Anatomic Pathology: Genitourinary Pathology

426) This image depicts a section from a prostate biopsy of a 67-year-old man with a prostate-specific antigen (PSA) value of 0.2 ng/mL. The CORRECT diagnosis is:

• Radiation changes can affect both neoplastic and nonneoplastic glands. A rising PSA level is usually what prompts a rebiopsy of the patient postradiation therapy, and it is important to distinguish radiation atypia in benign glands from recurrent carcinoma.

• Radiated prostates oftentimes show a decrease in the density of benign glands. The benign glands maintain their normal architecture, which is only altered by the atrophic changes. Cytologic atypia can be seen as in any other organ postradiation therapy and is characterized by smudgy degenerative atypia. Nucleoli are inconspicuous.

• The basal cell layer is usually quite prominent. If not apparent, it can be accentuated with high molecular weight keratin (HMWK) and/or p63 immunohistochemical staining.

• Prostatic adenocarcinoma with radiation atypia oftentimes shows a blander appearance than the benign glands and is characterized by individual cells or glands with abundant vacuolated cytoplasm and prominent nucleoli.

Bostwick DG, Egbert BM, Fajardo LF: Radiation injury of the normal and neoplastic prostate. Am J Surg Pathol 1982;6(6):541-551.

Magi-Galluzzi C, Sanderson H, Epstein JI: Atypia in nonneoplastic prostate glands after radiotherapy for prostate cancer: duration of atypia and relation to type of radiotherapy. Am J Surg Pathol 2003;27(2):206-212.

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