Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.
Department of Pathology and Molecular Medicine, Wellington School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand.
Pathology. 2018 Jun;50(4):382-388. doi: 10.1016/j.pathol.2018.01.002. Epub 2018 Apr 27.
This study investigates the macroscopic features of prostate cancers in unfixed prostatic tissue. For the study 514 radical prostatectomy specimens received at the Karolinska University Hospital were examined. The glands were bisected horizontally prior to fixation. Features on the cut surface of the prostate that were considered conclusive or suspicious for cancer were seen in 52% and 24% of specimens, respectively. In microscopic sections from these areas substantial cancers (≥2 mm) were found in 94% and 69%, of glands, respectively. When no cancer was seen grossly, substantial cancers were still identified histologically in 56% of cases on the cut surface of the prostate. Of substantial tumours 58% had distinct gross findings and 20% were considered to be suspicious for cancer on macroscopic examination. It was noted that gross assessment of the tumour diameter usually underestimated the microscopic extent of the tumour (p < 0.001). Of tumours that could be identified conclusively, 30% were tan, 30% white, 16% yellow and 24% orange. Transition zone tumours were most often orange (61%) while peripheral zone tumours were usually tan or white (35% and 33%). All macroscopically identifiable cancers were poorly circumscribed. Among substantial cancers, transition zone tumours were less frequently visualised than peripheral zone tumours (33% and 13%, respectively; p < 0.001). Findings conclusive for cancer macroscopically usually predict microscopic cancer, but substantial cancers may be present even if no cancer is seen grossly. Transition zone tumours are more difficult than peripheral zone tumours to visualise macroscopically.
本研究调查了未固定前列腺组织中前列腺癌的宏观特征。在这项研究中，检查了卡罗林斯卡大学医院收到的 514 个前列腺根治性切除术标本。在固定之前，将腺体水平地对半切开。在前列腺的切面中，被认为是癌症的明确或可疑特征的特征分别在 52%和 24%的标本中可见。在这些区域的显微镜切片中，在分别为 94%和 69%的腺体中发现了实质性癌症（≥2 毫米）。当肉眼未见癌症时，在前列腺的切面上仍有 56%的病例在组织学上发现了实质性癌症。在实质性肿瘤中，有 58%有明显的大体发现，20%在大体检查时被认为可疑为癌症。值得注意的是，肿瘤直径的大体评估通常低估了肿瘤的显微镜下范围（p < 0.001）。在可以明确识别的肿瘤中，30%为棕色，30%为白色，16%为黄色，24%为橙色。移行带肿瘤最常见为橙色（61%），而外周带肿瘤通常为棕色或白色（35%和 33%）。所有肉眼可识别的癌症都边界不清。在外周带肿瘤中，移行带肿瘤的可见性明显低于外周带肿瘤（分别为 33%和 13%；p < 0.001）。在宏观上可以明确诊断为癌症的发现通常可以预测微观癌症，但即使肉眼看不到癌症，也可能存在实质性癌症。移行带肿瘤比外周带肿瘤更难肉眼观察。
