Abstract
BackgroundProstate adenocarcinoma has well known benign mimickers. Histiocytic proliferations usually impose differential diagnosis with high-grade component of acinar adenocarcinoma (Gleason pattern 5).Case presentationWe present herein three cases of histiocytic lesions of the prostate in which accurate recognition avoided inappropriate upgrading (malakoplakia associated with prostate adenocarcinoma, two cases) and false positive diagnosis at biopsy (xanthoma with signet ring morphology).ConclusionIn needle biopsies, pathologists should have a low threshold to perform immunostains when considering a differential diagnosis between high-grade carcinoma and a histiocytic lesion. In prostatectomy specimens, abrupt transition to solid areas in low and intermediate grade tumors should raise concern to exclude malakoplakia. PAS and von Kossa stains are inexpensive and a valuable tool to highlight typical Michaelis–Gutmann bodies.
Highlights
Prostate adenocarcinoma has well known benign mimickers
The differential diagnosis of adenocarcinoma and benign conditions is best stratified by morphologic presentations that resemble Gleason pattern 3, Gleason pattern 4 and Gleason pattern 5 (Srigley 2004; Trpkov 2018)
Since immunohistochemistry is less commonly employed in radical specimens, pathologists should be alert of the potential concomitancy of prostate adenocarcinoma and histiocytic proliferations that resemble
Summary
Pathologists should have a low threshold to perform immunostains when considering a differential diagnosis between high-grade carcinoma and a histiocytic lesion. PAS and von Kossa are inexpensive stains and a valuable tool to highlight typical Michaelis–Gutmann bodies
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