Histologic Variants of Acinar Adenocarcinoma, Ductal Adenocarcinoma, Neuroendocrine Tumors, and Other Carcinomas

  • Rajal B. ShahEmail author
  • Ming Zhou


Histologic variants of prostate acinar adenocarcinoma, ductal adenocarcinoma, neuroendocrine tumors, and other carcinomas account for 5–10% of prostate carcinomas and frequently are associated with ordinary acinar prostate adenocarcinoma. The morphologic spectrum of histologic variants of acinar adenocarcinoma ranges from tumors often resembling benign conditions, such as foamy and pseudohyperplastic carcinoma, to highly aggressive forms, such as sarcomatoid carcinoma. These histologic variants of acinar adenocarcinoma, ductal adenocarcinoma, neuroendocrine tumors, and other carcinomas often differ from acinar carcinoma in clinical, immunophenotypic, ultrastructural, or genetic features. Some of this histologic spectrum also differ in prognosis and may necessitate a different therapeutic approach. This chapter outlines important clinical and pathologic characteristics of histologic variants of acinar adenocarcinoma, ductal adenocarcinoma, neuroendocrine tumors, and other carcinomas.


Prostate adenocarcinoma Histologic variants of acinar adenocarcinoma WHO classification of histologic variants of acinar adenocarcinoma Atrophic adenocarcinoma Pseudohyperplastic carcinoma Microcystic carcinoma Foamy gland carcinoma Mucinous (colloid) carcinoma Signet ring cell-like carcinoma Pleomorphic giant cell carcinoma Sarcomatoid carcinoma PIN-like adenocarcinoma PIN-like ductal carcinoma Ductal adenocarcinoma Neuroendocrine prostate cancer NEPC Well-differentiated neuroendocrine tumor Carcinoid tumor Small-cell neuroendocrine carcinoma Large cell neuroendocrine carcinoma Mixed neuroendocrine carcinoma Treatment-emergent transformed neuroendocrine cancer Squamous and adenosquamous carcinoma Basal cell carcinoma Urothelial carcinoma Cowper’s glands Mucinous metaplasia Xanthomatous inflammation Benign atrophy Partial atrophy Postatrophic hyperplasia Benign prostatic hyperplasia BPH Prostatic intraepithelial neoplasia (PIN) 


