前列腺原发性印戒细胞癌的病理诊断和形态发生机制

Pathologic diagnosis and histogenesis of primary signet ring cell carcinoma of the prostate

目的 探讨前列腺原发性印戒细胞癌的组织发生、病理特征和鉴别诊断。方法 在2 62例经穿刺活检证实的前列腺癌中选出 10例印戒细胞癌 ,用SP法作前列腺特异性抗原 (PSA)、前列腺酸性磷酸酶 (PAP)、雄激素受体 (AR)等 9种免疫组织化学标记和AB/PAS ,黏液卡红染色 ,3例作电镜观察 ,并与 10例胃肠道印戒细胞癌作比较。结果 10例中仅 1例为纯印戒细胞癌 ,9例与经典型前列腺癌混合 ,印戒细胞癌成分均大于癌总量的 2 5 %。按形态特征和形成机制 ,可将印戒细胞分为胞质内空泡或内腔形成和胞质内PSA、PAP分泌物积聚二种类型 ,二种类型印戒细胞均缺乏胞质内黏液 ,故不同于消化道印戒细胞癌。结论 原发性印戒细胞癌是来自前列腺腺泡上皮的低分化特殊组织学类型腺癌。在穿刺活检中可以与来自消化道 ,泌尿道的浸润性或转移性印戒细胞癌鉴别 。

Objective To study the histogenesis, pathologic features and differential diagnosis of prostatic primary signet ring cell carcinoma. Methods 10 cases of the primary signet ring cell carcinoma were detected from 262 cases of prostate carcinomas diagnosed on needle biopsy were investigated by routine pathological, immunohistochemical and histochemical methods, and then compared with 10 cases of signet ring cell carcinomas of the stomach and colon. 3 cases were studied with electron microscopy. Results 9 cases of prostate signet ring cell carcinoma were associated with concurrent high-grade conventional prostatic carcinoma, but at least 25% of the neoplasm consisted of signet ring cells. Only one case was pure signet ring cell carcinoma. Neoplastic signet ring cells may be divided into two types: the first type showed formation of intracytoplasmic lumina or vacuole, and the second type had intracytoplasmic accumulation of excess PSA and/or PAP. Both types of signet ring cells were negative for mucin staining (AB/PAS and mucicarmine). Therefore they differed from signet ring cell carcinomas of the stomach and colon. Conclusions Primary prostate signet ring cell carcinoma is a low-differentiated adenocarcinoma of a special histologic type, which arises from the epithelial cells of the prostate acinus. They can be distinguished from metastatic signet ring cell carcinoma of the stomach and colon and also from vacuolate degeneration of conventional carcinoma after endocrine or radiation therapy.