adenocarcinoma


Expand All | Collapse All

  • Clinical

    • race: black > white > asian
    • age: 50+
    • site: usually posterior / posterolateral prostate
    • PSA > 4 ng/ml
    • metastasize to bone

  • Histology

    • architecture
      • infiltrative, splaying smooth muscle
      • haphazard, non-lobular
      • crowded
    • patterns
      • cribriform, fused glands, poorly formed glands
      • glands perpendicular to one another
      • lack basal cell layer
    • cytology
      • nuclear atypia, enlargement, hyperchromasia, prominent nucleoli
      • gland lumen less ruffled/convoluted
      • amphophilic cytoplasm: lighter color than normal glands
    • luminal
      • crystals (not corpora amylacea)
      • dense pink secretions
    • other malignant features
      • perineural invasion
      • mucinous fibroplasia (collagenous micronodules): pink fibers
      • glomerulations
    • Variants
      • atrophic
      • pseudohyperplastic
      • microcystic
      • foamy gland
      • mucinous (colloid)
      • signet ring cell
      • pleomorphic giant cell
      • sarcomatoid
      • oncocytic
      • lymphoepithelioma-like

  • Treatment effects

  • Gleason

    • Gleason 3 = discrete glands
    • Gleason 4 = fused, cribriform glands
    • Gleason 5 = solid sheets, single cells, comedo necrosis, karyorrhexis
    • Total score: most prevalent + next most prevalent
    • if a 3rd most prevalent, but higher score is present, it is included as the second score instead (Eg. 3+4+5 becomes 3+5)
    • lower grade areas < 5% of tumor are ignored (Eg. 4+3 with only a tiny amount of 3 becomes 4+4)
    • In radical prostatectomies, all tumor nodules over Gleason 3 get a score
    • For Gleason 4+3 or 3+4, give % that is Gleason 4

  • Grade group

    • 1: Gleason score 3+3=6
    • 2: Gleason score 3+4=7
    • 3: Gleason score 4+3=7
    • 4: Gleason score 8
    • 5: Gleason 9, 10

  • Stains

    • positive: racemase = AMACR = P504S
    • negative basal cell layer stains: p63, HMWCK = 34BE12 = CK903, p40
    • positive prostate specific markers: PSA, PAP
    		•