Prostatic Ductal Adenocarcinoma

Definition

Primary prostatic adenocarcinoma forming large ducts/acini filled with cribriform or papillary growths of columnar cells

Tall columnar cells with elongated nuclei
- Frequently pseudostratified
- Cytoplasm frequently amphophilic but occasionally clear
- Nuclei large and hyperchromatic, with prominent nucleoli
- Mitotic figures and necrosis are commonly seen
Forms spaces the size of large ducts
- Usually too densely packed to represent normal ducts
- Borders are typically smooth but not always round
Growth pattern papillary or cribriform
- Papillae have fibrovascular core
- Cribriform spaces typically slit-like
May incite desmoplastic response even within the prostate
Considered Gleason pattern 4
- If comedonecrosis is present, it should be scored as Gleason 5
- Frequently associated with conventional acinar carcinoma
- Overall grade should reflect both components
Clinical behavior appears to be at least as bad as similar grade acinar carcinoma
- Serum PSA and PAP usually elevated
- Although classically described as periurethral, it is found throughout the gland
Frequently also involves pre-existing ducts (see intraductal carcinoma)
- High molecular weight cytokeratin antibodies may highlight occasional involved ducts with basal cells
PSA, PAP positive
Differential diagnosis
- High grade PIN must be excluded

Prostatic Ductal Adenocarcinoma	High Grade PIN
Columnar cells with elongated nuclei	Generally cuboidal cells with round nuclei
Invasive large glands with no architectural preservation	May preserve normal duct-lobule architecture
Cribriform pattern common	Cribriform pattern rare
Papillae if present have vascular cores	Tufts of cells, but no papillae
Basal cells if present are usually patchy	Basal cells widespread but may be fewer than normal

Both are high grade carcinomas
Ductal carcinoma frequently has an intraductal component
- Demonstrated by focal presence of basal cells

Prostatic Ductal Adenocarcinoma	Non-ductal Intraductal Adenocarcinoma
Columnar cells with elongated nuclei	Cuboidal cells with round nuclei
Cribriform lumens frequently slit-like	Cribriform lumens usually round
Frequently has true papillae with vascular cores	Tufts but no true papillae
Usually lacks basal cells	Basal cells always present
Nuclear size 2-3 x normal	Nuclear size may be 6 x normal

The distinction from invasive cribriform acinar adenocarcinoma is also not as critical
- Both are high grade carcinomas

Prostatic Ductal Adenocarcinoma	Cribriform Acinar Adenocarcinoma
Columnar cells with elongated nuclei	Cuboidal cells with round nuclei
Cribriform lumens frequently slit-like	Cribriform lumens usually round
Frequently has true papillae	Tufts but no true papillae
Smooth edges without infiltration	Frequently has ragged infiltration at edges

Bibliography (for general references see Prostatic Acinar Adenocarcinoma)
- Humphrey, P. A. (2012), Histological variants of prostatic carcinoma and their significance. Histopathology, 60: 59–74.
- 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.
- Morgan TM, Welty CJ, Vakar-Lopez F, Lin DW, Wright JL. Ductal adenocarcinoma of the prostate: increased mortality risk and decreased serum prostate specific antigen. J Urol. 2010 Dec;184(6):2303-7.
- Robinson B, Magi-Galluzzi C, Zhou M. Intraductal carcinoma of the prostate. Arch Pathol Lab Med. 2012 Apr;136(4):418-25.
- 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.
- Robinson BD, Epstein JI. Intraductal carcinoma of the prostate without invasive carcinoma on needle biopsy: emphasis on radical prostatectomy findings. J Urol. 2010 Oct;184(4):1328-33.
For general diagnostic, grading and staging criteria, see also Prostatic Acinar Adenocarcinoma

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

Original posting/updates: 6/1/12