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Presented by Jonathan Epstein, MD and prepared by Armen Khararjian, MD
This case talks about:
An 80 year old man underwent a simple prostatectomy for lower urinary tract symptoms.
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Question 1 of 1
1. Question
Week 614: Case 2
An 80 year old man underwent a simple prostatectomy for lower urinary tract symptoms.
Correct
Answer: Adenoid cystic carcinoma of the prostate
Histology: The lesion consists of numerous basaloid cribriform glands populated by relatively bland cells with scant cytoplasm. The lumina within the cribriform glands contain dense pink secretions. In addition, there are foci composed of small solid nests with similar cells and peripheral palisading. Focally there is squamous differentiation with clear cytoplasm. The intervening stroma in areas is desmoplastic.
Discussion: There are several patterns of basal cell carcinoma of the prostate. The most distinctive is the adenoid cystic pattern as seen in this case. It bears striking resemblance to its salivary gland counterpart and we have recently demonstrated that a subset of these prostate tumors contain the same translocation as recently discovered in salivary gland adenoid cystic carcinoma. However, not all the tumors with an adenoid cystic pattern have the translocation and these tumors may also show other patterns that are typical for prostatic basal cell lesions, such that these tumors are considered variants of basal cell carcinoma as opposed to a distinct salivary gland-like entity. In this case the other pattern seen was solid nests with peripheral palisading. Other patterns include variably sized and shaped nests with central tubules lined by eosinophilic cytoplasm surrounded by basaloid cells. The last and most difficult pattern of basal cell carcinoma to diagnose resembles basal cell hyperplasia with the exception that the small basaloid nests and tubules are very infiltrative both within and outside the prostate. Features that favor basal cell carcinoma over basal cell hyperplasia are the presence of desmoplastic stroma, increased ki67 (>20%), and overexpression of Her2/Neu. Most prostatic basal cell carcinomas, with the exception of those composed of large nests with central necrosis, are locally infiltrative but typically do not metastasize to distant sites.
Incorrect
Answer: Adenoid cystic carcinoma of the prostate
Histology: The lesion consists of numerous basaloid cribriform glands populated by relatively bland cells with scant cytoplasm. The lumina within the cribriform glands contain dense pink secretions. In addition, there are foci composed of small solid nests with similar cells and peripheral palisading. Focally there is squamous differentiation with clear cytoplasm. The intervening stroma in areas is desmoplastic.
Discussion: There are several patterns of basal cell carcinoma of the prostate. The most distinctive is the adenoid cystic pattern as seen in this case. It bears striking resemblance to its salivary gland counterpart and we have recently demonstrated that a subset of these prostate tumors contain the same translocation as recently discovered in salivary gland adenoid cystic carcinoma. However, not all the tumors with an adenoid cystic pattern have the translocation and these tumors may also show other patterns that are typical for prostatic basal cell lesions, such that these tumors are considered variants of basal cell carcinoma as opposed to a distinct salivary gland-like entity. In this case the other pattern seen was solid nests with peripheral palisading. Other patterns include variably sized and shaped nests with central tubules lined by eosinophilic cytoplasm surrounded by basaloid cells. The last and most difficult pattern of basal cell carcinoma to diagnose resembles basal cell hyperplasia with the exception that the small basaloid nests and tubules are very infiltrative both within and outside the prostate. Features that favor basal cell carcinoma over basal cell hyperplasia are the presence of desmoplastic stroma, increased ki67 (>20%), and overexpression of Her2/Neu. Most prostatic basal cell carcinomas, with the exception of those composed of large nests with central necrosis, are locally infiltrative but typically do not metastasize to distant sites.
