Stanford School of Medicine

Surgical Pathology Criteria

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Prostatic Basal Cell Carcinoma


  • Malignant epithelial neoplasm of the prostate composed primarily of basaloid cells

Diagnostic Criteria

  • Composed primarily of basaloid cells
    • Hyperchromatic nuclei and high N:C ratio give an overall dark or blue appearance
    • Lumens if present may be lined by eosinophilic cells
  • Stroma usually desmoplastic or myxoid
  • Exhibits a variety of architectural patterns, frequently mixed
    • Adenoid cystic-like is most common
      • Rounded nests
      • Invaginations of stroma form pseudocribriform pattern
      • Frequent perineural invasion
    • Small solid nests with peripheral palisading
      • May form lumens
    • Basal cell hyperplastic-like
      • Glands lined by multiple layers of cells
      • Central ductal lumens
      • Infiltrative pattern
    • Small tubules with hyalinized luminal rims
      • May have intermingling cords of cells
    • Large solid nests
      • May have nuclear atypia and mitotic figures
      • May have central necrosis
      • Most aggressive type
  • Histologic features that help in distinction from benign basal cell hyperplasia
    • Infiltration between benign glands
    • Extraprostatic invasion (fat, bladder neck)
    • Perineural invasion
    • Tubules or nests with lumens lined by eosinophilic cells
    • Adenoid cystic pattern
    • Desmoplastic or myxoid stroma
    • Ki67 >20%
    • Strong diffuse bcl2 staining

Robert V Rouse MD
Department of Pathology
Stanford University School of Medicine
Stanford CA 94305-5342

Original posting/last update: 6/1/12

Supplemental Studies


bcl2 92%
HMWCK, p63 84%
Racemase (AMACR) 27%
  • High molecular weight cytokeratin (HMWCK) and p63 positive vary from negative/rare cells to outer layer only to multiple layers
  • Negative cases mostly with large nests and necrosis pattern
  • Ki67 >60% associated with aggressive behavior
  • Ki67 >20% supports carcinoma over hyperplasia
    • Usually <5% in hyperplasia
  • bcl2 expression is not seen in basal cell hyperplasia
  • Data from Ali 2007


  • Only a minority of cases behave aggressively
    • Local recurrence in 20%
    • Metastases in 12%
      • All in cases with large nests with central necrosis
  • Extraprostatic extension does not appear to be associated with adverse outcome
  • It is not clear that prostatectomy affects outcome
    • Most cases diagnosed on TURP
  • Not associated with elevated PSA or PAP


Prostatic Carcinomas

Prostatic Benign Lesions/Patterns Simulating Carcinoma

Other Lesions


  • The entire January 2012 issue of Histopathology is devoted to reviews on prostate cancers:
    • 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.
    • Egevad, L. (2012), Handling of radical prostatectomy specimens. Histopathology, 60: 118–124.
  • 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.
  • Ali TZ, Epstein JI. Basal cell carcinoma of the prostate: a clinicopathologic study of 29 cases. Am J Surg Pathol. 2007 May;31(5):697-705
  • Yang XJ; McEntee M; Epstein JI. Distinction of basaloid carcinoma of the prostate from benign basal cell lesions by using immunohistochemistry for bcl-2 and Ki-67. Human Pathology, 1998 Dec, 29(12):1447-50.                                                                                     
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