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Presented by Dr. Jonathan Epstein and prepared by Dr. J. Judd Fite.
Case 2. A 75 year old man was noted to have a papillary lesion at the verumontanum in the prostatic urethra which was removed by transurethral resection.
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Question 1 of 1
1. Question
Case 2. A 75 year old man was noted to have a papillary lesion at the verumontanum in the prostatic urethra which was removed by transurethral resection.
Correct
Answer: A. Prostatic ductal adenocarcinoma
Histology: The tumor consists of both papillary fronds and cribriform structures. The cells lining the papillary fronds are pseudostratified columnar. The cribriform glands have variably the same pseudostratified columnar epithelium or more cuboidal epithelium. There is not a lot of cytological atypia, with relatively few mitotic figures.
Discussion: The clinical history and morphology is typical of prostatic ductal adenocarcinoma. Prostatic ductal adenocarcinomas can present as a papillary urethral mass with hematuria, as seen in this case, mimicking a urothelial carcinoma. Alternatively, they can manifest as usual prostate adenocarcinoma with elevated serum PSA levels and be diagnosed on needle biopsy. The hallmark of ductal adenocarcinoma is based on its cytology of tall pseudostratified columnar epithelium as opposed to the simple cuboidal epithelium of usual (acinar) prostate adenocarcinoma. The two most common patterns of prostatic ductal adenocarcinoma are papillary and cribriform. It is not uncommon for there to be mixed ductal and acinar differentiation, as seen in this case. Ductal adenocarcinomas can have a range of cytological atypia from cases with very bland nuclei to those with more prominent nucleoli. Cases with bland cytology may be confused with benign entities such as prostatic urethral polyps. However, prostatic urethral polyps are polypoid not papillary and lined by either normal urothelium or benign cuboidal prostate cells with the underlying polyp filled with crowded but totally benign prostate glands, lacking the columnar epithelium of prostatic ductal adenocarcinoma. The term “intraductal carcinoma” refers to usual (acinar) prostate adenocarcinoma growing within prostatic ducts and acini surrounded by a basal cell layer. Prostatic ductal adenocarcinoma has a different cytology then “intraductal carcinoma” and usually prostatic ductal adenocarcinoma lacks basal cells, although when it arises in large periurethral prostatic ducts it may have an intraductal component. Papillary and cribriform prostatic ductal adenocarcinoma is graded as Gleason pattern 4.
Incorrect
Answer: A. Prostatic ductal adenocarcinoma
Histology: The tumor consists of both papillary fronds and cribriform structures. The cells lining the papillary fronds are pseudostratified columnar. The cribriform glands have variably the same pseudostratified columnar epithelium or more cuboidal epithelium. There is not a lot of cytological atypia, with relatively few mitotic figures.
Discussion: The clinical history and morphology is typical of prostatic ductal adenocarcinoma. Prostatic ductal adenocarcinomas can present as a papillary urethral mass with hematuria, as seen in this case, mimicking a urothelial carcinoma. Alternatively, they can manifest as usual prostate adenocarcinoma with elevated serum PSA levels and be diagnosed on needle biopsy. The hallmark of ductal adenocarcinoma is based on its cytology of tall pseudostratified columnar epithelium as opposed to the simple cuboidal epithelium of usual (acinar) prostate adenocarcinoma. The two most common patterns of prostatic ductal adenocarcinoma are papillary and cribriform. It is not uncommon for there to be mixed ductal and acinar differentiation, as seen in this case. Ductal adenocarcinomas can have a range of cytological atypia from cases with very bland nuclei to those with more prominent nucleoli. Cases with bland cytology may be confused with benign entities such as prostatic urethral polyps. However, prostatic urethral polyps are polypoid not papillary and lined by either normal urothelium or benign cuboidal prostate cells with the underlying polyp filled with crowded but totally benign prostate glands, lacking the columnar epithelium of prostatic ductal adenocarcinoma. The term “intraductal carcinoma” refers to usual (acinar) prostate adenocarcinoma growing within prostatic ducts and acini surrounded by a basal cell layer. Prostatic ductal adenocarcinoma has a different cytology then “intraductal carcinoma” and usually prostatic ductal adenocarcinoma lacks basal cells, although when it arises in large periurethral prostatic ducts it may have an intraductal component. Papillary and cribriform prostatic ductal adenocarcinoma is graded as Gleason pattern 4.
