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Presented by George Netto, M.D. and prepared by Alex Chang, M.D.
Case 1: A 79 year old male presented with hematuria and elevated PSA. He underwent a 12 core prostatic biopsy.
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Question 1 of 1
1. Question
Week 422: Case 1
A 79 year old male presented with hematuria and elevated PSA. He underwent a 12 core prostatic biopsy.
Correct
Answer: High grade urothelial carcinoma with Prostatic intraductal spread
Histology: none provided
Discussion: Prostatic urothelial carcinoma seen in association with bladder urothelial neoplasia may be invasive via direct stromal extension from the bladder, purely intraductal, or intraductal and invasive. The diagnosis of urothelial carcinoma on prostate needle biopsy is rare and especially difficult. It can mimic prostatic adenocarcinoma in terms of findings on digital rectal exam and ultrasound, along with the potential for an elevated serum PSA level. There may be no prior or concurrent history of urothelial carcinoma in the bladder in a significant portion of cases. Histologic features and immunohistochemical studies are essential to establish the diagnosis. Urothelial carcinoma involving the prostate differs from adenocarcinoma of the prostate both architecturally and cytologically. Urothelial carcinoma in the prostate typically forms nests of tumor, whereas poorly differentiated prostate cancer tends to form sheets, individual cells, or cords. Urothelial carcinoma involving the prostate frequently contains areas of necrosis. Cytologically, urothelial carcinomas involving the prostate tend to show greater nuclear pleomorphism, variably prominent nucleoli, and increased mitotic activity compared to even poorly differentiated prostate adenocarcinoma. The presence of stromal inflammation, that is frequently seen in urothelial carcinoma on biopsy, differs from the typical lack of associated inflammation seen with ordinary adenocarcinoma of the prostate. The overall prognosis of urothelial carcinoma diagnosed on prostatic needle biopsy is poor, even in cases without histologic evidence of stromal invasion on biopsy. In these cases with intraductal cancer on biopsy, invasive cancer is most likely present elsewhere in the prostate that was not sampled. Although the prognosis is poor, even with only apparent intraductal involvement, histologic recognition is essential, as the only opportunity for improved outcome is early and aggressive therapy.
Reference(s):
– Epstein JI and Netto GJ. Biopsy Interpretation of the Prostate. 4th ed. 2007.Incorrect
Answer: High grade urothelial carcinoma with Prostatic intraductal spread
Histology: none provided
Discussion: Prostatic urothelial carcinoma seen in association with bladder urothelial neoplasia may be invasive via direct stromal extension from the bladder, purely intraductal, or intraductal and invasive. The diagnosis of urothelial carcinoma on prostate needle biopsy is rare and especially difficult. It can mimic prostatic adenocarcinoma in terms of findings on digital rectal exam and ultrasound, along with the potential for an elevated serum PSA level. There may be no prior or concurrent history of urothelial carcinoma in the bladder in a significant portion of cases. Histologic features and immunohistochemical studies are essential to establish the diagnosis. Urothelial carcinoma involving the prostate differs from adenocarcinoma of the prostate both architecturally and cytologically. Urothelial carcinoma in the prostate typically forms nests of tumor, whereas poorly differentiated prostate cancer tends to form sheets, individual cells, or cords. Urothelial carcinoma involving the prostate frequently contains areas of necrosis. Cytologically, urothelial carcinomas involving the prostate tend to show greater nuclear pleomorphism, variably prominent nucleoli, and increased mitotic activity compared to even poorly differentiated prostate adenocarcinoma. The presence of stromal inflammation, that is frequently seen in urothelial carcinoma on biopsy, differs from the typical lack of associated inflammation seen with ordinary adenocarcinoma of the prostate. The overall prognosis of urothelial carcinoma diagnosed on prostatic needle biopsy is poor, even in cases without histologic evidence of stromal invasion on biopsy. In these cases with intraductal cancer on biopsy, invasive cancer is most likely present elsewhere in the prostate that was not sampled. Although the prognosis is poor, even with only apparent intraductal involvement, histologic recognition is essential, as the only opportunity for improved outcome is early and aggressive therapy.
Reference(s):
– Epstein JI and Netto GJ. Biopsy Interpretation of the Prostate. 4th ed. 2007.
