Unusual Epithelial and Nonepithelial Neoplasms of the Prostate



The vast majority of prostatic neoplasms are epithelial, and the most common is conventional acinar prostatic adenocarcinoma. This chapter will focus exclusively on unusual epithelial and non-epithelial neoplasms that may involve the prostate. The unusual primary epithelial tumors of the prostate that will be discussed in this chapter are: mucinous adenocarcinoma of the prostate; prostatic ductal adenocarcinoma, intraductal carcinoma of the prostate, and squamous cell carcinoma; sarcomatoid carcinoma of the prostate; prostatic carcinoid tumor; prostatic adenocarcinoma with paneth cell-like neuroendocrine differentiation; small cell carcinoma; basal cell carcinoma; urothelial carcinoma; and mucin-producing urothelial-type adenocarcinoma (prostatic urethral adenocarcinoma). The unusual secondary epithelial tumors of the prostate that will be discussed in this chapter include: urothelial carcinoma and colorectal adenocarcinoma. The unusual primary mesenchymal tumors of the prostate included in this chapter include: stromal tumor of unknown malignant potential and stromal sarcoma. Gastrointestinal stromal tumor arising from the colorectal wall is the unusual secondary mesenchymal tumor of the prostate that will be discussed in this chapter.


Prostate Tumor Epithelial Mesenchymal Primary Secondary 


  1. 1.
    Grignon DJ. Unusual subtypes of prostate cancer. Mod Pathol. 2004;17(3):316–27.CrossRefPubMedGoogle Scholar
  2. 2.
    Mazzucchelli R, Lopez-Beltran A, Cheng L, et al. Rare and unusual histological variants of prostatic carcinoma: clinical significance. BJU Int. 2008;102(10):1369–74.PubMedGoogle Scholar
  3. 3.
    Epstein JI, Lieberman PH. Mucinous adenocarcinoma of the prostate gland. Am J Surg Pathol. 1985;9:299–308.CrossRefPubMedGoogle Scholar
  4. 4.
    Ro JY, Grignon DJ, Ayala AG, et al. Mucinous adenocarcinoma of the prostate: histochemical and immunohistochemical studies. Hum Pathol. 1990;21:593–600.CrossRefPubMedGoogle Scholar
  5. 5.
    Osunkoya AO, Epstein JI. Primary mucin-producing urothelial-type adenocarcinoma of prostate: report of 15 cases. Am J Surg Pathol. 2007;31:1323–9.CrossRefPubMedGoogle Scholar
  6. 6.
    Osunkoya AO, Nielsen ME, Epstein JI. Prognosis of mucinous adenocarcinoma of the prostate treated by radical prostatectomy: a study of 47 cases. Am J Surg Pathol. 2008;32(3):468–72.CrossRefPubMedGoogle Scholar
  7. 7.
    Lane BR, Magi-Galluzzi C, Reuther AM, et al. Mucinous adenocarcinoma of the prostate does not confer poor prognosis. Urology. 2006;68(4):825–30.CrossRefPubMedGoogle Scholar
  8. 8.
    Melicow MM, Pachter MR. Endometrial carcinoma of prostatic utricle (uterus masculinus). Cancer. 1967;20:1715–22.CrossRefPubMedGoogle Scholar
  9. 9.
    Bostwick DG, Kindrachuk RW, Rouse RV. Prostatic adenocarcinoma with endometrioid features. Clinical, pathologic, and ultrastructural findings. Am J Surg Pathol. 1985;9(8):595–609.CrossRefPubMedGoogle Scholar
  10. 10.
    Epstein JI, Woodruff JM. Adenocarcinoma of the prostate with endometrioid features. A light microscopic and immunohistochemical study of ten cases. Cancer. 1986;57:111–9.CrossRefPubMedGoogle Scholar
  11. 11.
    Ro JY, Ayala AG, Wishnow KI, Ordonez NG. Prostatic duct adenocarcinoma with endometrioid features: immunohistochemical and electron microscopic study. Semin Diagn Pathol. 1988;5:301–11.PubMedGoogle Scholar
  12. 12.
