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Prostatic Mucinous Adenocarcinoma

Definition

  • Primary prostatic adenocarcinoma composed of at least 25% extracellular mucin

Diagnostic Criteria

  • Lakes of extracellular mucin must make up at least 25% of the volume of the tumor
    • If less than 25%, designate as adenocarcinoma with focal mucin
    • In a biopsy, designate as adenocarcinoma with mucinous features
  • Epithelial component may grow as strips, glands, cribriform structures and signet ring cells (rare)
    • May float in mucin or line mucin filled spaces (usually partially)
  • Collagenous micronodules (mucinous fibroplasia) may be present
  • Grading has been somewhat controversial
    • Some designate all as Gleason 4+4
    • Some "mentally subtract the mucin" and score it as an ordinary carcinoma
      • Usually results in score 4+3 (Osunkoya 2008)
  • Clinical behavior appears to be similar to usual carcinoma (Osunkoya 2008, Lane 2006)
  • PSA, PAP and low molecular weight cytokeratins positive
    • High molecular weight cytokeratin negative
    • CK7/20 double positive rare
  • Urothelial and non-prostatic origin must be excluded
    • Mucinous urothelial carcinoma
      • HMWCK positive and CK7/20 double positive in most cases
      • PSA and PAP negative (Osunkoya 2007)
        • Some older reports find some positivity
    • GI tract adenocarcinoma must be ruled out
      • PSA and PAP negative
      • CDX2 positive in GI primaries but also reported positive in 30% of mucinous prostate carcinomas (Leite 2008)
      • History, endoscopy and imaging are critical
  • Bibliography (for general references see Prostatic Acinar Adenocarcinoma)
    • Humphrey, P. A. (2012), Histological variants of prostatic carcinoma and their significance. Histopathology, 60: 59–74.
    • Osunkoya AO, Nielsen ME, Epstein JI. Prognosis of mucinous adenocarcinoma of the prostate treated by radical prostatectomy: a study of 47 cases. Am J Surg Pathol. 2008 Mar;32(3):468-72.
    • Lane BR, Magi-Galluzzi C, Reuther AM, Levin HS, Zhou M, Klein EA. Mucinous adenocarcinoma of the prostate does not confer poor prognosis. Urology. 2006 Oct;68(4):825-30.
    • Osunkoya AO, Epstein JI. Primary mucin-producing urothelial-type adenocarcinoma of prostate: report of 15 cases. Am J Surg Pathol. 2007 Sep;31(9):1323-9.
    • Leite KR, Mitteldorf CA, Srougi M, Dall'oglio MF, Antunes AA, Pontes J Jr, Camara-Lopes LH. Cdx2, cytokeratin 20, thyroid transcription factor 1, and prostate-specific antigen expression in unusual subtypes of prostate cancer. Ann Diagn Pathol. 2008 Aug;12(4):260-6.
  • 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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