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Presented by Dr. Jonathan Epstein and prepared by Dr. Yembur Ahmad
This case talks about a 40-year-old man with a prostatic mass.
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1. Question
History: A 40 year old man underwent a radical prostatectomy for a prostatic mass.
Choose the correct diagnosis:
Correct
Correct Diagnosis: D
Histological Description: Part of this tumor contains a nodule with the most common pattern of STUMP consisting of slightly hypercellular or normocellular stroma with scattered atypical, but degenerative appearing cells. The STUMP atypical cells contain hyperchromatic multinucleated nuclei with degenerative appearing smudgy chromatin lacking mitotic activity. Intervening benign prostate glands between the STUMP cells are crowded with basal cell hyperplasia. In addition, there are spindled areas with marked hypercellularity and increased mitotic activity including atypical mitotic figures with an infiltrative pattern extending between benign prostate glands.
Discussion: STUMPs are well-circumscribed nodules. They may recur within a few months or years after TURP resulting in urinary obstruction. Uncommonly, STUMPs can be associated with stromal sarcoma on concurrent material (as in this case) or on repeat biopsy, suggesting a malignant progression. If entirely resected and no sarcomatous component, then STUMPs are entirely cured. Stromal sarcomas can extend out of the prostate and metastasize to distant sites, such as bone, lung, abdomen and retroperitoneum. Both STUMPs and stromal sarcomas are often positive for CD34, smooth muscle actin, desmin, and progesterone receptor, such that immunohistochemistry is not helpful in the differential diagnosis. Leiomyomas and leiomyosarcomas of the prostate present as well-circumscribed nodules with intersecting fascicles and even leiomyosarcomas lack a very infiltrative growth pattern.
Incorrect
Correct Diagnosis: D
Histological Description: Part of this tumor contains a nodule with the most common pattern of STUMP consisting of slightly hypercellular or normocellular stroma with scattered atypical, but degenerative appearing cells. The STUMP atypical cells contain hyperchromatic multinucleated nuclei with degenerative appearing smudgy chromatin lacking mitotic activity. Intervening benign prostate glands between the STUMP cells are crowded with basal cell hyperplasia. In addition, there are spindled areas with marked hypercellularity and increased mitotic activity including atypical mitotic figures with an infiltrative pattern extending between benign prostate glands.
Discussion: STUMPs are well-circumscribed nodules. They may recur within a few months or years after TURP resulting in urinary obstruction. Uncommonly, STUMPs can be associated with stromal sarcoma on concurrent material (as in this case) or on repeat biopsy, suggesting a malignant progression. If entirely resected and no sarcomatous component, then STUMPs are entirely cured. Stromal sarcomas can extend out of the prostate and metastasize to distant sites, such as bone, lung, abdomen and retroperitoneum. Both STUMPs and stromal sarcomas are often positive for CD34, smooth muscle actin, desmin, and progesterone receptor, such that immunohistochemistry is not helpful in the differential diagnosis. Leiomyomas and leiomyosarcomas of the prostate present as well-circumscribed nodules with intersecting fascicles and even leiomyosarcomas lack a very infiltrative growth pattern.
