Does prostate acinar adenocarcinoma with Gleason Score 3 + 3 = 6 have the potential to metastasize?

Diagnostic Pathology

Liang Cheng⁵  Francesco Montorsi³  Alberto Briganti⁴  Matteo Santoni¹  Antonio Lopez-Beltran²  Roberta Mazzucchelli⁶  Marina Scarpelli⁶  Rodolfo Montironi⁶ 

[1] Medical Oncology, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Ancona, Italy;Fundação Champalimaud, Lisbon, Portugal;Vita-Salute San Raffaele University, Milan, Italy;Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy;Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA;Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Via Conca 71, I???60126 Torrette, Ancona, Italy

关键词: Periprostatic lymph node;    Lymph node metastasis;    Lymphovascular invasion;    Gleason score;    Gleason score 6 adenocarcinoma;    Prostate cancer;   

Others  :  1149520
DOI  :  10.1186/s13000-014-0190-z

 received in 2014-08-22, accepted in 2014-09-20,  发布年份 2014

【 摘 要 】

Background

There is a worldwide debate involving clinicians, uropathologists as well as patients and their families on whether Gleason score 6 adenocarcinoma should be labelled as cancer.

Case description

We report a case of man diagnosed with biopsy Gleason score 6 acinar adenocarcinoma and classified as low risk (based on a PSA of 5 ng/mL and stage cT2a) whose radical prostatectomy specimen initially showed organ confined Gleason score 3?+?3?=?6, WHO nuclear grade 3, acinar adenocarcinoma with lymphovascular invasion and secondary deposit in a periprostatic lymph node. When deeper sections were cut to the point that almost all the slice present in the paraffin block was sectioned, a small tumor area (<5% of the whole tumor) of Gleason pattern 4 (poorly formed glands) was found in an extraprostatic position.

Conclusion

The epilogue was that the additional finding changed the final Gleason score to 3?+?3?=?6 with tertiary pattern 4 and the stage to pT3a.

