Malignant epithelial neoplasm of the prostatic acini and ducts
See Classification/Links in left sidebar for Ductal, Intraductal, Small Cell, Mucinous types
Presence of any one of the following features, even if only focal, is considered diagnostic of prostatic adenocarcinoma (none are required for diagnosis and in real life, it is rather uncommon to have these without obvious carcinoma near by)
Circumferential perineural invasion
Glands adjacent to and indenting nerves is not sufficient as a solitary diagnostic criterion
Partial surrounding of nerve may be used as supportive evidence for a diagnosis of carcinoma
Epithelial proliferation projecting into the gland lumen
Typically a cribriform tuft with a single attachment to the side of the gland
Resembles a glomerulus in Bowman’s space
Mucinous fibroplasia / collagenous micronodules
Dense nodules of collagen surrounded and encased by epithelium
Frequently entraps epithelial cells
Frequently appears to represent organized, hyalinized mucin
The presence of the following features can also be used to make the diagnosis of carcinoma, but none are specific by themselves and none of them is required
Generally more than one must be present and the focus must not be explainable as a benign glandular collection
Nuclear enlargement (moderate) and hyperchromasia large nucleoli
Nuclei are frequently enlarged, but typically uniform
Very large or pleomorphic nuclei suggest a non-prostatic primary (or normal seminal vesicle)
May be seen in acute inflammation, partial atrophy
Prominent enlarged nucleoli
Nucleoli >3 μ are very rare outside of carcinoma
Enlarged nucleoli but <3 μ, while not diagnostic may still be helpful
Basal cells have prominent but small nucleoli
Luminal blue (acidic) mucin or dense pink amorphous secretion
May be seen in adenosis and rarely in partial atrophy
Bright red, sharp corners, rectangular
May be seen in adenosis
Do not confuse with fractured corpora amylacea which may have occasional sharp edges
Sharp luminal border
Normal glands frequently have an undulating border
Nuclei consistently lined up basally
Normal glands usually have nuclei at many levels
Not seen in all carcinomas but helpful when present
A distinct population of glands surrounding or separating benign glands
Lack of lobularity
Crowded, haphazard glands
Immunohistochemical demonstration of complete absence of basal cells can be confirmatory of a diagnosis of carcinoma but must be interpreted with caution (see Supplemental Studies)
The entire January 2012 issue of Histopathology is devoted to reviews on prostate cancers:
Epstein, J. I. (2012), Diagnosis of limited adenocarcinoma of the prostate. Histopathology, 60: 28–40.
Montironi, R., Scarpelli, M., Mazzucchelli, R., Cheng, L. and Lopez-Beltran, A. (2012), The spectrum of morphology in non-neoplastic prostate including cancer mimics. Histopathology, 60: 41–58.
Humphrey, P. A. (2012), Histological variants of prostatic carcinoma and their significance. Histopathology, 60: 59–74.
Delahunt, B., Miller, R. J., Srigley, J. R., Evans, A. J. and Samaratunga, H. (2012), Gleason grading: past, present and future. Histopathology, 60: 75–86.
Cheng, L., Montironi, R., Bostwick, D. G., Lopez-Beltran, A. and Berney, D. M. (2012), Staging of prostate cancer. Histopathology, 60: 87–117.
Egevad, L. (2012), Handling of radical prostatectomy specimens. Histopathology, 60: 118–124.
Kristiansen, G. (2012), Diagnostic and prognostic molecular biomarkers for prostate cancer. Histopathology, 60: 125–141.
Two recent reviews in Archives of Pathology:
Brian Robinson, Cristina Magi-Galluzzi, Ming Zhou , (2012) Intraductal Carcinoma of the Prostate. Archives of Pathology & Laboratory Medicine: April 2012, Vol. 136, No. 4, pp. 418-425.
Lars Egevad, Roberta Mazzucchelli, Rodolfo Montironi , (2012) Implications of the International Society of Urological Pathology Modified Gleason Grading System. Archives of Pathology & Laboratory Medicine: April 2012, Vol. 136, No. 4, pp. 426-434.
Eble JN, Sauter G, Epstein JI, Sesterhenn IA (Eds): World Health Organization Classification of Tumours. Pathology and Genetics of Tumours of the Urinary System and Male Genital Organs. IARC Press. Lyon 2004.
Kaleem Z, Swanson PE, Vollmer RT, Humphrey PA. Prostatic adenocarcinoma with atrophic features: a study of 202 consecutive completely embedded radical prostatectomy specimens. Am J Clin Pathol. 1998 Jun;109(6):695-703.
