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Basal cell carcinoma of the prostate : A clinicopathologic study of 29 cases
ALI Tehmina Z. ; EPSTEIN Jonathan I.
The American journal of surgical pathology，    2007, vol. 31,  697-705

29 cases of basal cell carcinoma of the prostate including what others call adenoid cystic carcinoma of the prostate.
Patients' age ranged from 42 to 89 (mean 69) years.
24 (86%) cases showed more than 1 pattern: adenoid cysticlike (AC-P) pattern and small solid nests with peripheral palisading were the most predominant patterns, each seen in 18 cases (64%). Other patterns included: basal cell hyperplasialike in 9 cases (32%); small tubules occasionally lined by a hyaline rim in 9 cases (32%), with 4 of these cases also demonstrating intermingling cords of cells; and large solid nests in 8 cases (28.5%), 5 of which had central necrosis. Fourteen cases of small nests and tubules were centrally lined by eosinophilic cells. Desmoplasia was noted in 20 (71%) cases. Infiltration around benign glands was seen in 10 (36%) cases, with predominantly small nests and AC-P. Invasion of thick muscle bundles of the bladder neck was seen in 10 of 21 TURP cases. Perineural invasion was noted in 3 cases with AC-P and 1 case of small basaloid nests. Perineural and vascular invasion was seen in 2 basal cell carcinomas with large basaloid nests.
Mitoses ranged from 0 to 60/10 hpf (mean = 4) （极少核分裂）.
bcl2 was diffusely positive in 22/ 24 (92%) cases （这不奇怪，BCL2在正常的基底细胞就是阳性）. Ki67 ranged from 2% to 80% (mean = 23%). Ki67 > 20% was seen in 13 (56.5%) cases, including all patterns except small solid nests.
Basal cell markers (HMWCK, p63) either: (1) highlighted multiple layers of cells in 15/25 (60%) cases with sparing of the inner most luminal layer; (2) labeled just the outermost layers in 6/25 (24%) cases; or (3) reacted with only a few scattered cells in 4/25 (16%) cases (3 with large solid nests with central necrosis, 1 with tubules and cords). Seven patients had RP with: 5/7 showing extraprostatic extension with 1/5 also showing seminal vesicle involvement and 2/5 also with a positive margin; 1/7 having organ confined disease; and 1/7 showing no residual disease. An additional 11 cases showed extraprostatic extension on TURP with bladder neck invasion (n = 10) or periprostatic adipose tissue invasion (n = 1). Of 29 (65.5%) cases,
（预后较前列腺癌为好）19 had follow-up > 1year with a mean of 4.3 years (1 to 19 y). Of 19 (77%) cases, 14 had no evidence of disease after 1 to 19 (mean 5.8) years. Of 19 patients, 4 locally recurred with 2 after TURP, 1 after enucleation, and 1 after RP. Metastases developed in 4/29 patients: 1 in lung, 1 in lung and liver, 1 in lung, bone and liver, 1 in penile urethra.
Basal cell carcinomas are rare tumors with a broad morphologic spectrum. These tumors predominantly show an indolent course with local infiltrative behavior. A small subset behaves aggressively with local recurrences and distant metastases.
The most common morphology among those with an aggressive behavior is large solid nests more often with central necrosis, high Ki67%, and less staining with basal cell markers.

 好啊病例

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基底细胞癌

基底细胞癌的一般形态学特点：

基底样细胞呈浸润性生长；细胞排列成巢状、管状、梁状，周边细胞可呈栅栏状排列，可呈腺样囊性癌样排列。基底细胞癌的其它恶性特征还包括：前列腺外的浸润，神经侵犯、坏死及促结缔组织增生。基于本例的HE形态学，应该是基底细胞癌，有待于免疫组化证实。

基底细胞癌的免疫组化特点：高分子角蛋白及P63阳性；PSA及PSAP阴性。

 这例可能既有高级别PIN，又有腺癌。因为在低倍镜下见到局灶有浸润。不大像是萎缩后的增生。必要时，需要IHC标记鉴别。

至于具体组织学分型和Gleason分级，需要看切片或楼主提供更多的低倍和高倍图片。谢谢！