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Presented by Dr. Andres Matoso and prepared by Dr. Robby Jones
This is a 71 year old male with a urethral polyp.
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1. Question
This is a 71 year old male with a urethral polyp. Choose the correct diagnosis below.
Correct
Answer: 2. Prostatic duct adenocarcinoma
Histology: Exophytic papillary intraurethral lesion with areas of cribriform growth. The epithelial lining is characterized by pseudostratified epithelial cells with abundant cytoplasm and prominent nucleoli. There are conspicuous mitoses.
Discussion: When prostatic duct adenocarcinoma occurs in proximity to the veromontanum, it can show an exophytic and papillary growth into the lumen of the urethra. The clinician usually submits these lesions as “urethral polyp.” The presence of pseudostratified epithelium with papillary architecture should suggest this diagnosis. Occasionally, benign prostatic glands can show papillary architecture but the nuclei would be bland without prominent nucleoli and without the nuclear pseudostratification characteristic of prostatic duct adenocarcinoma. Prostate markers could be used to differentiate from an intestinal type polyp. PIN4 can be patchy positive for basal cells. In general, prostatic duct adenocarcinoma has a prognosis that is similar to Gleason 8 (grade group 4).
References:
Am J Surg Pathol. 1999;23:1471-79
J Urol. 2010;184:2303-07Incorrect
Answer: 2. Prostatic duct adenocarcinoma
Histology: Exophytic papillary intraurethral lesion with areas of cribriform growth. The epithelial lining is characterized by pseudostratified epithelial cells with abundant cytoplasm and prominent nucleoli. There are conspicuous mitoses.
Discussion: When prostatic duct adenocarcinoma occurs in proximity to the veromontanum, it can show an exophytic and papillary growth into the lumen of the urethra. The clinician usually submits these lesions as “urethral polyp.” The presence of pseudostratified epithelium with papillary architecture should suggest this diagnosis. Occasionally, benign prostatic glands can show papillary architecture but the nuclei would be bland without prominent nucleoli and without the nuclear pseudostratification characteristic of prostatic duct adenocarcinoma. Prostate markers could be used to differentiate from an intestinal type polyp. PIN4 can be patchy positive for basal cells. In general, prostatic duct adenocarcinoma has a prognosis that is similar to Gleason 8 (grade group 4).
References:
Am J Surg Pathol. 1999;23:1471-79
J Urol. 2010;184:2303-07
