BERKELEY, CA (UroToday.com) - In my recent article, I have compiled 43 photo-micrographs to point out certain situations that cause interpretive problems for pathologists and that may be alleviated by effective initial and ongoing urologic pathology training.
For example, Gleason pattern 5 is defined as the presence of individual cancer cells not forming even, ragged gland spaces in a needle biopsy. However, these single cells are frequently overlooked amidst the fused, ragged glands of high-grade cancer, resulting in a Gleason score of 4+4 = 8, which needs to be revised, on second-opinion reports, to 4+4=9.
Glandular fusion is the prerequisite for diagnosing Gleason pattern 4, but fusion also may be overlooked or overcalled, resulting in important differences in Gleason score. Tumor cells in contact with fat cells, constituting extraprostatic extension (stage pT3 rather than pT2), can greatly influence treatment decisions but also can easily get overlooked.
Certain groups of benign small glands, most frequently atrophic glands, but also other benign entities, can mimic cancer and even show reactivity with diagnostic immunohistochemical stains that resemble those in cancer. These diagnostic immunostains—two prostatic basal cell markers and one cancer cell marker—while helping pathologists resolve a great many diagnostic dilemmas, occasionally introduce diagnostic dilemmas or misleading results. Thus, experience and caution is required in their interpretation.
Other topics covered in this photoessay include how to optimize submission of prostate cores--both the urologist's submission and that of the person processing gross specimens; atypical glands arising in association with high-grade prostatic intraepithelial neoplasia (HGPIN); the distinction between HGPIN and its more aggressive non-invasive cousin, intraductal carcinoma; and the differential diagnosis, mostly in transurethral resection specimens, between carcinoma of urothelial origin and that of prostatic origin.
Written by:
Kenneth A. Iczkowski, MD as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Associate Professor, Medical College of Wisconsin, Milwaukee, WI USA
Prostate pointers and pitfalls: The 10 most prevalent problems in prostate biopsy interpretation - Abstract