Stratified epithelium in prostatic adenocarcinoma: a mimic of high-grade prostatic intraepithelial neoplasia

Abstract

Typically glands of prostatic adenocarcinoma have a single cell lining, although stratification can be seen in invasive carcinomas with a cribriform architecture, including ductal carcinoma. The presence and diagnostic significance of stratified cells within non-cribriform carcinomatous prostatic glands has not been well addressed. The histomorphological features and immunohistochemical profile of cases of non-cribriform prostatic adenocarcinoma with stratified malignant glandular epithelium were analyzed. These cases were identified from needle biopsy cases from the consultation files of one of the authors and from a review of 150 consecutive in-house needle biopsy cases of prostatic adenocarcinoma. Immunohistochemistry was performed utilizing antibodies reactive against high molecular weight cytokeratin (34bE12), p63 and a-methylacylcoenzyme-A racemase (AMACR). A total of 8 cases were identified, including 2 from the 150 consecutive inhouse cases (1.3%). In 4 cases, the focus with glands having stratified epithelium was the sole carcinomatous component in the biopsy, while such a component represented 5-30% of the invasive carcinoma seen elsewhere in the remaining cases. The main attribute in all these foci was the presence of glandular profiles lined by several layers of epithelial cells with cytological and architectural features resembling flat or tufted high-grade prostatic intraepithelial neoplasia, but lacking basal cells as confirmed by negative 34bE12 and/or p63 immunostains in all cases. The AMACR staining profile of the stratified foci was variable, with 4 foci showing positivity, and 3 foci being negative, including two cases that displayed AMACR positivity in adjacent non-stratified prostatic adenocarcinoma. Prostatic adenocarcinoma with stratified malignant glandular epithelium can be identified in prostate needle biopsy samples harboring non-cribriform prostatic adenocarcinoma and resembles glands with high-grade prostatic intraepithelial neoplasia. These 'PIN-like' carcinomas can present in pure form. Recognition of this pattern of prostatic adenocarcinoma is necessary to correctly diagnose such cases as invasive carcinoma.

Precursor Lesions of Urologic Malignancies

“…These PIN-like ductal carcinomas resemble flat and tufting HGPIN but may be distinguished by the quantity and crowding of atypical glands, which are negative for basal cell markers (Figure 3, D). 31,32 Cystic dilation of the glands in PIN-like ductal carcinomas is also usually observed.…”

Abdominal lymph node metastasis from prostatic adenocarcinoma in a patient with esophageal squamous cell carcinoma

“…3B). Typically glands of prostatic adenocarcinoma have a single cell lining, although stratification can be seen in invasive carcinoma with a cribriform architecture, including ductal carcinoma 9) . Previous reported cases 7,8) also showed metastatic lymph node with cribriform pattern by hematoxylin and eosin staining.…”

Prostat Kanser Patolojisi

“…Verumontanum veya yakınında üretra içine uzanan ekzofitik, villöz/polipoid bir gelişim oluşabilir. Mikroskopide, sıklıkla papiller ve kribriform formlar, daha nadiren solid ve tek tek PIN-benzeri bezler görülür [42,43]. Belirgin intraduktal komponent sık izlenir.…”