PMC5711692_01
Comparative MRI and Micro-ultrasound images of index lesion. A) Coronal T2 MRI. B) Axial T2 MRI. C) Sagittal T2 MRI. D) Parasagittal micro-ultrasound of left lateral edge of prostate. E) Parasagittal micro-ultrasound of left medial edge of lesion. The Micro-ultrasound images show mottled tissue consistent with PRI-MUS grade 4, along with suspicious shadowing consistent with PRI-MUS grade 5. Suspicious findings in all images are marked with arrows.
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Micro-ultrasound imaging revealed a 30 cc gland with a large PRI-MUS 4-5 lesion in left base-mid and PRI-MUS 3 lesions in the left apex and right base (see Fig. 1).
Histology images from transverse sections taken from the radical prostatectomy specimen. A-C) Slices shown from mid-base region with adenocarcinoma areas traced in green. Scale bar represents 5mm. D-E) 20x magnification of Gleason pattern 4 (D) and single file pattern 5 carcinoma (E) of the lesion identified in (B).
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This analysis upgraded the diagnosis due to the presence of a small area of pattern 5 carcinoma (Fig. 2E) on the left side. The left apex was further involved by a small Gleason score 6 (3 + 3) adenocarcinoma. The right side of the prostate was found to contain a small Gleason score 7 (3 + 4) carcinoma with mucinous features, though it is not clear whether such a small focus could have contributed to the equivocal micro-ultrasound findings in that area.