Chapter 11 - Prostate Flashcards
What are the usual indications for prostate biopsy?
Elevated PSA
Palpalble nodule
History of abnormal biopsy
Describe the low power features of prostatic adenocarcinoma.
Small individual glands infiltating among larger benign glands.
Crowded, cribriform glands
Mucin, crystalloids, or pink luminal secretions
NO desmoplastic response
Describe the high power features of prostatic adenocarcinoma.
Large, cherry-red nucleoli
Enlarged & hyperchromatic nuclei
Lack of basal cell layer
Mitoses (uncommon)
What three features guarantee a diagnosis of prostatic adenocarcinoma?
- Perineural invasion
- Mucinous fibroplasia (hyalinized whorls of secretions)
- Glomeruloid forms
What is Gleason grading?
How does it differ between cancer resections and biopsies?
A histologic grade determined by architecture–not cytology.
In cancer resections, the second number is the second most common population. In biopsies, it is the highest secondary grade.
What are the features of Gleason grades 1 and 2?
- Rarely used; a circumscribed nodule of uniform crowded glands.
- A circumscribed nodules of well-defined glands with minimal infiltration at the peirphery; less uniform than pattern 1.
What are the features of Gleason grade 3?
Highly infiltrative glands with discrete and individual gland profiles (can draw a circle around each gland)
What are the features of Gleason grade 4?
Fused and ill-defined glands, sheets of cribriform glands, poorly formed lumens.
What are the features of Gleason grade 5?
A complete absence of glandular differentiation, solid sheets and cords of cells, single cells.
Why can’t Gleason 1/2 be diagnosed on biopsies?
They can only be identified in the context of surrounding tissue.
What features must be mentioned in the signout of a prostate biopsy?
Number of involved cores, percentage involvement, size of foci.
Perineural invasion, extraprostatic extension.
What is the clinical significance of prostatic intraepithelial neoplasia (PIN)?
It is considered a precursor lesion to prostate cancer but does not warrant excision or re-biopsy. Low-grade PIN is not reportable, but high-grade is.
What is the morphologic appearance of prostatic intraepithelial neoplasia (PIN)?
Glands with prominent papillary or micropapillary luminal surfaces. Can be cribriform but not back-to-back.
Darker and bluer glands.
Enlarged, hyperchromatic nuclei.
Retention of the basal cell layer (at least patchy)
Name 7 mimics of prostate cancer.
Adenosis
Atrophy
Basal cell hyperplasia
Cowper’s glands
Radiation changes
Seminal vesicle
Sclerosing adenosis
Describe the morphologic appearance of prostatic adenosis.
A hyperplastic lesion consisting of a lobular group of crowded glands which overlap with larger, benign glands. Can have nucleoli, but should have a basal layer.
Describe the morphologic appearance of prostatic atrophy.
Shrinkage of the cells forming the lumen, leaving rows of essentially flat nuclei. Small and irregular, angulated/staghorn appearing. Basal layer present.
Describe the morphologic appearance of prostatic basal cell hyperplasia.
Denim-blue, oval, regular nuclei surrounding the glandular nuclei. Recognize the dual population and do not worry about the multiple layers. Immunostain if needed.
Describe the morphologic appearance of Cowper’s glands.
What do they stain?
Mucous-filled secretory glands surrounding a coil of ducts. Lobular architecture with bland nuclei.
PAS+, PSA/PSAP-
Describe the morphologic appearance of radiation changes in prostate.
TOO much pleomorphism to be cancer. Atrophic cytoplasm and wildly pleomorphic nuclei.
Describe the morphologic appearance of seminal vesicle.
Very pleomorphic nuclei, like radiation atypia.
Golden globs of lipofuscin.
Describe the morphologic appearance of prostatic sclerosing adenosis
Hyperplastic and proliferative lesion with a hypercellular stroma. Remember that prostate cancer does not induce a stromal reaction.
How can one approach the presence of a few isolated abnormal glands?
Sign out as a focus of atypical glands (generating a repeat biopsy)
Immunostain for the basal layer (CK903, p63) or cancer (racemase).
What are the margins of the radical prostatectomy?
Left and right vas deferens (rarely submitted)
Apical (distal) margin
Bladder neck margin
How can anterior and posterior prostate be oriented histologically?
Posterior features neurovascular bundles (at the posterolaterla corners)
Anterior sections shoudl have smooth muscle bundles and a poorly defined capsule
(Verumontanum points anteriorly, too)