    Amin A, Epstein JI. Pathologic stage of prostatic ductal adenocarcinoma at radical prostatectomy: effect of percentage of the ductal component and associated grade of acinar adenocarcinoma. Am J Surg Pathol. 2011;35(4):615–9.CrossRefPubMedGoogle Scholar
  13. 13.
    Tavora F, Epstein JI. High-grade prostatic intraepithelial neoplasia like ductal adenocarcinoma of the prostate: a clinicopathologic study of 28 cases. Am J Surg Pathol. 2008;32(7):1060–7.CrossRefPubMedGoogle Scholar
  14. 14.
    Lee TK, Miller JS, Epstein JI. Rare histological patterns of prostatic ductal adenocarcinoma. Pathology. 2010;42(4):319–24.CrossRefPubMedGoogle Scholar
  15. 15.
    Kovi J, Jackson MA, Heshmat MY. Ductal spread in prostatic carcinoma. Cancer. 1985;56(7):1566–73.CrossRefPubMedGoogle Scholar
  16. 16.
    McNeal JE, Yemoto CE. Spread of adenocarcinoma within prostatic ducts and acini. Morphologic and clinical correlations. Am J Surg Pathol. 1996;20(7):802–14.CrossRefPubMedGoogle Scholar
  17. 17.
    Guo CC, Epstein JI. Intraductal carcinoma of the prostate on needle biopsy: histologic features and clinical significance. Mod Pathol. 2006;19(12):1528–35.CrossRefPubMedGoogle Scholar
  18. 18.
    Cohen RJ, Wheeler TM, Bonkhoff H, Rubin MA. A proposal on the identification, histologic reporting, and implications of intraductal prostatic carcinoma. Arch Pathol Lab Med. 2007;131(7):1103–9.PubMedGoogle Scholar
  19. 19.
    Henry PC, Evans AJ. Intraductal carcinoma of the prostate: a distinct histopathological entity with important prognostic implications. J Clin Pathol. 2009;62(7):579–83.CrossRefPubMedGoogle Scholar
  20. 20.
    Braslis KG, Davi RC, Nelson E, et al. Squamous cell carcinoma of the prostate: a transformation from adenocarcinoma after the use of a luteinizing hormone-releasing hormone agonist and flutamide. Urology. 1995;45:329–31.CrossRefPubMedGoogle Scholar
  21. 21.
    Miller VA, Reuter V, Scher HI. Primary squamous cell carcinoma of the prostate after radiation seed implantation for adenocarcinoma. Urology. 1995;46:111–3.CrossRefPubMedGoogle Scholar
  22. 22.
    Nabi G, Ansari MS, Singh I, et al. Primary squamous cell carcinoma of the prostate: a rare clinicopathological entity—report of 2 cases and review of literature. Urol Int. 2001;66:216–9.CrossRefPubMedGoogle Scholar
  23. 23.
    Parwani AV, Kronz JD, Genega EM, et al. Prostate carcinoma with squamous differentiation: an analysis of 33 cases. Am J Surg Pathol. 2004;28:651–7.CrossRefPubMedGoogle Scholar
  24. 24.
    Fine SW. Variants and unusual patterns of prostate cancer: clinicopathologic and differential diagnostic considerations. Adv Anat Pathol. 2012;19(4): 204–16.CrossRefPubMedGoogle Scholar
  25. 25.
    Ordonez NG, Ayala AG, von Eschenbach AC, et al. Immunoperoxidase localization of prostatic acid phosphatase in prostatic carcinoma with sarcomatoid changes. Urology. 1982;19:210–4.CrossRefPubMedGoogle Scholar
  26. 26.
    Wick MR, Young RH, Malvesta R, et al. Prostatic carcinosarcomas: clinical, histologic, and immunohistochemical data on two cases with a review of the literature. Am J Clin Pathol. 1989;92:131–9.PubMedGoogle Scholar
  27. 27.
    Delahunt B, Eble JN, Nacey JN, et al. Sarcomatoid carcinoma of the prostate: progression from adenocarcinoma is associated with p53 over-expression. Anticancer Res. 1999;19:4279–83.PubMedGoogle Scholar
  28. 28.
