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Pathology for Urologists

Prostatic Adenocarcinoma: Gleason Patterns 1 and 2

Image A
(click on the image above)

Image B
(click on the image above)

Pattern 1: circumscribed nodule, uniform well-formed medium-sized glands, with minimal adjacent stromal infiltration (key is circumscription).

    • Using strict criteria, this pattern is exceedingly rare and controversial in current practice. (be wary in making diagnosis)
    • Most described earlier (pre-immunohistochemistry era) were likely atypical adenomatous hyperplasias (AAH or adenosis).

Pattern 2: less circumscribed nodule with minimal infiltration to adjacent stroma, less uniform glands (less circumscribed than pattern 1) (image A) & (image B).

    • Also rare, usually seen in transition zone; seen incidentally and usually seen with other higher grades.
  • Because of the need to appreciate the entire nodular or circumscribe growth, diagnosis of patterns 1 and 2 are rarely, if ever, made in needle biopsy; diagnosis made only in TUR or prostatectomy specimens.
  • Glands in pattern 1 and 2 are larger than in pattern 3.

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