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Prostatic carcinoma variants

Foamy gland adenocarcinoma

Reviewers: Komal Arora, M.D., (see Reviewers page)
Revised: 23 March 2012, last major update March 2012
Copyright: (c) 2003-2012, PathologyOutlines.com, Inc.


● Rare variant with abundant foamy cytoplasm and minimal cytologic atypia (Am J Surg Pathol 2001;25:618, Am J Surg Pathol 1996;20:419, Am J Surg Pathol 1997;21:616)
● Usually large volume, bilateral, extraprostatic extension
● Foamy appearance due to intracytoplasmic vesicles, not lipid or neutral mucin
● Aggressive behavior despite its benign histologic appearance

Micro description

● Abundant xanthomatous cytoplasm, small hyperchromatic nuclei, minimal/no atypia, pink luminal secretions
● Hyperchromatic nuclei may make nucleoli difficult to see
● Cytoplasm differs between malignant and benign glands
● No obvious basal layer compared to normal glands
● Foamy morphology comprises most of cancer
● Usually Gleason score 3+3=6, occasionally Gleason 7 or higher (Am J Surg Pathol 2009;33:583)
● Needle biopsies may have only a few atypical foamy glands (Ann Diagn Pathol 2008;12:349)

Micro images

Various images

Postive stains

● Colloidal iron
● Alcian blue
● P504S (Am J Surg Pathol 2003;27:772)

Negative stains

● Mucicarmine
● Lipid

Electron microscopy

● Intracytoplasmic vesicles
● Polyribosomes

Differential diagnosis

Clear cell cribriform hyperplasia: basal cells readily identified
Cowper's glands: ducts often embedded in skeletal muscle
Gleason hypernephroid pattern 4: cytoplasm is optically clear but not foamy
Mucinous metaplasia: focal, cells positive for mucicarmine, PAS

End of Prostate > Other carcinomas > Foamy gland adenocarcinoma

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