    Hansel DE, Epstein JI. Sarcomatoid carcinoma of the prostate: a study of 42 cases. Am J Surg Pathol. 2006;30:1316–21.CrossRefPubMedGoogle Scholar
  29. 29.
    Azumi N, Shibuya H, Ishikura M. Primary prostatic carcinoid tumor with intracytoplasmic prostatic acid phosphatase and prostate specific antigen. Am J Surg Pathol. 1984;8:545–50.CrossRefPubMedGoogle Scholar
  30. 30.
    Almagro UA. Argyrophilic prostatic carcinoma: case report with literature review on prostatic carcinoid and “carcinoidlike” prostatic carcinoma. Cancer. 1985;55:608–14.CrossRefPubMedGoogle Scholar
  31. 31.
    Ghannoum JE, DeLellis RA, Shin SJ. Primary carcinoid tumor of the prostate with concurrent adenocarcinoma: a case report. Int J Surg Pathol. 2004;12:167–70.CrossRefPubMedGoogle Scholar
  32. 32.
    Zarkovic A, Masters J, Carpenter L. Primary carcinoid tumour of the prostate. Pathology. 2005;37(2):184–6.CrossRefPubMedGoogle Scholar
  33. 33.
    Tamas EF, Epstein JI. Prognostic significance of paneth cell-like neuroendocrine differentiation in adenocarcinoma of the prostate. Am J Surg Pathol. 2006;30(8):980–5.CrossRefPubMedGoogle Scholar
  34. 34.
    Grignon DJ. Unusual subtypes of prostate cancer. Mod Pathol. 2004;17:316–27.CrossRefPubMedGoogle Scholar
  35. 35.
    Mazzucchelli R, Lopez-Beltran A, Cheng L, et al. Rare and unusual histological variants of prostatic carcinoma: clinical significance. BJU Int. 2008;102:1369–74.PubMedGoogle Scholar
  36. 36.
    Tetu B, Ro JY, Ayala AB, et al. Small cell carcinoma of the prostate. Part 1. A clinicopathologic study of 20 cases. Cancer. 1987;59:1803–9.CrossRefPubMedGoogle Scholar
  37. 37.
    Christopher ME, Seftel AD, Sorenson K, Resnick MI. Small cell carcinoma of the genitourinary tract: an immunohistochemical, electron microscopic and clinicopathological study. J Urol. 1991;146:382–8.PubMedGoogle Scholar
  38. 38.
    Oesterling JE, Hauzeur CG, Farrow GM. Small cell anaplastic carcinoma of the prostate: clinical, pathological and immunohistological study of 27 patients. J Urol. 1992;147:804–7.PubMedGoogle Scholar
  39. 39.
    Nadig SN, Deibler AR, El Salamony TM, et al. Small cell carcinoma of the prostate: an underrecognized entity. Can J Urol. 2001;8:1207–10.PubMedGoogle Scholar
  40. 40.
    Wang W, Epstein JI. Small cell carcinoma of the prostate. A morphologic and immunohistochemical study of 95 cases. Am J Surg Pathol. 2008;32(1):65–71.CrossRefPubMedGoogle Scholar
  41. 41.
    Wenk RE, Bhagavan BS, Levy R, et al. Ectopic ACTH, prostatic oat cell carcinoma, and marked hypernatremia. Cancer. 1977;40:773–8.CrossRefPubMedGoogle Scholar
  42. 42.
    Valle J, von Boguslawsky K, Stenborg M, Andersson LC. Progression from adenocarcinoma to small cell carcinoma of the prostate with normalization of prostate-specific antigen (PSA) levels. Scand J Urol Nephrol. 1996;30(6):509–12.CrossRefPubMedGoogle Scholar
  43. 43.
    Miyoshi Y, Uemura H, Kitami K, et al. Neuroendocrine differentiated small cell carcinoma presenting as recurrent prostate cancer after androgen deprivation therapy. BJU Int. 2001;88(9):982–3.CrossRefPubMedGoogle Scholar
  44. 44.
    Nemoto K, Tomita Y. Neuroendocrine differentiation of localized prostate cancer during endocrine therapy. Scand J Urol Nephrol. 2007;41(6):558–60.CrossRefPubMedGoogle Scholar
  45. 45.
