Brawer M K, Nagle R B, Pitts W, Freiha F, Gamble S L
Department of Surgery/Urology, University of Arizona, Tucson 85724.
Cancer. 1989 Feb 1;63(3):454-60. doi: 10.1002/1097-0142(19890201)63:3<454::aid-cncr2820630311>3.0.co;2-e.
Postirradiation prostatic biopsy is believed by many to be the best measure of radiation effectiveness in prostatic cancer. Therapeutic irradiation may induce prostatic glandular atypia, which in its severe form can be confused with persistent adenocarcinoma on prostatic biopsies. In the current study, 37 postirradiation prostate biopsy specimens were evaluated by immunohistochemistry using a specific monoclonal anticytokeratin antibody (KA1) that reacts with the basal cells of normal or hyperplastic glands, but is nonreactive with the lumenal cells or with prostatic carcinoma cells. Persistent carcinoma was observed in 19 cases in which antibody staining was absent. The noncarcinomatous glands retained reactivity, but this reactivity appeared in a new and previously undescribed pattern. The irradiated lesion was characterized by cellular pleomorphisism, with enlargement of nuclei and loss of polarity. The immunoreactivity was seen in the enlarged basal cells and was seen to focally extend to involve the lumenal cell layer. In five of 37 cases, glands were seen that were so atypical on the routinely stained sections that a distinction from cancer could not be made. These same glands in the adjacent section reacted with KA1 in each case allowing us to conclude that the changes were benign. We conclude that the interpretation of postirradiation prostatic biopsy specimens may be aided by immunohistochemistry with this anticytokeratin antibody.
许多人认为放疗后前列腺活检是评估前列腺癌放疗效果的最佳方法。治疗性放疗可能会导致前列腺腺上皮异型增生，严重时在前列腺活检中可能会与持续性腺癌相混淆。在本研究中，使用一种特异性单克隆抗细胞角蛋白抗体（KA1）对37份放疗后前列腺活检标本进行免疫组化评估，该抗体与正常或增生腺管的基底细胞发生反应，但与管腔细胞或前列腺癌细胞无反应。在19例抗体染色阴性的病例中观察到持续性癌。非癌性腺管保持反应性，但这种反应性呈现出一种新的、以前未描述过的模式。放疗后的病变表现为细胞多形性，细胞核增大且极性丧失。免疫反应性见于增大的基底细胞，并可见局灶性延伸至管腔细胞层。在37例病例中的5例中，常规染色切片上的腺管异型性非常明显，无法与癌进行区分。在相邻切片中，这些相同的腺管在每例中均与KA1发生反应，这使我们能够得出结论，这些改变是良性的。我们得出结论，使用这种抗细胞角蛋白抗体进行免疫组化有助于对放疗后前列腺活检标本进行解读。
