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Pseudohyperplastic carcinoma with xanthomatous changes: A neoplasm mimicking glandular hyperplasia of the prostate

Departamento de Patología, Instituto Nacional de Ciencias Médica y Nutrición Salvador Zubirán, Ciudad de México, México.
Actas urologicas españolas (Impact Factor: 1.02). 04/2010; 34(4):333-9. DOI: 10.1016/S2173-5786(10)70079-2
Source: PubMed
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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Available from: Julian Arista Nasr, Jun 30, 2015
Originals Prostate cancer
Pseudohyperplastic carcinoma with xanthomatous changes:
A neoplasm mimicking glandular hyperplasia of the prostate
J. Arista-Nasr*, B. Martínez-Benítez, J.A. Fernández-Amador, L. Bornstein-Quevedo
and J. Albores-Saavedra
Department of Pathology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), Mexico City, Mexico
ARTICLE INFORMATION
Article history:
Received on 12 May, 2009
Accepted on 16 September, 2009
Keywords:
Prostatic carcinoma
Xanthomatous
Foamy
Pseudohyperplastic
Prostatic biopsy
*Author for correspondence.
E-mail: brauliomb77@yahoo.com.mx, pipa5@hotmail.com (J. Arista-Nasr).
0210-4806/$ - see front matter © 2009 AEU. Published by Elsevier España, S.L. All rights reserved.
ABSTRACT
Introduction and objectives: 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 mistaken for benign glandular proliferations.
Methods: 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 such cases.
Results: Patient age ranged from 54 to 78 years (mean: 64 years). All patients had high
prostate-specific antigen levels, and digital rectal examination showed abnormalities
in four. 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 observed only occasionally. Several useful criteria for the diagnosis of
acinar carcinoma, such as perineural infiltration, mitosis, crystalloids, blue secretions, and
prostatic intraepithelial neoplasia, were absent.
Conclusions: Prostatic carcinoma with a pseudohyperplastic pattern and xanthomatous
changes mimics hyperplastic glands. Timely detection is critical to avoid treatment
delay.
© 2009 AEU. Published by Elsevier España, S.L. All rights reserved.
Actas Urológicas Españolas
www.elsevier.es/actasuro
actas urol esp. 2010;34(4):333–339
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334 actas urol esp. 2010;34(4):333–339
Introduction
In recent decades, varieties of prostatic adenocarcinoma have
been described whose cytological and architectural features
mimic benign lesions. These neoplasms include foamy gland
carcinoma of the prostate, also known as xanthomatous
carcinoma
1-5
, and pseudohyperplastic carcinoma
6-9
.
Both neoplasms have been studied in specimens from
radical prostatectomies, needle biopsies, and transurethral
resections
1-9
. Foamy gland carcinoma is a cancer showing
glands lined with cells with abundant foamy cytoplasm and
small, hyperchromatic nuclei. Nucleomegaly and prominent
nucleoli area rare and can be observed in isolated fields.
Dense eosinophilic intraluminal secretions are common.
In some cases, diagnosis requires immunohistochemistry
to confirm the absence of basal cells. Most foamy gland
carcinomas are moderately differentiated
2
.
Under low magnification, pseudohyperplastic carcinoma
displays a benign architectural pattern. It consists of medium
and large glands arranged in nests resembling hyperplastic
nodules. In most cases the glands have papillary infoldings,
intraluminal undulations, or cystic dilations. The complex
variety of this cancer shows multiple undulations and foldings,
and glands crowded together. Most cases show nucleomegaly
and/or prominent nucleoli that suggest malignancy
6
.
We recently reviewed five needle biopsies showing a
pseudohyperplastic pattern and cytological characteristics
of foamy gland carcinoma. All biopsies showed minimal
atypia, and four were originally interpreted as prostatic
glandular hyperplasia. The aim of this study is to describe the
clinicopathological characteristics of these neoplasms and to
illustrate criteria that help recognize them as malignant.
