Prostate adenocarcinoma: anterior tumour on MRI (PIRADS 5)

Case contributed by Dr Matthew Bastian-Jordan

Presentation

50 year old patient with PSA = 6.8

Patient Data

Age: 50
Gender: Male

Multi parametric MRI of the prostate demonstrates an anterior tumour involving the transitional zone (TZ) and anterior fibromuscular stroma (AFS).

PIRADS grading = 5.

MRI guided in bore biopsy performed.

Histopathology report: 

PIN4 staining demonstrates absence of myoepithelial cell staining around the atypical small acini which are also racemase +ve. These features support the malignant diagnosis.

On the immunoperoxidase stain some of the acini appear to show Gleason pattern 3. The diagnosis of Gleason 4 + 3 = 7 adenocarcinoma is preferred.

Summary:

PROSTATE BIOPSY - ADENOCARCINOMA, GLEASON 4 + 3 = 7.

Case Discussion

This is an example of a transitional zone tumour demonstrating the classic erased charcoal sign.

This can be known as PEATS (prostate evasive anterior tumour).

The T2 grading of this TZ lesion is 5, so the overall grading of PIRADS V2 is 5.

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Case information

rID: 46481
Case created: 5th Jul 2016
Last edited: 6th Jul 2016
Inclusion in quiz mode: Included

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