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post-hormone therapy prostate acinar adenocarcinoma

Sunday 12 February 2012

Hormone therapy

The histology of prostate cancer may be significantly altered following its treatment with hormonal therapy.

One pattern is that neoplastic glands develop pyknotic nuclei and abundant xanthomatous cytoplasm.

These cells then desquamate into the lumen of the malignant glands where they resemble histiocytes and lymphocytes, sometimes resulting in empty clefts.

In some areas, there may be only scattered cells within the stroma resembling foamy histiocytes with pyknotic nuclei and xanthomatous cytoplasm.

A related pattern is the presence of individual tumour cells resembling inflammatory cells. At low power, these areas may be difficult to
identify, and often the only clue to areas of hormonally treated carcinoma is a fibrotic background with scattered larger cells.

Immunohistochemistry for PSA or pancytokeratin can aid in the diagnosis of carcinoma in these cases by identifying the individual cells as epithelial cells of prostatic origin.

Cancer cells following hormonal therapy demonstrate a lack of high molecular weight cytokeratin staining, identical to untreated prostate cancer.

Following a response to combination endocrine therapy, the grade of the tumour appears artefactually higher, when compared to the grade of the pretreated tumour.

As with radiation, the response to hormonal therapy may be variable, with areas of the cancer appearing unaffected.