Thorson P, Vollmer R T, Arcangeli C, Keetch D W, Humphrey P A
Department of Pathology, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
Mod Pathol. 1998 Jun;11(6):543-51.
Prostate cancer screening and early detection efforts have resulted in the identification of smaller volume carcinomas of the prostate. We evaluated the diagnostic features of minimal (< 1 mm) carcinoma in sextant needle biopsy specimens of the prostate and in follow-up analyzed the features of the corresponding carcinomas in the whole gland. We reviewed specimens from 50 consecutive patients who had minimal carcinoma in needle biopsy tissue and who had undergone radical prostatectomy. Histologic grade, tumor size, pathologic stage, and margin status of the 50 carcinomas in the whole gland in which the carcinoma size was minimal in the sextant needle biopsy specimen were compared with those of 50 carcinomas in the whole gland in which carcinoma size was greater than 1 mm in the needle biopsy specimen. The most common morphologic features of these minimal carcinomas were nucleomegaly (96%), infiltrative growth pattern (88%), intraluminal secretions (78%), prominent nucleoli (64%), associated high-grade prostatic intraepithelial neoplasia (40%), amphophilic cytoplasm (36%), hyperchromatic nuclei (30%), and intraluminal crystalloids (22%). Perineural invasion (2%), collagenous micronodules (2%) and mitotic figures (2%) were uncommon. The mean tumor volume in the whole gland of carcinomas corresponding to minimal carcinoma in a needle biopsy specimen was significantly smaller (P=.029) at 1.1 mL than it was in carcinomas with tumor greater than 1 mm in the needle biopsy specimen at 1.6 mL, but other pathologic features of carcinoma in the whole gland were not significantly different. In conclusion, a constellation of morphologic attributes is important for establishment of a diagnosis of minimal carcinoma of the prostate in needle biopsy specimen. Most (82%) of the corresponding prostate cancers in the whole gland were pathologically significant.
前列腺癌筛查和早期检测工作已促使人们发现了体积较小的前列腺癌。我们评估了前列腺六分区穿刺活检标本中微小（<1mm）癌的诊断特征，并在后续分析了整个腺体中相应癌灶的特征。我们回顾了50例连续患者的标本，这些患者在穿刺活检组织中存在微小癌，并接受了根治性前列腺切除术。将六分区穿刺活检标本中癌灶体积最小的50例整个腺体癌的组织学分级、肿瘤大小、病理分期和切缘状态，与穿刺活检标本中癌灶体积大于1mm的50例整个腺体癌的上述指标进行比较。这些微小癌最常见的形态学特征为核肿大（96%）、浸润性生长模式（88%）、管腔内分泌物（78%）、明显核仁（64%）、相关的高级别前列腺上皮内瘤变（40%）、嗜双色性细胞质（36%）、核深染（30%）和管腔内晶体（22%）。神经周围侵犯（2%）、胶原微结节（2%）和核分裂象（2%）不常见。穿刺活检标本中对应微小癌的整个腺体癌灶平均体积为1.1mL，显著小于穿刺活检标本中肿瘤大于1mm的癌灶的平均体积1.6mL（P = 0.029），但整个腺体癌的其他病理特征无显著差异。总之，一系列形态学特征对于在穿刺活检标本中诊断前列腺微小癌很重要。整个腺体中大多数（82%）相应的前列腺癌具有病理意义。
