Basal Cell and Adenoid Cystic Carcinoma
Rafael E. Jimenez, MD
Gladell P. Paner, MD
Mahul B. Amin, MD
Key Facts
Terminology
-
Malignant neoplasm composed primarily of basaloid cells arising putatively from prostatic basal cells
Clinical Issues
-
Wide age range (28-89 years), but majority occur in older men
-
Most commonly presents with obstructive urinary symptoms
-
Normal serum PSA level
-
Local recurrence, metastasis, and death from disease reported in approximately 30% of cases
Macroscopic Features
-
White and fleshy tumor with ill-defined infiltrative edges and may have microcystic features
-
Tumor primarily centered in transition zone, with variable peripheral zone involvement
Microscopic Pathology
-
Basaloid tumor cells have scant cytoplasm, high nuclear to cytoplasmic ratio, and irregular or angulated nuclei with open chromatin
-
Infiltration of adjacent parenchyma is hallmark feature for diagnosis of malignancy
-
2 main histologic patterns
-
BCC consisting of variably sized solid nests, cords, or trabeculae with peripheral palisading of cells
-
ACC consisting of infiltrative nests with prominent cribriform architecture
-
Ancillary Tests
-
Basal cell markers(+) and usually PSA/PSAP(-)
TERMINOLOGY
Abbreviations
-
Adenoid cystic carcinoma (ACC)
-
Basaloid cell carcinoma (BCC)
Synonyms
-
Adenoid basal cell tumor, adenoid cystic-like tumor
Definitions
-
Malignant neoplasm composed primarily of basaloid cells arising putatively from prostatic basal cells
ETIOLOGY/PATHOGENESIS
Origin
-
Considered to arise from basal cells along prostatic ducts and acini
CLINICAL ISSUES
Epidemiology
-
Incidence
-
Uncommon: Approximately < 75 cases reported in the literature
-
-
Age
-
Wide age range (28-89 years), but majority occur in older men
-
Presentation
-
Most commonly presents with obstructive urinary symptoms
-
Thus most cases diagnosed on transurethral resection of prostate (TURP) specimens
-
-
Perianal pain
-
Few tumors incidentally encountered in needle biopsy during work-up for elevated serum PSA level for other causes
Laboratory Tests
-
Serum PSA levels may be normal or elevated
Treatment
-
Most reported cases treated with TURP, with a subset undergoing radical prostatectomy
-
Advanced stage treated with adjuvant radiotherapy or chemotherapy
Prognosis
-
Limited data available on clinical behavior
-
Local recurrence, metastasis, and death from disease reported in approximately 30% of cases
-
Metastases commonly to lung and liver
-
Bone metastasis rare compared to acinar adenocarcinoma
-
Presence of large solid nests with central necrosis, high Ki-67 staining, and less immunoreactivity to basal cell markers suggested to be associated with aggressive behavior
MACROSCOPIC FEATURES
General Features
-
Grossly apparent tumor that is white and fleshy with ill-defined infiltrative edges
-
May have microcystic features
Site of Involvement
-
Tumor widely involving prostate, including peripheral zone
MICROSCOPIC PATHOLOGY
Histologic Features
-
Basaloid tumor cells have scant cytoplasm, high nuclear to cytoplasmic ratio, and irregular or angulated nuclei with open chromatin
-
Basaloid cells may exhibit nuclear and cytoplasmic microvacuolation
-
Infiltration of adjacent parenchyma is hallmark feature of BCC
-
BCC pattern
-
Variably sized solid nests, cords, or trabeculae with peripheral palisading of basaloid cells
-
May be associated with extensive central necrosis
-
-
ACC pattern
-
Tumor grows in nests with prominent cribriform architecture
-
Eosinophilic, hyaline, basement membrane-like material may be present
-
Basophilic mucinous secretions may be present in lumina
-
-
Additionally, tubuloglandular pattern with collagenous rim and basal cell hyperplasia-like patterns may occur
-
Combination of these different architectural patterns is often encountered
-
Usually associated with desmoplastic stromal response, which may be fibromyxoid or myxoid
-
Rarely acinar, sebaceous, or squamous cell differentiation may be present
-
Perineural invasion, angiolymphatic invasion, or necrosis may be present
-
Extraprostatic extension is often present, including involvement of bladder neck or seminal vesicle
-
Tumor involvement of thick bladder neck muscles detected with relatively high frequency in TURP specimens
-
Subset may have synchronous or metachronous prostate cancer, such as acinar adenocarcinoma, sarcomatoid carcinoma, or small cell carcinoma
Predominant Pattern/Injury Type
-
Neoplastic
Predominant Cell/Compartment Type
-
Epithelial
ANCILLARY TESTS

Stay updated, free articles. Join our Telegram channel

Full access? Get Clinical Tree