Egan AJ, Lopez-Beltran A, Bostwick DG. Prostatic adenocarcinoma with atrophic features: malignancy mimicking a benign process. Am J Surg Pathol. 1997 Aug;21(8):931-5.
Cina SJ, Epstein JI. Adenocarcinoma of the prostate with atrophic features. Am J Surg Pathol. 1997 Mar;21(3):289-95.
Levi AW, Epstein JI. Pseudohyperplastic prostatic adenocarcinoma on needle biopsy and simple prostatectomy. Am J Surg Pathol. 2000 Aug;24(8):1039-46.
Arista-Nasr J, Martinez-Benitez B, Valdes S, Hernández M, Bornstein-Quevedo L.
Pseudohyperplastic prostatic adenocarcinoma in transurethral resections of the prostate. Pathol Oncol Res. 2003;9(4):232-5.
Yaskiv O, Cao D, Humphrey PA. Microcystic adenocarcinoma of the prostate: a variant of pseudohyperplastic and atrophic patterns. Am J Surg Pathol. 2010 Apr;34(4):556-61.
Hudson J, Cao D, Vollmer R, Kibel AS, Grewal S, Humphrey PA. Foamy gland adenocarcinoma of the prostate: incidence, Gleason grade, and early clinical outcome. Hum Pathol. 2012 Jan 3. [Epub ahead of print]
Zhao J, Epstein JI. High-grade foamy gland prostatic adenocarcinoma on biopsy or transurethral resection: a morphologic study of 55 cases. Am J Surg Pathol. 2009 Apr;33(4):583-90.
Tran TT, Sengupta E, Yang XJ. Prostatic foamy gland carcinoma with aggressive behavior: clinicopathologic, immunohistochemical, and ultrastructural analysis. Am J Surg Pathol. 2001 May;25(5):618-23.
Nelson RS, Epstein JI. Prostatic carcinoma with abundant xanthomatous cytoplasm. Foamy gland carcinoma. Am J Surg Pathol. 1996 Apr;20(4):419-26.
Hameed O, Humphrey PA. Stratified epithelium in prostatic adenocarcinoma: a mimic of high-grade prostatic intraepithelial neoplasia. Mod Pathol. 2006 Jul;19(7):899-906.
Tavora F, Epstein JI. High-grade prostatic intraepithelial neoplasialike ductal adenocarcinoma of the prostate: a clinicopathologic study of 28 cases. Am J Surg Pathol. 2008 Jul;32(7):1060-7.
Shah RB, Magi-Galluzzi C, Han B, Zhou M. Atypical cribriform lesions of the prostate: relationship to prostatic carcinoma and implication for diagnosis in prostate biopsies. Am J Surg Pathol. 2010 Apr;34(4):470-7.
Epstein JI, Allsbrook WC Jr, Amin MB, Egevad LL; ISUP Grading Committee. The 2005 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma. Am J Surg Pathol. 2005 Sep;29(9):1228-42.
Guo CC, Epstein JI. Intraductal carcinoma of the prostate on needle biopsy: Histologic features and clinical significance. Mod Pathol. 2006 Dec;19(12):1528-35.
Herawi M, Epstein JI. Immunohistochemical antibody cocktail staining (p63/HMWCK/AMACR) of ductal adenocarcinoma and Gleason pattern 4 cribriform and noncribriform acinar adenocarcinomas of the prostate. Am J Surg Pathol. 2007 Jun;31(6):889-94.
Herawi M, De Marzo AM, Kristiansen G, Epstein JI. Expression of CDX2 in benign tissue and adenocarcinoma of the prostate. Hum Pathol. 2007 Jan;38(1):72-8.
Brinker DA, Potter SR, Epstein JI. Ductal adenocarcinoma of the prostate diagnosed on needle biopsy: correlation with clinical and radical prostatectomy findings and progression. Am J Surg Pathol. 1999 Dec;23(12):1471-9.
Ross HM, Kryvenko ON, Cowan JE, Simko JP, Wheeler TM, Epstein JI. Do adenocarcinomas of the prostate with Gleason score (GS) ≤6 have the potential to metastasize to lymph nodes? Am J Surg Pathol. 2012 Sep;36(9):1346-52.
Pacelli A; Lopez-Beltran A; Egan AJ; Bostwick DG. Prostatic adenocarcinoma with glomeruloid features Human Pathology, 1998 May, 29(5):543-6
Oppenheimer JR; Wills ML; Epstein JI. Partial atrophy in prostate needle cores: another diagnostic pitfall for the surgical pathologist. American Journal of Surgical Pathology, 1998 Apr, 22(4):440-5.
