Difference between revisions of "Atrophy of the prostate gland"

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{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Atrophic prostatic glands -- intermed mag.jpg
| Width      =
| Caption    = Atrophic prostatic glands. [[H&E stain]].
| Synonyms  =
| Micro      = glands typically have a jagged edges/prows (in cancer the glands tend to have round edges), gland density is usually lower than in prostate carcinoma (glands are not back-to-back), nuclei small & hyperchromatic, scant cytoplasm
| Subtypes  =
| LMDDx      = [[prostate carcinoma]] - esp. [[atrophic prostate carcinoma]], [[atypical small acinar proliferation]]
| Stains    =
| IHC        = [[AMACR]] -ve, [[p63]] +ve (basal cells), [[CK34betaE12]] +ve (basal cells)
| EM        =
| Molecular  =
| IF        =
| Gross      =
| Grossing  =
| Site      = [[prostate gland]]
| Assdx      =
| Syndromes  =
| Clinicalhx =
| Signs      =
| Symptoms  = none
| Prevalence = very common
| Bloodwork  =
| Rads      =
| Endoscopy  =
| Prognosis  = benign
| Other      =
| ClinDDx    =
| Tx        = none
}}
'''Atrophy of the prostate gland''', also '''prostatic atrophy''', is a common change in the [[prostate gland]].  
'''Atrophy of the prostate gland''', also '''prostatic atrophy''', is a common change in the [[prostate gland]].  


It usually is seen focally; thus, it is sometimes called '''partial prostatic atrophy'''.
==General==
*Considered to be the most common mimicker of [[prostate carcinoma]].<ref name=pmid18408595>{{Cite journal  | last1 = Wang | first1 = W. | last2 = Sun | first2 = X. | last3 = Epstein | first3 = JI. | title = Partial atrophy on prostate needle biopsy cores: a morphologic and immunohistochemical study. | journal = Am J Surg Pathol | volume = 32 | issue = 6 | pages = 851-7 | month = Jun | year = 2008 | doi = 10.1097/PAS.0b013e31815a0508 | PMID = 18408595 }}</ref>
*Small glands - may mimic [[Gleason score|Gleason pattern]] 3.
*Inflammatory atrophy seems to be related to [[HGPIN]] and [[prostate cancer]];<ref name=pmid10595928>{{Cite journal  | last1 = De Marzo | first1 = AM. | last2 = Marchi | first2 = VL. | last3 = Epstein | first3 = JI. | last4 = Nelson | first4 = WG. | title = Proliferative inflammatory atrophy of the prostate: implications for prostatic carcinogenesis. | journal = Am J Pathol | volume = 155 | issue = 6 | pages = 1985-92 | month = Dec | year = 1999 | doi = 10.1016/S0002-9440(10)65517-4 | PMID = 10595928 }}</ref> however, the epidemiology is not compelling that this is a significant (clinical) association.<ref name=pmid24129226>{{Cite journal  | last1 = Celma | first1 = A. | last2 = Servián | first2 = P. | last3 = Planas | first3 = J. | last4 = Placer | first4 = J. | last5 = Quilez | first5 = MT. | last6 = Arbós | first6 = MA. | last7 = de Torres | first7 = I. | last8 = Morote | first8 = J. | title = Clinical Significance of Proliferative Inflammatory Atrophy in Prostate Biopsy. | journal = Actas Urol Esp | volume = 38 | issue = 2 | pages = 122-126 | month = Mar | year = 2014 | doi = 10.1016/j.acuro.2013.04.008 | PMID = 24129226 }}</ref>


On occasion, it can mimic [[prostate carcinoma]], especially ''[[atrophic prostate carcinoma]]''.
===Classification===
It can be classified into:<ref name=pmid20815946>{{Cite journal  | last1 = Billis | first1 = A. | title = Prostatic atrophy. Clinicopathological significance. | journal = Int Braz J Urol | volume = 36 | issue = 4 | pages = 401-9 | month =  | year =  | doi =  | PMID = 20815946 }}</ref>
#Focal prostatic atrophy.
#Diffuse prostatic atrophy.


