Case Overview

You can view up to 4 cases without signing up. Here is a cystoprostatectomy (Bladder & Prostate) specimen removed for invasive bladder cancer. The prostate is at the bottom of the pic, shown with the green arrow.

This tumor (black arrow) appears obviously necrotic; however, the appearance is compounded by the presence of bladder stones. The stones can break down with the help of fluid (urine) and become somewhat of a coarse paste-like consistency. This substance is adherent to, and basically indistinguishable from, the tumor. It does, however, give us a pretty good idea of the size of the tumor itself.

In addition to this obvious area, the surrounding mucosa looks concerning as well. Is this the ‘true’ border and size of the tumor, or is this just reactive change? Does the area marked with a drawn arrow demonstrate tumor involving the left ureteral orifice? (Probes entering both ureters) Are the margins free of tumor? Is the prostate involved by tumor? These are the many questions we must answer and help the Pathologist answer as a Pathologists’ Assistant.

Images

Here we have a prostate gland, removed for prostate cancer, which I have serially sectioned from the prostatic apex (A) to the bladder base (B). This is done after I ink the anterior half of the prostate capsule blue and the posterior half black.

#Bladder and #Prostate-gland removed for bladder cancer. The orange arrow points to the prostate (inked blue), and the blue arrow points to the papillary, friable bladder tumor.

#Bladder cancer Cystoprostatectomy - looking in bladder as if it were in patient. Prostate inferior. Tumor is a large necrotic mass on the posterior wall.

Radical #Cystectomy and prostatectomy for invasive bladder cancer. The top arrow points to the bladder tumor, and the bottom arrow points to the prostate.

Discussion

An important staging factor for prostate cancer is whether or not the tumor is confined to the prostate capsule. While this mass definitely presses on and bulges into the capsule, it appears (at least grossly) that the mass isn’t extending THROUGH the capsule. You can see, near the tip of the drawn arrow, small bands of fibrous tissue are present between the tumor and the inked capsule. Assuming the seminal vesicles are uninvolved and the microscopy confirms the tumor is confined to the prostate, this tumor will be a T2.

In addition to TNM staging, an important part of the pathology report for prostate cancer is the Histologic Grade of the tumor, in this case called the Gleason Score. Gleason scores for prostate cancer range from 6 to 10, with the higher number representing a higher grade tumor. This number is calculated by adding the 2 grades of the 2 most prominent cell “patterns” together to get the final number. The cells are graded from 1-5, with 1 being completely normal prostate tissue and 5 where the cells are so mutated that they barely represent normal prostate cells. Since normal prostate cells won’t be among the most prominent patterns in a cancer, you won’t see any total Gleason score lower than 6 (3+3). For prostate cancer, a Gleason score of 6 is considered low grade, 7 is considered intermediate grade, and 8 through 10 are all considered high grade tumors. Naturally, these high-grade tumors have an overall worse prognosis with an increased risk of recurrence.