Methods
From 2007 to 2008 we reviewed 280 biopsies with
prostate carcinoma, five of which (1.8%) were carcinomas
with a pseudohyperplastic pattern. The lining cells had
a xanthomatous appearance, with small hyperchromatic
nuclei. Sextant biopsies were taken from all five patients, and
the number of fragments per biopsy ranged from six to ten.
In each case, the following data were analyzed: age, digital
rectal examination, prostate-specific antigen (PSA) level,
additional biopsies, clinical course, and metastasis.
In the histological analysis the findings form the first
biopsy were recorded, including number of fragments with
carcinoma, size of the cancerous glands, growth pattern,
glands with undulations, papillary projections and/or
irregular borders, nucleomegaly, prominent nucleoli, mitoses,
perineural invasion, basophilic or eosinophilic intraluminal
secretions, crystalloids, prostatic intraepithelial neoplasia,
and areas of conventional acinar carcinoma. When the
nucleus occupied 10% of the cell surface or less, this was
interpreted as a xanthomatous change
10
. The Gleason score
was recorded only when areas of acinar carcinoma were
Palabras clave:
Carcinoma prostático
Xantomatoso
Espumoso
Pseudohiperplásico
Biopsia prostática
Carcicoma pseudohiperplásico con cambios xantomatosos: una neoplasia
que semeja hiperplasia glandular de la próstata
RESUMEN
Introducción y objetivos: En las últimas décadas se han descrito variedades de adenocarcino-
ma prostático que por su arquitectura y su aspecto citológico semejan lesiones benignas.
Estas neoplasias incluyen al carcinoma xantomatoso (espumoso) y al carcinoma pseudo-
hiperplásico. Recientemente hemos estudiado cinco carcinomas que mostraron una com-
binación citoarquitectónica de ambas neoplasias y fueron confundidas con proliferaciones
glandulares benignas.
Métodos: De un total de 280 biopsias con carcinoma prostático se seleccionaron cinco casos
(1,8%) de carcinoma pseudohiperplásico que mostraron cambios xantomatosos. Cuatro de
ellos fueron diagnosticados originalmente como hiperplasia glandular prostática.
Resultados: La edad de los pacientes varió de 54 a 78 años (promedio: 64 años). El antígeno
prostático estuvo elevado en todos, y en el examen digital rectal se encontraron altera-
ciones en cuatro. Las neoplasias mostraron atipia mínima y estuvieron constituidas por
glándulas de mediano y gran tamaño que se disponían en nidos semejantes a nódulos
hiperplásicos. Las glándulas mostraron proyecciones papilares, plegamientos y ondu-
laciones. La mayoría de los núcleos fueron basales, pequeños e hipercromáticos, y sólo
ocasionalmente se observó nucleomegalia. Varios criterios útiles en el diagnóstico de car-
cinoma acinar, incluyendo infiltración perineural, mitosis, cristaloides, secreciones azules
y neoplasia intraepitelial prostática, estuvieron ausentes.
Conclusiones: Los carcinomas prostáticos con patrón pseudohiperplásico y cambios xan-
tomatosos semejan glándulas hiperplásicas. Su reconocimiento oportuno es crucial para
evitar retardo en el tratamiento.
© 2009 AEU. Publicado por Elsevier España, S.L. Todos los derechos reservados.
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Page 2
actas urol esp. 2010;34(4):333–339 335
observed in the biopsy or the prostatectomy. Findings in
the prostatectomy and in the additional biopsies were also
recorded.
In all five cases immunohistochemical studies were done
with high molecular weight keratins (34BE12 and keratin 5/6,
Dako Corporation
®
) to establish the presence or absence of
basal cells.
Results
Table 1 summarizes the clinical data, and table 2 the
histological biopsy findings.
Case 1. A 54-year-old man. The digital rectal examination
revealed prostate induration; PSA was 12.7 ng/mL. Two of
the ten fragments obtained with the biopsy showed large
neoplastic glands arranged irregularly (fig. 1), with papillary
projections, luminal undulations, and cystic dilations. Most
glands were lined with columnar cells with xanthomatous
changes. The nuclei were small and hyperchromatic; there
was no nucleomegaly or prominent nucleoli (figs. 1 and 2).
