Prostate and seminal vesicle

Question 1

Prostate with small, crowded glands that are often back-to-back, lack basal layer, and infiltrate between benign glands. Glands contain blue tinged mucin, and have amphophilic cytoplasm (appearing darker than benign blands) and enlarged nuclei with prominent nucleoli. Perineural invasion is common and highly specific.

Answer 1

Prostatic acinar adenocarcinoma

Differential diagnosis:
Seminal vesicle
Urothelial carcinoma involving prostate gland

Plan:
Correlate with clinical history and radiology (?raised PSA ?prostate needle biopsies)
Examine further sections (e.g. for size, relation to margins, Gleason grade)
IPX to support Dx: p63, NKX3.1, AMACR (expect positive, with p63 showing loss of basal cells)
IPX to discount DDx: CK7, GATA3
Next steps: Synoptic report, discuss at MDT

Question 2

Necrotising granulomatous inflammation of prostate gland

Answer 2

Granulomatous prostatitis

Plan:
Correlate with clinical history and radiology (?BCG therapy ?immunosupression ?systemic granulomatous disease)
Correlate with concurrent microbiology investigations - if available, send fresh tissue for culture
Examine further sections
Special stains: Gram, PAS, GMS, ZN (to look for infectious agents)
Advice to clinician: May be idiopathic, due to BCG therapy, instrumentation, or infection. Clinical correlation is required.

Question 3

Seminal vesicle with deposition of amorphous eosinophilic material beneath the epitheium, with areas of ‘cracking’ artefact.

Answer 3

Amyloidosis of seminal vesicle

Plan:
Correlate with clinical history (?history of systemic amyloidosis or an antecedent condition such as inflammatory disease, myeloma)
Special stains: Congo red (expect ‘salmon pink’ staining with ‘apple green’ birefringence under polarised light)
Advice to the clinician: This condition can be an incidental finding localised to the seminal vesicle, or may reflect systemic amyloidosis. Clinical correlation is required.