Diagnosis: Gleason grade 5, 4, 4, 3 and no grading for Figs, 1, 2, 3, 4 and 5, respectively.   

            Comment: The ISUP consensus conference (See Case 209), proposed grading for histologic variants and variations of adenocarcinoma of the prostate. The consensus in cases with vacuoles (Fig. 1) was that tumors should be graded as if the vacuoles were not present, by only evaluating the underlying architectural pattern. The consensus was that ductal adenocarcinomas (Fig.2) should be graded as Gleason pattern 4. The majority of cases with colloid carcinoma (Fig.3) consist of irregular cribriform glands floating within a mucinous matrix. It was the uniform consensus that these cases should be considered pattern 4. It was the consensus that in adenocarcinomas with collagenous micronodules (Fig.4) one should try to subtract away the mucinous fibroplasia and grade the tumor based on the underlying glandular architecture. The majority of these cases would accordingly be graded as Gleason pattern 3. It was the consensus that small cell carcinoma of the prostate (Fig.5) has unique histologic, immunohistochemical, and clinical features. These clinicopathologic features differ from those associated with Gleason pattern 5 prostatic acinar carcinoma, such that small cell carcinoma should not be assigned a Gleason grade.