Which scoring system is used to grade the prostatic pathology shown in the image?
A. Gleason Scoring
B. Nottingham Grading
C. Child-Pugh score
D. Alvarado score
Ans:A. Gleason Scoring.
- First:Adenocarcinoma of the prostate. Carcinomatous tissue is seen on the posterior aspect (lower left). Note the solid whiter tissue of cancer, in contrast with the spongy appearance of the benign peripheral zone on the contralateral side.
- Second:Adenocarcinoma of the prostate demonstrating small glands crowded in between larger benign glands.
- Most carcinomas detected clinically are not visible grossly.
- More advanced lesions appear as firm, gray-white lesions with ill-defined margins that infiltrate the adjacent gland.
- On histologic examination, most lesions are moderately differentiated adenocarcinomas that produce well-defined glands.
- The glands typically are smaller than benign glands and are lined by a single uniform layer of cuboidal or low columnar epithelium, lacking the basal cell layer seen in benign glands.
- In further contrast with benign glands, malignant glands are crowded together and characteristically lack branching and papillary infolding.
- The cytoplasm of the tumor cells ranges from pale-clear (as in benign glands) to a distinctive amphophilic (dark purple) appearance. Nuclei are enlarged and often contain one or more prominent nucleoli .
- With increasing grade, irregular or ragged glandular structures, cribriform glands, sheets of cells, or infiltrating individual cells are present.
- Prostate cancer is graded by the Gleason system