Leistenschneider W, Nagel R
Pathol Res Pract. 1979 Dec;165(4):429-44. doi: 10.1016/s0344-0338(79)80035-7.
Cytologists are often confronted with unexpected prostatitis in aspiration biopsy smears, because clinically prostatitis may lead to suspicious induration of the prostate similar to carcinoma and therefore subject to diagnostic biopsy. The question is whether cytodiagnosis is a reliable method for the exact morphologic diagnosis of prostatitis. The following paper attempts to answer this question.
The basis of our cytologic differentiation of prostatitis was a series of 129 cases of prostatitis in 664 aspiration biopsies according to Franzén. In 82 of these 129 cases, we had simultaneously performed a transrectal needle punch biopsy, which allowed a diagnostic comparison between the cytologic and histologic diagnosis with special reference to the reliability of cytology. Epithelial atypias were classified into 4 grades: Grade 1: No atypia; Grade 2: Slight atypia; Grade 3: Marked atypia; Grade 4: Malignant epithelium. Cytomorphologic characteristics of each grade are described.
We found 6 different types in 4 main groups of prostatitis: 1. Acute prostatitis, purulent and abscessing types. 2. Chronic prostatitis. 3. Chronic relapsing prostatitis. 4. Granulomatous prostatitis, non specific and specific types. All types showed classic cytomorphologic inflammatory criteria. Marked atypias were found in group 3 and 4. Differential diagnosis with respect to carcinoma is not difficult, however, because marked atypias in these groups of prostatitis almost always appear focally. The diagnostic agreement between cytology and histology in 82 cases was found to be 87,6%.
Our results showed that prostatis may be adequately diagnosed with cytology and may be differentiated into 6 different types. However, differentiation between periductal and interstitial forms of chronic prostatitis is impossible with cytology. Reliable cytodiagnosis of prostatitis requires a good aspiration smear, so that at least one half of slide is covered with material from the prostate. Furthermore, epithelial atypias must be present to prove the presence of prostatitis. Because of the good reliability of the cytologic differentiation of prostatitis, aspiration biopsy may be a valuable aid to the clinician in the primary diagnosis of prostatitis, especially the chronic type, which currently is sometimes uncertain.
在针吸活检涂片检查中，细胞学家常常会遇到意想不到的前列腺炎病例，因为临床上前列腺炎可能会导致前列腺出现类似癌肿的可疑硬结，从而需要进行诊断性活检。问题在于细胞诊断对于前列腺炎的确切形态学诊断是否是一种可靠的方法。以下论文试图回答这个问题。
我们对前列腺炎进行细胞学鉴别诊断的基础是弗兰岑（Franzén）在664例针吸活检中收集的129例前列腺炎病例。在这129例病例中的82例中，我们同时进行了经直肠针穿活检，这使得能够对细胞学诊断和组织学诊断进行对比，特别关注细胞学诊断的可靠性。上皮异型性分为4级：1级：无异型性；2级：轻度异型性；3级：显著异型性；4级：恶性上皮。描述了各级的细胞形态学特征。
我们在前列腺炎的4个主要类型中发现了6种不同类型：1. 急性前列腺炎，脓性和脓肿型。2. 慢性前列腺炎。3. 慢性复发性前列腺炎。4. 肉芽肿性前列腺炎，非特异性和特异性类型。所有类型均显示出典型的细胞形态学炎症标准。在3级和4级中发现了显著异型性。然而，与癌肿的鉴别诊断并不困难，因为这些组别的前列腺炎中的显著异型性几乎总是局灶性出现。82例病例中细胞学与组织学诊断的符合率为87.6%。
我们的结果表明，前列腺炎可以通过细胞学进行充分诊断，并可分为6种不同类型。然而，细胞学无法区分慢性前列腺炎的导管周围型和间质型。前列腺炎的可靠细胞诊断需要一张良好的针吸涂片，以便至少一半的载玻片上覆盖有前列腺组织。此外必须存在上皮异型性才能证实前列腺炎的存在。由于前列腺炎细胞学鉴别的可靠性较高，针吸活检对于临床医生在前列腺炎的初步诊断中，尤其是对目前有时诊断不明确的慢性前列腺炎，可能是一种有价值的辅助手段。
