Case 53

A 76 year old male with PSA>10. Here is the core biopsy.

1. What's your interpretation?

   A: Basal cell hyperplasia

   B: HGPIN

   C: Adenocarcinoma

   D: Normal acini

Answer

This is a straight-up adenocarcinoma. A summary of the helpful features:

Diagnostic Criteria Classification:

• Major Criteria:

  • Infiltrative growth pattern (small atypical glands among benign glands, linear arrangement of crowded glands).

  • Absence of basal cells (often confirmed by immunohistochemical stains such as high-molecular-weight cytokeratins or p63).

  • Nuclear atypia (prominent nucleoli are common; nuclear enlargement is helpful but less diagnostic).

  • Invasive patterns like single cells, cells in cords, and fused/cribriform glands, which are characteristic of high-grade carcinoma.

• Minor Criteria:

  • Amphophilic cytoplasm.

  • Nuclear hyperchromasia.

  • Intraluminal amorphous eosinophilic material, crystalloids, and blue-tinged mucinous secretions.

  • Close proximity to high-grade prostatic intraepithelial neoplasia and periacinar retraction clefting.

• Features Against Diagnosis:

  • Corpora amylacea, atrophic glands, substantial inflammation, and atypical glands merging with benign glands.

2. From other part of the core biopsy, you see this. What's your grading?

   
   

   

   
   

   

   
   

Gleason grading

• 3+3
• 3+4
• 4+3
• 4+4

Answer

The correct answer is 3+4. There are areas of poorly formed gland without lumen.

References: https://tumourclassification.iarc.who.int/chaptercontent/36/100

Case credit: UCSD Pathology

Author: Wangpan Jackson Shi, MD