237. Pathology Prostate + PCa

Question 1

Most common type of PCa

3 Zones of prostate, which is site of most PCa

Dx of PCa

What 3 types of epithelial cells are found in Prostate?

Answer 1

95% ADENOCARCINOMA

1. Transition Zone
2. Central Zone
3. Peripheral Zone (site of PCa)

Dx: GOLD STD - Needle Core Biopsy - 12 cores, 6 locations

Epithelial: Secretory Cells, Basal Cells, Neuroendocrine Cells (visualize with IHC stain)

Question 2

Prostate Adenocarcinoma

• gross
• histo key features
• how to tell if PSA abnormal
• Basal Cell and Adenocarcinoma Markers + and -

Answer 2

Gross: Peripheral Zone mass, yellow, most multifocal
Histo: small infiltrating glands, extracellular pink crystalloid secretion, prominent nucleoli, perineural invasion

PSA: normally secreted to lumen, abnormal if stains outside of lumen - drains to blood - elevated in blood raises suspiscion

Markers:
(-): 34-beta-E12, p63 (basal cell markers - no basal cells left)
(+): PSA, AMACR (essential enzyme for beta-ox of BCFAs, relation to high fat diet? found in adenocarcinoma)

Question 3

What is the Gleason Grading Scores and Grading Groups?

Answer 3

Score: SUM of predominant pattern and 2nd most predominant pattern

1: noninvasive small glands
2: low grade gland size variation
3: well-formed malignant glands/cells (pink secretion)
4: fused glands/cribiforming
5: single cells/solid sheet, comedo (central necrosis)

Grade
I: = 6
II: 3+4
III: 4+3
IV: 8
V: 9-10

Question 4

High Grade Prostatic Intraepithelial Neoplasia (PIN)

• features
• risk

Basal Cell Carcinoma

• features
• IHC stain markers

Ductal Adenocarcinoma
- what it is, features, prognosis, IHC markers

Answer 4

PIN: neoplastic cells within pre-existing glands, like CIS but NOT CANCEROUS (may lead to prostate cancer)

BCC: form nests, perineural invasion
IHC - +PSA, +Nkx3.1, -AMACR, variable Ki67

Ductal Adenocarcinoma: histo variant of prostatic adenocarcionma

• tall columnar tumor cells
• prognosis equivalent to Gleason Pattern 4
• IHC: +Androgen receptor, +PSA

Question 5

Small Cell Carcinoma
- feature, prognosis

Primary Urothelial Cancer of Prostate

• feature
• prognosis

Answer 5

SCC: >50% assoc with prostatic adenocarcinoma

• “oat cell carcinoma”
• neuroendocrine differentiation
• aggressive disease, needing systemic tx, poor prognosis

Primary UCa prostate: derived from urothelium of prostatic urethra, similar to bladder UCa, no response to hormonal tx (urothelial tumor cells)

Question 6

BPH

• gross
• histo

Answer 6

Gross: enlarged prostate, multiple nodules most in transition zone, compress prostatic urethra may cause obstruction

Histo: nodular cell proliferation, components (glandular epithelial cells, stromal cells - may exist in different ratios)

Question 7

Other prostate diseases

Infarct with Assoc Squamous Metaplasia

• demographic
• findings

Nonspecific Granulomatous Prostatitis
- findings, histo, labs

Staging of PCa (T1-T4)

Answer 7

Infarct: elderly age, enlarged prostate, high PSA due to dead cells releasing it

Granulomatous: hard nodules on DRE, histo showing mixed inflammatory cells around ducts, epithelioid histiocytes +/- true granuloma (inflammation causes high PSA)

T1: within prostate
T2: within prostate (larger)
T3: outside capsule (3a), in seminal vesicles (3b)
T4: mets (LN, vertebrae)