The original diagnosis was glandular hyperplasia. When
the biopsy was reviewed, carcinoma was suspected due to
the irregular arrangement of glands and the xanthomatous
changes in the lining cells. After confirming the absence
of basal cells (fig. 3), it was concluded that this was a
pseudohyperplastic carcinoma with xanthomatous changes. A
radical prostatectomy was performed, which revealed foamy
gland carcinoma in both lobes. The neoplastic glands were
predominantly of medium and large size, had abundant
intraluminal eosinophilic secretion, and were interspersed
with smaller, apparently infiltrating neoplastic glands (fig. 4).
Conventional acinar adenocarcinoma was observed in isolated
fields, and the Gleason score was 7 (patterns 4 plus 3). The
neoplasm involved approximately 40% of the prostate and was
limited to the gland, with no pelvic lymph node metastases.
Case 2. A 62-year-old man with two high determinations of
PSA (4.9 ng/mL and 5.2 ng/mL). The digital rectal examination
did not reveal abnormalities. The neoplasm had large
neoplastic glands with minimal nuclear atypia, a papillary
pattern and multiple infoldings that closely resembled
glandular hyperplasia. The lining cells were xanthomatous,
and the nuclei were basal, small, and hyperchromatic (figs.
5 and 6). The immunohistochemical staining with high
molecular weight keratins revealed an absence of basal cells
(fig. 7). Radiological tests did not show metastasis.
Case 3. A 66-year-old man with prostate induration and
PSA 4.6 and 6.2 ng/mL. The neoplasm was found in two of six
fragments; it displayed irregularly arranged glands separated
by a moderate amount of stroma (fig. 8). Most glands
were of medium or large size, and had glandular foldings
and intraluminal papillary projections. The lining cells had
abundant clear cytoplasm and small, hyperchromatic basal
nuclei (fig. 8). Small amounts of intraluminal eosinophilic
secretions were found in isolated fields. The original
diagnosis was glandular hyperplasia. One year after the first
biopsy, PSA rose to 15.5 ng/mL, and a second biopsy was
done; this showed areas of foamy gland carcinoma with
pseudohyperplastic appearance in continuity with a high-
grade foamy gland carcinoma (Gleason score 8, pattern 4 plus
4) (fig. 9).
Case 4. A 78-year old man with an indurated node
in the right prostate lobe. PSA was 12 ng/mL. A sextant
biopsy was taken. A pseudohyperplastic carcinoma with
xanthomatous changes was found in one of the six slides.
The neoplastic glands were arranged in irregular nodes,
and were lined with columnar cells with abundant clear
cytoplasm. The nuclei were small, basal, and hyperchromatic;
nucleomegaly was observed only in isolated fields. The
original diagnosis was nodular hyperplasia of the prostate.
When analyzed retrospectively, the irregular growth pattern
of the pseudohyperplastic glands and the foamy cytoplasm
Histological findings in prostate biopsy
Medium and large glands 5
Glandular foldings and undulation 5
Intraluminal papillary projections 5
Xanthomatous cytoplasm 5
Columnar cells 5
Small, hyperchromatic basal nuclei 5
Eosinophilic secretions 2
Nucleomegaly 2
Prominent nucleoli 1
Basophilic secretions no
Mitoses no
Perineural invasion no
Crystalloids no
Prostatic intraepithelial neoplasia no
Table 2 Pseudohyperplastic carcinoma with xanthoma-
tous pattern
Age Digital rectal exam PSA
Clinical findings
Case 1 54 years Prostate induration 12.7 ng/mL
Case 2 62 years No abnormalities 4.9 and 5.2 ng/mL
Case 3 66 years Prostate induration 4.6 and 6.2 ng/mL
Case 4 78 years Node in the right lobe 12 ng/mL
Case 5 62 years Bilateral induration 20.7 ng/mL
Table 1 – Foamy gland carcinoma with pseudohyperplastic pattern
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336 actas urol esp. 2010;34(4):333–339
suggested the diagnosis of pseudohyperplastic carcinoma
with xanthomatous changes. After documenting the absence
of basal cells, the lesion was reclassified as carcinoma, and
hormone therapy was initiated. Fifteen months later, there
was no evidence of extraprostatic disease, and the last PSA
was 9.5 ng/mL.
