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Presented by Dr. Jonathan Epstein and prepared by Dr. Tricia Cottrell
History: A 55 year old male underwent a TURP from lower urinary tract symptoms.
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1. Question
A 55 year old male underwent a TURP from lower urinary tract symptoms.
Correct
Answer: B
Histological description: Focally within the TURP specimen there is a focus of crowded dilated glands. The glands are lined by flat and tufted pseudostratified columnar epithelium with nuclei showing visible nucleoli. The cytoplasm is amphophilic.
Discussion: Ductal adenocarcinoma is defined as a variant of adenocarcinoma of the prostate lined by pseudostratified columnar epithelium as opposed to the simple cuboidal epithelium of usual (acinar) prostatic adenocarcinoma. The classic most common patterns of ductal adenocarcinoma are cribriform and papillary and are associated with an adverse prognosis, comparable to Gleason pattern 4 acinar adenocarcinoma. More recently, a new variant of ductal adenocarcinoma has been described where the glands are simple non-cribriform glands resembling high grade PIN. Features that help to distinguish PIN-like ductal adenocarcinoma from high grade PIN is that in the former many of the glands are markedly dilated and often have a flat lining. In contrast, the glands comprising high grade PIN are usually the same size as normal prostate glands. While, there may be focal flat lining to high grade PIN, tufting patterns predominate. Ultimately, the distinction is based on demonstrating a lack of basal cells in PIN-like ductal adenocarcinoma. As a few glands of high grade PIN many lack basal cells in a given plane of section, one needs numerous glands with no basal cells in order to establish a definitive diagnosis of PIN-like ductal adenocarcinoma. PIN-like ductal adenocarcinoma has a relatively favorable prognosis and is graded as Gleason score 3+3=6.
Incorrect
Answer: B
Histological description: Focally within the TURP specimen there is a focus of crowded dilated glands. The glands are lined by flat and tufted pseudostratified columnar epithelium with nuclei showing visible nucleoli. The cytoplasm is amphophilic.
Discussion: Ductal adenocarcinoma is defined as a variant of adenocarcinoma of the prostate lined by pseudostratified columnar epithelium as opposed to the simple cuboidal epithelium of usual (acinar) prostatic adenocarcinoma. The classic most common patterns of ductal adenocarcinoma are cribriform and papillary and are associated with an adverse prognosis, comparable to Gleason pattern 4 acinar adenocarcinoma. More recently, a new variant of ductal adenocarcinoma has been described where the glands are simple non-cribriform glands resembling high grade PIN. Features that help to distinguish PIN-like ductal adenocarcinoma from high grade PIN is that in the former many of the glands are markedly dilated and often have a flat lining. In contrast, the glands comprising high grade PIN are usually the same size as normal prostate glands. While, there may be focal flat lining to high grade PIN, tufting patterns predominate. Ultimately, the distinction is based on demonstrating a lack of basal cells in PIN-like ductal adenocarcinoma. As a few glands of high grade PIN many lack basal cells in a given plane of section, one needs numerous glands with no basal cells in order to establish a definitive diagnosis of PIN-like ductal adenocarcinoma. PIN-like ductal adenocarcinoma has a relatively favorable prognosis and is graded as Gleason score 3+3=6.
