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Microscopic mimics of prostatic carcinoma

Adenosis/atypical adenomatous hyperplasia

Reviewers: Komal Arora, M.D., (see Reviewers page)
Revised: 22 May 2014, last major update May 2012
Copyright: (c) 2003-2014, PathologyOutlines.com, Inc.


● Microscopic proliferation of small glands with minimal atypia that may be mistaken for adenocarcinoma
● Found almost exclusively in transition zone (2% of TURPs, <1% of core biopsies)
● Frequently multifocal
● 86% associated with nodular hyperplasia
● Less commonly associated with verumontanum mucosal hyperplasia (Arch Pathol Lab Med 2001;125:358, Am J Surg Pathol 1995;19:506, Diagn Pathol 2008;3:34)
● Weak association with adenocarcinoma

Micro description

● Lobular appearance
● Small, round, crowded, closely spaced acini mixed with larger acini with similar features within a circumscribed nodule
● Complex and disorderly glands with an expansile or minimally infiltrative margin, crystalloids in up to 24%
● Usually no prominent nucleoli, no blue-tinged mucin; has normal sized nuclei, normochromasia, corpora amylacea common, may contain acidic mucin
● Resembles Gleason 1 and 2 adenocarcinomas (Am J Surg Pathol 1995;19:737, Arch Pathol Lab Med 2010;134:427, Int J Surg Pathol 2005;13:167)

Micro images

Various images

HMWCK / 34betaE12


● Mixture of CK903 positive and negative glands (i.e. glands with and without basal cell layer, but discontinuous staining)

Negative stains

● Usually P504S/AMACR (Am J Surg Pathol 2002;26:921)
● A significant percentage of AAH cases show stronger and more extensive AMACR expression when associated with prostatic adenocarcinoma, as compared to AAH foci found without coexisting prostate cancer (Prostate 2011;71:1746)

Differential diagnosis

● Low grade adenocarcinoma: haphazard glands, often at right angles to each other

End of Prostate > Microscopic mimics of prostatic carcinoma > Adenosis/atypical adenomatous hyperplasia

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