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Presented by George Netto, MD and prepared by Shien Micchelli, M.D.
Case 4: A 78 year old underwent prostate biopsies for elevated PSA.
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1. Question
Week 258: Case 4
A 78 year old underwent prostate biopsies for elevated PSA. The below illustrated spindle cell proliferation was positive for ER, PR, muscle specific actin (weak) and negative for CD34, C-Kit and S100./images/2_27_06_4a.jpg
/images/2_27_06_4b.jpg
/images/2_27_06_4c.jpgCorrect
Answer: Stromal tumor of unknown malignant potential (STUMP)
Histology: A spindle cell proliferation separates preexisting benign glands. The spindle cells are arranged in intersecting fascicles and focally demonstrate a storiform pattern. No significant cytologic atypia is seen. There is no evidence of increase mitotic activity or necrosis in this small sample.
Discussion: Stromal Tumor of Unknown Malignant Potential (STUMP) are tumors of the specialized prostatic stroma that can manifest in one of four different histologic patterns: a hypercellular stroma with scattered atypical cells separating benign prostatic glands, a hypercellular stroma with minimal cytological atypia associated with benign glands, a hypercellular stroma with or without atypia that is associated with benign glands in a “leaflike” growth pattern resembling phyllodes tumors of breast, and a hypercellular stroma without cytologic atypical and without glands. Given the usual limitation of sampling on needle biopsy, further clinical and imaging evaluation is required to determine the significance of such finding. Additional biopsies can help assess the extent of a STUMP and rule out an associated higher grade sarcomatous component.
Immunohistochemical analysis can be of some utility in distinguishing STUMP from other spindle cell proliferations of prostate. The latter include gastrointestinal stromal tumors (GIST) of adjacent rectal origin (C-kit positive), and solitary fibrous tumor of prostate (CD34 positive).
Reference(s):
– Gaudin PB, Rosai J, Epstein JI. Sarcomas and related proliferative lesions of specialized prostatic stroma: a clinicopathologic study of 22 cases. Am J Surg Pathol. 1998 ;22(2):148-62.Incorrect
Answer: Stromal tumor of unknown malignant potential (STUMP)
Histology: A spindle cell proliferation separates preexisting benign glands. The spindle cells are arranged in intersecting fascicles and focally demonstrate a storiform pattern. No significant cytologic atypia is seen. There is no evidence of increase mitotic activity or necrosis in this small sample.
Discussion: Stromal Tumor of Unknown Malignant Potential (STUMP) are tumors of the specialized prostatic stroma that can manifest in one of four different histologic patterns: a hypercellular stroma with scattered atypical cells separating benign prostatic glands, a hypercellular stroma with minimal cytological atypia associated with benign glands, a hypercellular stroma with or without atypia that is associated with benign glands in a “leaflike” growth pattern resembling phyllodes tumors of breast, and a hypercellular stroma without cytologic atypical and without glands. Given the usual limitation of sampling on needle biopsy, further clinical and imaging evaluation is required to determine the significance of such finding. Additional biopsies can help assess the extent of a STUMP and rule out an associated higher grade sarcomatous component.
Immunohistochemical analysis can be of some utility in distinguishing STUMP from other spindle cell proliferations of prostate. The latter include gastrointestinal stromal tumors (GIST) of adjacent rectal origin (C-kit positive), and solitary fibrous tumor of prostate (CD34 positive).
Reference(s):
– Gaudin PB, Rosai J, Epstein JI. Sarcomas and related proliferative lesions of specialized prostatic stroma: a clinicopathologic study of 22 cases. Am J Surg Pathol. 1998 ;22(2):148-62.