==General==
Focal atrophy can be subclassified as:<ref name=pmid20815946/>
*Small glands (may mimic Gleason score 3 pattern).
#Partial.
*Inflammatory atrophy seems to be related to [[HGPIN]] and [[prostate cancer]];<ref name=pmid10595928>{{Cite journal  | last1 = De Marzo | first1 = AM. | last2 = Marchi | first2 = VL. | last3 = Epstein | first3 = JI. | last4 = Nelson | first4 = WG. | title = Proliferative inflammatory atrophy of the prostate: implications for prostatic carcinogenesis. | journal = Am J Pathol | volume = 155 | issue = 6 | pages = 1985-92 | month = Dec | year = 1999 | doi = 10.1016/S0002-9440(10)65517-4 | PMID = 10595928 }}</ref> however, the epidemiology is not compelling that this is a significant (clinical) association.<ref name=pmid24129226>{{Cite journal  | last1 = Celma | first1 = A. | last2 = Servián | first2 = P. | last3 = Planas | first3 = J. | last4 = Placer | first4 = J. | last5 = Quilez | first5 = MT. | last6 = Arbós | first6 = MA. | last7 = de Torres | first7 = I. | last8 = Morote | first8 = J. | title = Clinical Significance of Proliferative Inflammatory Atrophy in Prostate Biopsy. | journal = Actas Urol Esp | volume = 38 | issue = 2 | pages = 122-126 | month = Mar | year = 2014 | doi = 10.1016/j.acuro.2013.04.008 | PMID = 24129226 }}</ref>
#Complete.
#Combined.


==Microscopic==
==Microscopic==
Line 28: Line 66:
DDx:
DDx:
*[[Atrophic prostate carcinoma]].
*[[Atrophic prostate carcinoma]].
*[[Atypical small acinar proliferation]].
*[[Prostate carcinoma]] - focal, low grade.


===Atrophy versus cancer===
===Atrophy versus cancer===
Line 59: Line 99:
|yes - eosinophilic <br>or blue
|yes - eosinophilic <br>or blue
|}
|}
===Images===
<gallery>
Image: Atrophic prostatic glands -- low mag.jpg | APG - low mag. (WC)
Image: Atrophic prostatic glands -- intermed mag.jpg | APG - intermed. mag. (WC)
Image: Atrophic prostatic glands -- high mag.jpg | APG - high mag. (WC)
Image: Atrophic prostatic glands -- very high mag.jpg | APG - very high mag. (WC)
</gallery>
www:
*[http://webpathology.com/image.asp?case=16&n=7 Atrophy (webpathology.com)].
*[http://webpathology.com/image.asp?case=16&n=5 Partial atrophy (webpathology.com)].
*[http://webpathology.com/image.asp?case=16&n=6 Sclerotic atrophy (webpathology.com)].
==IHC==
*Classically like normal prostate (AMACR -ve, p63 +ve, CK34betaE12 +ve).
**May be negative for basal cell markers, i.e. p63 and CK34betaE12.<ref name=pmid18408595>{{cite journal |author=Wang W, Sun X, Epstein JI |title=Partial atrophy on prostate needle biopsy cores: a morphologic and immunohistochemical study |journal=Am. J. Surg. Pathol. |volume=32 |issue=6 |pages=851–7 |year=2008 |month=June |pmid=18408595 |doi=10.1097/PAS.0b013e31815a0508 |url=}}</ref>


==Sign out==
==Sign out==
Generally, this finding is ''not'' reported; it is considered a normal finding.
Generally, this finding is ''not'' reported; it is considered a normal finding.
<pre>
Left Apex:
- Benign prostate tissue with glandular atrophy.
</pre>
===Micro===
The core shows rare, spaced, atrophic appearing glands, mostly with a wavy border and a decreased quantity of cytoplasm. Prominent nucleoli and significant nuclear enlargement are not identified.
There are none of the following: mitoses, adjacent PIN, suspicious luminal material, nuclear hyperchromasia.


