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Book - Molavi > Chapter 11 - Prostate > Flashcards

Chapter 11 - Prostate Flashcards

1
Q

What are the usual indications for prostate biopsy?

A

Elevated PSA

Palpalble nodule

History of abnormal biopsy

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2
Q

Describe the low power features of prostatic adenocarcinoma.

A

Small individual glands infiltating among larger benign glands.

Crowded, cribriform glands

Mucin, crystalloids, or pink luminal secretions

NO desmoplastic response

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3
Q

Describe the high power features of prostatic adenocarcinoma.

A

Large, cherry-red nucleoli

Enlarged & hyperchromatic nuclei

Lack of basal cell layer

Mitoses (uncommon)

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4
Q

What three features guarantee a diagnosis of prostatic adenocarcinoma?

A
  1. Perineural invasion
  2. Mucinous fibroplasia (hyalinized whorls of secretions)
  3. Glomeruloid forms
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5
Q

What is Gleason grading?

How does it differ between cancer resections and biopsies?

A

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.

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6
Q

What are the features of Gleason grades 1 and 2?

A
  1. Rarely used; a circumscribed nodule of uniform crowded glands.
  2. A circumscribed nodules of well-defined glands with minimal infiltration at the peirphery; less uniform than pattern 1.
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7
Q

What are the features of Gleason grade 3?

A

Highly infiltrative glands with discrete and individual gland profiles (can draw a circle around each gland)

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8
Q

What are the features of Gleason grade 4?

A

Fused and ill-defined glands, sheets of cribriform glands, poorly formed lumens.

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9
Q

What are the features of Gleason grade 5?

A

A complete absence of glandular differentiation, solid sheets and cords of cells, single cells.

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10
Q

Why can’t Gleason 1/2 be diagnosed on biopsies?

A

They can only be identified in the context of surrounding tissue.

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11
Q

What features must be mentioned in the signout of a prostate biopsy?

A

Number of involved cores, percentage involvement, size of foci.

Perineural invasion, extraprostatic extension.

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12
Q

What is the clinical significance of prostatic intraepithelial neoplasia (PIN)?

A

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.

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13
Q

What is the morphologic appearance of prostatic intraepithelial neoplasia (PIN)?

A

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)

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14
Q

Name 7 mimics of prostate cancer.

A

Adenosis

Atrophy

Basal cell hyperplasia

Cowper’s glands

Radiation changes

Seminal vesicle

Sclerosing adenosis

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15
Q

Describe the morphologic appearance of prostatic adenosis.

A

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.

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16
Q

Describe the morphologic appearance of prostatic atrophy.

A

Shrinkage of the cells forming the lumen, leaving rows of essentially flat nuclei. Small and irregular, angulated/staghorn appearing. Basal layer present.

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17
Q

Describe the morphologic appearance of prostatic basal cell hyperplasia.

A

Denim-blue, oval, regular nuclei surrounding the glandular nuclei. Recognize the dual population and do not worry about the multiple layers. Immunostain if needed.

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18
Q

Describe the morphologic appearance of Cowper’s glands.

What do they stain?

A

Mucous-filled secretory glands surrounding a coil of ducts. Lobular architecture with bland nuclei.

PAS+, PSA/PSAP-

19
Q

Describe the morphologic appearance of radiation changes in prostate.

A

TOO much pleomorphism to be cancer. Atrophic cytoplasm and wildly pleomorphic nuclei.

20
Q

Describe the morphologic appearance of seminal vesicle.

A

Very pleomorphic nuclei, like radiation atypia.

Golden globs of lipofuscin.

21
Q

Describe the morphologic appearance of prostatic sclerosing adenosis

A

Hyperplastic and proliferative lesion with a hypercellular stroma. Remember that prostate cancer does not induce a stromal reaction.

22
Q

How can one approach the presence of a few isolated abnormal glands?

A

Sign out as a focus of atypical glands (generating a repeat biopsy)

Immunostain for the basal layer (CK903, p63) or cancer (racemase).

23
Q

What are the margins of the radical prostatectomy?

A

Left and right vas deferens (rarely submitted)

Apical (distal) margin

Bladder neck margin

24
Q

How can anterior and posterior prostate be oriented histologically?

A

Posterior features neurovascular bundles (at the posterolaterla corners)

Anterior sections shoudl have smooth muscle bundles and a poorly defined capsule

(Verumontanum points anteriorly, too)

25
Q

What features define extraprostatic extension? How can it be assessed?

A

Presence of glands in the fat; not necessarily the same as a positive margin or capsular incision

Best appreciated at low power by following the contour of the edge of the prostate.

26
Q

What feature defines seminal vesicle invasion?

A

Tumor must be in the parenchyma of the seminal vesicle, not just be next to it.

27
Q

What are the morphologic features of prostatic ductal adenocarcinoma?

A

Tall, stratified columnar cells making papillary or cribfriform structures. May grow into urethra as exophytic masses. Behaves like a Gleason 4 lesion.

28
Q

Name some other forms of carcinoma in the prostate.

A

Mucinous carcinoma

Squamous cell carcinoma

Urothelial carcinoma

Sarcomatoid carcnoma

Basal cell carcinoma

29
Q

variants of usual prostate cancer.

A

Pseudohyperplastic carcinoma (mimics papillary architecture of benign hyperplasia)

Atrophic cancer (mimics atrophy)

Foamy gland cancer (abundant xanthomatous appearing cytoplasm)

30
Q

What are some prostatic stromal lesions?

A

Benign stromal nodules, stromal tumors of uncertain malignant potential, and stromal sarcomas.

Most common is leiomyosarcoma.

Rhabdomyosarcoma in children.

31
Q
A

Prostatic adenocarcinoma, low power.

Arrow: Adenocarcinoma

Arrowheads: Benign glands

32
Q
A

Benign prostatic glands

Arrowhead: Basal layer

Arrow: Papillary fronds

33
Q
A

Prostatic adenocarcinoma, high-power.

Arrowhead: Distinct nucleoli

Arrow: Benign adjacent glands

34
Q
A

Perineural invasion in prostatic adenocarcinoma

Arrow: Invasive malignant glands

35
Q
A

Gleason pattern 3

Arrow: Blue mucin in glands

36
Q
A

Gleason pattern 4

Arrow: Cribriform growth and adjacent fused glands

37
Q
A

Gleason pattern 5

Circle: Individual malignant invasive glands with prominent nucleoli

38
Q
A

High-grade prostatic intraepithelial neoplasia

Arrow: Larger and darker nucleoli with nucleoli

Arrowhead: Retained basal layer

39
Q
A

Atrophy

Arrow: Low cuboidal epithelium with attenuated cytoplasm

Arrowhead: Corpora amylacea

40
Q
A

Basal cell hyperplasia

Arrow: Cells with prominent nucleoli

Arrowhead: Benign epithelium

41
Q
A

Radiation atypia

Arrow: Pronounced nuclear pleomorphism

42
Q
A

Seminal vesicle

Arrowhead: Crowded, hyperchromatic nuclei

Arrow: Golden pigment

43
Q
A

Extraprostatic extension and perineural invasion.

Note, margin is negative.

44
Q
A

Ductal adenocarcinoma

Note tall columnar morphology with usual prostatic cytology.

Book - Molavi (29 decks)

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