    Han B, Mehra R, Suleman K, et al. Characterization of ETS gene aberrations in select histologic variants of prostate carcinoma. Mod Pathol. 2009;22(9):1176–85.CrossRefPubMedCentralPubMedGoogle Scholar
  46. 46.
    Scheble VJ, Braun M, Wilbertz T, et al. ERG rearrangement in small cell prostatic and lung cancer. Histopathology. 2010;56(7):937–43.CrossRefPubMedGoogle Scholar
  47. 47.
    Guo CC, Dancer JY, Wang Y, et al. TMPRSS2-ERG gene fusion in small cell carcinoma of the prostate. Hum Pathol. 2011;42(1):11–7.CrossRefPubMedGoogle Scholar
  48. 48.
    Lotan TL, Gupta NS, Wang W, et al. ERG gene rearrangements are common in prostatic small cell carcinomas. Mod Pathol. 2011;24(6):820–8.CrossRefPubMedCentralPubMedGoogle Scholar
  49. 49.
    Williamson SR, Zhang S, Yao JL, et al. ERG-TMPRSS2 rearrangement is shared by concurrent prostatic adenocarcinoma and prostatic small cell carcinoma and absent in small cell carcinoma of the urinary bladder: evidence supporting monoclonal origin. Mod Pathol. 2011;24(8):1120–7.CrossRefPubMedCentralPubMedGoogle Scholar
  50. 50.
    Grignon DJ, Ro JY, Ordonez NG, et al. Basal cell hyperplasia, adenoid basal cell tumor, and adenoid cystic carcinoma of the prostate gland: an immunohistochemical study. Hum Pathol. 1988;19:1425–33.CrossRefPubMedGoogle Scholar
  51. 51.
    Iczkowski KA, Ferguson KL, Grier DD, et al. Adenoid cystic/basal cell carcinoma of the prostate: clinicopathologic findings in 19 cases. Am J Surg Pathol. 2003;27:1523–9.CrossRefPubMedGoogle Scholar
  52. 52.
    McKenney JK, Amin MB, Srigley JR, et al. Basal cell proliferations of the prostate other than usual basal cell hyperplasia: a clinicopathologic study of 23 cases, including four carcinomas, with a proposed classification. Am J Surg Pathol. 2004;28:1289–98.CrossRefPubMedGoogle Scholar
  53. 53.
    Hosler GA, Epstein JI. Basal cell hyperplasia: an unusual diagnostic dilemma on prostate needle biopsies. Hum Pathol. 2005;36:480–5.CrossRefPubMedGoogle Scholar
  54. 54.
    Ali TZ, Epstein JI. Basal cell carcinoma of the prostate: a clinicopathologic study of 29 cases. Am J Surg Pathol. 2007;31(5):697–705.CrossRefPubMedGoogle Scholar
  55. 55.
    Yang XJ, McEntee M, Epstein JI. Distinction of basaloid carcinoma of the prostate from benign basal cell lesions by using immunohistochemistry for bcl-2 and Ki-67. Hum Pathol. 1998;29:1447–50.CrossRefPubMedGoogle Scholar
  56. 56.
    Greene LF, O’Dea MJ, Dockerty MB. Primary transitional cell carcinoma of the prostate. J Urol. 1976;116(6):761–3.PubMedGoogle Scholar
  57. 57.
    Algaba F, Santanlaria JM, Lamas M, Ayala G. Transitional cell carcinoma of the prostate. Eur Urol. 1985;11:87–90.PubMedGoogle Scholar
  58. 58.
    Cheville JC, Dundore PA, Bostwick DG, et al. Transitional cell carcinoma of the prostate: clinicopathologic study of 50 cases. Cancer. 1998;82(4):703–7.CrossRefPubMedGoogle Scholar
  59. 59.
    Edge SB, Byrd DR, Carducci M, et al., editors. AJCC cancer staging manual. 7th ed. New York: Springer; 2010.Google Scholar
  60. 60.
