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目的探讨假增生型前列腺癌(PHPA)的临床病理特征及其发生率和生物学行为。方法复查上海交通大学附属第六人民医院2005年1月1日-2006年12月31日860例直肠 B 超引导下前列腺穿刺活检和46例前列腺癌根治手术切片,对疑有 PHPA 组织作34βE12(或 CK5/6)、p63和 AMACR 单项免疫组织化学标记(EnVision法)和 34βE12/p63/AMACR 鸡尾酒抗体双重免疫组织化学标记,将在1个组织块中 PHPA 占该组织块中癌总量的面积百分比>60%的病例归入本组,并作病理学分析。结果 PHPA 在穿刺活检和前列腺癌根治标本中的发生率分别为7.0%和15.2%。66.7%的 PHPA 与普通型前列腺癌直接移行,76.7%在其他组织块中有普通型癌。PHPA 占穿刺活检中癌总量的比例为5%～100%,占根治标本中癌总量的比例为1%～30%。PHPA 以大中腺泡增生为主,癌细胞分化较好,排列有极性,腔内常有残存淀粉样小体,低倍镜下类似良性前列腺增生。但腺泡排列紧密,腔内有嗜酸性结晶体和颗粒状无定形物质,核增大,有大核仁,免疫标记 AMACR 阳性,基底细胞标记阴性,在20项提示恶性的形态学指标中10项出现几率≥66.7%。PHPA 虽然分化较好,但66.7%的 PHPA 有间质浸润,6.7%有神经浸润,3.3%有腺外浸润,3.3%发生骨转移,肿瘤分布部位周围带多于移行带。结论 PHPA 的实际发生率不低,绝大多数与普通型癌并存,由于形态学类似良性,肿瘤细胞量又不占多数,因此在诊断中容易被忽视,PHPA 高分化前列腺癌不同,应属于 Gleason3级的中分化腺癌。
Objective To investigate the clinicopathological features, incidence and biological behavior of pseudopopantic prostate cancer (PHPA). Methods Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University from January 1, 2005 to December 31, 2006 860 cases of transrectal B-guided prostate biopsy and 46 cases of prostate cancer radical surgical biopsy, suspected of PHPA tissue for 34βE12 ( Or CK5 / 6), double immunostaining of the p63 and AMACR immunohistochemical EnVision and 34betaE12 / p63 / AMACR cocktail antibodies, will account for the area of total cancerous tissue in one of the tissue blocks The percentage> 60% of the cases included in this group, and for pathological analysis. Results The incidence of PHPA in biopsy and radical prostatectomy was 7.0% and 15.2% respectively. 66.7% of PHPA migrate directly to common type of prostate cancer while 76.7% have common type of cancer in other tissue masses. PHPA accounted for 5% to 100% of the total number of cancer in the biopsy, accounting for 1% to 30% of the total cancers in the radical specimens. PHPA mainly in the proliferation of large and medium acinar cells, cancer cells are well differentiated, arranged in a polar cavity often residual amyloid, low magnification similar to benign prostatic hyperplasia. However, acinar arranged closely, there were eosinophilic crystals and granular amorphous substance in the cavity, nuclear enlargement, large nucleoli, immunolabeling AMACR positive, basal cell marker negative, in 20 tips malignant morphological indicators of 10 Occurrence probability ≥66.7%. Although PHPA was well differentiated, 66.7% of PHPA had interstitial infiltration, 6.7% had infiltration of nerves, 3.3% had infiltration of glands, and 3.3% had bone metastases. There were more bands around tumor sites than those with transitional zones. Conclusion The actual incidence of PHPA is not low, the vast majority of common type of cancer coexist, due to the morphological similar to benign, the majority of tumor cells are not accounted for in the diagnosis easily overlooked, PHPA highly differentiated prostate cancer should belong to Gleason3 Grade of differentiated adenocarcinoma.