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1:
Lobular Atrophy in Prostate
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Comments: The atrophic glands are arranged in multiple lobules separated by fibrotic stroma. They have well-formed open lumens and hyperchromatic nuclei.
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2:
Atrophy - Nuclear Features
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Comments: The atrophic glands have scant cytoplasm and hyperchromatic nuclei with occasional punctate nucleoli. The basal cell layer is fragmented but still present as confirmed by high molecular weight cytokeratin immunostain (next slide).
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3:
Atrophy - 34bE12 Immunostain
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Comments: The immunostain for high molecular weight cytokeratin can be helpful in distinguishing between atrophy (fragmented basal cell layer) from atrophic variant of prostatic adenocarcinoma (no basal cell layer).
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4:
Atrophic variant of Prostatic Adenocarcinoma
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Comments: Notwithstanding the superficial resemblance to atrophy, the glands in atrophic variant of prostatic adenocarcinoma show an infiltrative growth pattern. The nuclear features typical of malignancy are present (nuclear enlargement and prominent nucleoli). In difficult cases, HMWCK immunostains can be helpful.
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5:
Partial Atrophy
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Comments: Partial atrophy is one of the most challenging mimics of prostate cancer. The focus shown here still retains lobular configuration. The glands are pale and lack the basophilic appearance typical of a fully developed focus of atrophy. Nuclear enlargement and prominent nucleoli are lacking. Immunostaining with high molecularl weight cytokeratin and p63 cocktail showed fragmented basal cell layer confirming the diagnosis.
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6:
Sclerotic atrophy
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Comments: Note the dense areas of fibrosis surrounding the basophilic atrophic glands. Sometimes, the presence of sclerosis may create a deceptive infiltrating appearance leading to overdiagnosis of adenocarcinoma.
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7:
Simple atrophy
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Comments: Simple atrophy has a basophilic appearance due to a reduction in cytoplasmic volume which leads to a relative increase in nucleus/cytoplasmic ratio. The glands have rounded or angulated outlines.
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8:
Cystic atrophy
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Comments: Atrophic glands can undergo cystic change (Cystic atrophy). The cysts are variably sized and may be evident on gross examination of the prostatectomy specimen. In this image, the glands are arranged in a lobule and are lined by flattened or low cuboidal epithelium. Prostatic adenocarcinoma is present to the upper left.
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