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Abdominal
ultrasound showing
prostatic abscess
TRUS showing hypoechoic lesion
Pelvic CT showing an abscess in the prostate
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Transurethral unroofing of a prostatic abscess
Abscess drainage with transurethral resection
Contributed by Kenneth A. Iczkowski, M.D.
Prostatic microabscess
Contributed by Debra Zynger, M.D. and Kenneth A. Iczkowski, M.D.
Prostatectomy specimen
Extraprostatic extension (pT3a)
Seminal vesicle invasion (pT3b)
Anterior horn of
peripheral zone
Contributed by Murali Varma, M.B.B.S. and @pleasingpathology on Instagram
Infiltrative growth pattern
Glomerulations
Prominent nucleoli
Perineural invasion
Atrophic variant of prostate cancer
Atrophic variant of prostate cancer
Pseudohyperplastic variant of prostate cancer
Foamy gland variant of prostate cancer
Crystals in gland lumens
Pink amorphous material within gland lumens
Amphophilic cytoplasm
Mitosis
Collagenous micronodules
Adenocarcinoma
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Low grade epithelial stromal tumor
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Metastatic hepatocellular carcinoma
Low grade epithelial stromal tumor
Contributed by Kenneth A. Iczkowski, M.D.
Atrophic-like dilated cancer acini
Basaloid appearance
Atrophic, mucinous cancer
Strong diffuse nuclear p63 expression
Few p63 positive acini
Cytoplasmic p63
Contributed by Alcino Pires Gama, M.D., Bonnie Choy, M.D., Daniel Athanazio, M.D., Ph.D. and Maiara Souza, M.D.
Nests of basaloid cells
Palisading outer layer of basaloid cells
Smooth luminal structures
Infiltrative morphology
Extraprostatic extension
Extraprostatic extension
PIN4
PSA
BCL2
Contributed by Cristina Magi-Galluzzi, M.D., Ph.D.
Well circumscribed nodule
Mixed small and large acini
Basal cells
Crowded glands
Bland nuclear features
Fragmented basal cells
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Tumor abutting anorectal canal
Contributed by Susan Prendeville, M.D. and Gladell Paner, M.D.
Biopsy, prominent squamous areas
With obvious keratin
Mixed components, postradiation setting
Transition, squamous to glandular
Contributed by Andres Matoso, M.D., @katcollmd on Twitter and Case #85
Various images
Amyloid
Amyloid
66 year old man with radical prostatectomy for adenocarcinoma
Trichrome stain
Contributed by Andres Matoso, M.D. and @ThatGlassTho on Twitter
Low power of Cowper glands
Glands and skeletal muscle
Mucicarmin+
PAS+
NKX3.1+
Anatomy & histology-Cowper glands
Contributed by Andres Matoso, M.D.
Chromogranin A+
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Fundus
Seminal vesicles and ducts
McNeal zones
Sagittal view
Axial views
Contributed by Kenneth A. Iczkowski, M.D. and AFIP
Cross section of gland
Normal gland
Contributed by Kenneth A. Iczkowski, M.D.
Whole mount histology
Close up, anterior aspect
Basal versus secretory cells
Basal cell hyperplasia
Differential diagnosis of a multilayered epithelium
Hyperplastic central zone
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Seminal vesicles and prostate
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Normal seminal vesicles
Agenesis
Cyst
Seminal vesiculitis
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Cyst
Stones
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Normal seminal vesicle
Acquired cystic dilatation
Cyst
Calculus
Contributed by Faryal Shoaib, M.D., Y. Albert Yeh, M.D., Ph.D. and Andres Matoso, M.D.
Multilobulated tubular structures
Branching side ducts
Lining columnar cells
Enlarged epithelial cells
Large atypical cells
Alveolar-like mucosal folds
Eosinophilic crystalloids
Stromal hyaline body
Stromal hyaline body
Stromal hyaline body
Monstrous epithelial cells
Prostatic glands
Nuclear pleomorphism
Yellow pigment
Contributed by Mahmut Akgul, M.D.
Atrophic features
Atrophic features with PIN4 IHC
Atrophic features with PIN4 IHC
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mpMRI findings, cystic atrophy
Contributed by Kenneth A. Iczkowski, M.D.
Small acinar atrophy
Dilated acinar atrophy
Red doesn’t equal cancer
Sclerosing adenosis
Cancer mimicking atrophy
Contributed by Kenneth A. Iczkowski, M.D.
Basal cells in AIP
Papillary AIP, with invasive acini
Cocktail immunostain of AIP
Isolated AIP on biopsy
Cribriform AIP
AIP, favor intraductal
Grade 5 foamy glands
Not an AIP
Not an AIP, immunostain
Contributed by Kenneth Iczkowski, M.D.
