Surgical Pathology Criteria

Prostatic Adenocarcinoma

Differential Diagnosis

Benign lesions and patterns that may be confused with prostatic adenocarcinoma

Partial Atrophy Carcinoma
Frequently merges with atrophic glands Distinct population from adjacent benign glands
Apical cytoplasm typically lost with preservation of lateral cytoplasm, separating the nuclei Apical cytoplasm typically preserved or increased while lateral is lost resulting in nuclear crowding
Bland nuclei, lacking enlarged nucleoli Large atypical nuclei with large nucleoli frequently present
Lacks infiltrative pattern Infiltrative pattern usually present
Basal cell markers positive, but may be decreased No basal cells
Non-straightforward cases should be resolved with IPOX stains for  basal cell markers
Post-atrophic Hyperplasia Carcinoma
Usually related to a large duct Haphazard infiltrative pattern
Bland nuclei Large atypical nuclei with large nucleoli usually present
Basal cell markers strongly positive Basal cells absent
Stroma typically sclerotic No sclerosis of stroma
Non-straightforward cases should be resolved with IPOX stains for cell markers
Basal Cell Hyperplasia Carcinoma
Smooth borders, lobular pattern Infiltrative pattern
Usually produces a pattern of small blue glands with scant cytoplasm Low grade carcinomas are rarely blue in appearance as most have a moderate amount of pale or amphophilic apical cytoplasm
Residual luminal secretory population may be focally identified as a distinct population Carcinoma cells are typically uniform
Bland nuclei Large atypical nuclei usually present
Nucleoli are easy to find but are small to moderate size Nucleoli may be quite large
Basal cell markers strongly positive Basal cells absent
Non-straightforward cases should be resolved with IPOX stains for basal cell markers
Clear Cell Cribriform Hyperplasia Carcinoma
Smooth borders, lobular pattern Infiltrative pattern
Uniform, bland nuclei without prominent nucleoli Large atypical nuclei usually present
Nucleoli inconspicuous or absent Nucleoli may be quite large
May be associated with cellular BPH-type stroma Lacks BPH type-stroma or reactive stroma
Basal cell markers positive Basal cells absent
Non-straightforward cases should be resolved with IPOX stains for basal cell markers
Sclerosing Adenosis Carcinoma
Prominent sclerotic stroma Typically no stromal response in prostate
Basal cell markers strongly positive (p63, HMWCK) Basal cells absent
Myoepithelial markers positive in basal cells (smooth muscle actin, S100) Basal cells absent
Lacks cytologic atypia and macronucleoli May have cytologic atypia inclucing macronucleoli
Non-straightforward cases should be resolved with IPOX stains for basal cell and myoepithelial markers
Nephrogenic Adenoma Carcinoma
Papillary and cystic patterns usually also present Papillae and dilated cystic areas uncommon in low grade carcinoma
Prominent peritubular basement membrane Lacks basement membrane
PAX8, CK7 positive PAX8, CK7 negative
Non-straightforward cases should be resolved with IPOX stains
Seminal Vesicle / Ejaculatory Duct Carcinoma
Marked nuclear pleomorphism Marked nuclear pleomorphism is unusual in prostate carcinoma
Indistinct smudged chromatin Chromatin and nucleoli usually distinct
Cytoplasmic lipofuscin nearly always present Lipofuscin rarely seen in carcinoma
May have nuclear pseudoinclusions Nuclear pseudoinclusions rare
Surrounding muscular wall with a large central luminal space may identifiable in some biopsies Lacks a defined muscular wall and large central luminal space
Basal cell markers positive, prostate markers negative Basal cells absent, prostate markers positive
Non-straightforward cases should be resolved with IPOX stains for prostate and basal cell markers

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