Pathology of the Prostate. PathoBasic Tatjana Vlajnic

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1 Pathology of the Prostate PathoBasic Tatjana Vlajnic

2 Overview Adenocarcinoma of the prostate Grading Special variants Mimickers of prostate adenocarcinoma Atrophy Inflammatory conditions Granulomatous prostatitis

3 Overview Adenocarcinoma of the prostate Grading Special variants Mimickers of prostate adenocarcinoma Atrophy Inflammatory conditions Granulomatous prostatitis

4 Gleason patterns/grading Original Modified 2015

5 2015: Gleason pattern 4 Cribriform glands Glomeruloid glands

6 2015: New grading system «WHO/ISUP Grad»

7 Overview Adenocarcinoma of the prostate Grading Special variants Mimickers of prostate adenocarcinoma Atrophy Inflammatory conditions Granulomatous prostatitis

8 Adenocarcinoma of the prostate Acinar adenocarcinoma Ductal adenocarcinoma Intraductal carcinoma (IDC-P)

9 Ductal adenocarcinoma (DAc) Tall pseudostratified columnar cells Periurethral area (exophytic mass) Admixed with acinar adenoca >> pure Overall incidence 3.2% Pure ductal adenocarcinoma: % Gleason grade 4: cribriform/papillary

10 Long papillary fronds Pseudostratified columnar cells

11 Papillary (commonly seen on TUR-P) Cribriform (slit-like lumina)

12 Solid Individual glands (mimicking colonic adenoca)

13 On core needle biopsy (fragmentation!)

14 PIN-like ductal adenocarcinoma AMACR / p63

15 PIN-like ductal adenocarcinoma

16 Intraductal carcinoma (IDC-P) Not a precursor lesion Associated with high-grade, high-stage prostate carcinoma Overall incidence 2.8% Isolated on core biopsies: % Gleason grade should not be assigned Comment: Association with aggressive PrCa

17 IDC-P: Morphologic features Solid, dense cribriform, loose cribriform, micropapillary, flat Marked nuclear atypia and pleomorphism Nucleomegaly ( 6 times normal) Comedonecrosis, mitoses

18 HMWCK: basal cells

19

20 Overview Adenocarcinoma of the prostate Grading Special variants Mimickers of prostate adenocarcinoma Atrophy Inflammatory conditions Granulomatous prostatitis

21 Atrophy Mimicker of carcinoma (clinically/histology) Prostatic induration, suspicious on US Wide age range Distinct histologic variants: Simple atrophy Postatrophic hyperplasia (PAH) Partial atrophy Cave: active inflammation, post radiation!

22 Simple atrophy Basophilic appearance Glands with normal caliber /dilated

23 Postatrophic hyperplasia (PAH) Basophilic appearance Crowded glands, lobular High proloferation rate, mitoses

24 Postatrophic hyperplasia (PAH) Infiltrative pattern DD: atrophic variant adenocarcinoma! HMWCK

25 Partial atrophy Lacks basophilic appearance Crowded glands with pale cytoplasm

26 Partial atrophy Nuclei spaced apart, undulating luminal surfaces Nuclei reach the full height of the cytoplasm HMWCK: patchy staining

27 Immunohistochemistry p63, CK5/6 (basal cells) Tumor cells: AMACR+ PSA(P)+ ERG+ (50%) GSTpi (75-100%) CK7

28 Overview Adenocarcinoma of the prostate Grading Special variants Mimickers of prostate adenocarcinoma Atrophy Inflammatory conditions Granulomatous prostatitis

29 Granulomatous prostatitis Mimicker of carcinoma (clinically/histology) Prostatic induration, PSA elevation, suspicious on US/MRI Non-specific Post resection (TURP >> biopsy) Infectious (mycobacterial) Post-BCG, (systemic tuberculosis) Systemic

30 Non-specific granulomatous prostatitis Mixed inflammation incl. eosinophils No cesaeting granulomas

31 Non-specific granulomatous prostatitis Predominance of lymphocytes (cave DD lymphoma!)

32 Non-specific granulomatous prostatitis Predominance of macrophages (DD highgrade prostate carcinoma) PanCK CD68

33 References Epstein JI, et al. The 2014 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma: Definition of Grading Patterns and Proposal for a New Grading System. Am J Surg Pathol, 2016 Tavora F, Epstein JI. High-grade prostatic intraepithelial neoplasialike ductal adenocarcinoma of the prostate: a clinicopathologic study of 28 cases. Am J Surg Pathol, 2008 Guo CC, Epstein JI. Intraductal carcinoma of the prostate on needle biopsy: Histologic features and clinical significance. Mod Pathol Dec;19(12): Magers M, Kunju LP, Wu A. Intraductal Carcinoma of the Prostate: Morphologic Features, Differential Diagnoses, Significance, and Reporting Practices. Arch Pathol Lab Med Oct;139(10): Wang W, et al. Partial atrophy on prostate needle biopsy cores: a morphologic and immunohistochemical study. Am J Surg Pathol, 2008 Srigley JR. Benign mimickers of prostatic adenocarcinoma. Mod Pathol, 2004 Hameed O, et al. Pseudoneoplastic mimics of prostate and bladder carcinomas. Arch Pathol Lab Med, 2010 Biopsy Interpretation of the Prostate, Epstein JI, 5th Edition

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