Chap110N - Prostate pathology

  1. TNM staging of prostate cancer? - 2017
    • T1 Clinically inapparent tumour that is not palpable
    • T1a Tumour incidental histological finding in 5% or less of tissue resected
    • T1b Tumour incidental histological finding in more than 5% of tissue resected
    • T1c Tumour identified by needle biopsy (e.g. because of elevated prostate-specific antigen [PSA])

    • T2 Tumour that is palpable and confined within the prostate
    • T2a Tumour involves one half of one lobe or less 
    • T2b Tumour involves more than half of one lobe, but not both lobes
    • T2c Tumour involves both lobes

    • T3 Tumour extends through the prostatic capsule*
    • T3a Extracapsular extension (unilateral or bilateral) including microscopic bladder neck involvement
    • T3b Tumour invades seminal vesicle(s)

    T4 Tumour is fixed or invades adjacent structures other than seminal vesicles: external sphincter, rectum, levator muscles, and/or pelvic wall
  2. Updates in the American Joint Committee on Cancer (AJCC) staging of prostate cancer 2018
    Image Upload 1
  3. Needle core  biopsy? *
    At least 10-12 systematic prostatic 18G core biopsy. 

    Extended biopsy - additional targeted biopsies (Digital, TRUS, MRI)

    Saturation biopsy (> 20 cores) - clinical suspicion of malignancy but the standard core biospy are negative.
  4. Length of core to be mentioned in needle biopsy? *
    ?
  5. Guidelines for handling core biopsy? *
    • Each core to be sent in separate container with site identification 
    • Prevent bending of core
  6. Embedding and sectioning of specimen? *
    No more than two cores embedded together 

    Three level of tissues
  7. Reporting of core biopsy?
    • Gleason grading system by Dr Donald Gleason (1966)
    • Five architectural patterns - starting from 1-5 
    • Grading sum of two predominant pattern - 3+4 = 7 
    • Modifications - 2015 ISUP / 2016 WHO
  8. Modifications in 2016 WHO/2015 ISUP? *
    • Definitional changes - 
    • Gleason pattern 1 and 2, GS 2 to 5 should not be rendered, regardless of the specimen type 

    From practical standpoint Gleason pattern (GP) starts at 3 and GS starts at 6 

    • Operational changes - 
    • - GS - The predominant and the worst pattern irrespective of the percentage 
    • - If limited secondary pattern (<5%) - tumor of low grade can be ignored. The GS will be the sum of the predominant pattern.
  9. CAP guidelines on reporting core biopsies (single core)? *
    ?
  10. Gleason grade grouping?
    GS often grouped into 3 tiers 6,7, 8-10 for therapeutic and prognostic purpose 

    For prognostication and management gleason grade grouping was done 

    • Grade group 1 - Gleason score < 6 
    • Grade group 2 - Gleason score 3+4 = 7 
    • Grade group 3 - Gleason score 4+3 = 7 
    • Grade group 4 - Gleason score - 8 
    • Grade group 5 - Gleason score 9,10

    Relative abudance of pattern 4  PCa significantly impacts the prognosis.
  11. Role of immunohistochemistry?
    • P63 
    • HMWK 
    • AMACR
Author
prem777
ID
340890
Card Set
Chap110N - Prostate pathology
Description
Pathology of prostate
Updated