前列腺导管内癌的病理特征及临床意义

Pathological characteristics and clinical significance of intraductal carcinoma of the prostate

目的探讨前列腺导管内癌(IDC-P)的临床病理学特点、诊断及鉴别诊断。方法回顾性分析127例Gleason分级4级且Gleason评分8分的前列腺腺癌HE切片,对28例疑似IDC-P的病例采用免疫组织化学EnVison法标记P504s、CKH和p63,对符合IDC-P的病例进一步行PTEN、ERG及AR的表达,并同期比较含IDC-P及不含IDC-P的前列腺癌根治性病例的临床病理资料。结果 17例患者病理切片中含有IDC-P。组织学上IDC-P以筛状结构为主伴显著的细胞异型性,肿瘤细胞均表达P504 s,细胞周围基底细胞CKH及p63阳性。临床病理特点:含IDC-P病例患者的血清前列腺特异性抗原(PSA)水平为(131.98±64.56)ng/ml,高于不含IDC-P的前列腺腺癌患者(33.47±10.31)ng/ml,差异有统计学意义(t=2.670,P<0.05)。9例含IDC-P的前列腺腺癌与45例不含IDC-P的前列腺癌根治性切除标本对比,含IDC-P病例的精囊腺侵犯、盆腔淋巴结转移率、脉管内癌栓、前列腺外周纤维脂肪组织侵犯及手术切缘阳性率均高于非IDC-P病例组,差异有统计学意义(χ~2=4.811、12.150、5.400、3.972、9.334,P<0.05)。随访17例含IDC-P的前列腺癌患者,5例患者出现骨转移;78例不含IDC-P病例,6例患者出现骨转移。随访时间为2~16个月,含IDC-P的前列腺癌骨转移率高于非IDC-P的前列腺癌病例(χ~2=0.048,P<0.05),差异有统计学意义。结论在Gleason分级4级的前列腺腺癌病例中,CKH及p63免疫组织化学标记有助于识别IDC-P。由于IDC-P提示疾病进展快,预后差,需引起临床及病理医生的高度重视。

Objective To analyze the clinicopathologic characteristics,diagnosis and differential diagnosis of intraductal carcinoma of the prostate(IDC-P).Methods A total of 127 prostate cancer with Gleason score of 8(4+4)were collected from the Department of Pathology,Zhongda Hospital.For 28 suspected cases,p504s,CKH/p63,PTEN,ERG and AR were analyzed by EnVison method,and CKH/p63 staining was performed to help distinguish the basal cells.Meanwhile,the clinical and pathological data of IDC-P in prostate cancer were compared with that without IDC-P cases.Results Totally,there were 17 case of IDCP,which were pasitive for CKH/p63 in the basal cells,and p504s was positive in the tumor cells.Histologicaly,the dominant structure was cribriform pattern with marked cellular atypia.For the clinical characteristics,mean serum prostate-specific antigen in IDC-P cases was(131.98±64.56)ng/ml,which was significantly higer than that without IDC-P(33.47±10.31)ng/ml,with significant difference(t=2.670,P<0.05).On the other hand,9 cases with IDC-P-compared with 45 cases without IDC-P in radical prostatectomy,IDC-P cases were positively correlated with invasion of seminal vesicle,pelvic lymph node metastasis,intravascular tumor thrombus,extraprostatic extension and positive surgical margin(χ~2=4.811,12.150,5.400,3.972,9.334,P<0.05).17 patients were followed up for 2-16 months,5 patients showed multiple bone metastases,while 6 patients showed bone metastases in 78 patients without IDC-P of prostate carcinoma.Patients with IDC-P were more likely to have bone metastasis(χ~2=0.048,P<0.05).Conclusion For patients with Gleason grade 4,CKH and p63 are needed to distingaish IDC-P from prostate carcinoma.Given the current state of knowledge,our study supports that IDC-P represents an advanced stage of tumor progression with poor prognosis.Attention should be paid to the IDC-P both on the clinicians and pathologists.