Quantitative ASAP
Three atypical acini and triple stain
Four atypical acini and triple stain
Qualitative ASAP
Upper left atypical acini and triple stain
Large atypical acini and triple stain
Eight small acini and triple stain
ASAP + HGPIN
ASAP + HGPIN and triple stain
ASAP + HGPIN and triple stain
Contributed by Debra Zynger, M.D.
Straight luminal border
Triple stain
Crowded, straight luminal border, mucin and nuceloli
Contributed by Anil Parwani, M.D., Ph.D., M.B.A. and Andres Matoso, M.D.
Benign mimicker of prostatic cancer
Basal epithelium proliferation
Intraluminal amorphic secretions
Florid basal cell hyperplasia
Basal cell carcinoma
Contributed by Debra L. Zynger, M.D.
H&E
Triple stain with CK5-p63-AMACR
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BPH on MRI
Contributed by Sara Moscovita Falzarano, M.D., Ph.D.
Prominent periurethral nodularity
Contributed by Sara Moscovita Falzarano, M.D., Ph.D.
Glandular / epithelial type
Benign prostatic glands
Stromal nodule
p63
p63 / HMWK
Contributed by Rafael E. Jimenez, M.D. and Arpan Samaddar, M.B.B.S.
Clusters of cribriform acini
Clear cells
Intact basal cell layer
Small nuclei without atypia
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Mass of cystic component between bladder and rectum
Cystic mass with solid component connected to the seminal vesicle
Solid and cystic pelvic mass
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Laparoscopic view
Contributed by Daniel Athanazio, M.D., Ph.D.
Cystic mass centered in the seminal vesicle
Cut surface
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Multilobulated cystic mass
Cut surface
Contributed by Daniel Athanazio, M.D., Ph.D.
Cystic tumor
Finger-like projections
Finger-like projections
Leaf-like projections
Nonproliferative stroma
Bland epithelium
GATA3
GATA3
GATA3
GATA3
PSA negative
Calretinin negative
Prostein negative
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Cystic ductal adenocarcinoma
Contributed by He Huang, M.D., Ph.D. and Sarah Findeis, M.D.
Glandular, cribriform and papillary patterns
Pseudostratified columnar cells
Mitotic figures
Papillary architecture
Papillary and cribriform pattern
Core with papillae
Pseudostratification
and papillae
Mixed acinar and ductal adenocarcinoma
Pseudostratification
and
fibrovascular
core
Contributed by @prietopath on Twitter
Contributed by @prietopath on Twitter (see original post here)">
Foamy gland adenocarcinoma
Contributed by @prietopath on Twitter (see original post here)">
Foamy gland adenocarcinoma
CK34BE12
p63
AMACR
| Evolution of grading of special prostate cancer patterns | |||
| Histologic pattern | 2005 consensus | 2014 consensus | 2019 consensus |
| Branched / undulating glands | Include as Gleason 3 | ||
| Cribriform (under Gleason scheme: mostly 3, sometimes 4) | 4 but can be 3 if much larger than benign gland, round and has loose cells | Always 4 | Always 4 and presence or absence should be specified for 3+4, 4+3 or 4+4 |
| Glomeruloid variant | No consensus, 3 versus 4 | Always 4 | -- |
| Mucinous variant | No consensus, some favored 4 | Depends on growth pattern regardless of mucin; could be 3, 4 or 5 | -- |
| Small cell (pure) | Do not grade | -- | -- |
| Intraductal, pure form | -- | Do not grade | Do not grade |
| Intraductal, associated with invasive cancer | -- | -- | Include in estimating the percentage of grade 4, instead of keeping it separate |
| Ductal | 4+4=8 | -- | -- |
| Adenoid cystic / basal cell carcinoma | -- | Do not grade | Do not grade |
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Prostatic hypoechoic lesion (ultrasound)
Prostatic hypointense lesion (MRI)
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Xanthogranulomatous
prostatitis with
abscess
Contributed by Y. Albert Yeh, M.D., Ph.D.
Dilated ducts with inflammation
Histiocytes and giant cells
Expansile inflammatory areas
Foreign body giant cells
BCG related giant cells
Sarcoid related lesions
Sarcoid related giant cells
Sarcoid related Langhans cells
Contributed by Ximing J. Yang, M.D., Ph.D.
Multiple granulomas
Langhans giant cells
BCG induced granuloma
Foreign body giant cell granuloma
Indeterminate granuloma
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Device to generate uniform thickness of sections in radical prostatectomy
Whole mount sectioning
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Prostate cancer pathogenesis
Contributed by Y. Albert Yeh, M.D., Ph.D. and Nicholas P. Reder, M.D., M.P.H.
