2019-18 / JUNE 17

A 58-year-old male presented with urinary obstruction and elevated PSA of 12 ng/ml. He underwent transurethral resection of the prostate (TURP).


What is the correct diagnosis?

a. Adenocarcinoma of the prostate, Gleason score 4+4=8, Grade group 4

b. Adenocarcinoma of the prostate, Gleason score 4+5=9, Grade group 5

c. Adenocarcinoma of the prostate, Gleason score 4+3=7, Grade group 3

d. Sclerosing adenosis

Sclerosing adenosis

This TURP specimen demonstrates a proliferation of poorly formed and complex glands mimicking high-grade prostate carcinoma. Low-power recognition is a key. It typically forms a well-circumscribed nodule of tightly packed glands (Image 1). At medium magnification, glands demonstrate complex proliferation, poorly formed glands, fused glands, and even single cells with signet ring cell-like features, mimicking high-grade cancer (Image 2). Stroma surrounding the glands is cellular and hyalinized (Image 3). Prominent nucleoli, crystalloids, and blue mucin are common (Image 3). Basal cells are highlighted with basal cell marker p63 (Image 4). Basal cells undergo myoepithelial metaplasia and show coexpression of basal cell markers and S-100 and muscle-specific actin. When one or more well-circumscribed cellular lesions mimicking high-grade prostate cancer are encountered in TURP or biopsies from the transition zone of the prostate, sclerosing adenosis should be ruled out.

Benign mimics of prostatic adenocarcinoma. Trpkov K.
Mod Pathol 2018. 31:S22-46

Sclerosing adenosis of the prostate. A clinicopathological and immunohistochemical study of 11 cases. 2) Jones EC, Clement PB, Young RH.
Am J Surg Pathol 1991,15:1171-1180

Rajal Shah
Cleveland Clinic


Sclerosing adenosis, prostate cancer, benign mimics