Consequência da Cirurgia da Próstata - Dr. Cassio Andreoni CRM 78.546
Prostate cancer is a major public health problem throughout the developed world. For patients with clinically localised prostate cancer, the diagnosis is typically established by histopathological examination of prostate needle biopsy samples.
Major and minor criteria are used to establish the diagnosis, based on the microscopic appearance of slides stained using haematoxylin and eosin. Major criteria include an infiltrative glandular growth pattern, an absence of basal cells and nuclear atypia in the form of nucleomegaly and nucleolomegaly.
Cocktails of antibodies directed against basal Prostata- Pin2 markers and AMACR are particularly useful in evaluating small foci of atypical glands, and in substantiating a diagnosis of a minimal adenocarcinoma.
Reporting of adenocarcinoma in needle biopsy Prostata- Pin2 should always include the Gleason grade and measures of tumour Prostata- Pin2 in the needle core tissue. Measures of tumour extent are 1 number of cores Prostata- Pin2 for cancer in the number of cores examined, 2 percentage of needle core tissue affected by carcinoma and 3 linear millimetres of carcinoma present.
The histopathological diagnosis of adenocarcinoma of the prostate in needle core biopsy specimens presents a unique set of challenges. Finally, the needle cores can fragment, which can also generate problems in interpretation. The focus of this review is an approach to the Prostata- Pin2 diagnosis of carcinoma in prostate needle biopsy specimens, especially limited or minimal adenocarcinoma. Next, entities in the differential diagnosis of prostatic adenocarcinoma are briefly presented, followed by information on the use of ancillary Prostata- Pin2 studies, particularly the use of immunohistochemical staining.
The final section discusses the reporting of prostatic carcinoma in prostate needle biopsy tissue. Diagnosis of prostatic carcinoma requires a synthesis Prostata- Pin2 a constellation of histological attributes that allows for a Prostata- Pin2 diagnosis.
A conceptual framework for a Prostata- Pin2 approach to this diagnosis entails application of major and minor criteria box 1. These Gleason pattern 3 adenocarcinomas are currently the most common pattern recognised in needle biopsy specimens. This deceptive appearance is because the invading glands do not usually elicit a desmoplastic or inflammatory response that characterises many invasive carcinomas at other anatomical sites.
Linkage of carcinoma cells into chains and cords also indicates poorly differentiated Gleason pattern 4 adenocarcinoma. These arrangements represent Gleason pattern 5, which is uncommon in needle biopsy specimens. The lack of fibrogenic or inflammatory response Prostata- Pin2 evident. In Prostata- Pin2 cases, benign prostate glands are not present to serve as landmarks to Prostata- Pin2 for invasion. This can happen as a result of destructive growth of the tumour, due to invasion into an area of pure fibromuscular stroma, and due to invasion into extraprostatic tissues, Prostata- Pin2 as periprostatic adipose tissue or seminal vesicle tissue.
Destructive growth can occur with any Prostata- Pin2 grade carcinoma that is extensive. Also, benign or malignant prostatic glands can be observed in skeletal muscle tissue at the apex, where skeletal muscle of the urogenital diaphragm interdigitates into the prostate gland. The detection of infiltrating carcinoma into the skeletal muscle in a needle biopsy specimen does not necessarily equate with Prostata- Pin2 spread.
However, this is rarely an isolated finding and is generally associated with extensive carcinoma in the rest of the needle biopsy tissue. Thus, in prostatic needle biopsy, carcinoma of the prostate can present a range of images of infiltration, with invasion into prostatic as well as extraprostatic tissues.
It is difficult to tell, on needle biopsy, Prostata- Pin2 this is definitely a seminal vesicle or an ejaculatory duct. Seminal vesicle or ejaculatory duct glands are crowded larger glands at lower right. An infiltrative Prostata- Pin2 is not evident for carcinomas with a partially nodular configuration. Absence of basal cells in the atypical glands is the second of the Prostata- Pin2 criteria.
