Case 1 -

Verumontanum, Biopsy: Atypical Papillary Intraductal Proliferation of the Prostatic Epithelium, Highly Suspicious for Adenocarcinoma of Prostate with Ductal Features Follow Up: 72 Months Ned; Post Re-turp and Peripheral Zone Bxs Mahul B. Amin Cedars Sinai Medical Center Los Angeles, CA

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Click here to download handout in 1-up pdf format for the current section Clinical History 67 year old male with a history of gross hematuria, acute prostatitis and benign prostatic hypertrophy. Cystoscopy revealed a small, polypoid growth with a broad base emanating from the left side of the verumontanum in the prostatic urethra. A biopsy was performed. Pertinent Laboratory Data: Elevated PSA (7 ng/mL) Case 1 - Figure 1 Low power view of lesion in prostatic urethra demonstrating a papillary and glandular architecture. Case 1 - Figure 2 Low power view of lesion in prostatic urethra demonstrating a papillary and glandular architecture. Case 1 - Figure 3 Low power view of lesion in prostatic urethra demonstrating a papillary and glandular architecture. Case 1 - Figure 4 Higher power demonstrating that the lesional cells are tall columnar to cuboidal. Case 1 - Figure 5 Higher power demonstrating that the lesional cells are tall columnar to cuboidal. Case 1 - Figure 6 Higher power demonstrating that the lesional cells are tall columnar to cuboidal. Prominent nucleoli are present. Case 1 - Figure 7 Higher power demonstrating that the lesional cells are tall columnar to cuboidal. Prominent nucleoli are present. Case 1 - Figure 8 The lesion in the prostatic urethra is positive for PSA. Case 1 - Figure 9 Triple cocktail immunohistochemistry - p63, high molecular weight cytokeratin and racemase Case 1 - Figure 10 References: Samaratunga H, Duffy D, Yaxley J, Delahunt B. Any proportion of ductal adenocarcinoma in radical prostatectomy specimens predicts extraprostatic extension. Hum Pathol. 2010 Feb;41(2):281-5. Epub 2009 Dec 11. Cohen RJ, Wheeler TM, Bonkhoff H, Rubin MA. A proposal on the identification, histologic reporting, and implications of intraductal prostatic carcinoma. Arch Pathol Lab Med. 2007 Jul;131(7):1103-9. Review. Randolph TL, Amin MB, Ro JY, Ayala AG. Histologic variants of adenocarcinoma and other carcinomas of prostate: pathologic criteria and clinical significance. Mod Pathol. 1997 Jun;10(6):612-29. Review. Dawkins HJ, Sellner LN, Turbett GR, Thompson CA, Redmond SL, McNeal JE, Cohen RJ.Distinction between intraductal carcinoma of the prostate (IDC-P), high-grade dysplasia (PIN), and invasive prostatic adenocarcinoma, using molecular markers of cancer progression. Prostate. 2000 Sep 1;44(4):265-70. Guo CC, Epstein JI. Intraductal carcinoma of the prostate on needle biopsy: Histologic features and clinical significance.Mod Pathol. 2006 Dec;19(12):1528-35. Epub 2006 Sep 15. Aydin H, Zhang J, Samaratunga H, Tan N, Magi-Galluzzi C, Klein E, Jones JS, Zhou M. Ductal adenocarcinoma of the prostate diagnosed on transurethral biopsy or resection is not always indicative of aggressive disease: implications for clinical management. BJU Int. 2010 Feb;105(4):476-80. Epub 2009 Aug 25. Samaratunga H, Letizia B. Prostatic ductal adenocarcinoma presenting as a urethral polyp: a clinicopathological study of eight cases of a lesion with the potential to be misdiagnosed as a benign prostatic urethral polyp. Pathology. 2007 Oct;39(5):476-81.