title: Collagenous micronodules in prostate cancer revisited: are they solely associated with Gleason pattern 3 adenocarcinomas?
abstract: Collagenous micronodules (CMs) are microscopic stromal nodular eosinophilic fibrillar collagen deposition of uncertain histogenesis seen in prostatic adenocarcinoma. Per the 2005 International Society of Urologic Pathology (ISUP) consensus conference, they are categorized as Gleason pattern 3. This study analyzes morphological and clinical features of CMs from a large series of radical prostatectomies. Hematoxylin and eosin stained slides for 129 radical prostatectomies for adenocarcinoma of prostate with CMs and for 93 prostatic adenocarcinoma cases without CMs as comparison were examined out of a total of 667 cases performed from January 2010 to December 2011 at Houston Methodist Hospital. CMs were identified in 19% of all radical prostatectomies (129/667 cases). Almost all tumors with CMs were located in the peripheral zone (98%) as single or multiple foci of prostatic cancer glands. The vast majority of cases (96%) were identified in association with mucinous secretion. A cribriform Gleason pattern 4 was associated in 86 cases (67%). The CMs were associated with glomerulation (42%) and amphophilic luminal secretion (59%). 88 cases (68%) showed tumor foci with Gleason pattern ≥ 4 in close association with CMs. Multivariate analysis revealed CMs of the prostatic adenocarcinoma are closely related to mucinous secretion, cribriform growth pattern, and Gleason pattern 4. This study suggests that CMs are more frequently associated with Gleason pattern 4 cancer warranting morphologic reappraisal of CMs, rather than the consensus assignment of Gleason pattern 3.
authors.affiliation: Department of Pathology and Genomic Medicine, Urology, Houston Methodist Hospital, Weill Medical College of Cornell University Houston, Texas, USA ; Department of Pathology, College of Medicine, Yeungnam University Daegu, South Korea.
authors.forename: Mi J
authors.initials: MJ
authors.lastname: Kim
authors.affiliation: Department of Pathology and Genomic Medicine, Urology, Houston Methodist Hospital, Weill Medical College of Cornell University Houston, Texas, USA.
authors.forename: Mukul K
authors.initials: MK
authors.lastname: Divatia
authors.affiliation: Department of Pathology and Genomic Medicine, Urology, Houston Methodist Hospital, Weill Medical College of Cornell University Houston, Texas, USA.
authors.forename: Jeong H
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Department of Pathology and Genomic Medicine, Urology, Houston Methodist Hospital, Weill Medical College of Cornell University Houston, Texas, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Shen
authors.affiliation: Department of Urology, Houston Methodist Hospital, Weill Medical College of Cornell University Houston, Texas, USA.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Miles
authors.affiliation: Department of Preventive Medicine, School of Medicine, Daegu Catholic University Daegu, South Korea.
authors.forename: Jun H
authors.initials: JH
authors.lastname: Hwang
authors.affiliation: Department of Pathology and Genomic Medicine, Urology, Houston Methodist Hospital, Weill Medical College of Cornell University Houston, Texas, USA.
authors.forename: Alberto G
authors.initials: AG
authors.lastname: Ayala
authors.affiliation: Department of Pathology and Genomic Medicine, Urology, Houston Methodist Hospital, Weill Medical College of Cornell University Houston, Texas, USA.
authors.forename: Jae Y
authors.initials: JY
authors.lastname: Ro
mesh_terms: D000230:Adenocarcinoma / Q000145:classification / Q000473:pathology* / Q000601:surgery; D000368:Aged; D014408:Biomarkers, Tumor / Q000378:metabolism*; D003094:Collagen / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011467:Prostate / Q000473:pathology; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000145:classification / Q000473:pathology* / Q000601:surgery
chemical_list: D014408:Biomarkers, Tumor; D003094:Collagen
keywords: Gleason pattern 3; Gleason pattern 4; Prostate adenocarcinoma; collagenous micronodules; mucinous fibroplasia