Bostwick DG; Wollan P; Adlakha K. Collagenous micronodules in prostate cancer. A specific but infrequent diagnostic finding. Archives of Pathology and Laboratory Medicine, 1995 May, 119(5):444-7
Giannico GA, Ross HM, Lotan T, Epstein JI. Aberrant expression of p63 in adenocarcinoma of the prostate: a radical prostatectomy study. Am J Surg Pathol. 2013 Sep;37(9):1401-6.
Warrick JI, Humphrey PA. Foamy gland carcinoma of the prostate in needle biopsy: incidence, Gleason grade, and comparative α-methylacyl-CoA racemase vs. ERG expression. Am J Surg Pathol. 2013 Nov;37(11):1709-14.
Schultz L, Maluf CE, da Silva RC, Falashi Rde H, da Costa MV, Schultz MI. Discontinuous foci of cancer in a single core of prostatic biopsy: when it occurs and performance of quantification methods in a private-practice setting. Am J Surg Pathol. 2013 Dec;37(12):1831-6. PubMed PMID: 24225844.
Epstein JI, Egevad L, Humphrey PA, Montironi R; Members of the ISUP Immunohistochemistry in Diagnostic Urologic Pathology Group. Best practices recommendations in the application of immunohistochemistry in the prostate: report from the international society of urologic pathology consensus conference. Am J Surg Pathol. 2014 Aug;38(8):e6-e19. PubMed PMID: 25029122.
Mohanty SK, Smith SC, Chang E, Luthringer DJ, Gown AM, Aron M, Amin MB. sEvaluation of contemporary prostate and urothelial lineage biomarkers in a consecutive cohort of poorly differentiated bladder neck carcinomas. Am J Clin Pathol. 2014 Aug;142(2):173-83. PubMed PMID: 25015857.
Andreoiu M, Cheng L. Multifocal prostate cancer: biologic, prognostic, and therapeutic implications. Hum Pathol. 2010 Jun;41(6):781-93. PubMed PMID: 20466122.
Arias-Stella JA 3rd, Varma KR, Montoya-Cerrillo D, Gupta NS, Williamson SR. Does discontinuous involvement of a prostatic needle biopsy core by adenocarcinoma correlate with a large tumor focus at radical prostatectomy? Am J Surg Pathol. 2015 Feb;39(2):281-6. doi: 10.1097. PubMed PMID: 25353288
Amin MB, Lin DW, Gore JL, Srigley JR, Samaratunga H, Egevad L, Rubin M, Nacey J, Carter HB, Klotz L, Sandler H, Zietman AL, Holden S, Montironi R, Humphrey PA, Evans AJ, Epstein JI, Delahunt B, McKenney JK, Berney D, Wheeler TM, Chinnaiyan AM, True L, Knudsen B, Hammond ME. The critical role of the pathologist in determining eligibility for active surveillance as a management option in patients with prostate cancer: consensus statement with recommendations supported by the College of American Pathologists, International Society of Urological Pathology, Association of Directors of Anatomic and Surgical Pathology, the New Zealand Society of Pathologists, and the Prostate Cancer Foundation. Arch Pathol Lab Med. 2014 Oct;138(10):1387-405. doi: 10.5858/arpa.2014-0219-SA. Epub 2014 Aug 5. Review. PubMed PMID: 25092589.
Montironi R, Hammond EH, Lin DW, Gore JL, Srigley JR, Samaratunga H, Egevad L, Rubin MA, Nacey J, Klotz L, Sandler H, Zietman AL, Holden S, Humphrey PA, Evans AJ, Delahunt B, McKenney JK, Berney D, Wheeler TM, Chinnaiyan A, True L, Knudsen B, Epstein JI, Amin MB; College of American Pathologists; International Society of Urological Pathology; Association of Directors of Anatomic and Surgical Pathology. Consensus statement with recommendations on active surveillance inclusion criteria and definition of progression in men with localized prostate cancer: the critical role of the pathologist. Virchows Arch. 2014 Dec;465(6):623-8. doi: 10.1007/s00428-014-1668-5. Epub 2014 Oct 16. PubMed PMID: 25316188.
Epstein JI(1), Egevad L, Amin MB, Delahunt B, Srigley JR, Humphrey PA; Grading
Committe. The 2014 International Society of Urological Pathology (ISUP) Consensus
Conference on Gleason Grading of Prostatic Carcinoma: Definition of Grading
Patterns and Proposal for a New Grading System. Am J Surg Pathol. 2016 Feb;40(2):244-52. doi: 10.1097/PAS.0000000000000530..