Kunju Lakshmi P, Rubin Mark A, Chinnaiyan Arul M, Shah Rajal B
Department of Pathology, University of Michigan School of Medicine, Ann Arbor, MI, USA.
Am J Clin Pathol. 2003 Nov;120(5):737-45. doi: 10.1309/3T3Y-0K0T-UMYH-3WY2.
We stained 37 prostate needle biopsies and 3 transurethral resections (TURP) containing atypical foci and 20 morphologically unequivocal prostate cancer biopsies, including 4 with foamy features, with P504S. Of 20 biopsies with unequivocal cancer, 18 showed variable P504S staining (sensitivity, 90%); 1 minute cancer and 1 foamy cancer lacked P504S staining. Of 40 cases with atypical foci (biopsies, 37; TURP, 3), 9 were diagnosed as high-grade prostatic intraepithelial neoplasia (HGPIN), 2 were excluded, and 29 had foci of atypical small glandular proliferation. Of these 29 cases, 7 were highly suggestive of cancer, 2 of which lacked P504S staining. In 22 cases with benign atypical foci, 11 were diagnosed as postatrophic hyperplasia (none expressed P504S) and 7 as atypical adenomatous hyperplasia (AAH; 1 showed focal weak P504S staining). Of 9 HGPIN specimens, 8 showed predominantly diffuse, moderate P504S staining. P504S has slightly lower sensitivity for detection of prostate cancer than found previously. Heterogeneous expression patterns may explain negativity in some biopsy specimens with minute cancer. In atypical small glandular proliferations, diffuse positive P504S staining in atypical glands strongly supports a cancer diagnosis, but negative staining does not exclude it. P504S seems to have low sensitivity for detecting foamy prostate cancer. Most HGPINs show diffuse moderate P504S staining. AAH may show focal P504S staining. We recommend using P504S along with morphologic examination and conventional basal cell markers.
我们用P504S对37份含有非典型病灶的前列腺穿刺活检标本和3份经尿道前列腺切除术（TURP）标本以及20份形态学明确的前列腺癌活检标本进行染色，其中20份活检标本中有4份具有泡沫样特征。在20份明确为癌的活检标本中，18份显示P504S染色情况各异（敏感性为90%）；1份微小癌和1份泡沫样癌缺乏P504S染色。在40份有非典型病灶的病例中（活检标本37份，TURP标本3份），9份被诊断为高级别前列腺上皮内瘤变（HGPIN），2份被排除，29份有非典型小腺泡增生灶。在这29份病例中，7份高度怀疑为癌，其中2份缺乏P504S染色。在22份良性非典型病灶病例中，11份被诊断为萎缩后增生（均不表达P504S），7份被诊断为非典型腺瘤样增生（AAH；1份显示局灶性弱阳性P504S染色）。在9份HGPIN标本中，8份主要表现为弥漫性、中度P504S染色。P504S检测前列腺癌的敏感性略低于先前报道。异质性表达模式可能解释了一些微小癌活检标本中的阴性结果。在非典型小腺泡增生中，非典型腺泡弥漫性阳性P504S染色强烈支持癌的诊断，但阴性染色不能排除癌。P504S检测泡沫样前列腺癌的敏感性似乎较低。大多数HGPIN显示弥漫性中度P504S染色。AAH可能显示局灶性P504S染色。我们建议将P504S与形态学检查及传统基底细胞标志物联合使用。
