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atrophic acinar adenocarcinoma

Sunday 12 February 2012

As described under histopathology, most prostate cancers have abundant cytoplasm. An unusual variant of prostate cancer resembles benign atrophy owing to its scant cytoplasm.

Although ordinary prostate cancers may develop atrophic cytoplasm as a result of treatment (see carcinoma affected by hormone therapy), atrophic prostate cancers are usually unassociated with such a prior history.

The diagnosis of carcinoma in these cases may be based on several
features.

First, atrophic prostate cancer may demonstrate a truly infiltrative process with individual small atrophic glands situated between larger benign glands.

In contrast, benign atrophy has a lobular configuration.

A characteristic finding in some benign cases of atrophy is the presence of a centrally dilated atrophic gland surrounding by clustered smaller glands, which has been termed "post-atrophic hyperplasia (PAH)".

Although the glands of benign atrophy may appear infiltrative on needle biopsy, they are not truly infiltrative, as individual benign atrophic glands are not seen infiltrating in between larger benign glands.

Whereas some forms of atrophy, are associated with fibrosis, atrophic
prostate cancer lack such a desmoplastic stromal response.

Atrophic prostate cancer may also be differentiated from benign atrophy by the presence of marked cytologic atypia.

Atrophy may show enlarged nuclei and prominent nucleoli, although not the huge eosinophilic nucleoli seen in some atrophic prostate cancers.

Finally, the concomitant presence of ordinary less atrophic carcinoma can help in recognizing the malignant nature of the adjacent atrophic cancer glands.