High-grade foamy gland prostatic adenocarcinoma on biopsy or transurethral resection

A morphologic study of 55 cases

Research output: Contribution to journalArticle

Abstract

Foamy gland carcinoma is a variant of adenocarcinoma of the prostate that typically is assigned a Gleason score 3+3 = 6. The morphologic features of high foamy gland carcinoma have not been previously studied. We analyzed 55 cases of high-grade (Gleason score 7 or greater) foamy gland carcinoma of the prostate in needle biopsy (n = 49) or transurethral resection (n = 6) specimens. The number of cores involved by high-grade foamy gland carcinoma ranged from 1 to 12, with more than 1 core involved in 61% of cases (mean 3.4 cores). On average, 84% of the total tumor volume was foamy gland carcinoma, with high-grade foamy gland cancer averaging 73% of the total foamy gland carcinoma. The following results pertain only to the high-grade foamy gland cancer component. The most common architectural pattern was cribriform (73%), followed by fused/poorly defined glands (55%), cords/single cells (11%), and solid sheets (5%). Nuclear enlargement was observed in 45 of the 55 studied cases (82%). Prominent nucleoli were either absent or infrequent in 38 cases (69%). Frequent to numerous prominent nucleoli were seen more frequently in foamy gland carcinoma with Gleason score 8 or above (52%) than those with Gleason score 7 (16%) (P <0.004). Mitotic figures were observed in 22 cases (40%), and present in 65% of the cases with Gleason score 8 or above, but only in 22% of the cases with Gleason score 7 (P <0.002). In 31 cases (56%), intraluminal dense pink secretions were identified. Perineural invasion and extraprostatic extension identified on the biopsy specimens were noted in 18 cases (33%) and in 5 cases (9%), respectively. In 18 cases (33%), there was at least a moderate stromal reaction. A moderate or greater stromal reaction was seen in 48% (11/23) of the cases with Gleason score 8 or above compared with 22% (7/32) of the cases with Gleason score 7 (P = 0.04). In 6 cases, there was a peculiar extensive desmoplastic reaction almost obscuring the carcinoma component, 5 of which were Gleason scores 4+4 = 8. Concurrent ordinary acinar nonfoamy adenocarcinoma was encountered in 26 of 55 cases (47%) with the following Gleason scores: Gleason 6 (27%); Gleason 7 (27%); and Gleason 8 to 10 (46%). Associated ordinary high-grade prostatic intraepithelial neoplasia and foamy gland variant of high-grade prostatic intraepithelial neoplasia/intraductal adenocarcinoma were seen in 13 cases (24%) and 11 cases (20%), respectively. Of the 19 cases with available immunohistochemical stains for high molecular weight cytokeratin, 7 (37%) showed nonspecific labeling of cancer cells in a nonbasal cell pattern. A similar finding was seen in 1 of the 7 (14%) cases with available stains for p63. α-methyl-CoA racemase positivity was noted in all 9 cases stained. In summary, uncommonly foamy gland carcinoma consists of cribriform, fused/poorly formed glands, cords/single cells, and solid sheets typical of Gleason patterns 4 and 5. High-grade foamy gland cancer shares certain morphologic features with more typical lower-grade foamy gland cancer including relatively bland nuclei with more difficult to identify nucleoli and frequent intraluminal dense pink secretions. However, consistent with their higher architectural grade, high-grade foamy gland cancers had more prominent nucleoli and increased mitotic figures compared with lower-grade foamy gland cancer. A unique subset of high-grade foamy gland carcinoma poses particularly difficult diagnostic challenges, with scattered, scant, relatively bland foamy glands imbedded in an extensive densely sclerotic desmoplastic stroma.

