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Pathology for Urologists

Prostatic Adenocarcinoma: Gleason Pattern 3

Image A
(click on the image above)

Image B
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  • Most frequent pattern.
  • Well-formed, individual infiltrating glands (well formed gland – continuous lining and with lumina or space in the middle) (image A) & (image B).
  • Includes very large gland (pseudohyperplastic variant), as well as small but well formed gland (microacinar) (it's not about the size).
  • A good rule of thumb is that if you can mentally draw a circle around each gland without running into another gland, you're dealing with a pattern 3 (versus fused glands of pattern 4).
  • The difficult cases in needle biopsy are usually small focus of Gleason pattern 3, because they look the closest to benign glands.
  • In contrast to benign glands, carcinoma glands are usually small-caliber crowded and have rigid or "sharp" lumina.
    • Other nuclear, cytoplasmic and luminal features also important (as enumerated above).

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