A friend and I were reminiscing the other night about our high school biology class at Sullivan High with Mr. Dubin. That course was the first time I ever used a microscope. Believe me, I had no idea that staring at magnified pieces of tissue would be the basis of my future career.

What crosses my desk, or more literally my microscope stage, on a daily basis? Looking at five or eight or twelve sets of prostate biopsies, with multiple parts to each set, I may be examining over 200 slides in a day. There is plenty to see. But since the goal of 99.9% of prostate biopsies is to try to either confirm or rule out the presence of cancer, most of what is on the slide is background music, or sometimes just noise. Just as you tune out much of what you hear every day, I have to tune out the other “stuff.”  It is on the slide, but like an Evelyn Wood trained speed reader, I try to hone in on the important and try to ignore the rest.

Remember that study a few years ago claiming pigeons could identify cancer on a slide? That was a lot of pigeon poop. But how about you? Could you think back to your own high school biology class and separate the benign from the malignant? Give it a try. Take a look at pictures A through F at the beginning of the post, make a diagnosis, and see how accurate you are. You can click on the picture to get an enlargement. Leave your number correct in the Comment field on the blog site or on Facebook. All the pictures are from cases I saw in the last day. A shout out to the great Anatomic Pathology Team at UroPartners Lab that keeps the slides coming.

Answers are below.

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A) You might have thought this picture looked very busy. Lots of cells here, but most of them are inflammatory cells. This patient probably has prostatitis, an inflammation of the gland. No fun to have, but not cancer. I am sure the patient was relieved to get his benign diagnosis.

B) Did you recognize this as normal prostate? Benign, with nothing to indicate the glands are at any risk to become cancerous. That’s all we identify in about half of our patients. It’s good to see.

C) Yes, those are cancerous glands. This is what we would consider a low grade (less aggressive) prostate cancer. Some men with this type of lesion may not need any treatment, just careful follow-up and a good relationship with their urologist.

D) No, these glands are in the biopsy, but not part of the prostate. They are colon glands. How did they get into the sample? To take the biopsy, the urologist passes the needle through the patient’s rectum, the end part of the colon. Little fragments of colon tissue frequently become incorporated into the biopsy. Nothing to worry about for the patient, and usually pretty easy to recognize on the slide.

E) See all those small dark cells? This is an aggressive prostate cancer. Tumors like this have a propensity to spread, so most men with a tumor formed by cells like this will get some form of therapy. Fortunately, there are some great new treatments, some even involving the bodies own immune system to fight the cancer.

F) This can be a tricky one. The cell nuclei look dark and irregular, often a hallmark of cancer. But see all that golden brown pigment? That’s called lipofuscin, and that easily identifies the glands as being part of the seminal vesicles, benign structures that sit on top of the prostate. I have often felt there must be some higher being that put that lipofuscin there to save me from making a bad diagnostic mistake.

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So how did you do? Could you separate the good from the bad? I’ll bet you could do better than a pigeon, but maybe not better than me!

Don’t forget to give your score in the Comment field of either the blog page or Facebook.

The opinions expressed above are the opinions of the authors, not UroPartners LLC.

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