Original languageEnglish (US)
Pages (from-to)583-890
Number of pages308
JournalAmerican Journal of Surgical Pathology
Volume33
Issue number4
DOIs
StatePublished - Apr 2009

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Neoplasm Grading
Adenocarcinoma
Biopsy
Carcinoma
Neoplasms
Prostatic Intraepithelial Neoplasia
Prostate
Coloring Agents
Keratin-7
Racemases and Epimerases
Needle Biopsy
Coenzyme A
Tumor Burden
Molecular Weight

Keywords

  • Foamy gland carcinoma
  • Gleason grading system
  • Prostate adenocarcinoma

ASJC Scopus subject areas

  • Anatomy
  • Pathology and Forensic Medicine
  • Surgery
  • Medicine(all)

Cite this

@article{32ad67e0fc6a49ce852945f5a5e71403,
title = "High-grade foamy gland prostatic adenocarcinoma on biopsy or transurethral resection: A morphologic study of 55 cases",
abstract = "Foamy gland carcinoma is a variant of adenocarcinoma of the prostate that typically is assigned a Gleason score 3+3 = 6. The morphologic features of high foamy gland carcinoma have not been previously studied. We analyzed 55 cases of high-grade (Gleason score 7 or greater) foamy gland carcinoma of the prostate in needle biopsy (n = 49) or transurethral resection (n = 6) specimens. The number of cores involved by high-grade foamy gland carcinoma ranged from 1 to 12, with more than 1 core involved in 61{\%} of cases (mean 3.4 cores). On average, 84{\%} of the total tumor volume was foamy gland carcinoma, with high-grade foamy gland cancer averaging 73{\%} of the total foamy gland carcinoma. The following results pertain only to the high-grade foamy gland cancer component. The most common architectural pattern was cribriform (73{\%}), followed by fused/poorly defined glands (55{\%}), cords/single cells (11{\%}), and solid sheets (5{\%}). Nuclear enlargement was observed in 45 of the 55 studied cases (82{\%}). Prominent nucleoli were either absent or infrequent in 38 cases (69{\%}). Frequent to numerous prominent nucleoli were seen more frequently in foamy gland carcinoma with Gleason score 8 or above (52{\%}) than those with Gleason score 7 (16{\%}) (P <0.004). Mitotic figures were observed in 22 cases (40{\%}), and present in 65{\%} of the cases with Gleason score 8 or above, but only in 22{\%} of the cases with Gleason score 7 (P <0.002). In 31 cases (56{\%}), intraluminal dense pink secretions were identified. Perineural invasion and extraprostatic extension identified on the biopsy specimens were noted in 18 cases (33{\%}) and in 5 cases (9{\%}), respectively. In 18 cases (33{\%}), there was at least a moderate stromal reaction. A moderate or greater stromal reaction was seen in 48{\%} (11/23) of the cases with Gleason score 8 or above compared with 22{\%} (7/32) of the cases with Gleason score 7 (P = 0.04). In 6 cases, there was a peculiar extensive desmoplastic reaction almost obscuring the carcinoma component, 5 of which were Gleason scores 4+4 = 8. Concurrent ordinary acinar nonfoamy adenocarcinoma was encountered in 26 of 55 cases (47{\%}) with the following Gleason scores: Gleason 6 (27{\%}); Gleason 7 (27{\%}); and Gleason 8 to 10 (46{\%}). Associated ordinary high-grade prostatic intraepithelial neoplasia and foamy gland variant of high-grade prostatic intraepithelial neoplasia/intraductal adenocarcinoma were seen in 13 cases (24{\%}) and 11 cases (20{\%}), respectively. Of the 19 cases with available immunohistochemical stains for high molecular weight cytokeratin, 7 (37{\%}) showed nonspecific labeling of cancer cells in a nonbasal cell pattern. A similar finding was seen in 1 of the 7 (14{\%}) cases with available stains for p63. α-methyl-CoA racemase positivity was noted in all 9 cases stained. In summary, uncommonly foamy gland carcinoma consists of cribriform, fused/poorly formed glands, cords/single cells, and solid sheets typical of Gleason patterns 4 and 5. High-grade foamy gland cancer shares certain morphologic features with more typical lower-grade foamy gland cancer including relatively bland nuclei with more difficult to identify nucleoli and frequent intraluminal dense pink secretions. However, consistent with their higher architectural grade, high-grade foamy gland cancers had more prominent nucleoli and increased mitotic figures compared with lower-grade foamy gland cancer. A unique subset of high-grade foamy gland carcinoma poses particularly difficult diagnostic challenges, with scattered, scant, relatively bland foamy glands imbedded in an extensive densely sclerotic desmoplastic stroma.",
keywords = "Foamy gland carcinoma, Gleason grading system, Prostate adenocarcinoma",
author = "Jin Zhao and Epstein, {Jonathan Ira}",
year = "2009",
month = "4",
doi = "10.1097/PAS.0b013e31818a5c6c",
language = "English (US)",
volume = "33",
pages = "583--890",
journal = "American Journal of Surgical Pathology",
issn = "0147-5185",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - High-grade foamy gland prostatic adenocarcinoma on biopsy or transurethral resection

