Montironi R, Mazzucchelli R, Pomante R
Institute of Pathological Anatomy and Histopathology, University of Ancona, Torrette di Ancona, 60020, Italy.
Adv Clin Path. 1997 Jan;1(1):35-47.
For urologists and pathologists one of the two main issues in prostate pathology is the identification of those prognostic factors that could predict the exact outcome of individual patients with prostate cancer (PC). Therefore, the goal is to tailor the therapeutic approach to the clinical, morphological and biological features of each patient. The other issue involves the early detection of PC, preferably in the preinvasive phase, in order to treat the patient efficaciously. For this reason, understanding the biology of preinvasive or precursors lesions has become increasingly important. Prostatic intraepithelial neoplasia is only one of these lesions, and the best known to date. The role of others, such as atypical adenomatous hyperplasia, is considered as worth exploring. Prostatic intraepithelial neoplasia (PIN) represents the putative precancerous end of the morphologic continuum of cellular proliferations within prostatic ducts and acini. Two grades of PIN are identified (low grade and high grade), and high grade PIN is considered the direct precursor of invasive carcinoma. The continuum which culminates in high grade PIN and early invasive cancer is characterised by basal cell layer disruption, basement membrane disruption, progressive loss of markers of secretory differentiation, increasing nuclear and nucleolar abnormalities, increasing proliferative potential, and increasing variation in DNA content (aneuploidy). Clinical studies suggest that PIN predates carcinoma by ten years or more, with low grade PIN first emerging in men in the third decade of life. The clinical importance of recognising PIN is based on its strong association with carcinoma; its identification in biopsy specimens of the prostate warrants further search for concurrent invasive carcinoma. The issue of precursors of prostate cancer has several facets which reflect the multiplicity of patterns and variants of PC. A big step forward in understanding some basic aspects has already been made, especially in relation to PIN. More will be available soon. A large contribution to the management of isolated PiN lesions found in prostate biopsies is expected from molecular pathology and quantitation analysis.
对于泌尿外科医生和病理学家而言，前列腺病理学的两个主要问题之一是确定那些能够预测前列腺癌（PC）个体患者确切预后的预后因素。因此，目标是根据每位患者的临床、形态学和生物学特征来调整治疗方法。另一个问题是早期检测前列腺癌，最好是在浸润前期，以便有效治疗患者。出于这个原因，了解浸润前或前驱病变的生物学特性变得越来越重要。前列腺上皮内瘤变只是这些病变之一，也是迄今为止最广为人知的。其他病变，如非典型腺瘤样增生的作用，被认为值得探索。前列腺上皮内瘤变（PIN）代表前列腺导管和腺泡内细胞增殖形态连续体的假定癌前终点。PIN分为两级（低级别和高级别），高级别PIN被认为是浸润性癌的直接前驱病变。以高级别PIN和早期浸润性癌告终的连续体的特征是基底细胞层破坏、基底膜破坏、分泌分化标志物逐渐丧失、核及核仁异常增加、增殖潜能增加以及DNA含量变异增加（非整倍体）。临床研究表明，PIN比癌早出现十年或更久，低级别PIN最早出现在男性生命的第三个十年。识别PIN的临床重要性基于其与癌的强关联；在前列腺活检标本中发现PIN需要进一步寻找同时存在的浸润性癌。前列腺癌前驱病变问题有多个方面，反映了PC模式和变体的多样性。在理解一些基本方面已经取得了很大进展，特别是与PIN相关的方面。很快会有更多进展。分子病理学和定量分析有望对前列腺活检中发现的孤立PIN病变的管理做出重大贡献。
