 |
|
|
|
|
|
|
3:
Prostatic Adenocarcinoma - Gleason Pattern 3
|
|
Comments: Gleason grade 3 is the most commonly seen pattern. Even at low magnification, one can easily appreciate the variation in size, shape, and spacing of glands. Many small glands have occluded or abortive lumens. There is no evidence of glandular fusion.
|
|
|
|
|
|
|
|
5:
Prostatic Adenocarcinoma - Gleason Pattern 3
|
|
Comments: : The majority of the glands in this field have occluded or small abortive lumens. Many glands have sharply angulated contours. Gleason grade 3 was assigned to this biopsy.
|
|
|
|
|
|
6:
Gleason Pattern 3 - Large Gland Variant
|
|
Comments: This is an example of large gland variant of Gleason grade 3 (variant 3A). The cells are columnar and the nuclei are basally located. This is one of the more difficult patterns to identify in the needle biopsies.
|
|
|
|
|
|
7:
Gleason Pattern 3 - Large Gland Variant
|
|
Comments: The large gland variant of Gleason grade 3 (variant 3A) is not difficult to distinguish from the small gland variant (3B) and the cribriform variant (3C). The three variants have similar cancer-specific death rates, therefore their separation in a pathology report is unnecessary.
|
|
|
|
|
|
8:
Prostate Adenocarcinoma - Crystalloids
|
|
Comments: Numerous eosinophilic crystalloids are seen in this focus. Crystalloids are not specific for adenocarcinoma and can be seen in benign glands, atypical adenomatous hyperplasia, PIN, and other conditions.
|
|
|
|
|
|
9:
Prostatic Adenocarcinoma - Crystalloids
|
|
Comments: Crystalloids may also been seen in metastatic deposits of prostatic adenocarcinoma. When the primary site is unknown, the presence of crystalloids in metastases is strong evidence of prostatic origin.
|
|
|
|
|
|
10:
Prostatic Adenocarcinoma - Gleason Pattern 4
|
|
Comments: This biopsy is completely replaced by Gleason grade 4 adenocarcinoma. The glands are fused and there is no intervening stroma. Glandular fusion is a hallmark of Gleason grade 4.
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
18:
Prostatic Adenocarcinoma - Gleason Pattern - 5
|
|
Comments: At higher magnification, only rare gland lumens or vacuoles are seen, creating a signet ring cell appearance (For a better example of signet ring cell pattern of prostate cancer, go to next section – variants of prostate cancer)
|
|
|
|
|
|
19:
Prostatic Adenocarcinoma - Blue Mucin
|
|
Comments: Acidic mucin is commonly found in the glands of prostate cancer. It is seen as fine wisps of basophilic material in the gland lumen. However, mucin may also be found in atypical adenomatous hyperplasia, sclerosing adenosis (see example in benign mimics of prostate cancer), and PIN.
|
|
|
|
|
|
20:
Prostatic Adenocarcinoma - Extraprostatic Extension
|
|
Comments: In this prostate biopsy, malignant glands are seen surrounded by adipose tissue. This is an example of extraprostatic extension (EPE). Other examples of EPE that may be encountered in needle biopsies include tumor adjacent to pigmented epithelium of seminal vesicle or within skeletal muscle.
|
|
|
|
|
|
21:
Prostate AdenoCA - Minimal Diagnostic Focus
|
|
Comments: In spite of the minute size of this focus, the cytologic and architectural features are sufficiently compelling for an unequivocal diagnosis of adenocarcinoma.
|
|
|
|
|
|
22:
Prostate AdenoCA - Radiation Changes
|
|
Comments: This biopsy was performed due to rising PSA several years after radioactive seed implantation (brachytherapy) for prostate cancer. The cytologic and architectural atypia seen here is within the spectrum of radiation-induced changes. There was no evidence of recurrent cancer.
|
|
|
|
|
|
23:
Prostate AdenoCA - Radiation Changes
|
|
Comments: The immunostain for high molecular weight cytokeratin 34bE12 performed on the previous case shows the atypical cells to be predominantly basal cells.
|
|
|
|
|
|
24:
Prostate AdenoCA - Poor Histology
|
|
Comments: Pathologists are increasingly being called upon to diagnose prostate cancer on minute foci often consisting of no more than 3-5 atypical glands. Good histology is absolutely essential for this. In this obvious focus of cancer, cytologic features are impossible to appreciate due to poor histology (not from our laboratory!!!!)
|
|
|
