Ductal adenocarcinoma is relatively rare, is frequently associated and inter-mixed with acinar adenocarcinoma, and can be confused with microscopic mimickers.
15) Due to the non-targeted nature of TRUS guidance and because ductal adenocarcinoma typically only represents a small proportion of the tumour composed mainly of acinar adenocarcinoma, areas of ductal cancer can easily be missed.
8) These findings support a diagnosis of a pure prostatic acinar adenocarcinoma
with micropapillary features.
Features seen within PTAT that create difficulty in distinguishing it from prostatic acinar adenocarcinoma
include the following: (1) crowded and sometimes disorganized patterns of growth, (2) relatively high nuclear to cytoplasmic ratio with slightly enlarged nuclei, (3) straight luminal borders in some glands, (4) the presence of visible but small nucleoli, (5) negative staining of some glands for basal cells markers, and (6) positive staining of some glands for racemase (Figures 1, A through F, and 2, A through F).
Immunohistochemical antibody cocktail staining (p63/HMWCK/AMACR) of ductal adenocarcinoma and Gleason pattern 4 cribriform and noncribriform acinar adenocarcinomas
of the prostate.
The presence of nuclear hyperchromasia, with smudged chromatin and scattered pleomorphic cells (sometimes striking) beyond what is seen in acinar adenocarcinoma
, as well as the presence of lipofuscin granules, occasional intranuclear inclusions, and in the case of the seminal vesicle, a muscular wall, are all helpful clues leading toward the correct diagnosis.
The only cytology specimen in the nonresponder group was a fine-needle aspiration of the lung where the tumor was considered to be an acinar adenocarcinoma
Staining for PSA is usually negative, (23,24,26) but in some cases positivity with this marker has been reported, especially in cases in association with concomitant acinar adenocarcinoma