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前列腺上皮内瘤病理形态特征及临床意义

张德远   

  1. 贵州省毕节地区医院病理科
  • 收稿日期:2011-01-26 修回日期:2011-03-29 出版日期:2011-08-15 发布日期:2011-08-15
  • 通讯作者: 张德远

Morphological features of prostate intraepithelial neoplasia and its significance

  • Received:2011-01-26 Revised:2011-03-29 Published:2011-08-15 Online:2011-08-15

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摘要： 【摘要】 目的 探讨前列腺上皮内瘤病理形态学特征及临床意义。方法：收集贵州省毕节地区医院病理科2008.01-2010.12前列腺标本，经常规病理切片复查，103例（其中前列腺摘除术标本42例，前列腺电气化切除标本61例）纳入研究。病理诊断前列腺癌26例，前列腺增生77例。全部病例进行34βE12,P63和P504S免疫组织化学Elivision法标记。结果：26例前列腺癌中23例见到HGPIN,:77例BPH中24例有PIN,其中LGPIN18例,HGPIN6例。HGPIN共计29例；HGPIN组织学类型以簇状型和微乳头状型多见，占92%。免疫组化表现：34ΒE12,P63在29例HGPIN腺管周围基底细胞呈不连续阳性表达；P504S大部阳性，其中前列腺癌伴有HGPIN组中，癌灶周围表达（++）~（+++），远离癌灶（-）~（+）；6例BPH伴有HGPIN中2例P504S（+）~（++），阳性率86%。结论：HGPIN是目前公认唯一前列腺癌前病变，病理诊断较困难，必须与前列腺不典型小腺泡增生，前列腺导管内癌等相鉴别；P504S是HGPIN和前列腺癌敏感性抗体，其表达或强度可能与肿瘤恶性或进展程度呈正相关；正确识别HGPIN必须依靠其病理形态特征及免疫组化综合判断。

关键词: 前列腺, 癌, 上皮内瘤, 免疫组化染色

Abstract: 【Abstract】 Objective To investigate the morpaology of prostate intraepithelial neoplasia(PIN) and its significance. Methods 103 specimen of prostate biopsy, including 26 cases with prostate carcinoma and 77 cases of benign prostate hyperplasia (BPH), were collected. Morphological features were reviewed. The expression of 34BE12, P63 and p504s were assayed in all patients by immunohistochemistry. Results High grade intraepithelial neoplasia(HGPIN) was found in 23 of 26 case with prostate carcinoma. There was no low grade intraepithelial neoplasia (LGPIN) to be observed in the patients above. Of 77 cases with BPH, intraepithelial neoplasia were found in 24 cases,(including 18 cases of LGPIN and 6 cases of HGPIN ). The histological types of HGPIN were mainly cluster and micropapilla structures (accounting for 92%). Immunohistochemistry: Among 29 cases with HGPIN , the discontinuous expression of 34βE12 was observed in basal cell around gland. In those of prostate carcinoma with HGPIN, P504s expression was from poor to moderate positive in the lesions of HGPIN near carcinoma(+-++), whereas was from moderate to strong expression in those away from carcinoma(++-+++); In the patients who were BPH with HGPIN, the positive expression was only observed in the two of 6 cases. The positive ratio of P504s was 82% in the case with HGPIN. Conclusion HGPIN is only precancerous lesion of prostate carcinoma. It must be differentiated from atypical hyperplasia of small alveolar gland and intraductocarcinoma of prostate; P504s is specific to HGPIN and carcinoma of prostate. The expression of it is probably associated with the progression of these tumors.; The correct diagnosis of HGPIN must depend on morphologic features and immunohistochemistry stain.

Key words: prostate, carcinoma, intraepithelial neoplasia, immunohistochemistry stain