SM_237b: Pathology of the Prostate

Question 1

Most prostate cancer is ___

Answer 1

Most prostate cancer is adenocarcinoma

Question 2

____ is the gold standard for diagnosis of prostate cancer

Answer 2

Prostate needle core biopsy w/ 12 cores at 6 locations is the gold standard for diagnosis of prostate cancer

Question 3

Prostatic gland consists primarily of ___

Answer 3

Prostatic gland consists primarily of epithelial cells

• Secretory cells
• Basal cells
• Neuroendocrine cells

Question 4

Describe diagnostic features of prostatic adenocarcinoma

Answer 4

Prostatic adenocarcinoma diagnostic features

• Architectural: small glands, infiltrating, straight luminal borders, no basal cells, retraction
• Extracellular material: blue mucin, crystalloids, pink secretion
• Cytological: prominent nucleoli, nuclear enlargement, hyperchromasia, amphophilic cytoplasm, mitosis
• Special structures: perineural invasion, collagenous micronodules, glomeruloid structures, capsule invasion

Question 5

____, ____, and ____ are key histological features of prostatic adenocarcinoma

Answer 5

Small glands, infiltrating patterns, and prominent nucleoli are key histological features of prostatic adenocarcinoma

Question 6

Perineural invasion of prostatic adenocarcinoma predicts ___

Answer 6

Perineural invasion of prostatic adenocarcinoma predicts extraprostatic extension

Question 7

Prostate specific antigen is secreted by ___

Answer 7

Prostate specific antigen is secreted by luminal cells of prostate

Question 8

____ occurs in prostatic adenocarcinoma

Answer 8

Loss of basal cells occurs in prostatic adenocarcinoma

Question 9

____ is an essential enzyme for beta-oxidation of branched chain fatty acids that is a new prostate cancer marker

Answer 9

Alpha-methylacyl-CoA racemase (AMACR) is an essential enzyme for beta-oxidation of branched chain fatty acids that is a new prostate cancer marker

• Possible relation to high fat diet

Question 10

This is ___

Answer 10

This is prostate adenocarcinoma

Question 11

Describe the Gleason Grading System for prostate

Answer 11

Gleason Grading System for prostate

• Based on cell differentiation (architecture)
• Correlates well with prognosis
• Grade 1-5
• Score 2-10
• Gleason score is sum of predominant pattern and second most prevalent pattern

Question 12

This is Gleason ____

Answer 12

This is Gleason grade 1

Question 13

This is Gleason ____

Answer 13

This is Gleason grade 2

Question 14

This is Gleason ____

Answer 14

This is Gleason grade 3

Question 15

This is Gleason ____

Answer 15

This is Gleason grade 4 (fused glands)

Question 16

This is Gleason ____

Answer 16

This is Gleason grade 4

Question 17

This is Gleason ____

Answer 17

This is Gleason grade 5 (single cells)

Question 18

This is Gleason ____

Answer 18

This is Gleason grade 5 (solid sheet)

Question 19

This is Gleason ____

Answer 19

This is Gleason grade 5 (comedo)

Question 20

Lower Gleason score has ___ prognosis

Answer 20

Lower Gleason score has better prognosis

• 4+3 is worse than 3+4

Question 21

High grade prostatic intraepithelial neoplasia is ___

Answer 21

High grade prostatic intraepithelial neoplasia is neoplasm cells growing within pre-existing glands (ducts and acini)

• Non-invasive neoplastic lesion
• Precursor lesion of prostate cancer

Question 22

This is ___ of prostate

Answer 22

This is basal cell carcinoma of prostate

Question 23

Describe ductal adenocarcinoma of prostate

Answer 23

Ductal adenocarcinoma of prostate

• “Endometrioid carcinoma”
• Histological variant of prostatic adenocarcinoma
• Tall columnar tumor cell
• Equivalent to Gleason pattern 4
• Androgen receptor positive and PSA positive

Question 24

Describe small cell carcinoma of prostate

Answer 24

Small cell carcinoma of prostate

• More than 50% of cases associated with prostatic adenocarcinoma
• “Oat cell carcinoma”
• Neuroendocrine differentiation
• Aggressive systemic disease requiring special treatment

Question 25

Describe primary urothelial carcinoma of prostate

Answer 25

Pimary urothelial carcinoma of prostate

• Derived from urothelium of prostatic urethra
• Morphologically similar to urothelial carcinoma of bladder
• Do not respond to hormonal therapy

Question 26

Describe benign prostatic hyperplasia

Answer 26

Benign prostatic hyperplasia

• Hyperplasia: increase in number of cells
• Enlarged prostate
• Multiple nodules mostly located in transition zone
• Compressed prostatic urethra

Question 27

Benign prostatic hyperplasia involves ____ and components of ____ and ____

Answer 27

Benign prostatic hyperplasia involves nodular cell proliferation and components of glandular epithelial cells and stromal cells

Question 28

This is ____

Answer 28

This is prostatic infarct and associated squamous metaplasia

Question 29

Describe non-specific granulomatous prostatitis

Answer 29

Non-specific granulomatous prostatitis

• Hard nodules on digital exam
• Mixed inflammatory cells around ducts
• Epithelioid histiocytes
• True granuloma may not be obvious

Question 30

Describe pathological staging of prostate cancer

Answer 30

Pathological staging of prostate cancer

• T2: confined within prostate
• T3: outside prostatic capsule (T3A) or in seminal vesicles (T3B)

Surgical margins or volume of tumor can also be used to evaluate extent of cancer

Question 31

This is stage ___

Answer 31

This is stage T3a prostatic adenocarcinoma

Question 32

This is stage ___

Answer 32

This is stage T3b prostatic adenocarcinoma

Question 33

These are ____

Answer 33

These are metastatic prostate adenocarcinoma