Case 5. A 62-year-old man with PSA 20.7 ng/mL. The digital
rectal examination revealed induration of both prostate lobes.
Pseudohyperplastic carcinoma with xanthomatous changes
was found in 3 of the 10 fragments. The neoplastic glands
were large and had papillary projections and foldings (figs. 10
and 11). Nucleomegaly and prominent nucleoli were identified
in isolated glands. In one fragment, the pseudohyperplastic
carcinoma was admixed with acinar carcinoma consisting of
small glands which were recognizably malignant due to their
Figure 1 – (Case 1). Pseudohyperplastic carcinoma with
xanthomatous pattern. The image suggests hyperplasia,
but the neoplastic glands are arranged in poorly-defined
nests, are irregularly distributed, and large.
Figure 4 – (Case 1). Pseudohyperplastic carcinoma with
xanthomatous pattern in a specimen from prostatectomy.
The glands have a pseudohyperplastic aspect and
xanthomatous cytoplasm (left). There is abundant
intraluminal eosinophilic secretion in some fields (right). Near
the foamy glands there are smaller, infiltrative-looking cells.
Figure 2 – (Case 1). Medium-sized glands in a
pseudohyperplastic carcinoma with xanthomatous
changes.
Figure 5 – (Case 2). Pseudohyperplastic carcinoma with
xanthomatous changes and minimal atypia resembling a
hyperplastic node.
Figure 3 – (Case 1). High molecular weight keratin (keratin
5/6), positive in benign residual gland (right), and negative
in a nest of neoplastic cells with a pseudohyperplastic
pattern (left).
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actas urol esp. 2010;34(4):333–339 337
infiltrative appearance. The Gleason score in these areas was
8 (pattern 4 plus 4) (fig. 10). At the time of the review there
was no evidence of metastasis, and a prostatectomy was
planned.
None of the five biopsies showed mitoses, intraluminal
basophilic secretions, neural invasion or prostatic
intraepithelial neoplasia (table 2).
Immunohistochemistry
High molecular weight keratin testing (34BE12 and keratin
5/6, Dako Corporation) confirmed the absence of basal cells
in the malignant glands, and was negative in neoplastic cells.
In contrast, benign prostate tissue is strongly positive in the
basal cells of the lining (figs. 3 and 7).
Discussion
The combination of histological patterns in human malignant
neoplasms is a relatively common phenomenon, and has been
documented in many organs. The association of conventional
acinar carcinoma with several variants of carcinomas, such
as atrophic, pseudohyperplastic, and foamy gland carcinoma,
is common in the prostate
10
.
The tumors described in this article resembled
benign glandular proliferation because they presented
the well-differentiated architectural pattern typical of
Figure 6 – (Case 2). Pseudohyperplastic carcinoma with
xanthomatous changes. The cells have a foamy cytoplasm,
and small hyperchromatic nuclei.
Figure 9 – (Case 3). Second biopsy On the left,
pseudohyperplastic carcinoma with foamy changes, and
medium and large glands. On the right, the glands are
small and have an infiltrative aspect. There are small
amounts of intraluminal eosinophilic secretions.
Figure 8 – (Case 3). First biopsy. Pseudohyperplastic
carcinoma with xanthomatous changes. The neoplasm
shows medium to large glands arranged in an irregular
pattern. Most have multiple glandular foldings and
intraluminal papillary projections. The cytoplasm
is clear and abundant, and the nuclei are small and
hyperchromatic.
Figure 7 – (Case 2). Immunohistochemical staining with
high molecular weight keratins. The pseudohyperplastic
node is negative, in contrast to the benign residual tissue
(right).
