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Understanding Different Types of Prostate Cancer Cells
Introduction: Prostate cancer displays an amazing variety of patterns. Some of the uncommon variants of prostate cancer are depicted below. Many are high-grade tumors (Gleason grade 4 or 5) while other patterns mimic benign atrophic glands. For examples of "conventional" type of prostate cancer, please visit here.
Remember the higher the Gleason Grades (4 and 5) the less PSA is produced. It is possible to be diagnosed with a Gleason score of 8, 9 or 10 and have a PSA of less than 1. More commonly we will see PSA's in the 1 to 2 level with this diagnosis. These types of cells produce very little PSA, very difficult to stop and has a very poor prognosis. One really needs an expert Pathologist to read these. Click "here" for a list of expert pathologists.
An outside source about Gleason and the various Variants and other Prostate Pathology can be found by clicking "here"
For further detail about Gleason Grading and prognostic factors click "here" .
Types Pictured Below
PCa Mucin Producing
PCa Signet Ring Cell Pattern
PCa Atrophic Pattern
PCa Small Cell Carcinoma
Study on Small Cell
PCa Mucin Producing
Prostate Cancer - Mucin producing: Mucin (mucus) is produced by most prostate cancers. Sometimes it is produced in abundant quantities. In such cases, one sees cancer glands literally floating in pools of mucin. Mucin-producing cancer represents about 0.5% of all prostate cancers. Most of them are Gleason grade 4. For additional information click "here" .
PCa Signet Ring Cell Pattern
Prostate Cancer - Signet Ring Cell Pattern: Another rare variant of prostate cancer with a peculiar appearance as seen here. Usually they are high-grade tumors - Gleason grade 4 or 5. For additional information click "here" .
PCa Atrophic Pattern
Prostate Cancer - Atrophic pattern: This variant of prostate cancer mimics benign atrophic glands. It has no special clinical significance; however, pathologists need to be aware of this variant so that it is not mistaken for benign glands. For additional information click "here" .
PCa Small Cell Carcinoma
Small Cell Carcinoma - Prostate: An extremely rare variant of prostate cancer that behaves aggressively. It may not be associated with significant elevation of serum PSA. It is usually admixed with the "conventional type" of prostate cancer. For additional information click "here" .
A study on Small Cell:
Small cell carcinoma of the prostate. A morphologic and immunohistochemical study of 95 cases.
Wang W, Epstein JI.
Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.
Small cell carcinoma of prostate is rare, with the literature consisting of case reports and small series. The current work analyzes the morphology and immunohistochemistry of 95 cases of prostatic small cell carcinoma diagnosed at our institution. Specimens included 55 needle biopsies, 27 transurethral resections, 4 radical prostatectomies, and 9 biopsies from metastatic sites (some patients with >1 procedure). Patients ranged in age from 44 to 92 years old (mean: 69 y). Although serum prostate-specific antigen (PSA) in some cases was very high (up to 1896 ng/mL), the median value was only 4.0 ng/mL. Of cases with available information, 33/78 (42%) had a history of usual prostatic adenocarcinoma. The interval between the diagnosis of small cell carcinoma and prior usual prostatic cancer ranged from 1 to 300 months (median 25 mo). Pure small cell carcinoma was seen in 54/95 (57%) of cases with the remaining cases admixed with prostate adenocarcinoma. In cases with adenocarcinoma, there was a sharp demarcation between small cell carcinoma and adenocarcinoma in 20.5% of cases; in the remaining cases there was gradual merging of the 2 components. In mixed cases, small cell carcinoma predominated (median: 80% of the tumor); the Gleason score of the adenocarcinoma was > or =8 in 85% of these cases. In 61 cases (64%), small cell carcinoma was classic "oat cell" morphology with remaining the "intermediate cell" variant. Of the 95 cases: necrosis was seen in 40% (2% to 95% of the tumor); giant bizarre cells in 19%; Indian filing in 21%; rosette formation in 29%; focal vacuolated cytoplasm in 18%; and desmoplasia in 20%. Most (88%) of small cell carcinoma were positive for at least 1 neuroendocrine marker. In the small cell carcinoma component, 14/73 (19%) were positive for PSA, 17/61 (28%) positive for prostein (P501S), and 15/59 (25%) positive for prostate-specific membrane antigen, although often very focally. Stains for thyroid transcription factor-1 were positive in 23/44 (52.3%) cases. In this, the largest study of prostatic small cell carcinoma, we highlight the presence of morphologic features that may result in its underdiagnosis. Other more classic histologic features of small cell carcinoma along with rosettes are critical for its accurate diagnosis. P501S and prostate-specific membrane antigen were better in identifying the prostatic origin of small cell carcinoma than PSA, although the majority (60%) of prostatic small cell carcinomas were negative for all 3 markers.
PMID: 18162772 [PubMed - indexed for MEDLINE]
Page Reviewed and/or Updated:
September 21, 2008
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Information You Should Read
Stanford Univ. video on PCa
The Prostate - What, Where
The Prostate Biopsy
How To Tell a "Physician Artist"
The Doctors Appointment
Insignificant Cancer
Vocabulary, Glossary, etc.
Tables, Tests, Markers etc.
Gleason Info and Partin Tables
PSA - What it is and means
Locally Advanced Cancer
BPH
Prostatitis
Other Diagnostic Tools
Veterans Information
