which is now categorised as a distinct entity by WHO 2016, includes two biologically distinct diseases. IDCP associated with invasive carcinoma (IDCP-inv) generally represents a growth pattern of invasive prostatic adenocarcinoma while the rarely encountered pure IDCP is a precursor of prostate cancer.[20] The diagnostic criterion of nuclear size at least 6 times normal is ambiguous as size could refer to either nuclear area or diameter. If area, then this criterion could be re-defined as nuclear diameter at least three times normal as it is difficult to visually compare area of nuclei.[20] It is also unclear whether IDCP could also include tumors with ductal morphology.[20] There is no consensus whether pure IDCP in needle biopsies should be managed with re-biopsy or radical therapy. A pragmatic approach would be to recommend radical therapy only for extensive pure IDCP that is morphologically unequivocal for high-grade prostate cancer.[20] Active surveillance is not appropriate when low-grade invasive cancer is associated with IDCP, as such patients usually have unsampled high-grade prostatic adenocarcinoma.[20] It is generally recommended that IDCP component of IDCP-inv should be included in tumor extent but not grade.[20] However, there are good arguments in favor of grading IDCP associated with invasive cancer.[20] WHO 2016 recommends that IDCP should not be graded, but it is unclear whether this applies to both pure IDCP and IDCP-inv.[20]
-
Intraductal carcinoma of the prostate with an infiltrative growth pattern may be morphologically difficult to distinguish from invasive cancer. One focus shows comedonecrosis (arrow), morphologically suggesting Gleason pattern 5 invasive carcinoma (a haematoxylin and eosin, b CK5/6)[20]
-
Intraductal carcinoma of the prostate with very patchy basal cells identified by immunohistochemistry. At least some of the glands lacking basal cell immunoreactivity represent intraductal rather than invasive carcinoma (a haematoxylin and eosin, b CK 5/6)[20]
Ductal adenocarcinoma may have a prominent cribriforming architecture, with glands appearing relatively round, and may thereby mimic intraductal adenocarcinoma, but can be distinguished by the following features:[10]
Feature | Ductal adenocarcinoma | Intraductal adenocarcinoma |
---|---|---|
True fibrovascular cores in micropapillary architecture | Present | Usually absent |
Cribriform lumens | Lined by pseudostratified, columnar cells | Punched out lumens lined by cuboidal cells |
Basal cell markers | Usually negative | Usually positive |
Further workup
Further workup of a diagnosis of prostate cancer includes mainly:[citation needed]
Notes
- ^ a b c d e At least where noted, the numbers include cases where the pattern is found admixed with usual acinar adenocarcinoma.
- ^ a b Numbers for usual acinar adenocarcinoma do not include mixed patterns with other types.
- ^ a b Number refers to sporadic atrophic pattern adenocarcinoma.
- ^ "Rare" here refers to prevalence at least in core biopsies.
-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. - ^ 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.
- Robert V Rouse MD. "Prostatic Adenocarcinoma". Stanford Medical School. Last update 2/2/16
Reference list
- ^ a b c d e f g h i j k l m n o p q r s t u v w x y z aa ab ac ad ae af ag ah ai aj ak al am an ao ap aq ar as at au av aw ax ay az ba bb bc bd be bf bg bh bi Li J, Wang Z (February 2016). "The pathology of unusual subtypes of prostate cancer". Chin. J. Cancer Res. 28 (1): 130–43. doi:10.3978/j.issn.1000-9604.2016.01.06. PMC 4779761. PMID 27041935.
- ^ a b c d e f g 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 1999-768X. PMC 4459157. PMID 26171121.
- ^ a b "Prostatic Adenocarcinoma". Stanford University School of Medicine. Archived from the original on 2019-09-11. Retrieved 2019-10-30.
- ^ a b c d e f g h i j k l m n o 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.
- ^ a b c d e f g 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. PMID 29297496.
- ^ a b c d e f 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. PMID 20216381. S2CID 24149412.
- ^ 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. PMID 29297491.
- ^ Liu T, Wang Y, Zhou R, Li H, Cheng H, Zhang J (February 2016). "The update of prostatic ductal adenocarcinoma". Chin. J. Cancer Res. 28 (1): 50–7. doi:10.3978/j.issn.1000-9604.2016.02.02. PMC 4779765. PMID 27041926.
- ^ Robert V Rouse (2012-01-06). "Prostatic Ductal Adenocarcinoma". Stanford University School of Medicine.
- ^ a b c d e f 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. PMID 26414467.
- ^ a b 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): 307–315. doi:10.4132/KoreanJPathol.2013.47.4.307. ISSN 1738-1843. PMC 3759629. PMID 24009625.
- ^ a b Grignon, David J (2004). "Unusual subtypes of prostate cancer". Modern Pathology. 17 (3): 316–327. doi:10.1038/modpathol.3800052. ISSN 0893-3952. PMID 14976541.
- ^ a b c Robert V Rouse. "Papillary Urothelial (Transitional Cell) Carcinoma". Stanford University School of Medicine. Original posting/updates: 10/20/12, 12/29/12
- ^ 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.
- ^ 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. PMC 6243899. PMID 30483097.
- ^ 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. PMC 3216005. PMID 22110982.
- ^ Ninomiya, Sahoko; Kawahara, Takashi; Iwashita, Hiromichi; Iwamoto, Genta; Takamoto, Daiji; Mochizuki, Taku; Kuroda, Shinnosuke; Takeshima, Teppei; Izumi, Koji; Teranishi, Jun-ichi; Yumura, Yasushi; Miyoshi, Yasuhide; Asai, Takuo; Uemura, Hiroji (2018). "Prostate Basal Cell Carcinoma: A Case Report". Case Reports in Oncology. 11 (1): 138–142. doi:10.1159/000487389. ISSN 1662-6575.
- ^ a b Robert V Rouse MD. "Prostatic Adenocarcinoma". Stanford Medical School. Last update 2/2/16
- ^ Image by Mikael Häggström, MD. Reference for findings: Faryal Shoaib, M.D., Chinedum Okafor, M.D., Y. Albert Yeh, M.D., Ph.D. "Anatomy & histology-seminal vesicles / ejaculatory duct". Pathology Outlines.
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: CS1 maint: multiple names: authors list (link) Last staff update: 20 November 2023 - ^ a b c d e f g h i j k Varma, Murali; Delahunt, Brett; Egevad, Lars; Samaratunga, Hemamali; Kristiansen, Glen (2019). "Intraductal carcinoma of the prostate: a critical re-appraisal". Virchows Archiv. 474 (5): 525–534. doi:10.1007/s00428-019-02544-6. ISSN 0945-6317. PMC 6505500. PMID 30825003.
- "This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/),"
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This article incorporates text from a free content work. Licensed under Creative Commons Attribution 4.0 International (CC BY 4.0) license. (license statement/permission). Text taken from adenocarcinoma Prostate adenocarcinoma, Patholines.