==See also==
==See also==

Latest revision as of 14:50, 4 August 2022

Atrophy of the prostate gland
Diagnosis in short

Atrophic prostatic glands. H&E stain.
LM glands typically have a jagged edges/prows (in cancer the glands tend to have round edges), gland density is usually lower than in prostate carcinoma (glands are not back-to-back), nuclei small & hyperchromatic, scant cytoplasm
LM DDx prostate carcinoma - esp. atrophic prostate carcinoma, atypical small acinar proliferation
IHC AMACR -ve, p63 +ve (basal cells), CK34betaE12 +ve (basal cells)
Site prostate gland
Symptoms none
Prevalence very common
Prognosis benign
Treatment none

Atrophy of the prostate gland, also prostatic atrophy, is a common change in the prostate gland.

General

Classification

It can be classified into:[4]

  1. Focal prostatic atrophy.
  2. Diffuse prostatic atrophy.

Focal atrophy can be subclassified as:[4]

  1. Partial.
  2. Complete.
  3. Combined.

Microscopic

Features:

  • Glands often have a jagged edges/prows (in cancer the glands tend to have round edges) - key feature.
    • Prow = forward most part of a ship's bow that cuts through the water.[5]
      • You may have come across prow in the context of breast cancer, i.e. tubular carcinoma.
  • Gland density is usually lower than in prostate carcinoma, i.e. glands are not back-to-back - key feature.
  • Atrophic glands are often hyperchromatic.[6]
  • Scant cytoplasm - usually.

Negatives:

  • Nuclei like normal, i.e. nucleoli uncommon.
  • Should have two cell layers, i.e. epithelial and myoepithelial (may be difficult to see).

Notes:

  • Atrophic glands may be scattered with non-atrophic ones.
  • IHC may be misleading - basal cell loss.

DDx:

Atrophy versus cancer

Histologic feature Atrophy Cancer
Glandular architecture/
arrangement 		angulated glands, may
look like they originate
from one large duct 		round glands,
often back-to-back
Nuclear
hyperchromasia 		marked moderate
Cytoplasm scant/minimal moderate, may
be amphophilic
Basal cells may be visible absent
Nucleoli absent present
Secretions in
glands 		no yes - eosinophilic
or blue

Images

  • APG - low mag. (WC)

  • APG - intermed. mag. (WC)

  • APG - high mag. (WC)

  • APG - very high mag. (WC)

www:

IHC

  • Classically like normal prostate (AMACR -ve, p63 +ve, CK34betaE12 +ve).
    • May be negative for basal cell markers, i.e. p63 and CK34betaE12.[1]

Sign out

Generally, this finding is not reported; it is considered a normal finding. 

Left Apex:
- Benign prostate tissue with glandular atrophy.

Micro

The core shows rare, spaced, atrophic appearing glands, mostly with a wavy border and a decreased quantity of cytoplasm. Prominent nucleoli and significant nuclear enlargement are not identified.

There are none of the following: mitoses, adjacent PIN, suspicious luminal material, nuclear hyperchromasia.

See also

References

  1. ↑ 1.0 1.1 Wang, W.; Sun, X.; Epstein, JI. (Jun 2008). "Partial atrophy on prostate needle biopsy cores: a morphologic and immunohistochemical study.". Am J Surg Pathol 32 (6): 851-7. doi:10.1097/PAS.0b013e31815a0508. PMID 18408595. Cite error: Invalid <ref> tag; name "pmid18408595" defined multiple times with different content
  2. ↑ De Marzo, AM.; Marchi, VL.; Epstein, JI.; Nelson, WG. (Dec 1999). "Proliferative inflammatory atrophy of the prostate: implications for prostatic carcinogenesis.". Am J Pathol 155 (6): 1985-92. doi:10.1016/S0002-9440(10)65517-4. PMID 10595928.
  3. ↑ Celma, A.; Servián, P.; Planas, J.; Placer, J.; Quilez, MT.; Arbós, MA.; de Torres, I.; Morote, J. (Mar 2014). "Clinical Significance of Proliferative Inflammatory Atrophy in Prostate Biopsy.". Actas Urol Esp 38 (2): 122-126. doi:10.1016/j.acuro.2013.04.008. PMID 24129226.
  4. ↑ 4.0 4.1 Billis, A.. "Prostatic atrophy. Clinicopathological significance.". Int Braz J Urol 36 (4): 401-9. PMID 20815946.
  5. ↑ http://en.wikipedia.org/wiki/Prow
  6. ↑ SN. June 3, 2009.
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