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Prostatic Adenocarcinoma: Gleason Pattern 4

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  • Includes fused (image A), poorly formed (image B) and cribriform glands (image C) & (image D).
  • Main distinction between grade 3 and grade 4 is fusion of glands, whereas in grade 3 you should be able to see separate and distinct glands, in grade 4 the glands become fused (you can no longer draw a circle around each gland without hitting another gland).

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  • Glandular lumina may be lost (that is, the glands are poorly-formed)
  • Cribriform pattern consists of medium to large glands with lumina separated into compartments by cellular bridges (presence of necrosis raises to grade 5).