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Sunday, 6 March 2011

Prostatic Intraepithelial Neoplasia

                                      High-grade PIN - Flat Pattern



The acinar epithelial cells are pseudostratified and arranged linearly in this example of flat variant of high-grade PIN. There is nuclear and nucleolar enlargement. Note the prominent apical snouts.







High-grade PIN - Cribriform Pattern
In cribriform high-grade PIN interconnecting bridges of acinar epithelial cells extend across the lumen of the glands



High-grade PIN - Cribriform Pattern
Distinction of cribriform variant of high-grade PIN from adenocarcinoma may at times be extremely difficult. Immunostain for high molecular weight cytokeratin 34bE12 may be useful in such cases – basal cell layer is fragmented in PIN and absent in adenocarcinoma.


High-grade PIN - Tufted Pattern
Another example of tufted variant of high-grade PIN.



High-grade PIN & Cancer - 34bE12 Immunostain
The benign glands on upper right have continuous basal cell layer; high-grade PIN glands in the middle have fragmented basal cell layer; malignant glands on the left completely lack basal cell layer.



High-grade PIN - Prominent Nucleoli
This example of high-grade PIN shows all the classic histologic features: intermediate-to-large size preexisting glands displaying nuclear and nucleolar enlargement and fragmented basal cell layer.



High-grade PIN - Prominent Nucleoli
Another classic example of high-grade PIN, showing tufted and flat patterns. 


High-grade PIN
High-grade PIN consists of intermediate to large size preexisting glands with proliferative changes resulting in hyperchromatic appearance. Note the small foci of cancer adjacent to PIN on the upper left and lower right. 


High-grade PIN – Micropapillary Variant
he acinar epithelial cells are arranged in long, delicate, finger-like structures in this micropapillary variant. Atrophic acini are present at the bottom of the image.


                                High-grade PIN – Tufted Variant
Six variants of high-grade PIN have been described – tufted, micropapillary, flat, cribriform, small cell type, and the most recent addition – inverted type. The image depicts tufted variant. Note the enlarged nuclei, prominent nucleoli and residual basal cells. 

Cardiac Pathology

             please click here for cardiac pathology          
           http://www.slideworld.org/slideshow.aspx/Cardiac-Pathology-ppt-5167

Hypertension: New Concepts, Guidelines, and Clinical Management

Prostate Hyperplasia (slides)

 
                                     Prostate - Nodular Hyperplasia  
Hyperplasia of the median lobe of the prostate produces a polypoid mass that protrudes in the bladder lumen. 








                                Basal Cell Hyperplasia in Prostate Needle Biopsy
              Basal cell hyperplasia is usually seen in the transition zone. Occasionally, it may be encountered in needle biopsies (which sample peripheral zone).






                       Basal Cell Hyperplasia - Higher Magnification
             The nuclei are ovoid or round with finely reticular chromatin and rare punctate nucleoli. The cytoplasm is pale eosinophilic or clear








                                 Clear Cell Cribriform Hyperplasia
                                       Lobular clusters of glands with cribriform architecture 










                                Clear Cell Cribriform Hyperplasia
The glandular clusters have punched out lumens. The cytoplasm is clear or pale eosinophilic. The nuclei are uniform and lack nucleoli. Basal cells can be clearly seen. 










                                 Stromal Hyperplasia with Atypia
Large atypical cells with hyperchromatic nuclei containing intranuclear vacuoles are interspersed between benign glands. Prostatic stromal hyperplasia with atypia








                                  
                   Atypical Adenomatous Hyperplasia in Needle Biopsy
Atypical adenomatous hyperplasia (adenosis) - when seen in a needle biopsy - is one of the most challenging benign mimics of cancer. A partially sampled focus of cancer may be mistaken for AAH



                               Atypical Adenomatous Hyperplasia
                                          AAH encountered in a transurethral resection specimen. 










                  Atypical Adenomatous Hyperplasia - 34bE12 Immunostain
The immunostain for high molecular weight cytokeratin 34bE12 demonstrates fragmented basal cell layer in the previous focus of AAH.








