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    ABSTRACT: We studied 302 needle biopsies for perineural invasion for sensitivity and specificity in predicting capsular penetration in subsequent radical prostatectomies. Perineural invasion was seen in 20% of needle biopsies, with a sensitivity of 27% and a specificity of 96% in predicting capsular penetration. By including tumor with a Gleason sum of 7 or greater or perineural invasion on needle biopsy as being predictive, sensitivity increased to 36% with a specificity of 94%. By restricting perineural invasion to cases with more than one nerve involved or a nerve involvement of a diameter 0.1 mm or greater, specificity increased to 97% and 99%, respectively, with sensitivity falling to 15% and 9%, respectively. Measuring perineural invasion on needle biopsy helps to identify capsular penetration and may help in planning nerve-sparing radical prostatectomy in the decision of whether to sacrifice part or all of the neurovascular bundle on the side of the biopsy.
    American Journal of Surgical Pathology 05/1993; 17(4):336-41. · 4.87 Impact Factor
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    ABSTRACT: Classically, adenosis has been described as occurring in the transition zone of the prostate, a region not routinely sampled with needle biopsies. However, with urologists performing more needle biopsies, we have seen an increasing number of cases of adenosis in needle biopsies of the prostate. To better characterize the histologic features of adenosis present in needle biopsy specimens, we reviewed 63 needle biopsies of the prostate containing a total of 75 foci of adenosis. Of the 63 cases, 51 (81%) were seen in consultation by one of the authors, and in approximately 80% of these cases, the differential diagnosis included low-grade adenocarcinoma. Crystalloids were present in 18 foci (24%), a minimally infiltrative growth pattern in 10 foci (13%), prominent nucleoli in 10 foci (13%), scattered single cells in eight foci (11%), mitoses in two foci (3%), and blue-tinged muci-nous secretions in two foci (3%). Immunohistochemistry was performed on 29 (39%) foci to rule out adenocarcinoma. Intraluminal crystalloids, a minimally invasive growth pattern, and single cells occur with sufficient frequency in adenosis, such that their presence is not useful in distinguishing low-grade adenocarcinoma from adenosis; 62 (83%) of the foci of adenosis were found to contain none of the remaining histologic features (mitoses, blue-tinged luminal secretions, prominent nucleoli), whereas 12 foci (16%) had one of the features and one focus (1%) had two features. Adenosis should always be in the differential diagnosis when one is considering low-grade carcinoma on needle biopsy. The key feature of adenosis is the merging of small crowded glands with surrounding benign glands; in contrast, the small glands of adenocarcinoma differ in their cytoplasm, nuclei, or luminal contents from adjacent benign glands.
    American Journal of Surgical Pathology 08/1995; 19(7):737-47. · 4.87 Impact Factor
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    ABSTRACT: Demonstration of intraluminal crystalloids and mucin can aid in the diagnosis of prostatic adenocarcinoma. Crystalloids have been reported in 10% to 23% of prostatic adenocarcinomas. This incidence may not be accurate, however, because previous studies were based on specimens obtained by transurethral resection or transrectal biopsy. This study was based on the examination of 54 prostates (9 obtained from radical prostatectomies for prostate cancer and 45 from cystoprostatectomies for bladder carcinoma) processed by a whole-organ section method. Crystalloids were found in all nine prostatic carcinomas from radical prostatectomy specimens. Thirty-one of 45 specimens from cystoprostatectomies had single or multiple foci of adenocarcinoma; of these, 20 cases (64.5%) had crystalloids. Numbers of crystalloids varied not only from case to case but also from area to area within the same case. Crystalloids were occasionally identified in benign and dysplastic glands that were adjacent to areas of carcinoma. Cases without prostatic carcinoma and benign or dysplastic glands distant from areas of carcinoma did not contain crystalloids. Twenty-four prostatic adenocarcinomas had intraluminal mucin; mucin was not found in benign glands. In conclusion we found the incidence of crystalloids to be higher than that reported in previous studies, a difference we believe is because of sampling. We confirm previous observations that intraluminal crystalloids and mucin are helpful in diagnosing prostate adenocarcinoma.
    The Prostate 02/1988; 13(3):233-9. · 3.84 Impact Factor

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