Prostate - Prostatic duct carcinomas

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Prostate

Other carcinomas

Prostatic duct carcinomas

Reviewers: Komal Arora, M.D., (see Reviewers page)
Revised: 26 March 2012, last major update March 2012
Copyright: (c) 2003-2012, PathologyOutlines.com, Inc.

General
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● 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
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● 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
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Various images

High molecular weight cytokeratin is primarily negative with some focal staining

PAP

PSA

Positive stains
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● 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
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● 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)

End of Prostate > Other carcinomas > Prostatic duct carcinomas

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