转移性去势抵抗性前列腺癌的病理学特征

Clinicopathological features of metastatic castration-resistant prostate cancer

目的探讨转移性去势抵抗性前列腺癌的组织病理学特征。方法收集西海岸梦之队（West Coast Dream Team）的多机构前瞻性研究中2013年1月至2015年1月178例转移性去势抵抗性前列腺癌穿刺活检的病例，分析其临床特点，进行组织病理学观察，免疫组织化学EnVison法标记雄激素受体（AR）、前列腺特异性抗原（PSA）、嗜铬粒蛋白（CgA）、张力蛋白同源物基因（PTEN）的表达。结果178例病例中，诊断符合典型腺癌51例（28.7%）、非典型中间型癌41例（23.0%）、小细胞样癌24例（13.5%）。PSA的表达在非典型中间型癌组和小细胞样癌组（31/39，79.5%）较腺癌组（20/20，100%）减少（P〈0.05）；PTEN为67.4%（31/46）中较腺癌组46.3%（19/41）的表达增高（P〈0.05）。结论转移性去势抵抗性前列腺癌的组织学分类与原发性前列腺癌不同，有典型腺癌、非典型中间型癌及小细胞样癌3种组织病理学形态，三者有独特的病理形态学特点。PTEN在非典型中间型癌组及小细胞样癌组中比腺癌组的表达缺失明显减少，表明非典型中间型癌和小细胞样癌在肿瘤的发生、进展中与典型腺癌不同。

ObjectiveTo investigate the histopathological characteristics of metastatic castration-resistant prostate cancer.MethodsClinical findings, morphologic features, immunophenotypes of androgen receptor（AR）, prostatic specific antigen（PSA）, chromogranin A（CgA）, and phosphatase and tensin homolog deleted on chromosome ten（PTEN）（by EnVision method）of 178 core biopsies from patients with metastatic castration-resistant prostate cancer encountered from January 2010 to January 2015 from West Coast Dream Team were analyzed.ResultsIn the 178 cases, 51（28.7%）were diagnosed with typical adenocarcinoma, 41 cases（23.0%）with intermediate atypical carcinoma and 24 cases（13.5%）with small cell carcinoma.The expression of PSA was significantly lower in patients with intermediate atypical carcinoma or with small cell carcinoma（31/39, 79.5%）than in those with adenocarcinoma（20/20, 100%）. The expression of PTEN was significantly higher in patient with intermediate atypical carcinoma or with small cell carcinoma（31/46, 67.4%）than in those with adenocarcinoma（19/41, 46.3%）.ConclusionsThree histopathological subtypes exists in metastatic castration-resistant prostate cancer, including adenocarcinoma, intermediate type atypical carcinoma and small cell carcinoma.They are entities with unique pathological features.The expression of PTEN is significantly lower in the patients with intermediate atypical carcinoma or with small cell carcinoma than in those with adenocarcinoma, indicating that intermediate atypical carcinoma and small cell carcinoma are different from typical adenocarcinoma in tumor occurrence and progression.