Pseudohyperplastic carcinoma with xanthomatous changes: A neoplasm mimicking glandular hyperplasia of the prostate
ABSTRACT Varieties of prostatic adenocarcinoma whose architectural and cytological appearance mimicked benign lesions have been reported in recent decades. Such neoplasms include xanthomatous (foamy) carcinoma and pseudohyperplastic carcinoma. We recently studied five carcinomas showing a cytoarchitectural combination of both neoplasms which were confused with benign glandular proliferations.
Five cases (1.8%) of pseudohyperplastic carcinoma showing xanthomatous changes were selected from a total of 280 biopsies showing prostate carcinoma. Glandular prostatic hyperplasia was originally diagnosed in four of such cases.
Patient age ranged from 54 and 78 years (mean, 64 years). All patients had high prostate-specific antigen levels, and digital rectal examination showed abnormalities in four of them. Neoplasms showed minimal atypia and consisted of mid- to large-sized glands arranged in nests resembling hyperplastic nodules. Glands showed papillary projections, infoldings, and undulations. Most nuclei were basal, small and hyperchromatic, and nucleomegaly was only seen in two biopsies in isolated histological fields. Several useful criteria for diagnosis of acinar carcinoma, such as perineural infiltration, mitosis, crystalloids, blue secretions, and prostatic intraepithelial neoplasm, were absent.
Prostatic carcinoma with a pseudohyperplastic pattern and xanthomatous changes mimics hyperplastic glands. Timely detection is critical to avoid treatment delay.
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ABSTRACT: Pseudohyperplastic carcinoma (PHPC) is a prostatic neoplasm that can be easily mistaken for nodular hyperplasia or atypical adenomatous hyperplasia. To determine the frequency and clinicopathologic characteristics of PHPC, we reviewed 200 simple prostatectomy specimens. We found 3 cases (1.5%) of PHPC. The tumors were small and ranged in size from 4 to 6 mm. Two of them were erroneously diagnosed as benign glandular proliferations in the original interpretation. Their histologic aspect at low magnification showed nodules of well-differentiated medium-sized glands with cystic dilation in a tight arrangement that imparted a benign appearance. Corpora amylacea were found in 2 cases. However, the lining cells showed nucleomegaly and prominent nuclei in most of the neoplastic glands, and the high-molecular-weight keratin (34BE12) immunostain revealed absence of basal cells. α-Methylacyl-CoA-racemase was positive in 2 cases. In one case, a small focus of moderated acinar adenocarcinoma was found adjacent to the pseudohyperplastic glands facilitating the diagnosis. The 3 patients are disease-free 3 and 4 years after surgery probably because of the small size of the tumors; however, it must be emphasized that most PHPC are considered moderately differentiated and potentially aggressive neoplasms.Annals of diagnostic pathology 03/2011; 15(3):170-4. DOI:10.1016/j.anndiagpath.2010.11.007 · 1.11 Impact Factor
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ABSTRACT: Foamy gland carcinoma is a variant of prostatic acinar adenocarcinoma characterized by abundant foamy cytoplasm and often pyknotic nuclei. Limited data exist regarding outcome and the clinicopathologic attributes of this variant. We screened 477 radical prostatectomies for foamy gland carcinoma to determine the incidence, amount, and Gleason grade/score of foamy gland carcinoma within the prostate. Time until prostate-specific antigen biochemical recurrence after radical prostatectomy was compared for both foamy and control/nonfoamy cases. For validation of incidence, Gleason grade, and pathologic stage, a second series of 100 consecutive radical prostatectomies was screened for foamy gland carcinoma. Foamy gland carcinoma was found in 69 (14.5%) of 477 cases. The median Gleason score of the foamy component was 7, which was not significantly different from the Gleason score of the nonfoamy component within those cases or the 408 nonfoamy cases. The most common Gleason score was 7 (44/69). There was no difference between foamy gland and nonfoamy gland cases in recurrence rate (23% versus 22%) or the average time to prostate-specific antigen recurrence (130 versus 151 months). In the second series, foamy gland carcinoma was found in 23% of cases and had a median Gleason score of 7; and the most common Gleason score was 7 (11/23). Foamy gland carcinoma exists in a significant subset of prostatic carcinomas. This variant does not appear to harbor a different prognosis compared with usual acinar adenocarcinoma, but diagnostic recognition of foamy gland carcinoma is important because there is a Gleason grade 4 element in the majority of cases.Human pathology 01/2012; 43(7):974-9. DOI:10.1016/j.humpath.2011.09.009 · 2.81 Impact Factor