Macrocystic ductal adenocarcinoma of prostate: A rare gross appearance of prostate cancer

• Published in: Annals of diagnostic pathology Vol. 27; pp. 7 - 13
• Main Authors: Kojima, Fumiyoshi, Koike, Hiroyuki, Matsuzaki, Ibu, Iwahashi, Yoshifumi, Warigaya, Kenji, Fujimoto, Masakazu, Ono, Kazuo, Urata, Youji, Kohjimoto, Yasuo, Hara, Isao, Murata, Shin-ichi
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-04-2017
• Subjects: Adenocarcinoma - diagnosis; Adenocarcinoma - pathology; Aged; Aged, 80 and over; Cystadenocarcinoma; Cystic; Cysts; Ductal adenocarcinoma; Humans; Immunohistochemistry - methods; Macrocystic; Male; Middle Aged; Neoplasm Recurrence, Local - diagnosis; Neoplasm Recurrence, Local - pathology; Pathology; PIN-like; Prostate; Prostatic Neoplasms - diagnosis; Prostatic Neoplasms - pathology; ductal adenocarcinoma; prostate; PIN-like; macrocystic; cystic; cystadenocarcinoma; Ductal adenocarcinoma; Macrocystic; Cystic; Cystadenocarcinoma; Prostate
• ISSN: 1092-9134; 1532-8198
• DOI: 10.1016/j.anndiagpath.2016.12.002

Abstract Macroscopic cyst-formation by prostatic adenocarcinoma, herein referred to as macrocystic prostatic adenocarcinoma (MPA), is extremely rare. To date, no studies of prostate cancer performed based on gross cystic appearance have been reported. MPA can include various diseases, one of which is cystadenocarcinoma. Several cases of ductal adenocarcinoma exhibiting a macrocystic appearance have recently been reported; however, the histological and clinicopathological characteristics of MPAs have yet to be characterized and established. Therefore, we aimed to determine the histological and clinicopathological characteristics of MPA, via a multi-institutional investigation. We discovered five patients with MPA out of 1,559 treated patients (0.32%); all cases were ductal adenocarcinomas. MPA was found to have three growth patterns: Two cases showed a prevalence of exuberant papillary proliferation with a fibrovascular core in the macroscopic multilocular cysts. Two others predominantly exhibited multilocular cysts lined by flat epithelium with foci of low papillae, and the fifth had a cystic lesion with intracancerous necrosis. Three of the cases showed extraprostatic invasion; however, none of the patients experienced recurrence during the follow-up period. Each predominant growth pattern tended to exhibit unique clinicopathological characteristics with respect to serum prostate specific antigen level and tumor size and location. In conclusion, we demonstrated that MPA is a ductal adenocarcinoma that is composed of intracystic exuberant papillary proliferation and flat proliferation with foci of low papillae, both of which might exhibit different clinicopathololgical appearances.