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338 actas urol esp. 2010;34(4):333–339
pseudohyperplastic carcinoma, and the minimal cell atypia
characteristic of the foamy gland carcinoma. Four of the five
cases were originally diagnosed with nodular hyperplasia of
the prostate; the exception was case 5, which showed small
glands in an infiltrative pattern.
The diagnosis of pseudohyperplastic carcinoma with
xanthomatous changes should be suspected when there are
irregularly-arranged medium or large neoplastic glands with
foldings, undulations and papillary projections resembling
hyperplastic nodes. If the lining cells have xanthomatous
cytoplasm and small, hyperchromatic nuclei at the base, the
diagnosis of pseudohyperplastic carcinoma with xanthomatous
changes should be considered. When in doubt, the diagnosis
should be confirmed with immunohistochemical staining,
since xanthomatous cells are occasionally found in prostate
hyperplasia
11
. Another difference that helps to distinguish
between hyperplastic from pseudohyperplastic neoplastic
glands is the presence of easily recognizable basal cells in
most hyperplastic nodes.
Several useful criteria for diagnosis of prostate carcinoma,
including perineural infiltration, mitoses, crystalloids,
blue secretions, and prostatic intraepithelial neoplasia,
were absent. Additionally, there were scarce intraluminal
secretions, which were limited to isolated fields. The absence
of several useful criteria for the diagnosis of malignancy
in the usual type pseudohyperplastic carcinomas has been
acknowledged
9
.
The absence of nucleomegaly and the presence of
prominent nucleoli in most cells in foamy gland carcinoma
is well documented, and most of these neoplasms show
small, hyperchromatic, basophilic nuclei
2,4,5
. In the five cases
described here, the nuclei were small and hyperchromatic,
and uniformly situated at the base of the neoplastic cells.
Iczkowsky and Bostwick
12
have pointed out that nuclear
hyperchromasia is often a staining artifact, and its presence
may support the diagnosis of carcinoma in glandular
proliferations suspected of malignancy.
The differential diagnosis of foamy gland carcinoma
includes prostate adenosis, xanthogranulomatous
prostatitis, Cowper glands, mucinous metaplasia, low-
grade carcinomas
13
, and clear cell cribriform hyperplasia
14
.
Since the neoplastic glands in foamy gland carcinoma
with a pseudohyperplastic pattern contain medium and
large cells, the differential diagnosis includes nests of
hyperplastic glands, low-grade carcinoma, clear cell
cribriform hyperplasia, usual type pseudohyperplastic
carcinoma, and prostatic intraepithelial neoplasia.
The differences between hyperplastic glands and
pseudohyperplastic carcinoma are mentioned above. Low-
grade carcinoma may have glands lined with clear cells
resembling those of foamy gland carcinoma
10
; however,
cells often show nucleomegaly and prominent nucleoli,
and have smaller amounts of clear cytoplasm. In clear
cell cribriform hyperplasia, basal cells are identified in the
periphery of the acini, which become more apparent with
high molecular weight cytokeratin staining. Additionally,
pseudohyperplastic carcinoma shows non-fused
neoplastic glands, which provide a cribriform aspect
14
. The
difference between pseudohyperplastic carcinoma with
xanthomatous features and the usual pseudohyperplastic
carcinoma resides in the absence of nucleomegaly and/or
prominent nucleoli in the former; most cases of usual type
pseudohyperplastic carcinoma show nucleomegaly and
prominent nucleoli
2,6
. Prostatic intraepithelial neoplasia
appears in medium and large ducts, lacks foldings, and
the lining cells have variable amounts of nucleoli that
contrast with the small, hyperchromatic nuclei present
in pseudohyperplastic carcinoma with xanthomatous
changes
15
.
The prognosis of neoplasms with a combination of different
histological findings described here is unknown. Metastasis
was found in none of the five cases; however, the follow-up
period was too short, never exceeding two years.
Figure 10 – (Case 5). On the left, the neoplasm shows
glands in an branching pattern, with multiple foldings and
papillary projections. On the right, smaller glands with
infiltrative aspect are observed.
