Ruska K M, Sauvageot J, Epstein J I
Department of Pathology, The Johns Hopkins University Medical Institutions, Baltimore, Maryland, USA.
Am J Surg Pathol. 1998 Sep;22(9):1073-7. doi: 10.1097/00000478-199809000-00005.
This study addresses two issues regarding prostatic atrophy: (1) the histologic features of atrophy as seen on needle biopsy results and how they affect the diagnosis of atrophy and (2) the cellular kinetics of atrophy and what it suggests about the mechanism of atrophy. We reviewed hematoxylin and eosin sections for 103 prostate needle biopsy specimens with atrophy. Each biopsy specimen was classified as either simple atrophy (large atrophic glands without crowding: 53 cases) or postatrophic hyperplasia (PAH) (crowded focus of small atrophic acini: 50 cases). Cell proliferation in both the atrophic and benign glands was evaluated in 103 cases by immunohistochemistry using antibodies against MIB-1. The TdT-mediated dUTP-biotin nick-end labeling technique was performed on 61 cases to quantitate apoptosis in atrophic and benign glands. Thirty-two percent of cases showed chronic inflammation, 21% showed acute inflammation, 14% showed nucleoli, and 1% showed mitoses. In comparison to simple atrophy, PAH contained more frequent prominent nucleoli (p < 0.0001) and acute inflammation (p < 0.0001), yet not chronic inflammation. In a multivariate analysis, acute inflammation and PAH pattern influenced the presence of prominent nucleoli. Staining for MIB-1 was greater in atrophic (27.5 cells/1000 cells) than in benign glands (3.5 cells/1000 cells), greater in PAH than in simple atrophy (p = 0.0015), and greater with acute (p = 0.05) but not chronic inflammation. In a multivariate analysis, only the pattern of atrophy and not acute inflammation was found to influence MIB-1. The rate of apoptosis was negligible in both the benign and atrophic glands, did not vary with pattern of atrophy, and did not correlate with MIB-1. Despite the atrophic appearance, atrophic glands in PAH show more proliferative activity than benign, nonatrophic glands and show no evidence of active involution, justifying the term "postatrophic hyperplasia" for this pattern of atrophy. Prominent nucleoli are seen more frequently in postatrophic hyperplasia, even in the absence of acute inflammation. To avoid a potential erroneous diagnosis of cancer, a constellation of features suggestive of malignancy should be considered, rather than relying on prominent nucleoli as the sole criteria for the diagnosis of prostate cancer.
（1）针吸活检结果中所见萎缩的组织学特征及其对萎缩诊断的影响，以及（2）萎缩的细胞动力学及其对萎缩机制的提示。我们回顾了103例有萎缩的前列腺针吸活检标本的苏木精和伊红切片。每个活检标本分为单纯萎缩（大的萎缩性腺泡，无拥挤：53例）或萎缩后增生（PAH）（小的萎缩性腺泡的拥挤灶：50例）。通过使用抗MIB-1抗体的免疫组织化学方法，对103例萎缩性腺泡和良性腺泡中的细胞增殖进行了评估。对61例标本进行了TdT介导的dUTP生物素缺口末端标记技术，以定量萎缩性腺泡和良性腺泡中的细胞凋亡。32%的病例显示慢性炎症，21%显示急性炎症，14%显示核仁，1%显示有丝分裂。与单纯萎缩相比，PAH中核仁突出（p < 0.0001）和急性炎症（p < 0.0001）更为常见，但慢性炎症并非如此。在多变量分析中，急性炎症和PAH模式影响核仁突出的存在。MIB-1染色在萎缩性腺泡（27.5个细胞/1000个细胞）中比在良性腺泡（3.5个细胞/1000个细胞）中更强，在PAH中比在单纯萎缩中更强（p = 0.0015），在有急性炎症（p = 0.05）时更强，但在慢性炎症时并非如此。在多变量分析中，发现只有萎缩模式而非急性炎症影响MIB-1。良性腺泡和萎缩性腺泡中的细胞凋亡率均可忽略不计，不随萎缩模式而变化，也与MIB-1无关。尽管外观呈萎缩性，但PAH中的萎缩性腺泡比良性、非萎缩性腺泡显示出更多的增殖活性，且没有活跃退化的证据，因此将这种萎缩模式称为“萎缩后增生”是合理的。即使在没有急性炎症的情况下，核仁突出在萎缩后增生中也更常见。为避免潜在的癌症误诊，应考虑一系列提示恶性肿瘤的特征，而不是仅依靠核仁突出作为前列腺癌诊断的唯一标准。
