Foamy gland adenocarcinoma of the prostate: incidence, Gleason grade, and early clinical outcome

Hudson, Jena B.; Cao, Dengfeng; Vollmer, Robin T.; Kibel, Adam S.; Grewal, Shaun; Humphrey, Peter A.

doi:10.1016/j.humpath.2011.09.009

Cited by 37 publications

(42 citation statements)

References 14 publications

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“…Not all foamy gland carcinomas in this series had pyknotic nuclei, similar to previous reports, 1,18,24 and thus examination of both the foamy gland adenocarcinoma component and the commonly admixed nonfoamy usual acinar adenocarcinoma for nuclear enlargement and prominent nucleoli is a recommended diagnostic approach. These 10 cases of pure foamy gland carcinoma, which comprised 12% of all foamy gland carcinomas in needle biopsy, showed a linear extent as small as 2 mm, which could be easily missed, as previously reported.…”

Section: Discussionsupporting

confidence: 89%

“…18 Thus, in prostatic adenocarcinoma in both needle biopsies and radical prostatectomy cases, one can anticipate encountering foamy gland features on a regular basis. The results demonstrate that foamy gland carcinoma is relatively common on needle biopsy, with foamy gland features identified in 17% of cancer cases.…”

Section: Discussionmentioning

confidence: 99%

“…18 As is a common problem in prostate pathology, this may represent a clinical sampling issue, in which a prostate gland contains a Gleason grade 3+4 = 7 carcinoma, but only the pattern 3 component is sampled by needle biopsy. The finding that the majority of cases in the present series were of Gleason grade 3+3 = score of 6 is somewhat surprising, considering that the majority of foamy gland carcinomas in the whole gland are reported to be of a higher grade, with the largest study showing the majority to be Gleason score 3+4 = score of 7 at radical prostatectomy.…”

Section: Discussionmentioning

confidence: 99%

“…The incidence and Gleason grade of foamy gland carcinoma have been characterized in prostate glands from radical prostatectomy specimens, 18 but the incidence in needle biopsy has not been reported, and the Gleason grade in a series of consecutive needle biopsy cases has not been determined. The purpose of this study was to characterize the incidence and Gleason grade of foamy gland carcinoma in a large consecutive series of prostate needle biopsy cases.…”

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Foamy Gland Carcinoma of the Prostate in Needle Biopsy

Warrick

Humphrey

2013

American Journal of Surgical Pathology

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Foamy gland carcinoma is a variant of prostatic acinar adenocarcinoma characterized by abundant, foamy cytoplasm, frequently showing small, pyknotic nuclei. The incidence and Gleason grade of foamy gland carcinoma in a large prostate needle biopsy series have not been established. Foamy gland carcinoma may be deceptively benign appearing and missed on needle biopsy. Immunohistochemical staining for basal cells and α-methylacyl-CoA racemase (AMACR) can support a diagnosis of foamy gland carcinoma, but the sensitivity of AMACR for foamy gland carcinoma has been reported to be lower than that for usual acinar carcinoma. The utility of ERG immunohistochemistry in the diagnosis of foamy gland carcinoma has not been explored. The aim of this study was to characterize the incidence and Gleason grade of foamy gland carcinoma in a large consecutive series of prostate needle biopsy cases. We also assessed ERG expression in foamy gland carcinoma, in comparison with AMACR expression, to determine whether ERG expression provides added diagnostic value beyond AMACR expression. We evaluated a consecutive series of 476 prostatic adenocarcinoma needle core biopsy cases for presence, linear extent, and Gleason grade of foamy gland carcinoma. A selected block from each case containing foamy gland carcinoma was evaluated for AMACR and ERG expression by immunohistochemistry. Of the 476 cases, 17% contained a foamy gland carcinoma component, with 2% of the cases showing pure foamy gland carcinoma. Two cases of pure foamy gland carcinoma had a total linear extent of <3 mm. The majority (80%) of cases had a Gleason score 3+3=score of 6. Sensitivity of AMACR for foamy gland carcinoma was 92%, and sensitivity of ERG was 42%. No AMACR-negative case was ERG positive. Low AMACR expression was detected in 24 of 72 cases (33%), and of these cases ERG was positive in 5 (21%). In summary, foamy gland carcinoma features are relatively common in prostate needle core biopsies, the foamy gland carcinoma is admixed with usual acinar carcinoma in the majority of cases, and is usually not of high Gleason grade, although 20% are Gleason score 7 or greater. ERG immunohistochemistry did not provide added value beyond AMACR expression in most cases, suggesting that it need not be initially utilized in addition to basal cell markers and AMACR when immunohistochemistry is needed to substantiate a diagnosis of foamy gland malignancy. This is an important consideration in this era of cost-consciousness in application of immunohistochemistry. Sensitivity of AMACR for foamy gland carcinoma was comparable to that seen in studies of usual acinar carcinoma and is an excellent marker for foamy gland carcinoma of the prostate. ERG immunohistochemistry could be considered in a second round of immunostaining of select difficult cases of foamy gland carcinoma with low AMACR expression.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Foamy Gland Carcinoma of the Prostate in Needle Biopsy

Warrick

Humphrey

2013

American Journal of Surgical Pathology

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“…Other examples include neuroendocrine neoplasms 15 and adenosquamous carcinoma. 16 However, the overlapping of cytoarchitectural features in these variants of prostatic adenocarcinoma [4][5][6][7][8][9][10][11][12][13][14] have not been studied enough. In 2010, we reported 5 cases with a combination of histological criteria of pseudohyperplastic and foamy gland adenocarcinoma (FGA).…”

Section: Introductionmentioning

confidence: 99%

Pseudohyperplastic Adenocarcinoma With Foamy Changes in Needle Prostate Biopsy and Prostatectomy

et al. 2016

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Pseudohyperplastic adenocarcinoma (PHA) with foamy changes is composed of neoplastic glands that show a cytoarchitectural combination of both neoplasms. However, none of the previously reported cases have shown typical areas of foamy or PHA. We report on the clinicopathological characteristics of 5 cases consisting predominantly of pseudohyperplastic and foamy adenocarcinomas. In several histological fields, this neoplasm mimicked hyperplastic nodules or prostatic adenosis because they showed the nodular pattern of the PHA and the inconspicuous cytological atypia of foamy gland carcinoma. Four cases had a Gleason score of 6. In the prostatectomies, the neoplasm was limited to the prostatic gland. The evolution has been favorable in all patients after 3 years of follow-up, on average. The cases reported herein demonstrate that PHA and foamy adenocarcinoma may be associated and occasionally show overlapping histological criteria. The PHA with foamy changes must be distinguished from conventional foamy adenocarcinoma and PHA because it can closely resemble hyperplastic glands mainly in needle prostatic biopsy.

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The Genitourinary System

Sun

2014

Well-Differentiated Malignancies

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Foamy gland adenocarcinoma of the prostate: incidence, Gleason grade, and early clinical outcome

Cited by 37 publications

References 14 publications

Foamy Gland Carcinoma of the Prostate in Needle Biopsy

Foamy Gland Carcinoma of the Prostate in Needle Biopsy

Pseudohyperplastic Adenocarcinoma With Foamy Changes in Needle Prostate Biopsy and Prostatectomy

The Genitourinary System

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