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Prostatic carcinoma variants

Pseudohyperplastic adenocarcinoma

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


● Rare carcinoma that resembles benign hyperplastic glands
● Difficult to grade
● Epstein recommends deferring to the grade of the associated usual type adenocarcinoma in the radical prostatectomy specimen, which is often Gleason score 5-7
● False negative diagnostic rate was 1.3% for TURP specimens (Pseudo Oncol Res 2003;9:232)
● 60% of tumor has benign architectural but malignant nuclear features (Am J Surg Pathol 2000;24:1039)

Case reports

● 70 year old man (Case of the Week #117)

Micro description

● Papillary infoldings (100%), crowded glands, large atypical glands (95%), nuclear enlargement (95%), pink amorphous secretions (70%), occasional to frequent nucleoli (45%), branching (45%), crystalloids (45%), corpora amylacea (20%); at low power, transition to typical, small acinar adenocarcinoma may be helpful (Am J Surg Pathol 1998;22:1239)
● With core needle biopsy, only diagnostic clue may be a subtle disruption of the normal glandular - stromal relationship (Mod Pathol 2004;17:307, Am J Surg Pathol 2010;34:35)
● Despite its benign appearance, may be associated with intermediate grade cancer and can exhibit aggressive behavior

Micro images

Various images


Triple stain (AMACR, p63, HMWK)

Positive stains

● P504S in 70% of cases (Am J Surg Pathol 2003;27:772, Histopathology 2006;48:668)

Negative stains

● High molecular weight keratin and p63 show absence of basal cells in hyperplastic glands (normal glands serve as positive control)

Differential diagnosis

● Adenosis, high grade PIN (not as crowded or infiltrative), benign hyperplasia

End of Prostate > Other carcinomas > Pseudohyperplastic adenocarcinoma

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