B

Ragged infiltration

Marked Difficulty in Irregular Fused sheets Variable identifying and masses glands' lumens

In foci suspicious for cancer (pattern 1 and 2) positive reaction using the antibody P504S immunostaining helps to certify cancer diagnosis the local clinical stage of the primary together (P <0.001). The basic patterns leading to the Gleason scores are described in Table 1.

The main criteria for delineation of the subgrades are comprehensively summarized in Fig. 1 according to the original publications about Glea-son's scoring system. The subentities are still more precisely characterized by own drawings (Fig. 2).

Recently the WHO published the fascicle "Tumors of the Urinary System and Male Genital Organs". The criteria of Gleason patterns and scoring of prostate cancers are summarized in the following overview. The criteria of the main patterns are compatible with the original description, presented in Table 1.

WHO-Classification 2004

Gleason pattern l l+l = 2 = Gleason score

Well circumscribed nodule of closely packed glands, no infiltration (local in situ condition).

Gleason pattern 2 2+2 = 4 = Gleason score

Round or oval glands, loosely arranged, not as uniform as in pattern 1. Facultative minimal invasion, glands of intermediate size, with less variation than in Gleason pattern 3.

Gleason pattern 3 3+3=6 = Gleason score

Most common pattern: Higher degree of infiltration distance of glands more variable, more often malignant glands between preexistent. Often angular and small glands besides large ones. Cribriform pattern is rare and difficult to distinguish from cribriform high grade PIN.

Gleason pattern 4 4+4 = 8 = Gleason score

Gleason pattern 5 5+5 = 10 = Gleason score

Glands fused, cribriform, may be poorly defined, partly not separated by stroma, edges of fused glands scalopped, thin strands of connective tissue, loss of lumina in cribriform parts. Hypernephromatoid pattern, a rare variant.

Almost complete loss of glandular lumina, growth in solid sheets and strands or as single cells. Comedonecroses may be present.

If the tumor has only one pattern, Gleason score is obtained by doubling the pattern number (see scheme). If there exist two different pattern, the two pattern numbers are summed up, e.g. 3 plus 4 = 7 = Gleason score.

If there is found a tertiary pattern, prognosis worsens additionally.

Fig. 1. Prostate cancer scoring according to Gleason. See Table 1 for details of the patterns

In order to give an impression of the histo-pathological differences of high, moderate, and low differentiation cancers, Figs. 3-7 show the characteristic histopathological features of each.

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