Figure 11 – (Case 5). Detail of the pseudohyperplastic
glands. There are xanthomatous changes in the cytoplasm.
The nuclei are small and hyperchromatic, and arranged
uniformly at the base of the cells.
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actas urol esp. 2010;34(4):333–339 339
Conclusions
Pseudohyperplastic carcinoma with xanthomatous features is
an uncommon neoplasm; however, when it is found in needle
biopsies as the sole pattern, it can be easily mistaken for
benign glandular proliferation. Both foamy gland carcinoma
and pseudohyperplastic carcinoma are neoplasms described
in the past few decades; their morphology may be more
varied than recognized until now.
Conflict of interest
The authors state that they have no conflicts of interest.
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  • Source
    • "It could be important to establish the distinction between PHA with xanthomatous changes and xanthomatous (foamy) adenocarcinoma due to the greater aggressiveness that some authors have encountered in the latter [23]. In our study, the cases of PHA with xanthomatous changes did not have a particularly aggressive evolution [26]. Pseudohyperplastic carcinoma located in isolated fields can be easily overlooked due to its deceptively benign appearance and the scant quantity of neoplastic tissue frequently obtained from a needle biopsy. "
    [Show abstract] [Hide abstract] ABSTRACT: The similarity between some carcinomas and many benign glandular proliferations has been mentioned in the literature for decades. The description of the main histologic features of pseudohyperplastic carcinoma has been very useful in avoiding errors of interpretation, particularly false-negative results. In recent years, we have found some histologic variants of this neoplasm that have not been mentioned previously. In order to classify the different histologic growth patterns and comment on their differential diagnosis, we reviewed the architectural and cytologic features of 34 cases of pseudohyperplastic adenocarcinoma in 2 radical prostatectomies, 4 transurethral resections, and 28 needle biopsies. Growth patterns most commonly observed included nodular, complex, and mixed (nodular and complex) patterns. Other less frequent histologic varieties included adenosis-like pattern, prostatic intraepithelial neoplasia-like pattern, pseudohyperplastic adenocarcinoma with xanthomatous features, and limited pseudohyperplastic adenocarcinoma. Frequent changes in neoplastic glands included papillary infoldings, large/cystic glands, and branching. Criteria associated with malignancy include nuclear enlargement (92%), apparent nucleoli (85%), pink amorphous secretions (78%), and transition to small acinar carcinoma (70%). However, in some biopsies, nuclear atypia was little apparent. Fifteen of the 34 cases were misdiagnosed as benign and 5 as other malignant neoplasms, and included the following diagnoses: hyperplastic nodules (11), prostatic adenosis (2), diffuse adenosis of the peripheral zone (1), benign cystic glands (1), and less frequently other malignant tumors including xanthomatous carcinoma (2), low-grade prostatic adenocarcinoma (2), and atrophic carcinoma (1). It is important to recognize the different growth patterns of this neoplasm in order to avoid an underdiagnosis of malignancy. Copyright © 2015. Published by Elsevier Inc.
    Full-text · Article · May 2015 · Annals of Diagnostic Pathology
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    Full-text · Article · Sep 1998 · American Journal of Clinical Pathology
  • [Show abstract] [Hide abstract] ABSTRACT: Prostate carcinomas are continuously surprising the pathologists through their multitude of variants and histological subtypes, some of them being recently described and characterized. Among these are individualized: atrophic carcinoma, foamy gland, pseudohyperplastic, microcystic, certain subtypes of ductal adenocarcinoma and hormone-treated adenocarcinoma, which because of minimal architectural and/or cytological atypia are often under-diagnosed, especially in small tissue fragments. This paper presents the morphological criteria, including information provided by some immunohistochemical markers for positive and differential diagnosis of these variants/subtypes of prostate adenocarcinoma with which the pathologist should be familiar and avoid their confusion with a series of similar histological structures or benign/premalignant lesions.
    No preview · Article · Jan 2011 · Romanian journal of morphology and embryology = Revue roumaine de morphologie et embryologie
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