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Unusual and potentially important finding in a prostatic needle biopsy
  1. Sanjay A Pai1,
  2. Sanjeev V Katti2
  1. 1 Pathology and Laboratory Medicine, Columbia Asia Referral Hospital, Bangalore, India
  2. 2 Pathology, Columbia Asia Hospital- Whitefield, Bangalore, India
  1. Correspondence to Dr Sanjay A Pai, Pathology and Laboratory Medicine, Columbia Asia Referral Hospital Yeshwanthpur, Bangalore 560 055, India; sanjayapai{at}

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Clinical question

What is unusual or unique about this transrectal ultrasound-guided left midzone prostatic biopsy in a 66-year-old Asian Indian with a raised serum prostate-specific antigen (1278 ng/mL)? Review the high quality, interactive digital Aperio slide at and consider your diagnosis.

What is your diagnosis?

  1. The spaces are an artefact of fixation.

  2. The spaces represent an artefact of sectioning.

  3. The spaces represent extraprostatic fat infiltration by prostatic adenocarcinoma.

  4. Intraprostatic adipose tissue involved by adenocarcinoma.

The correct answer is after the discussion.


Until fairly recently, it was believed that there was no intraprostatic fat. Thus, a comment that there was infiltration of fat by a prostatic carcinoma implied that it was extraprostatic fat and hence, a pT3 disease. Invasion of fat by …

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  • Handling editor Iskander Chaudhry.

  • Contributors SAP saw all the slides and wrote the manuscript. SVK reviewed all cases where the possibility of fat was suspected at first evaluation in the biopsies.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.