Eble JN, Sauter G., Epstein JI, Sesterhenn IA - iarc

pale-clear, similar to benign glands.
Neoplastic glands may have
amphophilic cytoplasm, which may be a
useful diagnostic criterion of malignancy.
Prostate cancer cytoplasm of all grades
typically lacks lipofuscin, in contrast to its
presence in some benign prostatic
glands {314}.
Fig. 3.16 Adenocarcinoma with amphophilic cytoplasm and enlarged nuclei containing prominent nucleoli.
Nuclear features
Nuclei in prostate cancer range from
those indistinguishable from benign prostatic
epithelium to those with overt
malignancy. Typically, the extent of
nuclear atypia correlates with the architectural
degree of differentiation,
although exceptions occur. In most
prostate cancers, there are cytological
differences in the malignant glands when
compared to the surrounding benign
glands. Nuclear enlargement with prominent
nucleoli is a frequent finding,
although not every cancer cell will display
these features. Some neoplastic
nuclei lack prominent nucleoli, yet are
enlarged and hyperchromatic. Prostate
cancer nuclei, even in cancers which
lack glandular differentiation, show little
variabilility in nuclear shape or size from
one nucleus to another. Rarely, highgrade
prostate cancer, typically seen in
the terminal disseminated phase of the
disease, reveals marked nuclear pleomorphism.
Mitotic figures may be relatively
common in high-grade cancer, yet
are infrequent in lower grade tumours.
Cytoplasmic features
Glands of adenocarcinoma of the
prostate tend to have a discrete crisp,
sharp luminal border without undulations
or ruffling of the cytoplasm. In contrast,
equivalently sized benign glands have
an irregular luminal surface with small
papillary infoldings and a convoluted
appearance. The finding of apical snouts
is not helpful in distinguishing benign
versus malignant glands as they can be
seen in both. Cytoplasmic features of low
grade prostate cancer are also often not
very distinctive, since they are often
Intraluminal features
A feature more commonly seen in low
grade prostate cancer, as opposed to
higher grade cancer is prostatic crystalloids
{1111,2204}. These are dense
eosinophilic crystal-like structures that
appear in various geometric shapes
such as rectangular, hexagonal, triangular
and rod-like structures. Crystalloids,
although not diagnostic of carcinoma,
are more frequently found in cancer than
in benign glands. The one condition that
mimics cancer where crystalloids are frequently
seen is adenosis (atypical adenomatous
hyperplasia) {843}.
Intraluminal pink acellular dense secretions
or blue-tinged mucinous secretions
seen in hematoxylin and eosin stained
sections are additional findings seen
preferentially in cancer, especially lowgrade
cancer {703}. In contrast, corpora
amylacea, which consists of well-circumscribed
round to oval structures with
concentric lamellar rings, are common in
benign glands and only rarely seen in
prostate cancer {2204}.
Malignant specific features
Short of seeing prostatic glands in an
extra-prostatic site, there are only three
features that are in and of themselves
diagnostic of cancer, as they have not
been described in benign prostatic
A
B
Fig. 3.17 A Well differentiated carcinoma with mild nuclear atypia. B Apocrine-like cytoplasmic blebing in prostatic adenocarcinoma glands.
Acinar adenocarcinoma
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