Amin M B, Schultz D S, Zarbo R J
Department of Pathology, Henry Ford Hospital, Detroit, MI 48202.
Arch Pathol Lab Med. 1994 Mar;118(3):260-4.
Histologic review of 48 radical prostatectomy specimens containing both prostatic adenocarcinoma (PC) and high-grade prostatic intraepithelial neoplasia (PIN) resulted in 23 cases containing neoplastic cribriform gland (CGs) at the periphery or within PC fields. The histologic characteristics of CG PIN mimic those of CG PC in that a discernible basal cell layer defines CG PIN, while CG PC lacks a basal layer. To detect the presence of basal cells in CGs, step sections were immunostained with monoclonal antibody 34 beta E12 to high-molecular-weight cytokeratins (HMCK) found in basal cells, but not in PC cells. Optimal staining of formalin-fixed sections required pepsin predigestion followed by 14-hour monoclonal antibody incubation at 4 degrees C. Of 436 CG foci identified, 239 (55%) were outlined by a circumferential HMCK-positive layer (identifying PIN); 182 (42%) totally lacked this layer (identifying PC), with appropriate internal controls; and 15 (3%) stained indeterminately. In an attempt to distinguish CG PIN from PC by routine histologic examination alone, CGs with open, round spaces were classified as classic (156 foci); nonclassic CGs (265 foci) featured irregular oblong to slitlike spaces. Cribriform gland PIN defined by HMCK outlining was more often nonclassic (193 CG foci) in histologic pattern, and CG PC was usually "classic" (110 CG foci) (chi 2 = 75; P < .001). We conclude that (1) more than half (55%) of the CGs in the PC tumors studied contain a basal cell layer fulfilling the definition of PIN; (2) focal and isolated HMCK positivity is found amid PC, and thus the overall pattern of staining together with morphological features is critical to correctly exclude carcinoma; (3) grading of PC on the basis of the presence of CGs may lead to erroneous results if PIN foci are misinterpreted as PC; and (4) since CG PIN is usually found in intimate anatomic association with PC, HMCK staining to detect basal cells in isolated CGs encountered in biopsy specimens may be a useful diagnostic discriminant.
对48份包含前列腺腺癌（PC）和高级别前列腺上皮内瘤变（PIN）的根治性前列腺切除术标本进行组织学检查，结果发现23例标本的外周或PC区域内存在肿瘤性筛状腺体（CGs）。CG PIN的组织学特征与CG PC相似，即CG PIN有可识别的基底细胞层，而CG PC缺乏基底细胞层。为检测CGs中基底细胞的存在，对连续切片用单克隆抗体34βE12进行免疫染色，该抗体针对基底细胞中存在的高分子量细胞角蛋白（HMCK），而PC细胞中不存在。福尔马林固定切片的最佳染色需要胃蛋白酶预消化，然后在4℃下孵育单克隆抗体14小时。在鉴定出的436个CG病灶中，239个（55%）被连续的HMCK阳性层勾勒（鉴定为PIN）；182个（42%）完全缺乏该层（鉴定为PC），同时有适当的内部对照；15个（3%）染色结果不确定。为仅通过常规组织学检查区分CG PIN和PC，将具有开放圆形间隙的CGs分类为典型（156个病灶）；非典型CGs（265个病灶）具有不规则的长方形至裂隙状间隙。由HMCK勾勒定义的筛状腺体PIN在组织学模式上更常为非典型（193个CG病灶），而CG PC通常为“典型”（110个CG病灶）（χ2 = 75；P <.001）。我们得出结论：（1）在所研究的PC肿瘤中，超过一半（55%）的CGs含有符合PIN定义的基底细胞层；（2）在PC中发现局灶性和孤立性HMCK阳性，因此染色的总体模式以及形态学特征对于正确排除癌至关重要；（3）如果PIN病灶被误判为PC，基于CGs的存在对PC进行分级可能会导致错误结果；（4）由于CG PIN通常与PC在解剖学上紧密相关，对活检标本中遇到的孤立CGs进行HMCK染色以检测基底细胞可能是一种有用的诊断鉴别方法。