HGPIN with atypical glands
Atypical gland with basal cells
Single atypical gland
2 atypical glands
Atypical gland in 2 HGPINs
Atypical cytologic features
Small atypical glands adjacent to larger HGPIN glands
PIN4
Contributed by Murali Varma, M.D.
Flat HGPIN
Tufted HGPIN
Micropapillary and flat HGPIN
Micropapillary HGPIN
Inverted HGPIN
p63
CK5/6
AMACR
Contributed by Guang-Qian Xiao, M.D., Ph.D.
Adenosis
Prostatic adenocarcinoma
Atypical cribriform lesion
Prostatic adenocarcinoma
Partial atrophy
Partial atrophy
Carcinoma with radiation effect
Partial atrophy / neoacini
Prostatic ductal adenocarcinoma
p63 expressing prostatic adenocarcinoma
High molecular weight cytokeratin expressing prostatic adenocarcinoma
Contributed by Guang-Qian Xiao, M.D., Ph.D.
Adenosis
Prostatic adenocarcinoma
Atypical cribriform lesion
Prostatic adenocarcinoma
Partial atrophy
Carcinoma with radiation effect
Contributed by Erica Vormittag-Nocito, M.D. and Andre Kajdacsy-Balla, M.D., Ph.D.
Cribriform architecture
Comedonecrosis
Gleason pattern 5
Cribriform component
PIN4 triple stain
Gleason pattern 5, p63
Contributed by Ximing J. Yang, M.D., Ph.D.
Large tumor cells
have slightly more
cytoplasm and
fine
"salt-pepper"
chromatin
Strong/diffuse
chromogranin
staining
Sheets of large
tumor cells with
"salt and pepper"
chromatin
Minor
component of
prostatic
adenocarcinoma
Diffuse chromogranin+
AMACR (triple stain)
Negative HMWCK,
p63, PSA
Ki67 proliferative index up to 50%
Contributed by Nicholas P. Reder, M.D., M.P.H.
Acinar cells with crowded nuclei
Atypical acinar cells
Low grade PIN next to high grade PIN
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mpMRI of hypointense lesion
mpMRI showing hypointense mass
Contributed by Theodorus van der Kwast, M.D., Ph.D.
Histiocytes and inclusions
Histiocytic inflammation
PAS stain
Contributed by Andres Matoso, M.D.
Mesonephric remnant / hyperplasia with acini
Contributed by Ankur Sangoi, M.D.
Compact dilated cysts
Basal nuclei with amphophilic cytoplasm
Prominent nucleoli and luminal crystalloid
Cytoplasmic P504S
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Pelvic MRI, seminal vesicle mass
Contributed by Gladell Paner, M.D.
Mass of seminal vesicle
Contributed by Fiona Maclean, M.D. and Gladell Paner, M.D.
Cellular stroma surrounds epithelium
Urothelial component
Contributed by Francesca Sanguedolce, M.D., Ph.D.
Multiple morphologies
Inflammation, thickened basement membrane
Cytological features
Ki67
AMACR
PAX8
CK7
Contributed by Francesca Sanguedolce, M.D., Ph.D. and Ximing J. Yang, M.D., Ph.D.
Inflammatory cells
Duct inflammation and granuloma
Microabscesses
Foreign body giant cell
Early fibrosis
Benign glandular cells
Contributed by Deepika Kumar, M.D. and Peter A. Humphrey, M.D., Ph.D.
Variably sized glands
Cystic dilatation
Flat pseudostratified lining
Crowded glands
Nuclear atypia
Prominent nucleoli
Perineural invasion
Crowded glands
Micropapillary growth
Less cytologic atypia
Mimics PIN and BPH
Contributed by Kenneth A. Iczkowski, M.D.
Lobule of small acini
Multiple clusters of acini
Lobular arrangement of small acini
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T1 weighted axial MRI image
T2 weighted axial MRI image
Contributed by Kenneth Iczkowski, M.D.
Phyllodes tumor: malignant epithelium
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Lesion: low FDG uptake
Case #269
STUMP, prostate cross section
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STUMP that eventually metastasized
Contributed by Kenneth Iczkowski, M.D., Theo van der Kwast, M.D. and Case #269
STUMP in prostate biopsy that had cancer in other fields
Mitosis
Hypercellular stroma
Circumscription of nodule
Multinucleation
Degenerative atypia
STUMP positive for CD34
STUMP positive for desmin
STUMP positive for HHF35
STUMP with low index for Ki67
STUMP positive for progesterone receptor
Contributed by Kenneth A. Iczkowski, M.D.