  1. 1.
    Humphrey PA. Variants of acinar adenocarcinoma of the prostate mimicking benign conditions. Mod Pathol. 2018;31:S64–70.CrossRefGoogle Scholar
  2. 2.
    Moch H, Humphrey PA, Ulbright TM, Reuter VE, editors. WHO classification of tumours of the urinary system and male genital organs. Lyon: International Agency for Research on Cancer; 2016.Google Scholar
  3. 3.
    Brimo F, Epstein JI. Immunohistochemical pitfalls in prostate pathology. Hum Pathol. 2012;43:313–24.CrossRefGoogle Scholar
  4. 4.
    Wolters T, van der Kwast TH, Vissers CJ, Bangma CH, Roobol M, Schröder FH, et al. False-negative prostate needle biopsies: frequency, histopathologic features, and follow-up. Am J Surg Pathol. 2010;34:35–43.CrossRefGoogle Scholar
  5. 5.
    Yaskiv O, Cao D, Humphrey PA. Microcystic adenocarcinoma of the prostate: a variant of pseudohyperplastic and atrophic patterns. Am J Surg Pathol. 2010;34:556–61.CrossRefGoogle Scholar
  6. 6.
    Lane BR, Magi-Galluzzi C, Reuther AM, Levin HS, Zhou M, Klein EA. Mucinous adenocarcinoma of the prostate does not confer poor prognosis. Urology. 2006;68:825–30.CrossRefGoogle Scholar
  7. 7.
    Han B, Mehra R, Suleman K, Tomlins SA, Wang L, Singhal N, et al. Characterization of ETS gene aberrations in select histologic variants of prostate carcinoma. Mod Pathol. 2009;22:1176–85.CrossRefGoogle Scholar
  8. 8.
    Parwani AV, Herawi M, Epstein JI. Pleomorphic giant cell adenocarcinoma of the prostate: report of 6 cases. Am J Surg Pathol. 2006;30:1254–9.CrossRefGoogle Scholar
  9. 9.
    Hansel DE, Epstein JI. Sarcomatoid carcinoma of the prostate: a study of 42 cases. Am J Surg Pathol. 2006;30:1316–21.CrossRefGoogle Scholar
  10. 10.
    Hameed O, Humphrey PA. Stratified epithelium in prostatic adenocarcinoma: a mimic of high-grade prostatic intraepithelial neoplasia. Mod Pathol. 2006;19:899–906.CrossRefGoogle Scholar
  11. 11.
    Tavora F, Epstein JI. High-grade prostatic intraepithelial neoplasialike ductal adenocarcinoma of the prostate: a clinicopathologic study of 28 cases. Am J Surg Pathol. 2008;32:1060–7.CrossRefGoogle Scholar
  12. 12.
    Zhou M. High-grade prostatic intraepithelial neoplasia, PIN-like carcinoma, ductal carcinoma, and intraductal carcinoma of the prostate. Mod Pathol. 2018;31:S71–9.CrossRefGoogle Scholar
  13. 13.
    Brinker DA, Potter SR, Epstein JI. Ductal adenocarcinoma of the prostate diagnosed on needle biopsy: correlation with clinical and radical prostatectomy findings and progression. Am J Surg Pathol. 1999;23:1471–9.CrossRefGoogle Scholar
  14. 14.
    Dube VE, Farrow GM, Greene LF. Prostatic adenocarcinoma of ductal origin. Cancer. 1973;32:402–9.CrossRefGoogle Scholar
  15. 15.
    Aggarwal R, Zhang T, Small EJ, Armstrong AJ. Neuroendocrine prostate cancer: subtypes, biology, and clinical outcomes. J Natl Compr Cancer Netw. 2014;12:719–26.CrossRefGoogle Scholar
  16. 16.
    Epstein JI, Amin MB, Beltran H, Lotan TL, Mosquera JM, Reuter VE, et al. Proposed morphologic classification of prostate cancer with neuroendocrine differentiation. Am J Surg Pathol. 2014;38:756–67.CrossRefGoogle Scholar
  17. 17.
    Lotan TL, Gupta NS, Wang W, Toubaji A, Haffner MC, Chaux A, et al. ERG gene rearrangements are common in prostatic small cell carcinomas. Mod Pathol. 2011;24:820–8.CrossRefGoogle Scholar
  18. 18.
    Shen SS, Lerner SP, Muezzinoglu B, Truong LD, Amiel G, Wheeler TM. Prostatic involvement by transitional cell carcinoma in patients with bladder cancer and its prognostic significance. Hum Pathol. 2006;37:726–34.CrossRefGoogle Scholar
  19. 19.
    Kunju LP, Mehra R, Snyder M, Shah RB. Prostate-specific antigen, high-molecular-weight cytokeratin (clone 34betaE12), and/or p63: an optimal immunohistochemical panel to distinguish poorly differentiated prostate adenocarcinoma from urothelial carcinoma. Am J Clin Pathol. 2006;125:675–81.CrossRefGoogle Scholar
  20. 20.
    McKenney JK, Amin MB, Srigley JR, Jimenez RE, Ro JY, Grignon DJ, et al. Basal cell proliferations of the prostate other than usual basal cell hyperplasia: a clinicopathologic study of 23 cases, including four carcinomas, with a proposed classification. Am J Surg Pathol. 2004;28:1289–98.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Robert J Tomsich Pathology and Laboratory Medicine InstituteCleveland ClinicClevelandUSA
  2. 2.Tufts Medical CenterBostonUSA

Personalised recommendations