Department of Pathology, The Johns Hopkins Hospital, 401 North Broadway Street, Baltimore, MD 21231, USA.
Am J Surg Pathol. 2011 Jun;35(6):898-903. doi: 10.1097/PAS.0b013e318214f2f2.
Stromal tumors of uncertain malignant potential (STUMPs) are rare tumors characterized by an atypical, unique stromal proliferation of the prostate. Various stromal proliferations of STUMPs have been described; however, epithelial proliferations occurring within the STUMP have not been systematically described to date. We reviewed 89 cases of STUMP from our consultation service from 1990 to 2010. Nineteen cases without a glandular component were excluded. We next evaluated the glandular component of the remaining 70 cases of STUMP for glandular crowding and complexity, prostatic intraepithelial neoplasia (PIN), squamous metaplasia, urothelial metaplasia, basal cell hyperplasia, adenosis, and clear cell cribriform hyperplasia. In 58 cases (83%), the glandular component differed from glands on the same biopsy specimen uninvolved by STUMP. The most common abnormalities were glandular crowding in 35 of 70 (50%) and a very prominent basal cell layer in some glands in 32 of 70 (46%) cases. The next most frequent glandular variation from normal was prominent papillary infolding in 13 of 70 (19%) cases. Less-frequent epithelial changes within the STUMP were as follows: 10 of 70 (14%) showed cystically dilated glands; 7 of 10 (10%) had basal cell hyperplasia; 6 of 70 (9%) had urothelial metaplasia; 6 of 70 (9%) showed squamous metaplasia; 3 of 70 (4%) had cribriform hyperplasia; 3 of 70 (4%) had adenosis; and 1 case each showed high-grade PIN, low-grade PIN, and partial atrophy. The glandular component of STUMP was histologically normal in 12 (17%) cases. There was a tendency toward urothelial and squamous metaplasia in STUMPs with a phyllodes pattern, and a prominent basal cell layer in STUMPs with degenerative and cellular stroma. This is the first study to systematically describe the epithelial proliferations occurring in STUMP. This study suggests that, within STUMPs, there is epithelial-mesenchymal crosstalk, as has been described in benign prostate and in prostatic carcinogenesis. In unusual cases of STUMP, the epithelial proliferation may predominate to the extent that it can mask the diagnosis of STUMP.
不确定恶性潜能的间质肿瘤（STUMPs）是一种罕见的肿瘤，其特征为前列腺的非典型、独特的间质增生。已经描述了各种 STUMP 的间质增生；然而，到目前为止，尚未系统地描述发生在 STUMP 内的上皮增生。我们回顾了 1990 年至 2010 年我们咨询服务中的 89 例 STUMP 病例。排除了 19 例没有腺体成分的病例。接下来，我们评估了剩余 70 例 STUMP 病例的腺体成分，以评估腺体拥挤和复杂性、前列腺上皮内瘤变（PIN）、鳞状化生、尿路上皮化生、基底细胞增生、腺病和透明细胞筛状增生。在 58 例（83%）病例中，腺体成分与 STUMP 未累及的同一活检标本中的腺体不同。最常见的异常是 35/70（50%）例腺体拥挤和 32/70（46%）例某些腺体中非常突出的基底细胞层。仅次于正常的最常见的腺体变异是 13/70（19%）例突出的乳头状内折。STUMP 内较少见的上皮变化如下：10/70（14%）例表现为囊性扩张的腺体；7/10（10%）例有基底细胞增生；6/70（9%）例有尿路上皮化生；6/70（9%）例有鳞状化生；3/70（4%）例有筛状增生；3/70（4%）例有腺病；1 例分别显示高级别 PIN、低级别 PIN 和部分萎缩。在 12 例（17%）病例中，STUMP 的腺体成分组织学正常。在具有叶状模式的 STUMP 中，倾向于发生尿路上皮和鳞状化生，而在具有退行性和细胞性基质的 STUMP 中，存在明显的基底细胞层。这是第一项系统描述发生在 STUMP 中的上皮增生的研究。该研究表明，在 STUMP 中，存在上皮-间充质相互作用，正如良性前列腺和前列腺癌发生中所描述的那样。在 STUMP 的不常见病例中，上皮增生可能占主导地位，以至于可以掩盖 STUMP 的诊断。