T2 - A morphologic study of 55 cases

AU - Zhao, Jin

AU - Epstein, Jonathan Ira

PY - 2009/4

Y1 - 2009/4

N2 - Foamy gland carcinoma is a variant of adenocarcinoma of the prostate that typically is assigned a Gleason score 3+3 = 6. The morphologic features of high foamy gland carcinoma have not been previously studied. We analyzed 55 cases of high-grade (Gleason score 7 or greater) foamy gland carcinoma of the prostate in needle biopsy (n = 49) or transurethral resection (n = 6) specimens. The number of cores involved by high-grade foamy gland carcinoma ranged from 1 to 12, with more than 1 core involved in 61% of cases (mean 3.4 cores). On average, 84% of the total tumor volume was foamy gland carcinoma, with high-grade foamy gland cancer averaging 73% of the total foamy gland carcinoma. The following results pertain only to the high-grade foamy gland cancer component. The most common architectural pattern was cribriform (73%), followed by fused/poorly defined glands (55%), cords/single cells (11%), and solid sheets (5%). Nuclear enlargement was observed in 45 of the 55 studied cases (82%). Prominent nucleoli were either absent or infrequent in 38 cases (69%). Frequent to numerous prominent nucleoli were seen more frequently in foamy gland carcinoma with Gleason score 8 or above (52%) than those with Gleason score 7 (16%) (P <0.004). Mitotic figures were observed in 22 cases (40%), and present in 65% of the cases with Gleason score 8 or above, but only in 22% of the cases with Gleason score 7 (P <0.002). In 31 cases (56%), intraluminal dense pink secretions were identified. Perineural invasion and extraprostatic extension identified on the biopsy specimens were noted in 18 cases (33%) and in 5 cases (9%), respectively. In 18 cases (33%), there was at least a moderate stromal reaction. A moderate or greater stromal reaction was seen in 48% (11/23) of the cases with Gleason score 8 or above compared with 22% (7/32) of the cases with Gleason score 7 (P = 0.04). In 6 cases, there was a peculiar extensive desmoplastic reaction almost obscuring the carcinoma component, 5 of which were Gleason scores 4+4 = 8. Concurrent ordinary acinar nonfoamy adenocarcinoma was encountered in 26 of 55 cases (47%) with the following Gleason scores: Gleason 6 (27%); Gleason 7 (27%); and Gleason 8 to 10 (46%). Associated ordinary high-grade prostatic intraepithelial neoplasia and foamy gland variant of high-grade prostatic intraepithelial neoplasia/intraductal adenocarcinoma were seen in 13 cases (24%) and 11 cases (20%), respectively. Of the 19 cases with available immunohistochemical stains for high molecular weight cytokeratin, 7 (37%) showed nonspecific labeling of cancer cells in a nonbasal cell pattern. A similar finding was seen in 1 of the 7 (14%) cases with available stains for p63. α-methyl-CoA racemase positivity was noted in all 9 cases stained. In summary, uncommonly foamy gland carcinoma consists of cribriform, fused/poorly formed glands, cords/single cells, and solid sheets typical of Gleason patterns 4 and 5. High-grade foamy gland cancer shares certain morphologic features with more typical lower-grade foamy gland cancer including relatively bland nuclei with more difficult to identify nucleoli and frequent intraluminal dense pink secretions. However, consistent with their higher architectural grade, high-grade foamy gland cancers had more prominent nucleoli and increased mitotic figures compared with lower-grade foamy gland cancer. A unique subset of high-grade foamy gland carcinoma poses particularly difficult diagnostic challenges, with scattered, scant, relatively bland foamy glands imbedded in an extensive densely sclerotic desmoplastic stroma.

