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Pathology for Urologists

Basal Cell Carcinoma (Adenoid Cystic Carcinoma)

Image A
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Image B
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  • Malignant neoplasm composed of basaloid cells arising putatively from prostatic basal cells.
  • Very rare, only <75 cases reported.
  • Wide age range (30's – 80's), but majority occurs in older men.
  • Most commonly presents with obstructive urinary symptoms.
  • Normal serum PSA level.
  • Gross: white and fleshy tumor with ill-defined infiltrative edges and may have microcysts.
  • Primarily in transition zone, with variable peripheral zone involvement.
  • Basaloid tumor cells have scant cytoplasm, high nuclear to cytoplasmic ratio, and irregular to angulated nuclei.

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Image D
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  • 2 histologic patterns:
    • Basal cell carcinoma consists of variably sized solid nests, cords, or trabeculae with peripheral palisading of cells (image A) & (image B).
    • Adenoid cystic carcinoma consists of infiltrative nests with prominent cribriform architecture
      (image C) & (image D).
  • Immunohistochemistry: positive for basal cell markers (HMWK+ or p63+) and usually PSA- and PSAP-.
  • Limited clinical data available on clinical behavior.
  • Local recurrence, metastasis, and death from disease reported in ~30%.


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