Paraganglion of the prostate gland: an uncommon mimic of prostate cancer in needle biopsies
University of Wales, Cardiff, Wales, United KingdomHistopathology (Impact Factor: 3.45). 08/2005; 47(1):114-5. DOI: 10.1111/j.1365-2559.2005.02043.x
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ABSTRACT: The differential diagnoses of prostatic carcinoma and bladder epithelial neoplasms include several histologic mimics that should be known to avoid misdiagnosis. To discuss pseudoneoplastic lesions of the prostate and bladder that could potentially be confused with prostatic carcinoma and bladder epithelial neoplasms, respectively, with specific focus on their distinguishing histopathologic features. Relevant published literature and authors' experience. Pseudoneoplastic lesions in the prostate include those of prostatic epithelial origin, the most common being atrophy, adenosis (atypical adenomatous hyperplasia), basal cell hyperplasia, and crowded benign glands, as well as those of nonprostatic origin, such as seminal vesicle epithelium. Such lesions often mimic lower-grade prostatic adenocarcinoma, whereas others, such as clear cell cribriform hyperplasia and granulomatous prostatitis, for example, are in the differential diagnosis of Gleason adenocarcinoma, Gleason grade 4 or 5. Pseudoneoplastic lesions of the urinary bladder include lesions that could potentially be confused with urothelial carcinoma in situ, such as reactive urothelial atypia, and others, such as polypoid/papillary cystitis, where papillary urothelial neoplasms are the main differential diagnostic concern. Several lesions can mimic invasive urothelial carcinoma, including pseudocarcinomatous hyperplasia, von Brunn nests, and nephrogenic adenoma. Diagnostic awareness of the salient histomorphologic and relevant immunohistochemical features of these prostatic and urinary bladder pseudoneoplasms is critical to avoid rendering false-positive diagnoses of malignancy.
Chapter: Prostate Gland[Show abstract] [Hide abstract]
ABSTRACT: This chapter provides a practical overview of frequently used markers in the diagnosis and differential diagnosis of both common and rare neoplasms of prostate gland with a specific focus on adenocarcinoma and its mimickers. The chapter contains 41 questions; each question is addressed with a table, concise note, and representative pictures if applicable. In addition to the literature review, the authors have included their own experience and tested numerous antibodies reported in the literature. The most effective diagnostic panels of antibodies have been recommended for many entities, such as CK7, PAX2, and MUC6 being suggested as the best diagnostic panel for distinguishing seminal vesicles from prostatic ductal adenocarcinoma and high-grade prostatic intraepithelial neoplasia. Furthermore, immunophenotypes of normal prostate and seminal vesicles have been described, which tend to be neglected in the literature. KeywordsProstatic adenocarcinoma-P504S (AMACR)-PSA-PAX2-PIN4 (triple stain)
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ABSTRACT: Paraganglia are an uncommon but previously reported finding in the genitourinary system. Recognition of this entity in the prostate is important in distinguishing it from prostatic adenocarcinoma. In this series, 1230 radical prostectomy specimens were examined for the presence of paraganglia, and a total of 57 cases (4.5%) were found to contain paraganglia. The majority of paraganglia were extraprostatic and could easily mimic extension of prostatic adenocarcinoma into extraprostatic tissue. It is important to recognize paraganglia, particularly when they are extraprostatic and could confer a falsely higher tumor stage to the patient. The paraganglia demonstrated characteristic histology, and immunohistochemistry was supportive when enough tissue was available. No association between patient age and frequency of paraganglia was found.
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