AB - Foamy gland carcinoma is a variant of adenocarcinoma of the prostate that typically is assigned a Gleason score 3+3 = 6. The morphologic features of high foamy gland carcinoma have not been previously studied. We analyzed 55 cases of high-grade (Gleason score 7 or greater) foamy gland carcinoma of the prostate in needle biopsy (n = 49) or transurethral resection (n = 6) specimens. The number of cores involved by high-grade foamy gland carcinoma ranged from 1 to 12, with more than 1 core involved in 61% of cases (mean 3.4 cores). On average, 84% of the total tumor volume was foamy gland carcinoma, with high-grade foamy gland cancer averaging 73% of the total foamy gland carcinoma. The following results pertain only to the high-grade foamy gland cancer component. The most common architectural pattern was cribriform (73%), followed by fused/poorly defined glands (55%), cords/single cells (11%), and solid sheets (5%). Nuclear enlargement was observed in 45 of the 55 studied cases (82%). Prominent nucleoli were either absent or infrequent in 38 cases (69%). Frequent to numerous prominent nucleoli were seen more frequently in foamy gland carcinoma with Gleason score 8 or above (52%) than those with Gleason score 7 (16%) (P <0.004). Mitotic figures were observed in 22 cases (40%), and present in 65% of the cases with Gleason score 8 or above, but only in 22% of the cases with Gleason score 7 (P <0.002). In 31 cases (56%), intraluminal dense pink secretions were identified. Perineural invasion and extraprostatic extension identified on the biopsy specimens were noted in 18 cases (33%) and in 5 cases (9%), respectively. In 18 cases (33%), there was at least a moderate stromal reaction. A moderate or greater stromal reaction was seen in 48% (11/23) of the cases with Gleason score 8 or above compared with 22% (7/32) of the cases with Gleason score 7 (P = 0.04). In 6 cases, there was a peculiar extensive desmoplastic reaction almost obscuring the carcinoma component, 5 of which were Gleason scores 4+4 = 8. Concurrent ordinary acinar nonfoamy adenocarcinoma was encountered in 26 of 55 cases (47%) with the following Gleason scores: Gleason 6 (27%); Gleason 7 (27%); and Gleason 8 to 10 (46%). Associated ordinary high-grade prostatic intraepithelial neoplasia and foamy gland variant of high-grade prostatic intraepithelial neoplasia/intraductal adenocarcinoma were seen in 13 cases (24%) and 11 cases (20%), respectively. Of the 19 cases with available immunohistochemical stains for high molecular weight cytokeratin, 7 (37%) showed nonspecific labeling of cancer cells in a nonbasal cell pattern. A similar finding was seen in 1 of the 7 (14%) cases with available stains for p63. α-methyl-CoA racemase positivity was noted in all 9 cases stained. In summary, uncommonly foamy gland carcinoma consists of cribriform, fused/poorly formed glands, cords/single cells, and solid sheets typical of Gleason patterns 4 and 5. High-grade foamy gland cancer shares certain morphologic features with more typical lower-grade foamy gland cancer including relatively bland nuclei with more difficult to identify nucleoli and frequent intraluminal dense pink secretions. However, consistent with their higher architectural grade, high-grade foamy gland cancers had more prominent nucleoli and increased mitotic figures compared with lower-grade foamy gland cancer. A unique subset of high-grade foamy gland carcinoma poses particularly difficult diagnostic challenges, with scattered, scant, relatively bland foamy glands imbedded in an extensive densely sclerotic desmoplastic stroma.

KW - Foamy gland carcinoma

KW - Gleason grading system

KW - Prostate adenocarcinoma

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