    Tran KP, Epstein JI. Mucinous adenocarcinoma of urinary bladder type arising from the prostatic urethra. Distinction from mucinous adenocarcinoma of the prostate. Am J Surg Pathol. 1996;20(11): 1346–50.CrossRefPubMedGoogle Scholar
  61. 61.
    Ortiz-Rey JA, Dos Santos JE, Rodríguez-Castilla M, Alvarez C, Fariña L. Mucinous urothelial-type adenocarcinoma of the prostate. Scand J Urol Nephrol. 2004;38(3):256–7.CrossRefPubMedGoogle Scholar
  62. 62.
    Curtis MW, Evans AJ, Srigley JR. Mucin-producing urothelial-type adenocarcinoma of prostate: report of two cases of a rare and diagnostically challenging entity. Mod Pathol. 2005;18(4):585–90.CrossRefPubMedGoogle Scholar
  63. 63.
    Osunkoya AO, Netto GJ, Epstein JI. Colorectal adenocarcinoma involving the prostate: report of 9 cases. Hum Pathol. 2007;38(12):1836–41.CrossRefPubMedGoogle Scholar
  64. 64.
    Johnson DE, Chalbaud R, Ayala AG. Secondary tumors of the prostate. J Urol. 1974;112(4):507–8.PubMedGoogle Scholar
  65. 65.
    Zein TA, Huben R, Lane W, Pontes JE, Englander LS. Secondary tumors of the prostate. J Urol. 1985;133(4):615–6.PubMedGoogle Scholar
  66. 66.
    Bates AW, Baithun SI. Secondary solid neoplasms of the prostate: a clinico-pathological series of 51 cases. Virchows Arch. 2002;440(4):392–6.CrossRefPubMedGoogle Scholar
  67. 67.
    Schellhammer PF, Bean MA, Whitmore WF Jr. Prostatic involvement by transitional cell carcinoma: pathogenesis, patterns and prognosis. J Urol. 1977;118:399–403.PubMedGoogle Scholar
  68. 68.
    Revelo MP, Cookson MS, Chang SS, et al. Incidence and location of prostate and urothelial carcinoma in prostates from cystoprostatectomies: implications for possible apical sparing surgery. J Urol. 2004;171:646–51.CrossRefPubMedGoogle Scholar
  69. 69.
    Oliva IV, Smith SL, Chen Z, Osunkoya AO. Urothelial carcinoma of the bladder with transmural and direct prostatic stromal invasion: does extent of stromal invasion significantly impact patient outcome? Hum Pathol. 2011;42(1):51–6.CrossRefPubMedGoogle Scholar
  70. 70.
    Chuang AY, DeMarzo AM, Veltri RW, et al. Immunohistochemical differentiation of high-grade prostate carcinoma from urothelial carcinoma. Am J Surg Pathol. 2007;31(8):1246–55.CrossRefPubMedGoogle Scholar
  71. 71.
    Eble JN, Sauter G, Epstein JI, et al., editors. The world health organization classification of tumors of the urinary system and male genital organs. Lyon: IARC Press; 2004.Google Scholar
  72. 72.
    Herawi M, Epstein JI. Specialized stromal tumors of the prostate: a clinicopathologic study of 50 cases. Am J Surg Pathol. 2006;30(6):694–704.CrossRefPubMedGoogle Scholar
  73. 73.
    Hansel DE, Herawi M, Montgomery E, Epstein JI. Spindle cell lesions of the adult prostate. Mod Pathol. 2007;20(1):148–58.CrossRefPubMedGoogle Scholar
  74. 74.
    Nagar M, Epstein JI. Epithelial proliferations in prostatic stromal tumors of uncertain malignant potential (STUMP). Am J Surg Pathol. 2011;35(6):898–903.CrossRefPubMedGoogle Scholar
  75. 75.
    Madden JF, Burchette JL, Raj GV, et al. Anterior rectal wall gastrointestinal stromal tumor presenting clinically as prostatic mass. Urol Oncol. 2005;23:268–72.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Department of PathologyEmory University School of MedicineAtlantaUSA
  2. 2.Department of PathologyCleveland Clinic, Robert J. Tomsich Pathology and Laboratory Medicine InstituteClevelandUSA

Personalised recommendations