α-甲酰基辅酶A消旋酶在前列腺腺癌诊断和鉴别诊断中的作用

Assessment of P504S immunohistochemistry in diagnosis and differential diagnosis of prostatic adenocarcinoma

目的 观察α 甲酰基辅酶A消旋酶 (α methylacyl CoAracemase ,P5 0 4S)在前列腺腺癌的诊断和鉴别诊断中的价值。方法 对前列腺腺癌及其需要鉴别的病变 :前列腺上皮内瘤变、不典型腺瘤样增生、不典型小腺泡增生以及正常前列腺组织 (包括萎缩的腺体 )和良性增生进行光镜观察 ,用EnVision二步法免疫组织化学方法检测P5 0 4S、细胞角蛋白 (CK) 34βE12、p6 3在各类病变组织中的表达情况。根据P5 0 4S阳性表达部位区分其表达形式为 :胞质型、腔缘型、顶端胞质型及胞膜型。结果 78例前列腺腺癌中 ,91% (71/ 78)阳性表达P5 0 4S ,多表现为癌细胞弥漫性胞质内阳性着色较深的颗粒状物 ,少数为腺腔内缘或顶端胞质内及膜表达 ,9% (7/ 78)阴性表达P5 0 4S者均为亮细胞型 ;前列腺上皮内瘤变 (9例 ) ,不典型腺瘤样增生 (6例 )以及不典型小腺泡增生 (2例 )中均见P5 0 4S不同程度的表达 ;96 % (6 5 / 6 8)的正常及良性增生前列腺组织未见P5 0 4S阳性表达 ;增生的基底细胞也未见P5 0 4S阳性表达。结论 P5 0 4S的免疫组织化学染色对判断前列腺腺癌具有重要参考价值 ,若与CK34βE12或 p6

Objective To assess the utility of P504S immunohistochemistry in the diagnosis and differential diagnosis of prostatic adenocarcinoma.Methods Light microscopy and immunohistochemistry examinations (EnVision^(TM) staining) were performed in 117 cases of prostatic adenocarcinoma, PIN, AAH, ASAP, BPH and normal prostatic tissue to correlate the morphology and protein expression of P504S, 34βE12, and P63. Results Seventy-one of the 78 (91%) cases of prostatic adenocarcinoma stained positive for P504S, with strong cytoplasmic granular staining in most cases, and a weak or intense granular staining along the circumferential luminal and apical cell border membrane in a few cases. Negative P504S immunostaining was observed in 7 of 78 (9%) cases of prostatic adenocarcinoma, all of which were clear cell type prostatic adenocarcinoma. Cases of PIN (9 cases), AAH (6 cases) and ASAP (2 cases) showed various expression levels of P504S. Sixty-five of 68 (96%) cases of normal prostates and BPH were negative for P504S and basal cell hyperplasia cases were also negative. Conclusions P504S is a useful marker for microscopic diagnosis of prostatic adenocarcinoma, and immunohistochemistry study using a combination of P504S and 34βE12/p63 may be of greater benefit in aiding the differential diagnoses.