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Presented by Pedram Argani, M.D. and prepared by Amy Duffield, M.D., Ph.D.
Case 5: A 73 year-old male with a lung mass.
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1. Question
Week 351: Case 5
A 73 year-old male with a lung mass.images/5_12_08 5A.jpg
images/5_12_08 5B.jpg
images/5_12_08 5C.jpg
images/5_12_08 5D.jpg
images/5_12_08 5E.jpgCorrect
Answer: Metastatic prostatic adenocarcinoma
Histology: The lung contains a cellular, cribiform glandular proliferation. The cells have relatively round nuclei with prominent nucleoli. Cells demonstrate immunoreactivity for PSA and P501S, but are non-reactive for TTF-1. This patient had a history of prostatic adenocarcinoma, Gleason score 4+3=7 with extraprostatic extension.
Discussion: The cribiform pattern of prostatic adenocarcinoma, along with the relatively minimal pleomorphism, raises the differential of a carcinoid tumor. However, the chromatin is not finely dispersed as seen in a carcinoid tumor, and immunoreactivity for prostate specific antigen eliminates this possibility. An adenocarcinoma of the lung should not label for PSA or P501S, and would label for TTF-1. A pulmonary blastoma essentially resembles a Wilms tumor morphologically. These lesions are more primitive than the current case, and would not be expected to react for PSA or P501S.
Incorrect
Answer: Metastatic prostatic adenocarcinoma
Histology: The lung contains a cellular, cribiform glandular proliferation. The cells have relatively round nuclei with prominent nucleoli. Cells demonstrate immunoreactivity for PSA and P501S, but are non-reactive for TTF-1. This patient had a history of prostatic adenocarcinoma, Gleason score 4+3=7 with extraprostatic extension.
Discussion: The cribiform pattern of prostatic adenocarcinoma, along with the relatively minimal pleomorphism, raises the differential of a carcinoid tumor. However, the chromatin is not finely dispersed as seen in a carcinoid tumor, and immunoreactivity for prostate specific antigen eliminates this possibility. An adenocarcinoma of the lung should not label for PSA or P501S, and would label for TTF-1. A pulmonary blastoma essentially resembles a Wilms tumor morphologically. These lesions are more primitive than the current case, and would not be expected to react for PSA or P501S.
