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Pathology for Urologists

Ductal Adenocarcinoma (DA)


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  • Characterized by larger glands lined by tall columnar cells that are often pseudostratified and usually exhibits papillary or cribriform growth (image A), (image B), (image C), & (image D).
  • Occurs more commonly in combination with acinar adenocarcinoma.
  • Diagnosis as DA requires >80% of entire tumor showing this morphology. (Diagnosis not tenable in biopsy– "prostate carcinoma with ductal features")
  • Pure DA accounts for <1% of prostate cancer, whereas mixed ductal and acinar adenocarcinoma accounts for 5%.
  • Tumor may involve central or peripheral part of prostate.
    • Central tumor: may involve prostatic urethra and presents with obstructive symptoms and hematuria.
    • Peripheral tumor: presents with abnormal DRE and increased PSA.

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  • More aggressive than acinar adenocarcinoma with 5-year survival of 15-24%.
  • Graded as Gleason pattern 4, if pure, assigned as Gleason score 4+4=8. (Presence of necrosis will bump the tumor to Gleason pattern 5)
  • Biopsy showing carcinoma with ductal features indicates more advanced cancer at prostatectomy and shortened progression time than Gleason ≤ 7 acinar adenocarcinoma.
  • DDX:
    • HGPIN: contains basal cells (HMWK+ or p63+).
    • Intraductal spread of carcinoma: contains basal cells.
    • Cribriform (Gleason pattern 4) acinar adenocarcinoma: has low columnar or cuboidal tumor cells.

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