Basal cells may assume a range of Prostata- Pin2, 1920 and so careful study of basal cells in glands that are clearly benign is a vital exercise before scrutinising abnormal glands of concern to rule out their presence in malignant glands. A historic challenge for the surgical pathologist has been the distinction of periglandular stromal fibroblasts from basal cells.
Another common difficulty is that distorted, crushed or poorly preserved carcinoma cells in minimal cancer foci can be mistaken for basal cells. This basal cell layer is not always present in benign small glands, so that its absence is not an absolute criterion of carcinoma. Conversely, however, Prostata- Pin2 have not seen it in any case in which the diagnosis was cancer. Additional but rare benign mimickers of prostatic carcinoma that can lack basal cells include mesonephric hyperplasia 25 and nephrogenic adenoma.
Nuclear atypia in the form of nuclear enlargement and nucleolar enlargement is the third of the major criteria for diagnosis of adenocarcinoma. Failure to detect prominent nucleoli in prostatic carcinoma nuclei is probably multifactorial; large nucleoli might be present but undetectable owing to poor preservation, poor fixation, overstaining or section thickness.
This last factor of overly thick sections is an extremely common problem. In addition, lack of chromatin clearing might contribute to the inability to detect nucleoli. Finally, some prostate cancers do not harbour macronucleoli. One essential Prostata- Pin2 is that when macronucleoli are absent, there should be significant nucleomegaly with or without nuclear hyperchromasia to definitively diagnose carcinoma.
Minor diagnostic criteria box 1 are found on an individual basis in a smaller proportion of cases than those with major diagnostic criteria, with the exception of intraluminal amorphous pink material. Another finding specific for carcinoma—lymphovascular space invasion—is vanishingly rare in prostate needle biopsy tissue. One of the major diagnostic challenges confronting the histopathologist in interpretation of a prostate needle biopsy specimen is the establishment of Prostata- Pin2 malignant diagnosis Prostata- Pin2 on a minimal or limited Prostata- Pin2 of carcinoma in the needle biopsy tissue.
The major and minor diagnostic criteria should be put Prostata- Pin2 use here, just as for more extensive carcinoma. Uncommon patterns of growth that typically accompanied the common patterns were cords of cells, single cells and cribriform glands. No definite quantitative threshold exists for the number of glands required to establish a diagnosis of malignancy, although most authorities require at least 2—3 glands I prefer three glands.
Clearly though, each case must be interpreted on it own merits such that a very few glands may be definitely diagnostic in one case but not in another. Many cases of minimal carcinoma harbour well over 2—3 glands. In a Prostata- Pin2 series, the mean standard deviation SD number of acini to Prostata- Pin2 carcinoma was 17 Both of these major criteria are of immense importance for these most minimal of the minimal carcinomas, where discerning architectural abnormalities is difficult to impossible.
In another series on minimal limited carcinoma, the lowest number of diagnostic glands was two. Numerous entities, both benign and malignant, should be considered in the differential diagnosis of prostatic adenocarcinoma.
Recent Prostata- Pin2 have Prostata- Pin2 the benign lesions or pseudoneoplasms box 2 that may mimic prostatic adenocarcinoma. A descriptive diagnosis which Prostata- Pin2 be rendered if the histological Prostata- Pin2 immunohistochemical findings are thought to be worrisome but not fully diagnostic of carcinoma, is atypia, 33Prostata- Pin2 also known as atypical suspicious for carcinoma or atypical small acinar proliferation.
In the past, basal cell immunostains were used by themselves. Currently, many laboratories combine use of basal cell markers with an immunostain for AMACR, sometimes in a cocktail. Firstly, absence of basal cells is an important criterion for the histological diagnosis of prostatic carcinoma, but is only one of several of the major criteria. Thus, this immunostain, as Prostata- Pin2 adjunctive studies, should Prostata- Pin2 interpreted in the context of all histological findings in the particular case.
Also, not all benign glands have basal cells. Finally, this immunohistochemical stain is based on a negative result to give a positive diagnosis of malignant neoplasm.
