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Presented by Pedram Argani, M.D. and prepared by Priya Banerjee, M.D.
Case 5: 26 year old male with a prostatic and bladder mass.
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Question 1 of 1
1. Question
Week 360: Case 5
26 year old male with a prostatic and bladder massimages/8_4_08 5a.jpg
images/8_4_08 5b.jpg
images/8_4_08 5c.jpgCorrect
Answer: Paraganglioma
Histology: This lesion is composed of epithelioid cells with amphophilic cytoplasm, having a nested, highly vascular architecture. The lesion permeates throughout the prostatic stroma. The lesion shows random nuclear atypia, but mitotic activity is sparse. By immunohistochemistry, the lesion labels diffusely for synaptophysin and chromogranin, but not for cytokeratin. S100 protein demonstrates a sustentacular pattern of staining.
Discussion: Prostate adenocarcinoma typically features small acini which invade between pre-existing benign glands. Higher grade cancers demonstrate solid growth patterns. Prostate adenocarcinoma would label for cytokeratin and prostate specific antigen (PSA). Phyllodes tumor of the prostate, also known as STUMP, features a leafy pattern of stroma underlying benign prostatic epithelium. Most of these lesions behave in a locally aggressive fashion, and only lesions with overtly sarcomatous stroma which overgrows the epithelium have metastatic potential.
Paragangliomas have several associations with syndromes. Associated syndromes include MEN 2a and 2b, von Hippel Lindau syndrome, Neurofibromatosis type 1, and Sturge-Weber Syndrome. Isolated pheochromocytoma/paraganglioma is associated with Succinate Dehydrogenase (SDH) gene mutations.
Incorrect
Answer: Paraganglioma
Histology: This lesion is composed of epithelioid cells with amphophilic cytoplasm, having a nested, highly vascular architecture. The lesion permeates throughout the prostatic stroma. The lesion shows random nuclear atypia, but mitotic activity is sparse. By immunohistochemistry, the lesion labels diffusely for synaptophysin and chromogranin, but not for cytokeratin. S100 protein demonstrates a sustentacular pattern of staining.
Discussion: Prostate adenocarcinoma typically features small acini which invade between pre-existing benign glands. Higher grade cancers demonstrate solid growth patterns. Prostate adenocarcinoma would label for cytokeratin and prostate specific antigen (PSA). Phyllodes tumor of the prostate, also known as STUMP, features a leafy pattern of stroma underlying benign prostatic epithelium. Most of these lesions behave in a locally aggressive fashion, and only lesions with overtly sarcomatous stroma which overgrows the epithelium have metastatic potential.
Paragangliomas have several associations with syndromes. Associated syndromes include MEN 2a and 2b, von Hippel Lindau syndrome, Neurofibromatosis type 1, and Sturge-Weber Syndrome. Isolated pheochromocytoma/paraganglioma is associated with Succinate Dehydrogenase (SDH) gene mutations.
