Pitfalls and infrequent findings in fine‐needle aspiration of the prostate gland

Abstract

Based on the experience accumulated over two decades and in more than 7,000 transrectal fine-needle aspirations (FNAs) of the prostate gland, several benign and malignant unusual cytologic findings are described. Infrequent benign cytologic findings and possible pitfalls are atrophic prostatic epithelium, squamous metaplasia, transitional cells, granulomatous prostatitis, seminal vesicle epithelium, ganglion cells, lubricant artifacts, and treatment effects. Infrequent variants of carcinoma are foamy-cell carcinoma, prostatic duct adenocarcinoma, mucinous adenocarcinoma, transitional-cell carcinoma, small-cell carcinoma, squamous-cell carcinoma of the prostate, metastatic solid tumor within the prostate, and mesenchymal tumors. Cytopathologists must be able to diagnose these variants of prostate adenocarcinoma because on most occasions the variants imply a worse clinical prognosis. Appropriate training is essential to achieve success in this field of cytopathology. FNA of the prostate provides in a matter of minutes useful information concerning clinical management, prognosis, and treatment of patients.

Mucinous Adenocarcinoma of the Prostate: MRI and MR Spectroscopy Features

“…Thus, mucinous adenocarcinoma would be considered a high-risk finding that could well influence therapeutic decisions and approaches. Unfortunately, the diagnosis of mucinous adenocarcinoma of the prostate is often difficult to make before prostatectomy [1, 6] because the amount of tissue obtained with biopsy may not be representative of the entire tumor, and this subtype may not be recognized because of its rarity and lack of overt aggressive cytologic features.…”

Voided urine cytology in a case of hematospermia

“…11 However, VSC have been also reported as contaminants in transrectal fine needle aspirations of the prostate. 12,13 In these reports, the same conclusion is always mentioned: VSC are a pitfall in the cytodiagnosis of carcinoma. Nevertheless, two clues to its identification in the smears are the observation of yellowish-golden-brown cytoplasmic lipofuscin pigment and accompanying spermatozoa.…”

Cytology of metastatic prostate cancer following orchiectomy and antiandrogen therapy: A diagnostic challenge

“…7 In the limited FNA studies of the prostatic adenocarcinoma describing treatment effects, the malignant cell morphology is similar to the surgical pathology findings. 8,9 One such study describes, ''glycogen cells'' such that the neoplastic cells acquire transparent cytoplasm and hyperchromatic small nucleolus-poor nuclei thus resembling a fried-egg. The molecular mechanism of tumor suppression and apoptosis, by which androgen deprivation therapy works, is reflected in the morphologic appearance of the malignant cells.…”