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Presented by Jonathan Epstein, M.D. and prepared by Zarir E. Karanjawala, M.D., Ph.D.
Case 1: A 61 year old male with an elevated serum PSA level underwent prostate needle biopsies.
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1. Question
Week 338: Case 1
A 61 year old male with an elevated serum PSA level underwent prostate needle biopsies.images/epstein011408_1A.jpg
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images/epstein011408_1c.jpgCorrect
Answer: Adenocarcinoma of the prostate Gleason score 4+3=7 with CLL/SLL
Histology: In between benign prostate glands there is a crowded proliferation of both well formed discrete small glands as well as more poorly formed glands. Some of the glands contain large nuclei with visible nucleoli. A triple cocktail for p63, high molecular weight cytokeratin and AMACR shows an absence of basal cells and strong AMACR positivity which along with the pattern is diagnostic of adenocarcinoma of the prostate. The stain highlights the overall architecture of the glands where most of them are poorly formed glands with a few more well developed glands consistent with Gleason score 4+3=7.
Elsewhere on the prostate needle cores there was a dense lymphocytic infiltration. The infiltration extended out into the stroma away from benign prostate glands. The lymphoid population was monotonous consisting of small mature round lymphocytes without admixed plasma cells or other inflammatory cells. These lymphocytes were positive for CD20 and negative for CD3. They also expressed CD23 and CD5, consistent with small lymphocytic lymphoma/chronic lymphocytic leukemia.
Discussion: The most common form of leukemic involvement of the prostate is that of CLL/SLL. These lesions differ from non-specific chronic inflammation of the prostate where the inflammation tends to remain periglandular, is less dense, and often contains an admixture of plasma cells. Most patients with leukemic involvement of the prostate are known leukemics or have their diagnosis established at the time of workup for urinary symptoms. We have shown that patients with prostate cancer who are candidates for radical prostatectomy can experience long-term prostate cancer-free survival in the face of incidentally diagnosed low grade lymphoma. Because the management of most incidentally discovered low grade lymphomas is expectant, patients discovered having CLL /SLL on prostate needle biopsy should not be denied radical prostatectomy if otherwise they are candidates
Reference(s):
– Urology 53:175-9, 1999.Incorrect
Answer: Adenocarcinoma of the prostate Gleason score 4+3=7 with CLL/SLL
Histology: In between benign prostate glands there is a crowded proliferation of both well formed discrete small glands as well as more poorly formed glands. Some of the glands contain large nuclei with visible nucleoli. A triple cocktail for p63, high molecular weight cytokeratin and AMACR shows an absence of basal cells and strong AMACR positivity which along with the pattern is diagnostic of adenocarcinoma of the prostate. The stain highlights the overall architecture of the glands where most of them are poorly formed glands with a few more well developed glands consistent with Gleason score 4+3=7.
Elsewhere on the prostate needle cores there was a dense lymphocytic infiltration. The infiltration extended out into the stroma away from benign prostate glands. The lymphoid population was monotonous consisting of small mature round lymphocytes without admixed plasma cells or other inflammatory cells. These lymphocytes were positive for CD20 and negative for CD3. They also expressed CD23 and CD5, consistent with small lymphocytic lymphoma/chronic lymphocytic leukemia.
Discussion: The most common form of leukemic involvement of the prostate is that of CLL/SLL. These lesions differ from non-specific chronic inflammation of the prostate where the inflammation tends to remain periglandular, is less dense, and often contains an admixture of plasma cells. Most patients with leukemic involvement of the prostate are known leukemics or have their diagnosis established at the time of workup for urinary symptoms. We have shown that patients with prostate cancer who are candidates for radical prostatectomy can experience long-term prostate cancer-free survival in the face of incidentally diagnosed low grade lymphoma. Because the management of most incidentally discovered low grade lymphomas is expectant, patients discovered having CLL /SLL on prostate needle biopsy should not be denied radical prostatectomy if otherwise they are candidates
Reference(s):
– Urology 53:175-9, 1999.
