Berman D M, Yang J, Epstein J I
Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.
Am J Surg Pathol. 2000 Jan;24(1):140-4. doi: 10.1097/00000478-200001000-00018.
A 60-year-old man underwent radical prostatectomy for biopsy-proved adenocarcinoma of the prostate. Histologic examination of the entirely embedded prostatectomy specimen revealed extensive ordinary adenocarcinoma, Gleason's grade 3 + 3 = 6, involving both sides of the gland, and extending into extraprostatic soft tissue at the left base. Adjacent to the carcinoma, and separately, extensive high-grade prostatic intraepithelial neoplasia (PIN) was identified, much of which showed bland nuclei and abundant xanthomatous cytoplasm, identical morphologically to that seen in foamy gland prostate carcinoma. However, unlike foamy gland carcinoma, the foamy glands in the current patient were large, showed papillary infolding, and were associated with a discontinuous layer of basal cells, demonstrated by immunostaining for high-molecular weight cytokeratin. No invasive foamy gland carcinoma was identified in the prostatectomy specimen. Immunostains for Ki-67 showed an increased proliferation rate in foamy high-grade PIN glands when compared with adjacent benign glands. Review of additional outside biopsy material revealed foamy gland high-grade PIN on four of seven needle cores, two of which showed no carcinoma. This patient demonstrates a new subtype of high-grade PIN that is difficult to recognize on needle biopsy. It is important to distinguish foamy gland high-grade PIN from its infiltrating counterpart, and it is critical to recognize because of the association of high-grade PIN with prostate carcinoma.
一名60岁男性因活检证实为前列腺腺癌而接受了前列腺根治术。对整个包埋的前列腺切除标本进行组织学检查，发现广泛的普通腺癌，Gleason分级为3 + 3 = 6，累及腺体两侧，并延伸至左基底部的前列腺外软组织。在癌旁并单独发现广泛的高级别前列腺上皮内瘤变（PIN），其中许多显示核平淡和丰富的黄色瘤样细胞质，形态上与泡沫状腺前列腺癌所见相同。然而，与泡沫状腺癌不同，本例患者的泡沫状腺体较大，呈乳头状折叠，且与一层不连续的基底细胞相关，通过高分子量细胞角蛋白免疫染色证实。在前列腺切除标本中未发现浸润性泡沫状腺癌。Ki-67免疫染色显示，与相邻良性腺体相比，泡沫状高级别PIN腺体的增殖率增加。回顾其他外部活检材料，在七个穿刺针芯中的四个发现了泡沫状腺高级别PIN，其中两个未发现癌。该患者展示了一种在穿刺活检时难以识别的高级别PIN新亚型。将泡沫状腺高级别PIN与其浸润性对应物区分开来很重要，由于高级别PIN与前列腺癌相关，识别它至关重要。
