Older Male with PSA 1.68ng/ml and Abnormal DRE

Deloar Hossain, M.D.

Specimen Type:

Prostate

History:

70 year old man with PSA 1.68ng/ml and abnormal DRE underwent 12 core TRUS needle biopsy of the prostate.

Pathologic Features:

6 of 12 cores show a classical acinar carcinoma with a Gleason score of 7 (3+4). One of the core from the left base shows three moderately enlarged acini lined by 1 to 4 layers of malignant cells with a cluster of small round blue cells in the center (Fig 1-3). Immunostains shows the small clusters of cells are CD 56, synaptophysin, chromogranin positive and CD45 (LCA) negative.

Differential Diagnosis:

  • Intra acinar small cell carcinoma.
  • Intra acinar lymphocytic infiltrate.

Diagnosis:

Intra-acinar small cell carcinoma.

Presence of intar acinar small cell carcinoma (intra-epithelial neoplasia) does not alter the clinical outcome. Clinical outcome depends on the infiltrating adenocarcinoma (ref1).

References:

  1. Reyes AO, Swanson PE, Carbone JM, Humphrey PA
    Unusual histologic types of high-grade prostatic intraepithelial neoplasia. Am J Surg Pathol. 1997 Oct;21(10):1215-22.