Adenocarcinoma of the prostate with atrophic features

Adenocarcinomas of the prostate with attenuated cytoplasm (i.e., atrophic features) have not been studied formally and represent a diagnostic dilemma to the surgical pathologist. Forty-four cases of adenocarcinoma with atrophic features seen at the Johns Hopkins Medical Institutions were reviewed. Forty-two cases were seen on needle biopsy, and two were from transurethral resection specimens. Neoplastic atrophic glands were characterized by cells with a paucity of cytoplasm, such that the nuclei occupied almost the entire cell height. Atrophic cancers were defined as cancers with atrophic glands constituting > or = 50% of the tumor. Ony two of 44 patients whose prostatic adenocarcinoma showed atrophic features were on hormone therapy at the time of biopsy. Forty-one cases had an infiltrative pattern of growth. Thirty-nine cases were Gleason grade 3 + 3 = 6. Nuclear size was increased in 39 cases, and macronucleoli were noted in 21 cases. The most useful criteria to establish a diagnosis of adenocarcinoma were (1) an infiltrative pattern of growth, (2) the presence of macronucleoli, (3) increased nuclear size, and (4) the presence of adjacent, nonatrophic cancer.