Sakr W A, Grignon D J
Department of Pathology, Harper Hospital, Wayne State University, Detroit, Michigan 48201, USA.
Anal Quant Cytol Histol. 1998 Oct;20(5):417-23.
To summarize studies that have investigated the morphologic, spatial and volumetric relationship between prostate cancer and its putative precursors, high grade prostatic intraepithelial neoplasia (HGPIN) and atypical adenomatous hyperplasia (AAH).
Studies addressing the relationship between morphologic parameters of prostate cancer (i.e., stage, grade, volume and anatomic distribution) and both HGPIN and AAH are reviewed. Similar data based on our institutional experience with surgical and autopsy series of step-sectioned, totally embedded prostate glands are also presented.
Most investigators have demonstrated significant associations between HGPIN and carcinoma in terms of coexistence, "zonal" origin and physical proximity. The two lesions have a high tendency to be present simultaneously; both originate predominantly in the peripheral zone and are often found within the same microscopic field. Reports on the relationship between HGPIN and the stage of prostate cancer are less consistent, and the associations of this lesion with cancer grade and volume are exceedingly complex. HGPIN appears to be associated with moderately to poorly differentiated, smaller, often-multifocal tumors and is less frequent in large, high grade cancers. There are data suggesting a trend-of a reciprocal relationship between more extensive and diffuse HGPIN and large-volume prostate cancers. Conversely, there is a wide spectrum of volume distribution of the two lesions in glands harboring smaller tumors. Similar data concerning AAH are limited.
There are strong and consistent data supporting various aspects of the morphologic associations between HGPIN and prostate cancer. The indications that glands harboring larger tumors tend to contain less extensive HGPIN could raise the hypothesis that as carcinoma becomes larger, it may replace areas of the gland previously occupied by HGPIN. Alternatively, prostate cancer can evolve from ducts with HGPIN and gradually overgrow their precursor. There is a relative dearth of similar information concerning AAH.
总结研究前列腺癌与其假定前驱病变——高级别前列腺上皮内瘤变（HGPIN）和非典型腺瘤样增生（AAH）之间形态学、空间和体积关系的研究。
回顾探讨前列腺癌形态学参数（即分期、分级、体积和解剖分布）与HGPIN和AAH之间关系的研究。还展示了基于我们机构对连续切片、完全包埋前列腺的手术和尸检系列经验的类似数据。
大多数研究者已证实HGPIN与癌在共存、“区域”起源和物理邻近性方面存在显著关联。这两种病变同时存在的倾向很高；两者主要起源于外周区，且常出现在同一显微镜视野内。关于HGPIN与前列腺癌分期之间关系的报道不太一致，且该病变与癌症分级和体积的关联极为复杂。HGPIN似乎与中分化至低分化、较小且常为多灶性的肿瘤相关，在大的高级别癌症中较少见。有数据表明，更广泛弥漫的HGPIN与大体积前列腺癌之间存在一种相互关系的趋势。相反，在有较小肿瘤的腺体中，这两种病变的体积分布范围很广。关于AAH的类似数据有限。
有强有力且一致的数据支持HGPIN与前列腺癌形态学关联的各个方面。有迹象表明，有较大肿瘤的腺体往往含有不太广泛的HGPIN，这可能会引发这样的假设：随着癌变大，它可能会取代腺体中先前被HGPIN占据的区域。或者，前列腺癌可从伴有HGPIN的导管发展而来，并逐渐超越其前驱病变。关于AAH的类似信息相对较少。
