Prostate
Microscopic mimics of prostatic carcinoma
Atrophy

Author: Andres Matoso, M.D. (see Authors page)

Revised: 7 March 2016, last major update March 2016

Copyright: (c) 2003-2016, PathologyOutlines.com, Inc.

PubMed Search: Prostate atrophy [title]
Definition / General
  • Prostatic atrophy refers to the decrease in the amount of cytoplasm of acinic epithelium, sometimes accompanied by nuclear hyperchromasia and prominent nucleoli
  • There are several histologic variants of atrophy including simple atrophy, post-atrophic hyperplasia and partial atrophy
Essential Features
  • May mimic cancer clinically with induration of the gland or hypoechoic nodule by ultrasound
  • There are several histologic variants of atrophy including simple atrophy, post-atrophic hyperplasia and partial atrophy
  • When associated with fibrosis, the atrophic glands may appear infiltrative and mimic cancer
  • Must differentiate from the atrophic variant of prostatic adenocarcinoma, which has these features:
    • Huge nucleoli
    • Infiltrative growth between benign glands without atrophy
    • The presence of usual type adenocarcinoma
Terminology
  • Benign prostate tissue with atrophy
  • When associated with inflammation, it has been termed "proliferative inflammatory atrophy"
Epidemiology
  • More common with age but present at all age groups
Sites
  • More common in the peripheral zone of the prostate
Clinical Features
  • Can mimic prostate cancer clinically with induration of the gland and hypoechoic nodules on ultrasound
Prognostic Factors
  • Not associated with increased risk of malignancy
Treatment
  • Not required
Micro Description
  • Simple atrophy:
    • Characterized by its basophilic appearance at low magnification
    • Glands may be crowded or back to back with little intervening stroma
    • When associated with sclerosed stroma, the glands may assume a more angulated shape and infiltrative appearance
  • Postatrophic hyperplasia (PAH):
    • Also appears basophilic at low power but often surrounds a dilated duct and is arranged in lobules of crowded acini
    • Normally has more mitotic figures than adjacent non-atrophic glands
  • Partial atrophy
    • In contrast to simple atrophy and postatrophic hyperplasia, acini have a pale appearance and nuclei are more spaced apart
Micro Images

Images hosted on Other servers:

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Basophilic appearing glands

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Scant cytoplasm

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Partial atrophy

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Cystic atrophy

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Simple atrophy

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Sclerotic atrophy

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34βE12

Negative Stains
  • Atrophic glands can occasionally be negative or have patchy staining for basal cell markers
Differential Diagnosis
  • The main differential in needle biopsies is with prostate cancer with atrophic features
  • The key morphologic features to reach a diagnosis of atrophic cancer in needle biopsies include:
    • Huge nucleoli
    • Infiltrative growth between benign glands without atrophy
    • The presence of usual type adenocarcinoma
Additional References