前列腺腺癌中P504S的检测及意义

Detection of P504S (α-methylacyl-CoA racemase) in prostatic adenocarcinomas

目的评价P504S免疫组织化学染色在前列腺腺癌活检标本病理诊断中的应用价值。方法观察P504S在150例前列腺腺癌和相关疾病[良性前列腺增生(BPH)、前列腺上皮内肿瘤(PIN)、不典型小腺体增生(ASAP)]前列腺标本中的免疫组织化学染色情况,并结合HE切片、前列腺特异抗原(PSA)和CK34βBE12免疫组织化学染色及临床资料进行分析。结果在105例前列腺腺癌病例中,P504S染色阳性率为98.1％,其中弥漫阳性率(≥+++)为97.1％,染色情况与Gleason评分、患病年龄、血清总PSA值的关系无显著意义。在腺癌病例中:24例癌周有PIN,全部P504S弥漫阳性;82例周边有良性前列腺腺体,其中有8例P504S呈(+)(9.6％);8例周边有基底细胞增生(BCH),P504S均为阴性。在42例BPH中10例P504S呈(+)(23.8％),1例(++)(2.4％);在3例ASAP中未见阳性。结论P504S是诊断前列腺腺癌的阳性标记物,具有较佳的敏感性(97.1％)和特异性(86.0％)。在进行前列腺腺癌及其相关疾病的组织病理学诊断及鉴别时,还应结合HE切片、PSA、CK34βE12和p63等免疫组织化学染色情况以及临床资料。

Objective To evaluate the specificity and sensitivity of the monoclonal antibody P504S (AMACR) in detection of prostatic adenocarcinomas. Methods 150 cases, including prostatic adenocarcinomas ( n = 105 ) , benign prostatic hyperplasia ( BPH, n = 42) and atypical small acinar proliferation ( ASAP, n = 3 ) , were studied by immunohistiochemical analysis of P504S. The clinical data, HE, PSA and CK34βE12 staining slides were reviewed in all of the cases. Results P504S was strongly and diffusely positive ( ≥ + + + ) in 97. 1 % cases of prostatic adenocarcinomas and focally positive ( + ) in 2 cases, regardless of Gleason score, age and serum PSA. However, P504S was also positive in high grade PIN that surrounded adenocarcinomas (n = 24) and weakly positive ( + ) in benign prostatic hyperplasia that surrounded adenocarcinomas (8 out of 82 cases). In 42 cases of BPH, 10 cases (23. 8% ) show ( + ) staining, and 1 case (2.4% ) shows ( + + ) staining. P504S was negative in entire 8 cases of basal cell hyperplasia (BCH) and in 3 cases of ASAP. Conclusion P504S (AMACR), a recently established positive marker for prostatic adenocarcinomas, has good sensitivity (97. 1% ) and specificity (86. 0% ). It is crucial to correlate the P504S staining pattern with the findings of HE, PSA and CK34βE12 (or p63) staining, as well as clinical information to reach a correct diagnosis.