Prostate Flashcards
What are some features of Nodular Hyperplasia of the prostate?
Expression of p27 (negative in normal prostate)
Transition zone
Hyperplasia of stromal and glandular tissue; may contain corpora amylacea;
stromal component contains more smooth muscle and less elastic tissue than neoplastic
Name benign mimics of prostatic carcinoma
10 listed
Florid hyperplasia of mesonephric remnants
Xanthoma / foamy macrophages
Extramedullary hematopoesis (in myelofibrosis)
Atrophy
Partial Atrophy (the most common mimic - basal cell markers may be lost and cytoplasm may stain for AMACR)
Basal cell hyperplasia
Clear cell cribriform hyperplasia good to know
Sclerosing Adenosis
Adenosis
Radiation changes
How does the prostate normally stain for CK7 and CK20?
CK7 / CK 20 negative
What organs are negative for CK 7 and CK 20?
Liver
Kidney
Prostate
Adrenal
What are (4) prostatic basal cell markers?
34BE12 / CK903
GATA3
CK5/6
P63
What is the threshold above which PSA should be monitored, with performance of biopsy if it continues to rise?
4.0 mg/mL
In what region of the prostate does carcinoma typically arise?
Peripheral Zone
What are the (3) pathognomonic histological signs of prostate cancer?
Circumferential perineural invasion
Glomeruloid formation
Mucinous fibroplasia / collagenous micronodules
not pathognomonic but good hint: crystalloids, wispy blue mucin.
What are the (3) histologic types of prostatic carcinoma listed in the CAP protocol?
Acinar adenocarcinoma
Ductal adenocarcinoma
Small-cell neuroendocrine carcinoma
Name some other histologic types of prostatic carcinoma
Pure squamous cell carcinoma
Adenosquamous
Mucinous
Small cell neuroendocrine carcinoma
Signet ring carcinoma
Basal cell carcinoma / adenoid cystic carcinoma
Adenoid basal cell tumor
lymphoepithelioma-like
Sarcomatoid
Name some histologic variants of acinar adenocarcinoma
Foamy gland carcinoma
Prostatic adenocarcinoma with atrophic features
Pseudohyperplastic prostatic adenocarcinoma
PIN-like adenocarcinoma
Aberrant p63-expressing adenocarcinoma
What is ASAP?
Atypical Small Acinar Proliferation
Frequent problem in prostatic biopsies. Foci of small atypical glands that are suspicious but not diagnostic of carcinoma.
4 - 6% of biopsies
Warrants second biopsy
What are the histologic features of ductal prostatic adenocarcinoma?
Architecture: papillary and cribriform
Lined by columnar pseudostratified malignant epithelium
Intact basal cells
More advanced stage at presentation
May present as macrocystic, or as small prostatic urethral polyps
What is the immunoprofile of prostatic adenocarcinoma?
PSAP + (more sensitive, less specific, also stains rectal carcinoid!)
PSA + (more specific)
NKX3.1 +
AMACR (racemase): PIN and invasive carcinoma +; not used for evaluation of metastasis
Basal cell markers: absent in prostate cancer, present in adenosis, PIN: p63, p40, HMWCK (CK 5/6, 34BE12)
Name some benign entities that can stain with AMACR
adenosis (10%) nephrogenic adenoma (60%) partial atrophy (25%)
Is AMACR always positive in prostate carcinoma?
No. Negative in: 20% of conventional 65% of foamy gland 65% of atrophic 75% of pseudohyperplastic
Always use in combination with basal cell markers for prostate Ca and do not use for the origin of metastasis.
What are some histologic features of PIN?
Only high-grade is reported.
More basophilic than surrounding glands high N:C nuclear crowding amphophilic cytoplasm large nuclei with NUCLEOLI (should see at 20x)
Arhictectural variations: tufting, micropapillary, cribriform, flat/atrophic
Cytologic variations: foamy, hobnail
HGPIN found in step sectioned prostatectomies 59 - 100% of the time; may have high predictive value for presence of carcinoma. Does not often change follow-up protocols.
LGPIN common, not reported.
What are the features of INTRAductal carcinoma?
High-grade cancer colonizing glands, beyond HGPIN architecturally and cytologically.
ROSAI: Malignant epithelial (prostatic secretory) cells filling large prostatic acini or ducts, with at least partial preservation of basal cells, forming either:
1) solid or dense cribriform patterns
2) loose cribriform patterns or micropapillary with marked nuclear atypia (6x normal size) or nonfocal comedonecrosis.
PTEN protein loss by immunohistochemistry (not widely used)
IDC NOT factored into Gleason grading, but IS reported.
Features to distinguish intraductal (IDC) from ductal adenocarcinoma of the prostate?
Ductal: true papillary architecture
neoplastic cells with pseudostratified columnar morphology
vs.
IDC: cuboidal cells, round nuclei.
Features to distinguish invasive acinar adenocarcinoma with cribriform architecture from IDC?
Acinar adenocarcinoma: more irregular distribution, other patterns of invasion, more variation in size and shape of cribriform structures, absence of basal cells.
NB: to tell from HGPIN: IDC should bridge the entire intraluminal space; extension into adjacent ducts also a hint.
Define pT1, pT2, pT3 and pT4 in prostate resection specimens.
pT1: Does not exist ! no pT1 in prostate.
pT2: organ-confined
pT3a: extraprostatic extension or microscopic invasion of bladder neck
pT3b: invades seminal vesicles
pT4: Tumor is fixed or invades adjacent structures other than seminal vesicles (ex. external sphincter, rectum, bladder, levator muscles, and/or pelvic wall)
how are lymph nodes staged in prostate cancer (N stage)?
pN1: metastasis to regional nodes.
pM1a = mets to non-regional nodes.
What morphology (4) defines Gleason 4?
Poorly formed
Fused
Cribriform
Glomerulations
What morphology defines Gleason 5?
Lack gland formation
sheets
cribriform glands with central comedonecrosis
single infiltrating cells (mimics lobular breast)
