gleason grading#WHO classification and pictures#TNM classification# prostectomy

1. WHO -PROSTATE
TUMORS
Dr Y L S
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3. CLASSIFICATION OF PROSTATE TUMORS
 EPITHELIAL TUMORS
 glandular tumors
 Prostatic intraepithelial neoplasms
 ductal adenocarcinoma
 intraductal carcinoma
 urothelial carcinoma
 Squamous cell neoplasms
 Basal cell carcinoma
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4.  NEUROENDOCRINE TUMORS
 MESENCHYMAL TUMORS
 HEMATOLYMPHOID TUMORS
MISCELLANEOUS TUMORS
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6. Clinical features
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7. GRADING OF PROSTATE TUMORS
GRADE HISTOLOGY FEATURES
Grade 3 Well formed glands
Grade 4 Poorly formed glands ,fused glands
,glomerations and cribriform glands
Grade 5 Predominantly sheets, comedo necrosis
or single cells
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11. GLANDULAR NEOPLASMS
 ACINAR ADENOCARCINOMA
 Most of these tumors arises in the peripheral zone which extend into anterior
regions.
 Gross –grey to yellowish ,poorly deliniated ,firm areas.
 Microscopically these neoplasms exhibit wide range of spectrum from highly
neoplastic tumors to anaplastic tumors.
 4 different patterns are discussed mainly are-medium sized glands, small
glands, individual cell infiltration and cribriform glands.
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12. ACINAR ADENOCARCINOMA VARIENTS
 1)ATROPHIC –glands resemble benign glands ,smaller in size with less
cytoplasmic volume and flattened nuclei.
 Gleason -3.AMACR-70%.basal cells negative.
 2)PSEUDOHYPERPLASTIC-resembles BPH. histology shows papillary infolding,
luminal undulations and branching, rarely nodular patterns associated with
acinar patterns.
 Nucleus is round with prominent nucleoli and pseudo stratification. Gleason -
3.AMACR-77%
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13.  3)MICROCYSTIC- gland size can be upto 10 times than that of normal gland
with cystic dilations with lining flattened cells.
 4)FOAMY GLAND-16-22 %.it has abundant foamy/xanthomatous cytoplasm
admixed with non foamy glands with pyknotic nuclei and 33% showing
nucleoli. desmoplastic reaction+. Gleason -7.
 5)MUCINOUS(COLLOID)-0.2%.histology shows fused glands, cribriform ,nests
floats in mucin pools/lakes.
 6)SIGNET RINGS-aggressive Tumor cells shows single large vacuole that lacks
mucin .Diagnostic criteria at least 25% signet cells +.
 PSA +VE.
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14.  PLEOMORPHIC GIANT CELLS-rare and highly pleomorphic cells, bizzare and
anaplastic cells with atypical mitosis with pleomorphic giant cells. Gleason -3,
PSA -50%.
 SARCOMATOID VARIENT-(CARCINOSARCOMA)-Biphasic pattern with sarcoma
and adenocarcinoma pattern (same clone of origin),half Patients have
previous history of adeno ca with RT/HT treatment. Gleason -9.
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24. DUCTAL ADENOCARCINOMA
 Comprises of 3.2%.
 Gross-protrude into urethra as exophytic , polypoidal or papillary masses.
HPE-glandular predominantly, papillary, cribriform rarely solid patterns
.crowded and cystic dilated glands with out basal cells.
 Glands are lined with tall columnar pseudo stratified epithelial ampho philic
nucleus is elongated with sever atypia nucleoli+, mitosis+. intraluminal
necrotic debris is common
 Markers-AMACR, PSA, PSMA, prostein.
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27. UROTHELIAL CARCINOMA
 Comprising 4%.
 Occurs along with bladder carcinoma in prostate urethra
 Gross-areas of erythema/velvety mucosa. solid or sessile mass.
 HPE-similar to transitional carcinoma of bladder, urethra and prostatic ducts
with CIS. high nuclear pleomorphism with mitosis. sometimes tumor fills up
entire glands with comedo necrosis .tumor extensively involves prostate
without stromal invasion.
 Glandular and squamous differentiation with desmoplastic response seen
 Differntiate from urothelial ca-GATA3 ,P63 and HMWCK+;prostate shows
PSA,NKX3+.
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29. SQUAMOUS CELL CARCINOMA
 Comprises of <0.6%.associated with schistosomiasisc and previous treatment
with RT/HT.
 Tumors occurs more in the transitional zones than in peripheral regions.it has
to be diff from squamous metaplasia.
 Tumors are seen as nests or individually scattered with keratinisation.
