Atypical Small Acinar Proliferations in Prostate
Atypical Small Acinar Proliferation in Prostate
A serum PSA of 4.5 ng/ml resulted in this needle biopsy. Digital rectal examination and prostate ultrasound were normal. A single atypical focus (shown here) was found among 10 cores. The features are highly suspicious for adenocarcinoma, but were felt to be insufficient for an unequivocal diagnosis
Atypical Small Acinar Proliferation in Prostate
Another example of atypical small acinar proliferation suspicious for but not diagnostic of malignancy. This case was reviewed by an expert who concurred with the atypical diagnosis. For some observers, this focus may be diagnostic of adenocarcinoma
Adenocarcinoma in Repeat Biopsy
A repeat biopsy performed three months later (same case as previous image) showed an unequivocal focus of adenocarcinoma (Gleason 3+3=6). Interestingly, the cancer was in a location different from the atypical focus in the previous biopsy
Three atypical glands demonstrating rare prominent nucleoli. This was the only focus of concern among 12 cores
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Variants of Prostate Cancer
Prostate - Adenoid Basal Cell Tumor
It is considered to be a low-grade tumor but with potential of malignant behavior with distant metastases. Note the solid clusters of basaloid cells, some with punched-out lumens.
Prostate - Adenoid Basal Cell Tumor
Note the bland cytology and resemblance to basal cell hyperplasia; however, the lesion involved a large area of TUR specimen and was not circumscribed.
Prostate - Adenoid Basal Cell Tumor - Keratin
Immunostain for high molecular weight keratin 34bE12 shows stronger staining in the center of the clusters than at periphery. The cells usually lack immunoreactivity for PSA and PAP.
Prostate - Urothelial Carcinoma
Usually it represents a spread from carcinoma in the bladder or urethra. In this case, the tumor is localized to the larger prostatic ducts and did not show definitive evidence of stromal invasion. Distinction from Gleason grade 5 adenocarcinoma is important.
Prostatic Adenocarcinoma - Atrophic Variant
At low magnification, the majority of the glands in this needle biopsy have open dilated lumens and appear to be lined by flattened “atrophic” epithelium. However, this is an example of atrophic pattern of prostatic adenocarcinoma
Prostatic Adenocarcinoma - Atrophic Variant
The presence of prominent nucleoli and the absence of basal cell layer are features distinguishing it from benign atrophic glands. In the majority of cases, the presence of usual pattern (non-atrophic) of adenocarcinoma nearby is the main clue to correct diagnosis
Prostatic Adenocarcinoma - Foamy Gland Variant
This variant of prostatic adenocarcinoma shows abundant foamy cytoplasm in the tumor cells. Nuclear and nucleolar enlargement may be minimal; this case, however, shows enlarged nuclei with prominent nucleoli
Prostatic Adenocarcinoma - Neuroendocrine Cells
he spectrum of neuroendocrine differentiation in prostate cancer ranges from neuroendocrine cells with large eosinophilic granules (as seen in this case) to carcinoid-like pattern to small cell carcinoma.
| Prostatic AdenoCA - Neuroendocrine Cells Chromogranin stain Chromogranin immunostain nicely highlights the tumor cells exhibiting neuroendocrine differentiation |
Prostate - Small Cell Carcinoma
Small cell carcinoma in a needle biopsy. It is considered equivalent to Gleason grade 5.
Prostate - Small Cell Carcinoma
Note the usual features of small cell carcinoma including, nuclear hyperchromasia, nuclear molding, small punctate nucleoli, and brisk mitotic activity
Prostate - Small Cell Carcinoma : Chromogranin
The tumor in the preceding image stains strongly with antibodies to Chromogranin.
Prostatic Adenocarcinoma - Mucin Producing
Mucin-producing prostatic adenocarcinoma in a needle biopsy. Many glands are “floating” in pools of mucin. It is considered equivalent to Gleason grade 4
Prostatic Adenocarcinoma - Mucin Producing
A focus of mucin-producing adenocarcinoma from a radical prostatectomy specimen. Note the glandular fusion (Gleason grade 4). The bulk of the tumor was usual acinar adenocarcinoma, Gleason grade 3.
Prostatic Adenocarcinoma - Signet Ring Cell Pattern
At least 25% or more of the tumor should consist of this pattern to apply the designation signet ring cell carcinoma. More often seen as a minor component of Gleason grade 5 adenocarcinoma.
Prostatic Adenocarcinoma - Signet Ring Cell Pattern
The signet ring cell appearance may result from cytoplasmic lumens, intracytoplasmic mucin or lipid vacuoles.
Prostatic Adenocarcinoma - Ductal Type
The tumor consists of tall columnar cells arranged in papillary and ductal configurations. The majority of the cases contain foci of usual acinar adenocarcinoma. Controversy exists as to whether or not the ductal adenocarcinoma of prostate has worse prognosis than usual acinar adenocarcinoma.
The differential diagnosis of ductal adenocarcinoma of prostate includes urothelial carcinoma involving prostate, metastatic adenocarcinoma, and high-grade PIN among others. Arrow points to a mitotic figure in this image.
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Treatment induced changes in Prostate
Anti-Androgen Therapy : Prostate Cancer
Anti-Androgen Therapy : Benign Prostate
Anti-Androgen Therapy : Benign Prostate
Radiation Therapy : Benign Prostate
Radiation Therapy : Benign Prostate
Radiation Therapy : Benign Prostate - HMWCK Immunostain
Radiation Therapy : Benign Prostate
Anti-Androgen Therapy : Prostate Cancer
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Malignant Fibrous Histiocytoma in Prostate
This illustration shows a high grade sarcoma arising in the prostate. The tumor has the appearance of pleomorphic & giant cell MFH.
Inflammatory Pseudotumor in Prostate
his prostate needle biopsy was done in a middle-aged man for progressively rising PSA. It shows a spindle cell proliferation with abundant collagenous stroma containing a few inflammatory cells.
Inflammatory Pseudotumor in Prostate
Rare mitotic figures were seen. The remainder of the biopsies showed moderate to severe chronic inflammation.The cells in question were negative for PSA and PAP and positive for vimentin. A diagnosis of inflammatory pseudotumor was rendered. The PSA came down with antibiotic therapy
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Benign Prostate Glands - Keratin Immunostain
The antibody to high molecular weight keratin 34bE12 stains all normal basal cells as seen in this image. The stromal cells and acinar epithelial cells do not stain
Post-Atrophic Hyperplasia - Keratin
