Gleason Grading of Prostatic Carcinoma

 

 

Uploaded: 2007-06-21, Updated: 2007-07-07
 

Criteria for the diagnosis of prostatic adenocarcinoma

(Cancer 1996;78:376–81)

  • Major criteria

    – Architectural: infiltrative small glands or cribriform large/irregular glands

    – Single cell layer (absence of basal cells)

    – Nuclear atypia: nuclear and nucleolar enlargement

     

  • Minor criteria

    – Intraluminal wispy blue mucin (blue-tinged mucinous secretions)

    – Pink amorphous secretions

    – Mitotic figures

    – Intraluminal crystalloids

    – Adjacent high-grade PIN

    – Amphophilic cytoplasm

    – Nuclear hyperchromasia
 

Differential Diagnosis of Prostatic Cancer

(Journal of Clinical Pathology 2007;60:35-42)

  • Atypical adenomatous hyperplasia (adenosis)

  • Atrophy

  • Crowded benign glands

  • Basal cell hyperplasia

  • Sclerosing adenosis

  • Cribriform hyperplasia

  • Mesonephric hyperplasia

  • Nephrogenic metaplasia (adenoma)

  • Verumontanum mucosal gland hyperplasia

  • Squamous metaplasia

  • Transitional cell metaplasia

  • Radiation atypia

  • Prostatitis

  • Malacoplakia

  • Endometriosis

  • Postoperative spindle cell nodule

  • Atypical stromal cells

  • Extramedullary haematopoiesis

  • Cowper glands

  • Paraganglia in prostate

  • Benign glands adjacent to nerves and skeletal muscle

 

  

  • Well circumscribed nodule;

  • Glands: single, separate, closely packed, uniform, back to back, no infiltration into adjacent benign tissue;

  • Rounded/oval, medium-sized glands (larger than pattern 3), more abundant and pale-staining cytoplasm than other patterns.

  • Fairly circumscribed nodules of single, separate glands;  minimal infiltration at the edge of the tumor nodule;

  • Glands are more loosely arranged and not  as uniform as pattern 1.

  • Discrete glandular units;

  • Smaller glands than  in Gleason pattern 1 or 2;

  • Clear infiltrates into normal prostate glands;

  • Marked variation in size and shape with amphophilic cytoplasm;

  • Smoothly circumscribed small cribriform nodules of tumor.

  • Fused glands in chains, nests, or masses;

  • Ill-defined glands with poorly formed lumina;

  • Large cribriform glands;

  • Cribriform glands with an irregular border;

  • Hypernephromatoid.

  • No glandular differentiation;

  • Solid sheets, cords, or single cells;

  • Comedocarcinoma: central necrosis surrounded by papillary, cribriform, or solid masses.
 

Immunohistochemistry Staining
  CK-PIN Cocktails:

 

  • Basal cell markers: high-molecular-weight cytokeratins 34ßE12 or p63;

  • Selective neoplastic glandular marker: epithelium α-methylacyl coenzyme A racemase (AMCAR).

Reporting of adenocarcinoma in needle biopsy specimens

 

  1. Gleason grade

  2. Number of cores positive for cancer in the number of cores examined,

  3. Percentage of needle core tissue affected by carcinoma

  4. Linear millimeters of carcinoma present
References:
 

  • Journal of Clinical Pathology 2007;60:35-42

  • Cancer 1996;78:376–81

  • http://pathology2.jhu.edu/gleason/patterns.cfm