Unger P D, Wang Q, Gordon R E, Stock R, Stone N
Department of Pathology, Mount Sinai Hospital, New York, NY 10029, USA.
Arch Pathol Lab Med. 1997 Dec;121(12):1265-8.
Localized seminal vesicle amyloidosis is an unusual finding in surgical pathology material. Previous studies have demonstrated that the amyloid is directly produced by the seminal vesicle epithelial cells. We investigated the possible association of seminal vesicle amyloid in patients hormonally treated for prostate carcinoma.
Cases were collected from over 200 prostate needle biopsies, seminal vesicle biopsies, and prostatectomy specimens from the surgical pathology files at The Mount Sinai Hospital, New York, NY. None of the patients with seminal vesicle amyloidosis had a chronic inflammatory disorder, serum or urine protein abnormalities, or other identifiable masses.
Six cases of localized seminal vesicle amyloidosis were found in the surgical pathology material examined. Five of the six cases had prostatic carcinoma, and one case was seen in a biopsy for benign prostatic hyperplasia. Four of the five carcinoma cases had prior hormonal treatment (luteinizing hormone-releasing hormone agonist with an antiandrogen agent, and one patient, in addition, had received radiotherapy). The amyloid deposits were limited to the seminal vesicle lamina propria without involvement of vascular walls. The amyloid reacted with Congo red staining that was sensitive to potassium permanganate. Immunohistochemically, all cases were negative for AA amyloid, beta 2-microglobulin, and kappa and lambda light chains.
We raise the possibility that in some instances, prior hormonal therapy may act as a seminal vesicle epithelial stimulant for the elaboration of this protein.
局限性精囊淀粉样变是外科病理材料中一种不常见的发现。既往研究表明，淀粉样物质由精囊上皮细胞直接产生。我们调查了接受激素治疗的前列腺癌患者中精囊淀粉样变的可能关联。
病例取自纽约西奈山医院外科病理档案中的200多例前列腺穿刺活检、精囊活检及前列腺切除标本。患有精囊淀粉样变的患者均无慢性炎症性疾病、血清或尿液蛋白异常或其他可识别的肿块。
在所检查的外科病理材料中发现6例局限性精囊淀粉样变。6例中有5例患有前列腺癌，1例见于良性前列腺增生活检。5例癌病例中有4例曾接受激素治疗（促黄体生成素释放激素激动剂与抗雄激素药物，此外1例患者还接受了放疗）。淀粉样沉积物局限于精囊固有层，未累及血管壁。淀粉样物质与对高锰酸钾敏感的刚果红染色反应。免疫组化显示，所有病例的AA淀粉样蛋白、β2微球蛋白以及κ和λ轻链均为阴性。
我们提出一种可能性，即在某些情况下，既往激素治疗可能作为精囊上皮的刺激因素促使这种蛋白质的产生。