Virtual Slides

The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/13000_2014_190 webcite

【 授权许可】

   
2014 Montironi et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

【 参考文献 】

• [1]Berman DM, Epstein JI: When is prostate cancer really cancer? Urol Clin North Am 2014, 41:339-346.
• [2]Carter HB, Partin AW, Walsh PC, Trock BJ, Veltri RW, Nelson WG, Coffey DS, Singer EA, Epstein JI: Gleason score 6 adenocarcinoma: should it be labeled as cancer? J Clin Oncol 2012, 30:4294-4296.
• [3]Esserman LJ, Thompson IM Jr, Reid B: Overdiagnosis and overtreatment in cancer: an opportunity for improvement. JAMA 2013, 310:797-798.
• [4]Nickel JC, Speakman M: Should we really consider Gleason 6 prostate cancer? BJU Int 2012, 109:645-646.
• [5]Soloway MSR: Overdiagnosis and overtreatment in cancer: an opportunity for improvement. Eur Urol 2014, 65:249-250.
• [6]Mohler JL: The 2010 NCCN clinical practice guidelines in oncology on prostate cancer. J Natl Compr Canc Netw 2010, 8:145.
• [7]Ross HM, Kryvenko ON, Cowan JE, Simko JP, Wheeler TM, Epstein JI: Do adenocarcinomas of the prostate with Gleason score (GS)? 6 have the potential to metastasize to lymph nodes? Am J Surg Pathol 2012, 36:1346-1352.
• [8]Finley DS, Deane L, Rodriguez E, Vallone J, Deshmukh S, Skarecky D, Carpenter P, Narula N, Ornstein DK, Ahlering TE: Anatomic excision of anterior prostatic fat at radical prostatectomy: implications for pathologic upstaging. Urology 2007, 70:1000-1003.
• [9]Epstein JI: An update of the Gleason grading system. J Urol 2010, 183:433-440.
• [10]Sobin LH, Gospodarowicz MK, Wittekind C: Urological tumour, prostate. In UICC TNM Classification of Malignant Tumours. 7th edition. Edited by Sobin LH, Gospodarowicz MK, Wittekind C. Wiley-Blackwell, Oxford UK; 2009:243-248.
• [11]Egevad L, Mazzucchelli R, Montironi R: Implications of the International Society of Urological Pathology modified Gleason grading system. Arch Pathol Lab Med 2012, 136:426-434.
• [12]Epstein JI, Allsbrook WC Jr, Amin MB, Egevad LL: The 2005 International Society of Urological Pathology (ISUP) consensus conference on Gleason grading of prostatic carcinoma. Am J Surg Pathol 2005, 29:1228-1242.
• [13]Gleason DF: Classification of prostatic carcinomas. Cancer Chemother Rep 1966, 50:125-128.
• [14]Caras RJ, Sterbis JR: Prostate cancer nomograms: a review of their use in cancer detection and treatment. Curr Urol Rep 2014, 15:391.
• [15]Lughezzani G, Briganti A, Karakiewicz PI, Kattan MW, Montorsi F, Shariat SF, Vickers AJ: Predictive and prognostic models in radical prostatectomy candidates: a critical analysis of the literature. Eur Urol 2010, 58:687-700.
• [16]Brawer MK, Bostwick DG, Benson MC, Djavan B, Lilja H, Semionow A, Su S, Zhou Z, Foster CS, Algaba F, Hutter RVP, Montironi R, Mostofi FK, Sark W, Sesterehenn I, Pow Sang J: Prostate tissues factor. In Prostate Cancer. 2nd International Consultation on Prostate Cancer- 1999 Paris. Edited by Murphy G, Khoury S, Partin A, Denis L. Plymbridge Distributors Ltd, Plymouth, UK; 2000:162-201.
• [17]Venkataraman G, Rycyna K, Rabanser A, Heinze G, Baesens BM, Ananthanarayanan V, Paner GP, Barkan GA, Flanigan RC, Wojcik EM: Morphometric signature differences in nuclei of Gleason pattern 4 areas in Gleason 7 prostate cancer with differing primary grades on needle biopsy. J Urol 2009, 181:88-93.
• [18]Baydar DE, Baseskioglu B, Ozen H, Geyik PO: Prognostic significance of lymphovascular invasion in clinically localized prostate cancer after radical prostatectomy. Sci World J 2008, 8:303-312.
• [19]Brooks JP, Albert PS, O¿Connell J, McLeod DG, Poggi MM: Lymphovascular invasion in prostate cancer: prognostic significance in patients treated with radiotherapy after radical prostatectomy. Cancer 2006, 106:1521-1526.
• [20]Yee DS, Shariat SF, Lowrance WT, Maschino AC, Savage CJ, Cronin AM, Scardino PT, Eastham JA: Prognostic significance of lymphovascular invasion in radical prostatectomy specimens. BJU Int 2011, 108:502-507.
• [21]Kothari PS, Scardino PT, Ohori M, Kattan MW, Wheeler TM: Incidence, location, and significance of periprostatic and periseminal vesicle lymph nodes in prostate cancer. Am J Surg Pathol 2001, 25:1429-1432.
• [22]Hansen J, Budäus L, Spethmann J, Schlomm T, Salomon G, Rink M, Haese A, Steuber T, Heinzer H, Huland H, Graefen M, Michl U: Assessment of rates of lymph nodes and lymph node metastases in periprostatic fat pads in a consecutive cohort treated with retropubic radical prostatectomy. Urology 2012, 80:877-882.
• [23]von Bodman C, Godoy G, Chade DC, Cronin A, Tafe LJ, Fine SW, Laudone V, Scardino PT, Eastham JA: Predicting biochemical recurrence-free survival for patients with positive pelvic lymph nodes at radical prostatectomy. J Urol 2010, 184:143-148.
• [24]Briganti A, Karnes JR, Da Pozzo LF, Cozzarini C, Gallina A, Suardi N, Bianchi M, Freschi M, Doglioni C, Fazio F, Rigatti P, Montorsi F, Blute ML: Two positive nodes represent a significant cut-off value for cancer specific survival in patients with node positive prostate cancer. A new proposal based on a two-institution experience on 703 consecutive N?+?patients treated with radical prostatectomy, extended pelvic lymph node dissection and adjuvant therapy. Eur Urol 2009, 55:261-270.
• [25]Haffner MC, Mosbruger T, Esopi DM, Fedor H, Heaphy CM, Walker DA, Adejola N, Gürel M, Hicks J, Meeker AK, Halushka MK, Simons JW, Isaacs WB, De Marzo AM, Nelson WG, Yegnasubramanian S: Tracking the clonal origin of lethal prostate cancer. J Clin Invest 2013, 123:4918-4922.