 Adeno squamous carcinoma can also occur, where glandular pattern is positive
for PSA where as squamous component is positive for HMWCK.
 It has poor prognosis .rapid metastasis to bone –osteolytic lesions
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31. BASAL CELL CARCINOMA
 Prostatic basal cell proliferation is seen .PSA –normal
 Seen mc inTrans urethral region .
 HPE-adenoid cystic /cribriform pattern with secretions and basaloid pattern
with small nests/cords of basal cells.
 Mitosis is variable with desmoplastic reaction.
 Stromal invasion perineural invasion ,necrosis and extra prostatic extension is
common.
 BCL 2 and ki67 helps in differentiating from basal cell hyperplasia.
 Highly aggressive with metastasis to lungs, liver ,penis and bowel.
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33. NEUROENDOCRINE CARCINOMA
 NEUROENDOCRINE CELLS IN USUAL PROSTATE ADENOCARCINOMA
 These cells can occur in 10-100% cases in adenocarcinoma showing positivity
for synaptophysin ,chromogranin.
 There is no impact of neuroendocrine differentiation on outcome of patient.
 ADENOCARCINOMA WITH PANETH CELL LIKE NEUROENDOCRINE DIFFERNTIATION
 Positive for neuroendocrine markers characterized by eosinophilic
cytoplasmic granules .
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34.  Presence of these cell do not change grade of tumor hence they are
 Not included in Gleason grading
 These cells can be admixed with deeply amphophilic cytoplasm without
granules difficult to distinguish from these tumors.
 WELL DIFFERNTIATED NEUROENDOCRINE TUMOUR
 Very rare. they should be diagnosed when tumor is not concominant with
adeno ca and NEC markers are positive.
 Even though it has lymphatics metastasis it has good prognosis
 .
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35.  Sometimes these tumors ae admixed with usual adeno ca with bland
cytological features with NEC markers positivity.
 SMALL CELL NEUROENDOCRINE CARCINOMA
 It is similar to small cell carcinoma of lung usually admixed with adeno ca,
where there is abrupt transmission from small cells to acinar component.
 IHC positive for one or more NEC markers, most are positive for p53 and 25%
positivity for PSA and prostein.
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37. MESENCHYMAL TUMORS
 STROMAL TUMORS OF UNCERTAIN MALIGNANT POTENTIAL AND STROMAL
SARCOMA.
 Gross-whitish tan with solid or solid cystic pattern with smooth walled cystic
filled with bloody, mucinous or clear fluids.
 HPE-most common pattern is hyper cellular stroma with scattered atypical
degenerating looking cells admixed with benign prostatic glands.
 Glands exhibit crowding adenoid/squamous /urothelial/cribriform /clear cell
metaplasia or high grade PIN
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38.  PATTERNS-phyllodes subtype-leaf like pattern of fibrous stroma
 Myxoid pattern containing bland stromal cells
 Epithelioid stromal pattern
 Bland fusiform eosinophilic stromal cells admixed with benign glands
 CD34 may also express progesterone receptors.
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39.  Leiomyosarcoma
 Bulky mass that replaces prostate.
 Smooth muscle tumor showing moderate atypia, extensive necrosis variable
mitosis.
 Actin,vimentin,desmin,cytokeratin,s100 positive.
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40.  Rhabdomyosarcoma
 Mc childhood malignancy of prostate
 HPE-composed of undifferentiated round to spindle cells with focal rhabdo
myoblastic differentiation
 Classified as embryonal/spindle cell/pleomorphic types
 Poor prognosis ,high rates of metastasis.
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43. HEMATO LYMPHOID TUMORS
 Comprised of about 0.1% of primary tumors ,can occur as secondary tumor in
pts with lymphomas
 Tumor is enlarged ,smooth, non tender, not as hard as carcinoma.
 Mc lymphoma is DLBCL.
 CLL/SLL/MANTLE CELL lymphomas may occur as secondary tumors
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45. MISCELLANEOUS TUMORS
 CYSTADENOMA
 NEPHROBLASTOMA
 RHABDOID TUMOR
 GERM CELL TUMORS
 CLEAR CELL ADENOCRCINOMA
 MELANOMA
 PARAGANGLIOMA
 NEUROBLASTOMA
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47. METASTATIC TUMORS
 Secondary tumors of the prostate are non prostatic tumors that can directly
spread or metastasise from another site
 Mets can come from adenocarcinoma colon rectum, urinary bladder or
prostatic urethra.
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51. References
 WHO tumors of the urinary system and male genitals ,4th edition,2016
 Rosai and ackermans surgical pathology,11th edition.
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