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Presented by Dr. Pedram Argani and prepared by Dr. Yembur Ahmad
This case talks about an 84 year old male who undergoes a transurethral resection of the prostate.
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1. Question
This is an 84 year old male who undergoes a transurethral resection of the prostate.
Diagnosis:
Correct
Answer: C
Histologic Description: This is an unusual and worrisome lesion, since the glandular component is irregular and forms cords, which suggests the diagnosis of a prostatic adenocarcinoma with Gleason pattern 4. However, the key to the diagnosis is that the lesion is relatively circumscribed, and associated with altered stroma. Altered stroma is not commonly seen in prostatic adenocarcinoma, in contrast to most other invasive carcinomas. The lesional cells are surrounded modified basal cells with myoepithelial differentiation, as evidenced by S100 and actin staining. This supports the diagnosis of prostatic sclerosing adenosis.
Prostatic sclerosing adenosis is rare, and is one condition in which the basal cells of the prostate differentiate towards myoepithelial cells of the breast in that they label for actin and S100 protein. The presence of basal/myoepithelial cells precludes the possibility of prostatic adenocarcinoma in this case, as does the relatively circumscribed nature of the lesion. Prostatic infarct would be associated with stromal necrosis and frequently is associated with squamous metaplasia, which are not seen in the current case.Incorrect
Answer: C
Histologic Description: This is an unusual and worrisome lesion, since the glandular component is irregular and forms cords, which suggests the diagnosis of a prostatic adenocarcinoma with Gleason pattern 4. However, the key to the diagnosis is that the lesion is relatively circumscribed, and associated with altered stroma. Altered stroma is not commonly seen in prostatic adenocarcinoma, in contrast to most other invasive carcinomas. The lesional cells are surrounded modified basal cells with myoepithelial differentiation, as evidenced by S100 and actin staining. This supports the diagnosis of prostatic sclerosing adenosis.
Prostatic sclerosing adenosis is rare, and is one condition in which the basal cells of the prostate differentiate towards myoepithelial cells of the breast in that they label for actin and S100 protein. The presence of basal/myoepithelial cells precludes the possibility of prostatic adenocarcinoma in this case, as does the relatively circumscribed nature of the lesion. Prostatic infarct would be associated with stromal necrosis and frequently is associated with squamous metaplasia, which are not seen in the current case.
