Malpica A, Ro J Y, Troncoso P, Ordoñez N G, Amin M B, Ayala A G
Department of Pathology, University of Texas M.D. Anderson Cancer Center, Houston 77030.
Hum Pathol. 1994 Apr;25(4):390-5. doi: 10.1016/0046-8177(94)90148-1.
Nephrogenic adenoma (NA) of the prostatic urethra with involvement of the prostate gland can mimic other small-gland proliferations of the prostate, particularly adenocarcinoma of the prostate. To further characterize this lesion and refine diagnostic criteria we retrospectively reviewed the clinicopathologic features and immunohistochemical findings of eight cases of NA involving the prostate gland seen at The University of Texas M.D. Anderson Cancer Center from 1987 to 1992. The patients' ages ranged from 44 to 76 years (average age, 65 years). Six patients had lower genitourinary tract operations. Follow-up information was available for six patients (follow-up period, 5 to 38 months); only one patient had clinical evidence of recurrence (5 months after surgery). The remaining patients were alive and well with no evidence of disease. Histologically, NA was characterized by a proliferation of small tubules lined by a single layer of cuboidal or flattened cells with clear or eosinophilic cytoplasm. The nuclei were round with fine chromatin and there was no mitotic activity. Nucleoli were generally small, but occasionally prominent. All NA extended into the prostatic parenchyma, raising the possibility that these lesions may represent prostatic small-gland proliferations, particularly prostate adenocarcinoma. However, all cases tested were negative for prostate-specific antigen and prostatic acid phosphatase. Our findings indicate that the histologic features and the use of prostate-specific antigen and prostatic acid phosphatase immunostains will help to distinguish NA of the urethra involving the prostate from other small-gland proliferations (eg, small-acinar adenocarcinoma of the prostate, clear cell adenocarcinoma of the urethra, sclerosing adenosis, atypical adenomatous hyperplasia, florid hyperplasia of mesonephric remnants, simple lobular atrophy, and incomplete basal cell hyperplasia).
累及前列腺的前列腺尿道肾源性腺瘤（NA）可类似前列腺的其他小腺体增生，尤其是前列腺腺癌。为进一步明确该病变特征并完善诊断标准，我们回顾性分析了1987年至1992年在德克萨斯大学MD安德森癌症中心所见的8例累及前列腺的NA的临床病理特征及免疫组化结果。患者年龄44至76岁（平均年龄65岁）。6例患者有下泌尿生殖道手术史。6例患者有随访信息（随访期5至38个月）；仅1例患者有复发的临床证据（术后5个月）。其余患者存活且状况良好，无疾病证据。组织学上，NA的特征为单层立方或扁平细胞衬覆的小导管增生，细胞胞质清亮或嗜酸性。细胞核圆形，染色质细腻，无有丝分裂活性。核仁一般较小，但偶尔突出。所有NA均延伸至前列腺实质，提示这些病变可能代表前列腺小腺体增生，尤其是前列腺腺癌。然而，所有检测病例的前列腺特异性抗原和前列腺酸性磷酸酶均为阴性。我们的研究结果表明，组织学特征以及前列腺特异性抗原和前列腺酸性磷酸酶免疫染色的应用有助于将累及前列腺的尿道NA与其他小腺体增生（如前列腺小腺泡腺癌、尿道透明细胞腺癌、硬化性腺病、非典型腺瘤样增生、中肾残余物的 florid增生、单纯小叶萎缩和不完全基底细胞增生）相鉴别。
