Usefulness and significance of morphological criteria with regard to Gleason grade in the diagnosis of adenocarcinoma prostate

Abstract

Objectives: 1. To study Gleason grade and sum. 2. To study the morphological criteria and their significance. 3. To correlate morphological features with Gleason pattern. Materials and Methods: We studied 411 prostatic specimens, 342 benign and 69 neoplastic cases which were received over a period of two years duration at our Institution. The neoplastic cases were further categorized for occurence of the important morphological criteria with regard to Gleason Grade. Results: Out of the 69 cases of adenocarcinoma prostate, 3 cases were well differentiated adenocarcinoma (Gleason sum 2-4), 35 cases were moderately differentiated adenocarcinoma (Gleason sum 5-7) and 31 cases were poorly differentiated adenocarcinoma (Gleason Sum 8-10). Nucleomegaly was seen in 73%, prominent nucleoli in 60.8%, amphophilic cytoplasm in 19%, intraluminal crystalloids in 62%, collagen micronodules in 36%, chronic inflammation in 64%, perineural invasion in 91%, tumour infiltration was seen in 76%, retraction clefting in 66% cases and necrosis in 49% of the cases. Conclusion: Perineural invasion, Infiltrative pattern and Necrosis have significant correlation with higher Gleason Sum. Morphologically nucleomegaly, nucleolar changes, amphophilic cytoplasm and collagenous micronodules are important additional features which help in clinching the diagnosis.

Keywords

• Collagenous micronodules
• Gleason grade and sum
• intraluminal crystalloids
• perineural invasion. transrectal biopsies
• transurethral resection of prostate