前列腺导管腺癌临床病理分析及文献复习

摘要

目的:对前列腺导管腺癌(prostatic ductal adenocarcinoma,PDA)的临床-病理特征进行分析及总结,旨在加深临床医生对该疾病的认识.方法:回顾性分析自2011年以来第四军医大学西京医院病理科前列腺导管腺癌的临床特征、组织学形态及免疫组化结果,结合文献复习进行研究.结果:7例男性患者平均年龄68.43岁(59~75岁),肿瘤主要位于前列腺外周带和中央带,切面灰白、实性、质硬、结节状.多数病例为混合型PDA,与腺泡细胞癌混合存在.PDA肿瘤细胞呈柱状、假复层排列,细胞核长椭圆形或卵圆形,核仁明显,核分裂象多见,细胞浆呈嗜双色性,组织学结构主要为乳头状,此外也具有筛状、微乳头及囊性乳头状等结构.少数病例中肿瘤细胞缺乏显著多形性,细胞核位于基底部,核仁不明显,呈单层或假复层排列,细胞增殖活性较低,构成PIN样结构.肿瘤细胞阳性表达前列腺特异抗原(prostatic specific antigen,PSA)、前列腺特异性酸性磷酸酶(prostatic serum acid phosphatase,PSAP)和α-甲酰基辅酶A消旋酶(alpha-methylacyl coenzyme A racemase,AMACR),阴性表达基底细胞标记物(高分子量角蛋白及p63),Ki-67增殖指数为2%~25%.结论:PDA是前列腺癌中一种少见的亚型,较腺泡细胞癌更具有侵袭性,患者预后更差,早期诊断及积极治疗有助于提高患者预后.%Objective:To analyze and summarize the clinicopathological features of prostatic ductal adenocarcinoma (PDA) and enhance the knowledge level about this disease by clinician.Methods:Seven cases from 2011 to 2016 in the department of pathology at Xijing Hospital were analyzed retrospectively,in combined with the patients' clinicopathological data and literature review.Results:The average age of patients with PDA were 68.43 years old (59 to 75 years old).Those tumors predominantly located in the periurethral zone and central zone of prostate.The cut surface appeared to be grayish-white,solid,hard and nodular.Microscopically,most cases of PDA were existed in a mixed ductal-acinar adenocarcinoma form.The tumor cells were tall pseudostratified columnar epithelium with high-grade nuclei.Those nuclei were elongated and oval shape with prominent nucleoli and numerous mitoses.The cytoplasm was usually amphophilic.Besides the most common papillary growth pattern,there were several histological architectures in our article including cribriform,micropapillary and cystic papillary,etc.It was to be emphasized that few tumor cells arranged in simple or stratified columnar epithelium (case 1 and 3) and displayed minimal cytological atypia (lack of significant pleomorphism,high cellular proliferation activity and prominent nucleoli),which met the criteria of prostatic intraepithelial neoplasia (PIN)-like structure.Immunohistochemical studies revealed that tumor cells of PDA were positive for PSA,PSAP and AMACR,and the basal cell markers of HCK and p63 were negative expression.The labeling index of Ki-67 in PDA varied from 2% to 25%.Conclusion:PDA belongs to a rare histological variant of prostatic carcinoma.Compared with acinar adenocarcinoma,PDA is usually aggressive,and the prognosis of patients with PDA is poor.Early diagnosis and aggressive treatment could be helpful to improve the prognosis.