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Prostatic Ductal Adenocarcinoma

Definition

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

Alternate/Historical Names

  • Carcinoma of the prostatic utricle
  • Endometrioid carcinoma
  • Large duct carcinoma

Diagnostic Criteria

  • 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

    • The distinction from intraductal carcinoma is not as critical
      • 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

Classification/Lists

Prostatic Carcinomas

Prostatic Benign Lesions/Patterns Simulating Carcinoma

Other Lesions
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