Surgical Pathology Criteria

Prostatic Adenocarcinoma

Differential Diagnosis

Carcinoma patterns that may be confused with benign prostate

Pseudohyperplastic Carcinoma (Benign) Hyperplasia
Nuclei line up at base Nuclei frequently scattered at all levels
Luminal border sharp and smooth usually at least in areas Luminal border undulating
Lacks lobular pattern Lobular grouping
Luminal crystalloids or blue mucin very suggestive if present Crystalloids and blue mucin absent
Large atypical nuclei with large nucleoli Bland nuclei
No basal cells Basal cell markers positive
Glands may be densely packed with minimal stroma between Stroma clearly seen between glands
Non-straightforward cases should be resolved with IPOX stains for basal cell markers
Foamy Gland Carcinoma (Benign) Hyperplasia
Usually mixed with usual patterns of carcinoma Usually associated with benign glands and ducts
Luminal border sharp and smooth Luminal border undulating
Lacks lobular pattern Lobular grouping
No basal cells Basal cell markers positive
Non-straightforward cases should be resolved with IPOX stains for basal cell markers
Atrophic Carcinoma Benign Atrophy
Infiltrative architecture, too many glands Lobular groups, frequently with an associated larger duct
Most glands have round contours Most glands irregular and angulated
Luminal crystalloids or blue mucin very suggestive if present Crystalloids and blue mucin absent
Large atypical nuclei with large nucleoli but may be compressed by cellular flattening Bland nuclei
No basal cells Basal cell markers positive, but may be decreased
Non-straightforward cases should be resolved with IPOX stains for basal cell markers
Microcystic Carcinoma Benign Ducts
Crowded grouping dilated/cystic glands, frequently associated with typical carcinoma Scattered large ducts usually associated with small benign acini
Luminal border sharp and smooth Luminal border undulating
Nuclei line up at base Nuclei frequently scattered at all levels
Luminal crystalloids and blue mucin very suggestive if present Crystalloids and blue mucin absent
No basal cells Basal cell markers positive
Non-straightforward cases should be resolved with IPOX stains for basal cell markers
PIN-like Carcinoma High Grade PIN
Crowded grouping of large ducts/glands HG-PIN involves scattered large ducts separated by benign parenchyma
No basal cells Basal cell markers positive
May surround nerves No perineural invasion
Non-straightforward cases should be resolved with IPOX stains for basal cell markers

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