Prostate
Prostatic carcinoma variants
Prostatic duct carcinoma / ductal adenocarcinoma

Authors: Komal Arora, M.D. (see Authors page)

Revised: 9 August 2016, last major update March 2012

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

PubMed search: prostatic ductal adenocarcinoma
Cite this page: Prostatic duct carcinoma / ductal adenocarcinoma. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/prostateprostaticduct.html. Accessed December 8th, 2016.
Definition / General
  • Less than 1% of prostatic carcinomas
  • Usually periurethral, but can be seen in peripheral zone
  • Clinically may present as an exophytic papillary lesion in the prostatic urethra
  • On cystoscopy, appears villous or infiltrative into urethra, often near verumontanum
  • Associated with obstructive symptoms and hematuria; usually diagnosed on TURP
  • May have normal digital rectal examination and normal PSA
  • Formerly called endometrioid carcinoma of prostate but of prostatic origin (Arch Pathol Lab Med 1982;106:624)
  • Usually aggressive, less likely to respond to hormone therapy than classic adenocarcinoma, presents at higher stage (Am J Surg Pathol 1999;23:1471, Am J Surg Pathol 1985;9:595) and with lower serum PSA (J Urol 2010;184:2303)
Micro Description
  • Core biopsies usually show papillary or cribriform pattern with slit-like lumina (86%) or discrete glands lined by tall, pseudostratified epithelium with abundant, amphophilic cytoplasm (14%); may have pale / clear cytoplasm
  • Stromal fibrosis (67%), coexisting usual component (48%)
  • May have pagetoid spread throughout prostatic urethra or intraluminally within ducts before invading into surrounding stroma; as a result, the presence of basal cells does not exclude these tumors (Am J Surg Pathol 1997;21:435)
  • Rarely variants include: mucinous with goblet cell features, foamy gland, neuroendocrine with associated Paneth-like cells, micropapillary, cystic papillary (Pathology 2010;42:319)
Micro Images

Images hosted on other servers:

Various images


High molecular weight cytokeratin is
primarily negative with some focal staining

PAP

PSA

Positive Stains
  • High molecular weight cytokeratin may show basal cells in cribriforming ductal adenocarcinoma and also other patterns
  • PSA, PAP (Am J Surg Pathol 2007;31:889)
Differential Diagnosis
  • Cribriform pattern may resemble high grade PIN, but cribriform pattern has back to back irregular glands, extensive comedonecrosis, more prominent nuclear atypia, papillary component with fibrovascular cores (Am J Surg Pathol 2008;32:1060)
  • Urothelial carcinoma, rectal adenocarcinoma invading the prostate, prostatic urethral polyps, hyperplastic benign prostate glands (Med Princ Pract 2010;19:82)