Small cell-like glandular proliferation of prostate: a rare lesion not related to small cell prostate cancer

Small cell-like change (SCLC) is a rare prostate lesion which has been described in only two previous studies (total of eight cases). Its relation to possible neuroendocrine differentiation remained unclear. We evaluated 11 SCLC cases with immunohistochemistry and electron microscopy. SCLC was characterized by crowded hyperchromatic small nuclei with scant cytoplasm, rosette-like structures, finely granular chromatin with indistinct nucleoli, and lack of mitoses, apoptoses, and necroses. In nine cases, SCLC was admixed with high-grade cancer, and in two cases, it represented a separate intraductal process, spatially remote from a low-volume Gleason score 6 (grade group 1) cancer. Only 2/11 SCLC labeled for synaptophysin, chromogranin, and serotonin, although 6/11 were at least focally positive for TTF1. Staining for NKX3.1 and pancytokeratin was typically weak, focal, and markedly reduced compared to the adjacent cancer. SCLC was positive for ERG in 1/8 and for racemase in 6/10 cases, again typically in a focal and weak fashion. There was no immunoreactivity with CD56, p63, or HMWCK. Ki-67 highlighted only rare nuclei (<1 %). No neuroendocrine granules were demonstrated by electron microscopy in four cases that showed no immunoreactivity for neuroendocrine markers. In summary, SCLC is more frequently found in high-grade prostate cancer, but it may also be encountered as a noninvasive lesion in Gleason score 6 (grade group 1) cancer. Importantly, it does not appear to indicate neuroendocrine differentiation. The low-grade cytology, the lack of mitoses and apoptoses, and the minimal Ki-67 reactivity are findings to support its discrimination from a small cell carcinoma.

Virchows Archiv : an international journal of pathology. 2016 Oct 14 [Epub ahead of print]

Oleksandr N Kryvenko, Sean R Williamson, Kiril Trpkov, Nilesh S Gupta, Daniel Athanazio, Martin K Selig, Paul Taylor Smith, Cristina Magi-Galluzzi, Merce Jorda

Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, 1400 NW 12th Avenue, Room 4076, Miami, FL, 33136, USA. ., Department of Pathology and Laboratory Medicine, Henry Ford Health System, Detroit, MI, USA., Department of Pathology and Laboratory Medicine, Calgary Laboratory Service and University of Calgary, Calgary, AB, Canada., Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA., Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, 1400 NW 12th Avenue, Room 4076, Miami, FL, 33136, USA., R.T. Pathology and Laboratory Medicine Institute, Cleveland Clinic and Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA.