Prostate gland & seminal vesicles

Acinar / ductal adenocarcinomas

Ductal adenocarcinoma


Editorial Board Member: Bonnie Choy, M.D.
Deputy Editor-in-Chief: Maria Tretiakova, M.D., Ph.D.
Sarah Findeis, M.D.
He Huang, M.D., Ph.D.

Last author update: 11 November 2022
Last staff update: 11 November 2022

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PubMed search: Prostatic ductal adenocarcinoma

Sarah Findeis, M.D.
He Huang, M.D., Ph.D.
Page views in 2021: 17,003
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Cite this page: Findeis S, Huang H. Ductal adenocarcinoma. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/prostateprostaticduct.html. Accessed December 10th, 2022.
Definition / general
  • Rare subtype of prostatic carcinoma composed of large glands lined by tall columnar cells with pseudostratified nuclei
Essential features
  • Frequently mixed with acinar adenocarcinoma
  • Similar mortality rate to Gleason score 8 - 10 acinar adenocarcinoma for usual ductal adenocarcinoma
Terminology
  • Prostatic ductal adenocarcinoma, ductal carcinoma
ICD coding
  • ICD-O: 8500/3 - ductal adenocarcinoma
  • ICD-10: C61 - malignant neoplasm of prostate
  • ICD-11: 2C82.0 & XH7KH3 - adenocarcinoma of prostate & infiltrating duct carcinoma, NOS
Epidemiology
Sites
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; however, pure ductal adenocarcinoma may be seen as a noncystic mass with periurethral distribution or a multicystic mass (Abdom Radiol (NY) 2022;47:1929)
Radiology images

Images hosted on other servers:

Cystic ductal adenocarcinoma

Prognostic factors
Case reports
Treatment
  • Hormonal therapy, radiation or surgery
  • Tends to have a worse outcome compared to prostatic acinar adenocarcinoma (Eur Urol 2021;79:298)
Gross description
  • Similar to prostatic acinar adenocarcinoma
Microscopic (histologic) description
  • Large glands composed of tall columnar cells which often have pseudostratified nuclei
  • Patterns include cribriform, papillary, solid and prostatic intraepithelial neoplasia-like pattern
  • Arises in primary periurethral ducts or in peripheral prostatic ducts
  • Frequently is mixed with an acinar component (Virchows Arch 2013;46:429)
  • Most ductal adenocarcinoma is considered to be Gleason pattern 4 (5 if with comedonecrosis) (scored via the Gleason scoring system)
  • Cytoplasm is typically amphophilic, although it can be clear (Med Princ Pract 2010;19:82)
  • May have desmoplastic stromal reaction, hemorrhage, edema and inflammation (Mod Pathol 2018;31:S71)
  • May have intraductal spread (Mod Pathol 2018;31:S71)
  • Other unusual patterns that have been reported are foamy gland, Paneth cell-like neuroendocrine, micropapillary and cystic papillary (Pathology 2010;42:319)
  • Associated with seminal vesical invasion and less likely to be confined to the prostate than acinar adenocarcinoma with a Gleason score < 7 (Hum Pathol 2010;41:281, Virchows Arch 2013;46:429)
Microscopic (histologic) images

Contributed by He Huang, M.D., Ph.D. and Sarah Findeis, M.D.

Glandular, cribriform and papillary patterns

Pseudostratified columnar cells

Mitotic figures

Papillary architecture

Papillary architecture

Papillary and cribriform pattern

Papillary and cribriform pattern


Core with papillae

Core with papillae

Pseudostratification and papillae

Pseudostratification
and papillae

Mixed acinar and ductal adenocarcinoma

Mixed acinar and ductal adenocarcinoma

Pseudostratification and fibrovascular core

Pseudostratification
and
fibrovascular
core

Virtual slides

Images hosted on other servers:

Prostatic ductal adenocarcinoma

Cytology description
Negative stains
  • CK7, CK20 (can be patchy positive); typically negative for CDX2
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 style question #1

A single discrete lesion is identified within the prostate. What immunohistochemical profile would you expect to have with the above prostatic tumor?

  1. CDX2+, AMACR+, PSAP+
  2. CK5+, CK20+, NKX3.1+
  3. NKX3.1+, CK20-, PSA+
  4. PSA+, CK7+, AMACR+
Board review style answer #1
C. NKX3.1+, CK20-, PSA+. Ductal adenocarcinoma is CDX2-, CK7-, CK20-, PSA+, PSAP+, AMACR+ (77%), NKX3.1+.

Comment here

Reference: Ductal adenocarcinoma
Board review style question #2
You suspect prostatic ductal adenocarcinoma but your differential includes high grade prostatic intraepithelial neoplasia (HGPIN). Which of the following features favor ductal adenocarcinoma over HGPIN?

  1. Comedonecrosis
  2. Micropapillary formation
  3. Stronger AMACR staining pattern
  4. Very high PSA serum levels
Board review style answer #2
A. Comedonecrosis. Other answer choices: both can have AMACR positivity. Micropapillary pattern (and not true papillary fibrovascular cores) is more associated with HGPIN.

Comment here

Reference: Ductal adenocarcinoma
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