Reyes A O, Swanson P E, Carbone J M, Humphrey P A
Department of Pathology, Washington University Medical Center, St. Louis, Missouri 63110, USA.
Am J Surg Pathol. 1997 Oct;21(10):1215-22. doi: 10.1097/00000478-199710000-00013.
High-grade prostatic intraepithelial neoplasia (HGPIN) is the most likely precursor proliferation of peripheral zone, moderately to poorly differentiated prostatic adenocarcinomas. The usual cell type of the epithelial lining of HGPIN is a glandular epithelial cell with characteristic nuclear abnormalities. Here we report nine cases of unusual types of HGPIN, including three cases of signet-ring cell HGPIN, one case of small cell neuroendocrine HGPIN, and five cases of HGPIN with distinctive mucinous features. The three examples of signet-ring cell PIN were all associated with an invasive primary signet-ring cell carcinoma of the prostate. The HGPIN assumed a classical tufted and micropapillary architectural growth pattern, with the constituent cells exhibiting a morphologic appearance identical to that of the invasive signet-ring cells. The intraepithelial and invasive signet-ring cells were mucin negative and were immunoreactive for prostate-specific antigen (PSA). A fourth case displayed a mixed intraepithelial glandular-small cell neoplastic proliferation, where intraepithelial small cells were histologically identical to surrounding invasive small cell carcinoma cells. The small cell HGPIN and invasive small cell carcinoma cells were positive for the neuroendocrine markers chromogranin, synaptophysin, and neuron-specific enolase. In five cases, mucinous distension of HGPIN glands, producing a flat pattern of the epithelial lining layer, comprised the third unusual pattern of HGPIN. These blue mucinous secretions were readily detected by hematoxylin and eosin staining and were composed of both neutral (periodic acid-Schiff-positive) and acidic (alcian blue-positive) mucins. Herein we document the existence of an intraepithelial proliferation of neoplastic cell types-small cell neuroendocrine and signet-ring cell-that are usually considered as stromal-invasive cells in the prostate. The presence of these rare prostatic cell types in both HGPIN and invasive carcinoma provides further support for a close relationship between HGPIN and invasive carcinoma of the prostate. All three unusual types of HGPIN-signet-ring cell, small cell neuroendocrine, and mucinous-are important to diagnostically recognize because of the strength of association of HGPIN with invasive carcinoma.
高级别前列腺上皮内瘤变（HGPIN）是外周区中分化至低分化前列腺腺癌最可能的前驱性增殖病变。HGPIN上皮衬里的常见细胞类型是具有特征性核异常的腺上皮细胞。在此，我们报告9例不寻常类型的HGPIN，包括3例印戒细胞型HGPIN、1例小细胞神经内分泌型HGPIN和5例具有独特黏液特征的HGPIN。3例印戒细胞型PIN均与前列腺原发性浸润性印戒细胞癌相关。HGPIN呈现经典的簇状和微乳头结构生长模式，其组成细胞的形态外观与浸润性印戒细胞相同。上皮内和浸润性印戒细胞黏液阴性，但对前列腺特异性抗原（PSA）呈免疫反应性。第4例表现为上皮内腺性 - 小细胞混合性肿瘤增殖，其中上皮内小细胞在组织学上与周围浸润性小细胞癌细胞相同。小细胞HGPIN和浸润性小细胞癌细胞对神经内分泌标志物嗜铬粒蛋白、突触素和神经元特异性烯醇化酶呈阳性。在5例中，HGPIN腺体的黏液扩张导致上皮衬里层呈扁平模式，构成了HGPIN的第三种不寻常模式。这些蓝色黏液分泌物通过苏木精和伊红染色很容易检测到，由中性（过碘酸 - 希夫阳性）和酸性（阿尔辛蓝阳性）黏液组成。在此我们记录了肿瘤细胞类型——小细胞神经内分泌和印戒细胞——的上皮内增殖，这些细胞类型通常被认为是前列腺的基质浸润性细胞。这些罕见的前列腺细胞类型在HGPIN和浸润性癌中的存在，进一步支持了HGPIN与前列腺浸润性癌之间的密切关系。所有三种不寻常类型的HGPIN——印戒细胞型、小细胞神经内分泌型和黏液型——因其与浸润性癌的关联强度，在诊断上都很重要，需要予以识别。