Reactive chronic inflammation
Acute inflammation in lumens
Idiopathic granuloma in a TURP
Xanthomatous histiocyte proliferation
CD68 positive stain - confirmatory
Case #117
Various images
Triple stain (AMACR, p63, HMWK)
Contributed by Steven Christopher Smith, M.D., Ph.D.
Liver metastases
Contributed by Steven Christopher Smith, M.D., Ph.D.
Transurethral resection
Biphasic histology
Monophasic sarcomatoid carcinoma
Adenosquamous component
Subtle epithelial component
Focal epithelial differentiation
Heterologous chondrosarcoma pattern
Heterologous osteosarcoma pattern
Heterologous rhabdomyosarcoma pattern
Pleomorphic sarcomatoid pattern
Keratin positivity
ERG positivity
Contributed by Theodorus van der Kwast, M.D., Ph.D. and Liang Cheng, M.D.
Demarcated glandular nodule
Glandular proliferation
Myxoid area
Spindle cellular stroma
Eosinophilic basement membranes
Variably sized glands
Conspicuous nucleoli
Stromogenic glandular lesion
Smooth muscle actin
S100
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Various images
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CT and MRI of prostate
Whole body scan
Pelvic CT with contrast
MRI of prostate
Contributed by Theodorus van der Kwast, M.D., Ph.D. and Debra Zynger, M.D.
Sheets of carcinoma cells
Nuclear molding
Ribbons with pseudorosettes
Solid nests with glands
Solid sheets of adenocarcinoma
Pale and hyperchromatic tumor cells
Sheet of pale tumor cells
Dark cells within duct
Visible nucleoli
Chromogranin A staining
Contributed by Kenneth A. Iczkowski, M.D.
T2 weighted MRI
Contributed by Kenneth A. Iczkowski, M.D.
Needle biopsy
Keratinization with necrosis
Multinucleation
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Squamous cell carcinoma
Contributed by Debra L. Zynger, M.D.
Extraprostatic extension, multifocal (pT3a)
Seminal vesicle invasion (pT3b)
Contributed by Debra L. Zynger, M.D.
Extraprostatic extension (pT3a)
Bladder neck invasion (pT3a)
Seminal vesicle invasion (pT3b)
Rectal invasion (pT4)
Periprostatic lymph node metastasis (pN1)
Pelvic lymph node metastasis (pN1)
Neck lymph node metastasis (pM1a)
Bone metastasis (pM1b)
Lung metastasis (pM1c)
Brain metastasis (pM1c)
Contributed by Kenneth Iczkowski, M.D. and Debra L. Zynger, M.D.
Androgen deprivation, benign
Androgen deprivation, cancer
Radiotherapy, benign
Radiotherapy, benign
Cryotherapy, benign
Cryotherapy, cancer
Suspicious for cancer
Shrunken benign acinus
Radiation change, carcinoma
Contributed by Alcino Pires Gama, M.D. and Bonnie Choy, M.D.
tNEPC (SCNEC)
tNEPC (SCNEC)
LCNEC with acinar adenocarcinoma
LCNEC with acinar adenocarcinoma
tNEPC (SCNEC), synaptophysin
tNEPC (SCNEC), NKX3.1
tNEPC (SCNEC), chromogranin
tNEPC (SCNEC), INSM1
tNEPC (LCNEC), synaptophysin positive
tNEPC (LCNEC), synaptophysin negative
tNEPC (LCNEC), Ki67
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Polypoid mass
Filling defect
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Urethrocystoscopic view of polyp
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Brown-tan knob-like polyp
Contributed by Y. Albert Yeh, M.D., Ph.D.
Fibroepithelial polyp
Polypoid mass
Cloverleaf-like and club-like projections
Broad based papillae
Cloverleaf-like projections
Club-like projections
Broad based finger-like papillae
Urethritis cystica and glandularis
Polypoid and club-like projections
Focal calcifications
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Paraffin blocks
before and
after block
flipping
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Primary carcinoid tumor of the verumontanum
Contributed by Alcino Pires Gama, M.D. and Bonnie Choy, M.D.
Prostatic ductal adenocarcinoma
Adenoid cystic (basal cell) carcinoma of the prostate
Treatment related neuroendocrine carcinoma
Intraductal carcinoma of the prostate
Amin: 2022
Cheng: 2019
Epstein: 2021
Epstein: 2020
Epstein: 2020
IARC: 2022
Lopez-Beltran: 2018
Matoso: 2020
Robinson: 2018
Shah: 2019
VandenBussche: 2022
Wobker: 2021
Yang: 2020
Zhou: 2022
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