Hameed Omar, Humphrey Peter A
Department of Pathology and Immunology, Washington University Medical Center, St Louis, MO 63110, USA.
Mod Pathol. 2006 Jul;19(7):899-906. doi: 10.1038/modpathol.3800601. Epub 2006 Apr 7.
Typically glands of prostatic adenocarcinoma have a single cell lining, although stratification can be seen in invasive carcinomas with a cribriform architecture, including ductal carcinoma. The presence and diagnostic significance of stratified cells within non-cribriform carcinomatous prostatic glands has not been well addressed. The histomorphological features and immunohistochemical profile of cases of non-cribriform prostatic adenocarcinoma with stratified malignant glandular epithelium were analyzed. These cases were identified from needle biopsy cases from the consultation files of one of the authors and from a review of 150 consecutive in-house needle biopsy cases of prostatic adenocarcinoma. Immunohistochemistry was performed utilizing antibodies reactive against high molecular weight cytokeratin (34betaE12), p63 and alpha-methylacyl-coenzyme-A racemase (AMACR). A total of 8 cases were identified, including 2 from the 150 consecutive in-house cases (1.3%). In 4 cases, the focus with glands having stratified epithelium was the sole carcinomatous component in the biopsy, while such a component represented 5-30% of the invasive carcinoma seen elsewhere in the remaining cases. The main attribute in all these foci was the presence of glandular profiles lined by several layers of epithelial cells with cytological and architectural features resembling flat or tufted high-grade prostatic intraepithelial neoplasia, but lacking basal cells as confirmed by negative 34betaE12 and/or p63 immunostains in all cases. The AMACR staining profile of the stratified foci was variable, with 4 foci showing positivity, and 3 foci being negative, including two cases that displayed AMACR positivity in adjacent non-stratified prostatic adenocarcinoma. Prostatic adenocarcinoma with stratified malignant glandular epithelium can be identified in prostate needle biopsy samples harboring non-cribriform prostatic adenocarcinoma and resembles glands with high-grade prostatic intraepithelial neoplasia. These 'PIN-like' carcinomas can present in pure form. Recognition of this pattern of prostatic adenocarcinoma is necessary to correctly diagnose such cases as invasive carcinoma.
通常，前列腺腺癌的腺体有单层细胞内衬，尽管在具有筛状结构的浸润性癌（包括导管癌）中可见分层。非筛状癌性前列腺腺体内分层细胞的存在及其诊断意义尚未得到充分探讨。对具有分层恶性腺上皮的非筛状前列腺腺癌病例的组织形态学特征和免疫组化谱进行了分析。这些病例是从其中一位作者会诊档案中的针吸活检病例以及对150例连续的内部前列腺腺癌针吸活检病例的回顾中确定的。使用针对高分子量细胞角蛋白（34βE12）、p63和α-甲基酰基辅酶A消旋酶（AMACR）的抗体进行免疫组化。共鉴定出8例，其中2例来自150例连续的内部病例（1.3%）。在4例中，具有分层上皮的腺体灶是活检中唯一的癌性成分，而在其余病例中，该成分占其他部位所见浸润性癌的5%-30%。所有这些病灶的主要特征是存在由几层上皮细胞内衬的腺体轮廓，其细胞学和结构特征类似于扁平或簇状高级别前列腺上皮内瘤变，但所有病例经34βE12和/或p63免疫染色阴性证实缺乏基底细胞。分层灶的AMACR染色情况各不相同，4个灶呈阳性，3个灶呈阴性，包括2例在相邻的非分层前列腺腺癌中显示AMACR阳性的病例。在患有非筛状前列腺腺癌的前列腺针吸活检样本中可识别出具有分层恶性腺上皮的前列腺腺癌，其类似于高级别前列腺上皮内瘤变的腺体。这些“PIN样”癌可呈纯形式。认识这种前列腺腺癌模式对于正确诊断此类侵袭性癌病例很有必要。
