Older Male with Prostate Nodular Hyperplasia

Specimen Type:

Prostate

History:

A 77 year old man with a 5-year history of prostate nodular hyperplasia presented with urinary obstructive symptoms. Transurethral resection consisted of 22 grams of prostatic chips. The majority of the chips revealed nodular hyperplasia. About 30% of the specimen showed areas of white fleshy tissue with cribriform proliferation measuring 2.3 cm in aggregate.

Pathologic Features:

Tumor nests of various sizes infiltrate myxoid stroma with poorly circumscribed border (Fig.8.1). There are 2 distinct architectural patterns: The first pattern is predominant consisting of nests and trabeculae of cells arranged in a cribriform pattern with microcystic spaces containing basement membrane material (Fig.8.2 A, 8.2B, 8.2C ). The second pattern: nests of basaloid cell with scant cytoplasm and peripheral palisading ( Fig.8.3A, 8.3B). This tumor is strongly positive for high molecular weight cytokeratin 34bE12 ( Fig.8.4).

Differential Diagnosis:

The differential diagnosis includes atypical adenomatous hyperplasia (Fig. 8.5), sclerosing adenosis ( Fig. 8. 6A, 8.6B), basal cell hyperplasia ( Fig. 8.7), atypical basal cell hyperplasia ( Fig. 8.8A, 8.8B), basal cell adenoma , post-atrophic hyperplasia ( Fig 8.9A, 8.9B), high-grade prostatic intraepithelial neoplaisa (PIN) cribriform pattern (Fig 8.10), and prostatic adenocarcinoma cribriform subtype ( Fig. 8.11)/

Diagnosis:

Adenoid Cystic/Basal Cell Carcioma (ACBCC) of the Prostate

Key Features:

  • Poorly circumscribed nests or trabeculae of cells infiltrating myxoid stroma
  • There are two distinct architectural patterns: adenoid cystic and basaloid
  • Adenoid cystic pattern: Nests of cells arranging in a cribriform pattern. Microcystic spaces contain mucinous material
  • Basaloid pattern: Variably sized round basaloid cell nests with prominent peripheral palisading
  • The tumor cells are positive for high-molecular weight cytokeratin and/or p63
  • The tumor cells are positive for cytokeratin 7 and negative for cytokeratin 20
  • Extraprostatic extension, perineural invasion, and macronucleoli may be present
  • Potentially aggressive neoplasm requiring ablative therapy

Follow-up: The patient died of tumor with lung metastasis 3.5 years after the diagnosis.

References:

  1. Iczkowski KA, Ferguson KL, Grier DD, Hossain D, Banerjee SS, McNeal JE, Bostwick DG. Adenoid cystic/basal cell carcinoma of the prostate: clinicopathologic findings in 19 cases. Am J Surg Pathol. 2003 Dec;27(12):1523-9.
  2. Bostwick DG. Adenoid basal cell tumor (basal cell carcinoma; adenoid cysticlike tumor. In David G. Bostwick and John N Eble ED. Urologic Surgical Pathology. 375-377. Mosby, St. Louis, Missouri 63146 (1997).
  3. Grignon DJ, Ro JY, Ordonez NG, Ayala AG, Cleary KR. Basal cell hyperplasia, adenoid basal cell tumor, and adenoid cystic carcinoma of the prostate gland: an immunohistochemical study. Hum Pathol. 1988 Dec;19(12):1425-33.
  4. Young RH, Frierson HF Jr, Mills SE, Kaiser JS, Talbot WH, Bhan AK. Adenoid cystic-like tumor of the prostate gland. A report of two cases and review of the literature on "adenoid cystic carcinoma" of the prostate. Am J Clin Pathol. 1988 Jan;89(1):49-56.