Prostatic Adenocarcinoma
Differential Diagnosis
Cribriform prostatic lesions
- Basal cell hyperplasia
- Cribriform areas usually contain a distinct luminal secretory cell population
- Associated with adjacent small acini plugged with small blue cells
- Only grade 5 carcinoma could be composed of cells with such scant cytoplasm
- Microcalcifications are frequent
- They are rare in prostatic adenocarcinoma
- Basal cell markers (p63 & HMWCK) are extensively positive
- Clear cell cribriform hyperplasia
- Lobular architecture
- Uniform, bland nuclei without prominent nucleoli
- May be associated with cellular BPH-type stroma
- Basal cells present on IPOX stains
- High grade PIN
- Cribriform HG PIN is rare
- Scattered large ducts involved
- Ducts retain near normal caliber
- Basal cells present on IPOX stains but may be decreased
- Nuclei must be atypical but lack the marked pleomorphism of intraductal carcinoma (see below)
- Frequently racemase positive
- (Gleason pattern 3 carcinoma)
- General consensus is that all or nearly all cases of cribriform pattern 3 carcinoma are really examples of something else on this list
- Gleason pattern 4 carcinoma
- Usually bordered by or associated with raggedly infiltrating glands or poorly formed glands
- Cytologically atypical nuclei and nucleoli
- Gleason pattern 5 carcinoma
- As for Gleason pattern 4 but with comedonecrosis
- Frequently non-cribriform pattern 5 is also present
- Ductal carcinoma
- Frequently papillary as well as cribriform
- Cribriform spaces may be slit-like
- Cytologically markedly atypical nuclei
- Marked enlargement of duct size with irregular shapes and fusion
- Cells may be columnar with pseudostratified, elongated nuclei
- Graded as pattern 4 or 5, depending upon presence of comedonecrosis
- Frequently associated with a pattern 3 component
- Basal cells absent or rare
- If present, it could be considered Intraductal Carcinoma
- Intraductal carcinoma
- Marked enlargement of duct size
- May be irregular and branching
- Ducts filled with cribriform, papillary and/or solid growth without fibrovascular stroma required
- Basal cells present at least focally around periphery required
- High grade cytology, comedonecrosis
or solid/dense cribriform pattern required
- High grade cytology means nuclei 6 times larger than normal
- Dense cribriform means spaces make up <50% of intraluminal mass
- Pleomorphic cells may preferentially localize to the periphery of nests
- This is considered to represent high grade carcinoma that has invaded pre-existing ducts
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