Gaudin P B, Rosai J, Epstein J I
Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
Am J Surg Pathol. 1998 Feb;22(2):148-62. doi: 10.1097/00000478-199802000-00002.
Sarcomas and related proliferative lesions of the specialized prostatic stroma have been the subject of case reports and, thus, have not been well characterized. We reviewed the clinicopathologic features of 22 cases and studied the immunohistochemical profile of 9. Patient age ranged from 25 to 86 years; mean age was 54 years, and peak incidence was in the 6th and 7th decades. The most common clinical presentation was urinary retention, then abnormal results of digital rectal examination, hematuria or hematospermia, and a palpable rectal mass. The cases were grouped into two categories: prostatic stromal proliferation of uncertain malignant potential (PSPUMP, 18 cases) and prostatic stromal sarcoma (PSS, 4 cases) based on the degree of stromal cellularity and the presence of mitotic figures, necrosis, and stromal overgrowth. Four histologic patterns of PSPUMP were identified: (1) hypercellular stroma with scattered cytologically atypical cells associated with benign glands, (2) hypercellular stroma with minimal cytological atypia associated with benign glands, (3) hypercellular stroma with or without cytologically atypical cells, associated with benign glands in a "leaflike" growth pattern that resembled phyllodes tumors of the mammary gland, and (4) hypercellular stroma without cytologically atypical stromal cells and without glands. Prostatic stromal sarcoma showed greater cellularity, mitoses, necrosis, and stromal overgrowth than PSPUMP and consisted either of stromal elements with benign glands in a pattern that resembled malignant phyllodes tumors of the mammary gland (3 cases) or of purely stromal elements (1 case). Positive immunohistochemical reactions were noted using vimentin in 9 of 9 cases, CD34 in 8 of 8, HHF-35 in 2 of 8, smooth muscle actin in 3 of 9, desmin in 4 of 8, S-100 protein in 0 of 9, estrogen receptor in 1 of 7, and progesterone receptor in 6 of 7. None of the cases classified as PSS were positive for HHF-35, smooth muscle actin, or desmin. Of the 13 patients classified as having PSPUMP who did not undergo definitive local therapy at the time of diagnosis, recurrent signs or symptoms were seen in six (46%), necessitating additional therapy. Distant metastases to lung and bone developed in one patient classified as having PSS. Clinical and pathologic findings in this patient suggested a progression from PSPUMP to PSS. We conclude that sarcomas and related proliferative lesions of the specialized prostatic stroma encompass a spectrum of histologic features and may be grouped into two clinicopathologic categories: PSPUMP and PSS. Based on their distinctive histologic appearance and immunohistochemical profile, PSPUMP and PSS can be differentiated from other mesenchymal lesions of the prostate.
前列腺特殊间质的肉瘤及相关增殖性病变已有病例报告，但尚未得到充分的特征描述。我们回顾了22例患者的临床病理特征，并对其中9例进行了免疫组化分析。患者年龄从25岁至86岁不等；平均年龄为54岁，发病高峰在60和70岁。最常见的临床表现是尿潴留，其次是直肠指检异常、血尿或血精，以及可触及的直肠肿块。根据间质细胞密度、有丝分裂象、坏死及间质过度生长情况，将病例分为两类：恶性潜能不确定的前列腺间质增生（PSPUMP，18例）和前列腺间质肉瘤（PSS，4例）。PSPUMP有四种组织学模式：（1）细胞增多的间质伴有散在的细胞学非典型细胞，与良性腺体相关；（2）细胞增多的间质伴有极少的细胞学非典型性，与良性腺体相关；（3）细胞增多的间质，有或无细胞学非典型细胞，与呈“叶状”生长模式的良性腺体相关，类似乳腺叶状肿瘤；（4）细胞增多的间质，无细胞学非典型性间质细胞且无腺体。前列腺间质肉瘤比PSPUMP具有更高的细胞密度、有丝分裂、坏死及间质过度生长，其组成要么是伴有良性腺体的间质成分，呈类似乳腺恶性叶状肿瘤的模式（3例），要么是纯粹的间质成分（1例）。9例中有9例波形蛋白免疫组化反应阳性，8例中有8例CD34阳性，8例中有2例HHF-35阳性，9例中有3例平滑肌肌动蛋白阳性，8例中有4例结蛋白阳性，9例中有0例S-100蛋白阳性，7例中有1例雌激素受体阳性，7例中有6例孕激素受体阳性。所有分类为PSS的病例HHF-35、平滑肌肌动蛋白或结蛋白均为阴性。13例诊断时未接受确定性局部治疗的PSPUMP患者中，6例（46%）出现复发症状，需要进一步治疗。1例分类为PSS的患者发生了肺和骨的远处转移。该患者的临床和病理表现提示从PSPUMP进展为PSS。我们得出结论，前列腺特殊间质的肉瘤及相关增殖性病变具有一系列组织学特征，可分为两个临床病理类别：PSPUMP和PSS。基于其独特的组织学表现和免疫组化特征，PSPUMP和PSS可与前列腺的其他间质性病变相鉴别。
