前列腺萎缩后增生11例病理形态学观察

Postatrophic hyperplasia of prostate:a study of 11 cases

目的探讨前列腺萎缩后增生（PAH）的病理形态学特征和鉴别诊断。方法收集前列腺PAH标本11例，选择34βE12、p63、P504S、PSA和PSAP抗体检测，观察其病理形态学特点和免疫组化表达特点。结果11例PAH患者均来自临床诊断为良性前列腺增生的手术切除标本，经进一步病理检查发现有PAH病灶，与正常前列腺相比，11例均可见增多的大小不一的腺泡，其中包括囊状扩张的大腺泡和似增生样结构的小腺泡。“增生”的腺泡体积较小、排列密集，其中2例小腺泡周围可见基底细胞，9例基底细胞难以明确。“增生”的小腺泡需要与癌性腺泡鉴别，这些腺泡边缘34βE12或v63（＋），结合上皮细胞P504S（-）可明确诊断；3例小腺泡上皮PSA和PSAP（＋）弱于周围萎缩的腺上皮细胞。11例均有间质纤维增生和淋巴细胞浸润，其中1例边缘伴有上皮内瘤，2例伴有腺瘤样增生。结论前列腺PAH是较少见的前列腺瘤样病变，在HE切片中易误诊为前列腺癌。基底细胞标记物34陋12、p63和癌性上皮标记物P504S联合应用对前列腺PAH的诊断具有价值。

prostate. To investigate the pathological features and differential diagnosis of postatrophic hyperplasia （PAH） The expression of 34βE12, p63, P504S, PSAP was detected in 11 eases of PAH. The pathological morphology and immunohistocbemical features of PAH were studied. Results The eleven cases all had been diagnosed as benign prostate hyperplasia and excised by radical prostateetomies. The glandular aeini of various size were observed, compared with normal prostate, including big aeini of dilated cysts and small ＂hyperplastic＂ aeini closely packed. The eleven eases were diagnosed as PAH. In hematoxylin and eosin stained section, basal cells were detected in 2 eases and uncertain in 9 cases. Immunohistechemically, nearly intact basal cells were observed around all small acini with P504S antibody. In 3 cases PSA and PSAP positive stained small acini were weaker than that of the surrounding dilated acini. Fiberous hyperplasia and chronic inflammatory cells were observed in the stroma of all the eleven cases. One case of prostatic intraepithelial neoplasma and 2 atypical adenomatous hyperplasia were also found around the postatrophic hyperplasia. Conclusions PAH is a rare prostatic tumor-like lesion and tends to be misdiagnosed as prostatic carcinoma. Basial cell markers （34βE12 and P63） combining with epithelial cell marker （P504S） are very useful in differential diagnosis of PAH from other prostatic tumor-like lesions.