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High grade solid variants of prostatic adenocarcinoma and urothelial carcinoma can show overlapping histological features and their differentiation may require careful histological and immunohistochemical evaluation. The presence of surface urothelial carcinoma in situ is considered a helpful clue in support of a diagnosis of urothelial carcinoma. We present a series of three cases in which the high grade prostatic adenocarcinoma mimics urothelial carcinoma in situ, through a partly intraductal growth pattern within the prostatic duct system and partial replacement of the urothelium of the prostatic urethra. This may be a potential diagnostic pitfall, especially if present in small superficial mucosal biopsies, or when represented in samples from the bladder neck or penile urethra.
A 70-year-old male subject underwent radical prostatectomy with bilateral iliac lymph node dissection for prostatic adenocarcinoma, following diagnosis on needle core prostatic biopsies performed for an elevated serum prostate specific antigen (PSA) of 40 μg/l. Sections from the prostate gland showed bilateral multifocal Gleason score 4+3=7 prostatic adenocarcinoma of microacinar type, predominantly in the posterior peripheral zones of the gland. Focally there was a higher grade malignant proliferation (figure 1A,B), partly within prostatic ducts and partly invading the stroma. There was necrosis with calcification and the cells generally lacked nucleoli. Some glandular spaces were identified. This intraductal process …
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