                                       Post-atrophic Hyperplasia
          Clusters of atrophic prostatic acini with proliferative changes. At low magnification, it may be mistaken for adenocarcinoma; however, they lack cytologic features of cancer such as prominent nucleoli.










                               Post-atrophic Hyperplasia - Higher Magnification
This case is not difficult to distinguish from prostatic adenocarcinoma. In challenging cases, the immunostain for high molecular weight cytokeratin is invaluable

Prostate Metaplasia (slides)

 
                               Urothelial Metaplasia in Prostate Needle Biopsy
The central portions of the prostatic ducts are normally lined by urothelium. When urothelial lining is seen in more peripheral ducts and glands as in this needle biopsy, the term urothelial metaplasia is used.










                                Urothelial Metaplasia in Prostate Needle Biopsy
      Note the lack of cytologic atypia which is helpful in distinguishing urothelial metaplasia from high-grade PIN.  













                                     Mucinous Metaplasia in Prostate


In this transurethral resection, clusters of mucinous glands lined by tall columnar cells are seen admixed with usual prostatic glands. The mucin is positive for mucicarmine, PAS, and alcian blue. The glands are negative for PSA and PAP.








                                       Mucinous Metaplasia in Prostate
The nuclei are small and basally located and lack prominent nucleoli. The differential diagnosis is with Cowper’s glands and adenocarcinoma.












                              Mucinous Metaplasia in Prostate Needle Biopsy
Mucinous metaplasia in a needle biopsy of the prostate. Note partial involvement in one of the glands on the right.
















                      Squamous Metaplasia : PSA Immunostain
                      Mucinous glands are negative for PSA immunostain. Same case as previous slide.


















                             Squamous Metaplasia in Prostate Needle Biopsy
             Squamous metaplasia in prostate can be seen in response to infarction, inflammation, radiation therapy, or androgen deprivation therapy


















                             Squamous Metaplasia in TUR Specimen
                      Squamous metaplasia adjacent to an area of infarction in a transurethral resection specimen

Prostate Atrophy (slides)

                                                             Cystic atrophy
                                      Atrophy - 34bE12 Immunostain


                                               Lobular Atrophy in Prostate


                                           Atrophy - Nuclear Features


                                                                Partial Atrophy


                                                         Sclerotic atrophy


                                                             Simple atrophy


                                  Atrophic variant of Prostatic Adenocarcinoma

Prostate : Inflammation(slides)

                                          Prostate : Acute Inflammation


                                                 Prostate : Malakoplakia    
                                     Prostate : Post-biopsy granuloma


                                  Prostate : Non-specific Granulomatous Inflammation


                                   Prostate : Non-specific Granulomatous Inflammation


                             Prostate : Post-BCG Granulomatous Inflammation


                             Prostate : Post-BCG Granulomatous Inflammation


                                                    Prostate : Xanthoma


                                    Prostate : Xanthoma (CD68 Immunostain)

Prostate and Seminal Vesicles

                                                      prostate gland Normal

                                 Neuroendocrine Cells in Atrophic Prostate Glands
 

                                       
                              
                                           Normal glands


                                          Normal glands - 34bE12 Immunostain


                                           Corpora Amylacea in Prostate Biopsies


                                                
                   

                            Corpora Amylacea in Prostate Biopsies
                                            Corpora Amylacea in Prostate Biopsies


                                          Prostate - Crystalloids in Benign Glands


                                               Ganglia in Prostate Biopsies


                                               Ganglia in Prostate Biopsies


                                                   Ganglia in Prostate Biopsies


                                                    Paraganglion in Prostate Biopsies


                                                     Paraganglion in Prostate Biopsies


                    Paraganglion in Prostate Biopsies - Immunoreactivity for Synaptophysin


                                               Paraganglion in Prostate Biopsies
                                                    Perineural Indentation by Benign Prostatic Glands


                                                  Pigment in Prostatic Epithelium


                                                       Pigment in Prostatic Epithelium


                                                Rectal Mucosa in Prostate Biopsy


                                               Skeletal Muscle in Prostate Biopsies


 
                                                 Spermatozoa in Prostate Biopsy
                                                     Seminal vesicle


 
                                                         Seminal vesicle - Older Man


                                            Seminal vesicle - Young Man