McCluggage W Glenn, Ganesan Raji, Hirschowitz Lynn, Miller Keith, Rollason Terence P
Department of Pathology, Royal Group of Hospitals Trust, Belfast, UK.
Am J Surg Pathol. 2006 Feb;30(2):209-15. doi: 10.1097/01.pas.0000180446.17517.b8.
Prostatic tissue has rarely been described in the lower female genital tract. We describe 6 cases of ectopic prostatic tissue: 5 involving the cervix and 1 the vagina. The latter is the first reported example of benign prostatic tissue in the vagina. The age of the patients ranged from 21 to 65 years; and in all cases, the prostatic tissue was located within the cervical or vaginal stroma without involvement of the surface. In all cases, there were both glandular and squamous elements, which varied in prominence. In some cases, the squamous elements predominated to such an extent that the underlying glandular component was easily overlooked. In the glandular areas, a double cell layer of luminal and basal cells was focally apparent. There was little cytologic atypia or mitotic activity. Immunohistochemically, 3 of 6 cases were positive with prostate specific antigen (PSA) and all 6 cases marked with prostatic acid phosphatase (PSAP). In some of the positive cases, staining was focal. Positive staining with prostatic markers was confined to the glandular elements with no staining of the squamous areas. Immunohistochemical staining with the high molecular weight cytokeratin 34betaE12 highlighted the basal cell layer, which often extended into the center of the cellular islands, reminiscent of basal cell hyperplasia involving the prostate gland. All cases tested were CD10 positive (largely restricted to the basal cell layer), alpha-methylacyl-CoA racemase positive, and p16 negative. Estrogen receptor (ER) and progesterone receptor (PR) were negative in the glandular areas, but ER was positive in the squamous elements in all cases and PR was positive in 1 case. All cases tested were androgen receptor positive and exhibited a low MIB-1 proliferation index with only scattered positive nuclei. The presence of ectopic prostatic tissue in the lower female genital tract may be more common than is appreciated. Once the possibility is considered, the diagnosis is easily confirmed using immunohistochemistry, although staining with prostatic markers may be focal and PSA may be negative. Ectopic prostatic tissue in the lower female genital tract is almost certainly a benign condition, based on the morphology, including the presence of a double cell layer, although follow-up of larger numbers of cases is required. Possible theories of histogenesis include a developmental anomaly, metaplasia of preexisting endocervical glands, and derivation from mesonephric remnants.
前列腺组织在女性下生殖道中鲜有报道。我们描述了6例异位前列腺组织病例：5例累及宫颈，1例累及阴道。后者是阴道内良性前列腺组织的首例报道。患者年龄在21至65岁之间；所有病例中，前列腺组织均位于宫颈或阴道基质内，未累及表面。所有病例均有腺性和鳞状成分，其突出程度各异。在某些病例中，鳞状成分占主导地位，以至于其下的腺性成分容易被忽视。在腺性区域，可见局部明显的管腔细胞和基底细胞双层结构。几乎没有细胞异型性或有丝分裂活性。免疫组化显示，6例中有3例前列腺特异性抗原（PSA）呈阳性，所有6例前列腺酸性磷酸酶（PSAP）均呈阳性。在一些阳性病例中，染色为局灶性。前列腺标志物阳性染色仅限于腺性成分，鳞状区域无染色。高分子量细胞角蛋白34βE12免疫组化染色突出了基底细胞层，该层常延伸至细胞岛中心，类似于前列腺的基底细胞增生。所有检测病例CD10均为阳性（主要局限于基底细胞层），α-甲基酰基辅酶A消旋酶阳性，p16阴性。腺性区域雌激素受体（ER）和孕激素受体（PR）均为阴性，但所有病例鳞状成分中ER均为阳性，1例PR为阳性。所有检测病例雄激素受体均为阳性，且MIB-1增殖指数较低，仅有散在阳性核。女性下生殖道中异位前列腺组织的存在可能比我们认识到的更为常见。一旦考虑到这种可能性，使用免疫组化很容易确诊，尽管前列腺标志物染色可能是局灶性的，且PSA可能为阴性。基于形态学，包括存在双层细胞，女性下生殖道中的异位前列腺组织几乎肯定是一种良性病变，尽管需要对更多病例进行随访。可能的组织发生学理论包括发育异常、宫颈内膜腺的化生以及中肾残余物的起源。
