High-grade foamy gland prostatic adenocarcinoma on biopsy or transurethral resection: a morphologic study of 55 cases.

Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, MD 21231, USA.
The American journal of surgical pathology (Impact Factor: 4.59). 12/2008; 33(4):583-90. DOI: 10.1097/PAS.0b013e31818a5c6c
Source: PubMed

ABSTRACT Foamy gland carcinoma is a variant of adenocarcinoma of the prostate that typically is assigned a Gleason score 3+3=6. The morphologic features of high foamy gland carcinoma have not been previously studied. We analyzed 55 cases of high-grade (Gleason score 7 or greater) foamy gland carcinoma of the prostate in needle biopsy (n=49) or transurethral resection (n=6) specimens. The number of cores involved by high-grade foamy gland carcinoma ranged from 1 to 12, with more than 1 core involved in 61% of cases (mean 3.4 cores). On average, 84% of the total tumor volume was foamy gland carcinoma, with high-grade foamy gland cancer averaging 73% of the total foamy gland carcinoma. The following results pertain only to the high-grade foamy gland cancer component. The most common architectural pattern was cribriform (73%), followed by fused/poorly defined glands (55%), cords/single cells (11%), and solid sheets (5%). Nuclear enlargement was observed in 45 of the 55 studied cases (82%). Prominent nucleoli were either absent or infrequent in 38 cases (69%). Frequent to numerous prominent nucleoli were seen more frequently in foamy gland carcinoma with Gleason score 8 or above (52%) than those with Gleason score 7 (16%) (P<0.004). Mitotic figures were observed in 22 cases (40%), and present in 65% of the cases with Gleason score 8 or above, but only in 22% of the cases with Gleason score 7 (P<0.002). In 31 cases (56%), intraluminal dense pink secretions were identified. Perineural invasion and extraprostatic extension identified on the biopsy specimens were noted in 18 cases (33%) and in 5 cases (9%), respectively. In 18 cases (33%), there was at least a moderate stromal reaction. A moderate or greater stromal reaction was seen in 48% (11/23) of the cases with Gleason score 8 or above compared with 22% (7/32) of the cases with Gleason score 7 (P=0.04). In 6 cases, there was a peculiar extensive desmoplastic reaction almost obscuring the carcinoma component, 5 of which were Gleason scores 4+4=8. Concurrent ordinary acinar nonfoamy adenocarcinoma was encountered in 26 of 55 cases (47%) with the following Gleason scores: Gleason 6 (27%); Gleason 7 (27%); and Gleason 8 to 10 (46%). Associated ordinary high-grade prostatic intraepithelial neoplasia and foamy gland variant of high-grade prostatic intraepithelial neoplasia/intraductal adenocarcinoma were seen in 13 cases (24%) and 11 cases (20%), respectively. Of the 19 cases with available immunohistochemical stains for high molecular weight cytokeratin, 7 (37%) showed nonspecific labeling of cancer cells in a nonbasal cell pattern. A similar finding was seen in 1 of the 7 (14%) cases with available stains for p63. Alpha-methyl-CoA racemase positivity was noted in all 9 cases stained. In summary, uncommonly foamy gland carcinoma consists of cribriform, fused/poorly formed glands, cords/single cells, and solid sheets typical of Gleason patterns 4 and 5. High-grade foamy gland cancer shares certain morphologic features with more typical lower-grade foamy gland cancer including relatively bland nuclei with more difficult to identify nucleoli and frequent intraluminal dense pink secretions. However, consistent with their higher architectural grade, high-grade foamy gland cancers had more prominent nucleoli and increased mitotic figures compared with lower-grade foamy gland cancer. A unique subset of high-grade foamy gland carcinoma poses particularly difficult diagnostic challenges, with scattered, scant, relatively bland foamy glands imbedded in an extensive densely sclerotic desmoplastic stroma.

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    ABSTRACT: Foamy gland carcinoma is a subtype of acinar adenocarcinoma characterized by foamy appearance, large cytoplasm, pyknotic nuclei, inconspicuous nucleoli and infiltrative pattern. In this study, we investigated the histological features and the incidence of foamy gland carcinoma. We compared foamy gland carcinoma with acinar adenocarcinoma according to age, prostate specific antigen (PSA) value, Gleason score, peripheral nerve invasion and accompanying high grade prostatic intraepithelial neoplasia (HGPIN). Besides, we investigated the diagnostic value of immunohistochemical markers in foamy gland carcinoma. A total of 863 TRUS-guided prostate needle core biopsies performed at our hospital pathology clinic between 1 January 2010 and 31 December 2011 were examined, 251 of these were diagnosed acinar type adenocarcinoma. Conventional acinar type adenocarcinoma was present in 195 (78%) cases and foamy gland carcinoma in 56 cases (22%). We found that 11 (19%) of the 56 foamy gland carcinoma cases were pure and 45 (81%) cases were mixed with conventional acinar type adenocarcinoma. Single-core localization was present in 7 of 14 pure foamy gland carcinomas and the number of cases with a Gleason score of 7 and above was 21 (37%). No statistically significant difference was found between foamy gland carcinoma and conventional acinar type adenocarcinoma in terms of age, Gleason score, HGPIN and PSA values. Peripheral nerve invasion was found to be statistically significantly more common in foamy gland carcinoma compared to acinar type adenocarcinoma (P < 0.05). The staining percentage of immunohistochemical markers in foamy gland carcinoma was 90.1% for p63, 90.6% for 34Beta12 and 90.6% for AMACR.
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