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India’s first virtual Cancer Pathology diagnostic centre

Mimics of Prostate Cancer

www.oncopathology.info.

Atrophy

• looks suspicious for adenocarcinoma at first glance.
• the nuclei are small and hyperchromatic.
• No prominent nucleoli are seen.
• Some glands are lined by obviously benign flattened atrophic epithelium.
• The immunostain for high molecular weight cytokeratin can be helpful in distinguishing between atrophy (fragmented basal cell layer) from atrophic variant of prostatic adenocarcinoma (no basal cell layer).

Atypical adenomatous hyperplasia

• It may show the infiltrative architecture of cancer,
• lacks the cytologic features such as prominent nucleoli.
• The immunostain for high mol. wt. Cytokeratin will show fragmented basal cell layer in most cases.

Post-Atrophic Hyperplasia

• Post-atrophic hyperplasia architecturally mimics adenocarcinoma
• lacks the cytologic features.
• In difficult cases, the immunostain for high mol. wt. cytokeratin can be performed which would show at least a few basal cells in post-atrophic hyperplasia.

Sclerosing Adenosis

• small glands with infiltrative growth pattern in a cellular spindled stroma.
• The plump spindle cells in the stroma are nicely seen here.
• The lining acinar epithelial cells lack cytologic atypia – no significant nuclear or nucleolar enlargement is seen
• Myoepithelial differentiation in basal cells of the acini of Sclerosing adenosis is illustrated with the immunostain for muscle specific actin.

Cowper’s Glands

• They have a lobular configuration and are often associated with skeletal muscle fibers
• The glands are lined by goblet cells distended with mucin.
• The small hyperchromatic nuclei are pushed to the periphery.
• Sometimes ducts lined by cuboidal cells are present in the center of the lobules.

Mucinous Metaplasia

• Mucinous metaplasia is seen in about 1% of prostates.
• It may occasionally resemble prostatic adenocarcinoma. However, it lacks prominent nucleoli and the does not show immunoreactivity for PSA and PAP.
• The cells are positive for PAS, mucicarmine and Alcian blue.

Prostatic xanthoma

• Prostatic xanthoma is an uncommon benign lesion that may mimic high-grade prostatic adenocarcinoma.
• It consists of lipid-laden macrophages that may be arranged in small circumscribed nodules or infiltrating cords extending into the stroma
• diffusely positive for CD68 (shown here), and negative for CAM5.2, PSA, and PSAP.

Case of the Week 61

The following pieces of tissue (labeled “skin”) were received in the laboratory from an 80 year old man. No further history was available. On closer examination, they appeared to be friable ‘scabs’:

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Answer to Case of the Week 60

Answer: Copepods are involved in the following parasite life cycles:

1. Diphyllobothrium latum, the broad fish tapeworm
2. Dracunculus medinensis, the Guinea worm
3. Spirometra spp., the cause of sparganosis in humans
4. the agents of gnathostomiasis: Gnathostoma spinigerum and Gnathostoma hispidum

Blood Bank Guy Now with Blog

I would hope that nearly all physicians in the course medical school, residency, fellowship and junior staff time encounter a mentor or two along the way. I have been fortunate enough to have several good mentors and a few great ones. Among those is Dr. Joe Chaffin, recently appointed medical director and vice president of a large blood center in Denver, CO.

When I was a resident (not said in a gravely old voice…yet) Joe ran the blood bank at Walter Reed Army Medical Center teaching several years of residents throughout the national capital area everything you wanted to or needed to know about blood banking and not a lot of minutia to clog your brain in risk of losing the big picture and important need to know material. During that time Joe also taught at the Osler review course for pathology. My class and those before and after me benefited from Joe’s interests in computer programming, going through courses and quizzes written on a Macintosh! Of course, Joe at the time was the only one smart enough to have a Mac but I eventually caught on. Last but not least, around the same time Joe started the website Blood Bank Guy (no doubt with a Mac) and was responsible for our department website, still in the infancy of the Internet and later dismantled to a shell of its former shelf following increased DOD restrictions on public web content in 2001. Little remains of that today.

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Case of the Week 60

The following objects are Cyclops–one of the most common genera of microscopic fresh water Copepods (small crustaceans) that are involved in a number of parasite life cycles. So the question for this week: Which human parasites have Copepods in their life cycle?

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