glomerulation in prostatic adenocarcinoma

Definition: Glomeruloid glands in prostatic adenocarcinoma are characterized by dilated glands containing intraluminal cribriform structures with a single point of attachment, resembling a renal glomerulus .

Images

 Adenocarcinoma of Prostate : Glomerulations

• http://www.webpathology.com/image.asp?n=16&Case=20
• https://twitter.com/rlhutton/status/880211841128857600

 glomeruloid glands in prostatic adenocarcinoma

• https://twitter.com/GeronimoJrLapac/status/813320491868033024
• https://twitter.com/GeronimoJrLapac/status/856811425213415425
• https://twitter.com/sarahheatsky/status/659505058720186372

On prostate biopsy, glomeruloid glands are exclusively associated with carcinoma and not associated with benign mimickers.

The grading of such glomeruloid structures is controversial.

Some urological pathologists do not assign a grade to glomeruloid patterns and rather just grade the surrounding tumor.

According to some experts for the rare case where the entire tumor is composed of glomeruloid glands, a grade of 3+3=6 is assigned as long as the glomeruloid structures are small.

Larger glomeruloid structures are uniformly accepted by urological pathologists as Gleason pattern 4.

Other experts in the field feel that all glomeruloid structures should be assigned a Gleason pattern 4.

A study of ours, subsequent to the consensus conference, indicated that glomerulations were overwhelmingly associated with concurrent Gleason pattern 4 or higher-grade carcinoma.

In several cases, transition could be seen among small glomerulations, large glomeruloid structures, and cribriform pattern 4 cancer.

These data suggest that glomerulations represent an early stage of cribriform pattern 4 cancer and are best graded as Gleason pattern 4.

Differential diagnosis

 normal acini with protrusion to the vessel lumen simulating a glomeruloid acini