Mai Kien T, Ahmed Itrat, Robertson Susan J, Belanger Eric C, Veinot John P, Islam Shahid
Division of Anatomical Pathology, Department of Laboratory Medicine, Hospital and Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Diagn Cytopathol. 2008 Oct;36(10):715-20. doi: 10.1002/dc.20886.
Involvement of the urinary bladder by prostatic adenocarcinoma (PCA) occasionally occurs. In this study, we analyzed urine cytological findings in patients with secondary involvement of the urinary bladder by PCA with the help of the immunocytochemistry. The cases were divided into two groups: (1) prospective study group: three cases; and (2) retrospective study group: 12 cases which were retrieved from our cytopathological files. The urine cytology specimens (cytospins) from all cases were submitted for prostatic specific antigen (PSA) immunocytochemistry. Additional immunostaining for high-molecular-weight cytokeratin (HMWCK) was performed if PSA immunoreactivity was negative. All cytospin smears showed atypical cells characterized by large, round and uniform nuclei with prominent nucleoli and dense cytoplasm. They were present as single cells or in cell groups simulating urothelial carcinoma. The diagnosis of PCA was made if the atypical cells were either immunoreactive for PSA or nonreactive for HMWCK. The urothelial cells were PSA- and HMWCK+. The immunostaining supported the PCA diagnosis in all three cases from the prospective group and two cases in the retrospective group. The remaining 10 cases in the retrospective group were diagnosed as negative: 3, atypia: 5 urothelial carcinoma: 2. The positive diagnosis for PCA was based on the PSA immunoreactivity or nonreactivity to HMWCK and the cytological atypia. In conclusions, immunostaining for PSA and HMWCK performed on cytospins of urine specimens from patients with a prior history of high-grade and/or stage of PCA is helpful to make a positive diagnosis of secondary bladder involvement from PCA.
前列腺腺癌（PCA）偶尔会累及膀胱。在本研究中，我们借助免疫细胞化学分析了PCA继发性累及膀胱患者的尿液细胞学检查结果。病例分为两组：（1）前瞻性研究组：3例；（2）回顾性研究组：从我们的细胞病理学档案中检索出12例。所有病例的尿液细胞学标本（细胞离心涂片）均进行前列腺特异性抗原（PSA）免疫细胞化学检测。如果PSA免疫反应性为阴性，则进行高分子量细胞角蛋白（HMWCK）的额外免疫染色。所有细胞离心涂片均显示非典型细胞，其特征为细胞核大、圆形且均匀，核仁突出，细胞质致密。它们以单个细胞或模拟尿路上皮癌的细胞团形式存在。如果非典型细胞对PSA免疫反应阳性或对HMWCK无反应，则诊断为PCA。尿路上皮细胞PSA和HMWCK均呈阳性。免疫染色支持前瞻性组的所有3例以及回顾性组的2例诊断为PCA。回顾性组其余10例诊断为阴性：不典型增生3例、尿路上皮癌5例、阴性2例。PCA的阳性诊断基于PSA免疫反应性或对HMWCK无反应以及细胞学非典型性。总之，对有PCA高级别和/或分期病史患者的尿液标本细胞离心涂片进行PSA和HMWCK免疫染色有助于对PCA继发性膀胱累及做出阳性诊断。
