Prostate
Prostatic carcinoma variants
Ductal adenocarcinoma

Senior Author: He Huang, M.D., Ph.D.
Editor-in-Chief: Debra Zynger, M.D.
Sarah Findeis, M.D.
He Huang, M.D., Ph.D.

Topic Completed: 18 October 2019

Revised: 18 October 2019

Copyright: 2003-2019, PathologyOutlines.com, Inc.

PubMed search: Prostatic ductal adenocarcinoma [title]

Sarah Findeis, M.D.
He Huang, M.D., Ph.D.
Page views in 2018: 7,347
Page views in 2019 to date: 7,901
Cite this page: Findeis S, Huang H. Ductal adenocarcinoma. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/prostateprostaticduct.html. Accessed December 9th, 2019.
Definition / general
  • Rare subtype of prostatic carcinoma composed of glands lined by pseudostratified columnar cells resembling intestinal / endometrioid epithelium
Essential features
  • More likely to be mixed with acinar adenocarcinoma than to be pure
  • Locally aggressive with seminal vesicle invasion and extraprostatic extension
  • Similar mortality rate to Gleason score 8 - 10 acinar adenocarcinoma
Terminology
  • Prostatic ductal adenocarcinoma
ICD coding
  • ICD-10: C61 - malignant neoplasm of prostate
Epidemiology
Sites
  • Prostate
Pathophysiology
  • Unknown
Etiology
  • Unknown
Clinical features
Diagnosis
  • Similar to other prostate cancers, often diagnosed through transrectal needle biopsies
  • Periurethral tumor may be diagnosed by transurethral resection of the prostate
Laboratory
Radiology description
  • Not diagnostically helpful at this time
Radiology images

Images hosted on other servers:

Cystic ductal adenocarcinoma

Prognostic factors
  • Has similar mortality rate to acinar carcinoma with Gleason score of 8 - 10 (Urology 2015;86:777)
Case reports
Treatment
  • Hormonal therapy, radiation or surgery
Gross description
  • Similar to prostatic acinar adenocarcinoma
Microscopic (histologic) description
  • Glands composed of tall columnar cells which are either in a cribriform, papillary, solid and prostatic intraepithelial neoplasia-like pattern which arise in primary periurethral ducts or in peripheral prostatic ducts
  • Cytoplasm is typically amphophilic, although can be clear (Med Princ Pract 2010;19:82)
  • In contrast to cribriform acinar adenocarcinoma, the cribriform pattern is composed of intraglandular epithelial bridging with slit-like lumens instead of the punched out lumens of an acinar adenocarcinoma cribriform pattern (Am J Surg Pathol 2011;35:615)
  • Most ductal adenocarcinoma is considered as Gleason pattern 4 (5 if with comedonecrosis)
  • Prostatic intraepithelial neoplasia-like ductal adenocarcinoma is assigned as Gleason pattern 3 (Histopathology 2012;60:59)
  • Other unusual patterns that have been reported are foamy gland and Paneth cell-like (Pathology 2010;42:319)
  • Associated with seminal vesical invasion and less likely to be confined to the prostate than acinar carcinoma Gleason score 7 and below (Hum Pathol 2010;41:281, Virchows Arch 2013;46:429)
  • Will likely be intermixed with acinar component
  • Scored via the Gleason scoring system
Microscopic (histologic) images

Contributed by He Huang, M.D., Ph.D.

Glandular, cribriform and papillary patterns

Pseudostratified columnar cells

Mitotic figures

Virtual slides

Prostatic ductal adenocarcinoma

Cytology description
  • Sheets of columnar cells with some gland formation or papillary architecture with inconspicuous nucleoli (Acta Cytol 2013;57:184)
Positive stains
Negative stains
Molecular / cytogenetics description
Sample pathology report
  • Prostate, radical prostatectomy:
    • Prostatic ductal adenocarcinoma, Gleason score 4+4=8, grade group 4 (see synoptic report)
Differential diagnosis
Board review question #1
A single discrete lesion is identified within the prostate. What immunohistochemical profile would you expect to have with the following prostatic tumor?



  1. CDX2+, AMACR+, PSAP+
  2. NKX3.1+, CK20-, PSA+
  3. PSA+, CK7+, AMACR+
  4. CK5+, CK20+, NKX3.1+
Board review answer #1
B. NKX3.1+, CK20-, PSA+. Ductal adenocarcinoma is CK7-, CK20-, PSA+, PSAP+, AMACR+, NKX3.1+.

Reference: Prostate - Prostatic duct carcinoma / ductal adenocarcinoma

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Board review question #2
You suspect prostatic ductal adenocarcinoma but your differential includes acinar adenocarcinoma, Gleason pattern 4. Which of the following findings favor ductal adenocarcinoma over acinar adenocarcinoma, Gleason pattern 4?

  1. High PSA serum levels
  2. Glands composed of columnar cells
  3. Smooth, punched out luminal shape
  4. Stronger AMACR staining pattern
Board review answer #2
B. Glands composed of columnar cells. Acinar adenocarcinoma Gleason pattern 4 is composed of cribriforming glands with cuboidal cells whereas ductal adenocarcinoma has columnar cells. Other answer choices: Ductal adenocarcinoma tends to have lower PSA serum levels. The lumens are slit-like, not punched out. AMACR does not have a significantly different staining pattern between the two entities.

Reference: Prostate - Prostatic duct carcinoma / ductal adenocarcinoma

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