Prostate Flashcards
MC infectious cause of prostatitis
E. Coli
Enterococcus
T or F: acute prostatitis causes clinically elevated PSA
True
MC site of metastasis of acinar prostate adenocarcinoma and what type
Bone (MC: lumbar spine) - osteoblastic
T or F: IHC useful to disprove cancer, not prove cancer
True
T or F: tumors showing treatment effect (androgen deprivation or radiation therapy) are not graded
True
What is the importance of recording percentage of pattern 4 in Gleason score 7?
3+4 with a small amount of pattern 4 (less than or equal to 10%) may be eligible for active surveillance
T or F: in the setting of high grade cancer, ignore low grade cancers if they occupy <5% of the area of the tumor
True
T or F: high grade tumor of any quantity should be included
True
An early molecular event for development of prostate cancer
TMPRSS2-ERG fusion
Presence of this mutation significantly increases risk of prostate cancer
BRCA2
What are considered extraprostatic extension?
Invading fat
Involving loose connective tissue beyond the plane of the prostate
Involving perineural spaces in the neurovascular bundles
Invasion of UB neck
Seminal vesicle involvement (muscular wall)
A descriptive term used when there us a collection of small glands suspicious for cancer but lack definitive diagnostic features
Atypical small acinar proliferation (ASAP)
How many glands are needed to diagnose cancer?
No absolute number but at least 3
Architecture of HGPIN
Tufting, micropapillary and flat growth pattern
A distinct precursor lesion with high risk of progression to cancer or part of intraductal spread of invasive cancer.
Pattern: solid, dense (>50% Epithelium to luminal space ratio) or loose cribriform and micropapillary pattern
Dx?
Is ihc needed?
Graded?
Prognosis?
Intraductal carcinoma (IDC)
Yes to demonstarte basal cells
Not graded
Associated with high gleason grade and tumor volume
Term used if a lumen-spanning atypical lesion morphologically falls short of intraductal carcinoma
Atypical intraductal proliferation
Subtype of prostatic adenocarcinoma with tall, columnar, pseudostartified epithelium with elongated nuclei arranged in papillary and cribriform architecture in dilated glands (like endometrioid adenocarcinoma)
Grade?
Typical location?
Prognosis?
Ductal adenocarcinoma
Pattern 4 but if there is necrosis, grade as 5
Typically periurethral location
More aggressive than acinar adeno, with seminal vesicle invasion and EPE
More likely to be mixed with acinar rather than pure
Why is it important to know the location of the urothelial carcinoma that has spread into the prostate?
If from bladder: prostate stroma (T4)/ mucosal (T2)
If from prostatic urethra: prostate stroma (T2)
Tumor with adenoid/cystic pattern with inspissated secretions and small solid nests with hyaline rim.
(+) p63 outer cells
(+) CK7 luminal cells
HER2 overexpression
Graded?
Behavior?
Basal cell carcinoma
GS not used
Aggressive
Extremely rare and mostly arise from either divergent differentiation of basal
Cells or transdufferentiation of usual adenocarcinoma following hormonal therapy
SCCA
A patient with treated prostate cancer came in for monitoring. Biopsy of the prostate showed sheets of small dark blue cells.
(+) synaptophysin
Dx?
Risk factor?
Criteria?
Small cell neuroendocrine carcinoma
Treated prostate cancer
Positive in at least 1 NE marker
A biopsy of the prostate shows hypercellular stroma with scattered degenerative appearing cells admixed with benign glands
Dx?
Prognosis
Stromal tumor of uncertain malignant potential (STUMP)
Good prognosis
Proliferation of basal cells and appears blue due to crowded nuclei with scant cytoplasm filling tubules that may form solid nests
Basal cell hyperplasia
Nodules of clear cells with smooth gland borders. Cells show uniform bland nuclei without prominent nucleoli.
Most often seen in central zone on TURP in BPH
Clear cell cribriform hyperplasia
Glands with abundant mucin-filled cytoplasm (PASD+) with lobular architecture most often seen in periurethral area near the apex
Cowper’s glands
Well-circumscribed tightly packed uniform glands with lobular architecture with cells with pale to clear cytoplasm.
Occurs in transition zone.
What is the difficulty encountered in distinguishing from adenocarcinoma?
Adenosis/ atypical adenomatous hyperplasia
Basal cells may be decreased in adenosis
Lobular or focally infiltrative proliferation of dense spindled stroma and entrapped epithelial elements that lack cytologic atypia.
(+) p63, HMWCK, SMA, s100
Sclerosing adenosis
The MC benign mimicker of prostatic carcinoma on needle biopsy.
Why is PIN-4 interpretation problematic in this case?
Partial atrophy
Because basal cells may be patchy or absent and luminal AMACR reactivity is common
Here, there are tightly packed very small cytologically bland glands clustered around a larger dilated “feeder” vessel
Post-atrophic hyperplasia (PAH)
MC cause of malakoplakia in prostate
Stains for MG bodies?
E. Coli
Klebsiella pneumoniae
Von kossa and prussian blue
IHC to differentiate seminal vesicle glands and prostate glands
CK7 (+) in seminal vesicle glands
Hyperplasias mc occur in what zone of the prostate
Transition zone
MC form of prostatitis
Chronic abacterial prostatitis (chronic pelvic pain syndrome)
- prostatic secretions contain >10 leukocytes/hpf but negative culture
What is the main androgen in the prostate and how is it formed
Where does it bind
How does it cause BPH
Dihydrotestosterone (DHT)
From testosterone through action of type 2 5alpha-reductase (stromal cells)
Type 1 from extraprostatic testosterone
Activates AR receptors in stroma and epithelium —> growth factor production (FGF and TGF-B)—> increase proliferation of stromal cells and decrease the death of epithelial cells
Note: estrogen also contributes
BPH affects what zone
Inner periurethral zone and transition zone