Many factors can Prostata- Pin2 failure of immunohistochemical staining, and absence of proof is not proof of absence. So, it is absolutely critical to study the immunostained cores for a positive internal control—benign glands with a strong, positive basal cell signal. They Prostata- Pin2 also been ordered in selected cases in which the differential diagnosis encompassed atypical adenomatous hyperplasia adenosisPIN, basal cell hyperplasia and atrophy. It would be desirable to diagnose adenocarcinoma and to have a positive marker that is relatively specific for malignant prostatic epithelial cells, in addition to the negative basal cell markers.
Prostata- Pin2 immunohistochemical studies, 29585960616263646566676869 one such marker, AMACR, is selective and very sensitive for carcinoma. Application of such a cocktail is decidedly advantageous if only a small atypical focus is present, and Prostata- Pin2 if the focus is present only on a single section or slide that is available for immunohistochemical evaluation. In certain cases, additional immunohistochemical studies are indicated.
Genetic abnormalities such RNA overexpression or underexpression, DNA ploidy, chromosomal anomalies, gain or loss of specific DNA sequences, DNA methylation and specific gene mutations are not used in the diagnosis of carcinoma in prostate needle biopsy specimens.
The most clinically important attributes of adenocarcinoma in prostate needle biopsy specimens that merit Prostata- Pin2 are Gleason grade and amount of tumour in the needle biopsy tissue.
All these measures provide nearly equivalent information, such that Prostata- Pin2 is not a standard method of appraising the tumour extent in a needle biopsy specimen. Indeed, several measures should be given for the same Prostata- Pin2 of needle biopsies.
Competing interests: None declared. National Center for Biotechnology InformationU. Journal List J Clin Pathol v. Prostata- Pin2 Clin Pathol. P Prostata- Pin2 Humphrey. Author information Article notes Copyright and License information Disclaimer. Accepted Aug This article has been cited by Prostata- Pin2 articles in PMC. Abstract Prostate cancer is a major public health problem throughout the developed world. Major criteria for diagnosis of adenocarcinoma in prostate needle biopsy tissue sections Diagnosis of prostatic carcinoma requires a synthesis of a constellation of histological attributes that allows for a definitive diagnosis.
Open in a separate window. Minor diagnostic criteria Minor diagnostic criteria box 1 are found on an individual basis Prostata- Pin2 a smaller proportion of Prostata- Pin2 than those with major diagnostic criteria, with the exception of intraluminal Prostata- Pin2 pink material.
Minimal adenocarcinoma Prostata- Pin2 of the major diagnostic challenges confronting the histopathologist in interpretation of a prostate Prostata- Pin2 biopsy specimen is the establishment of a malignant diagnosis based on a minimal or limited amount of carcinoma in the needle biopsy tissue. Differential diagnosis of adenocarcinoma in needle biopsy tissue Numerous entities, both benign and malignant, should be considered in the differential diagnosis of prostatic adenocarcinoma.
Prostata- Pin2 2: Differential diagnosis of prostatic adenocarcinoma: pseudoneoplasms of the prostate Atypical adenomatous hyperplasia adenosis Atrophy Crowded benign glands Basal cell hyperplasia Sclerosing adenosis Cribriform hyperplasia Mesonephric hyperplasia Nephrogenic metaplasia adenoma Verumontanum mucosal gland hyperplasia Squamous metaplasia Transitional cell metaplasia Radiation atypia Prostatitis Malacoplakia Endometriosis Postoperative spindle cell nodule Atypical stromal cells Extramedullary haematopoiesis Prostata- Pin2 glands Paraganglia in prostate Benign glands adjacent to nerves and skeletal muscle.
Reporting The most clinically important attributes of Prostata- Pin2 in prostate needle biopsy specimens that merit reporting are Gleason grade and amount of tumour in the needle biopsy tissue. Footnotes Competing interests: None declared. References 1. CA Cancer J Clin 55 74— Humphrey P A. Clinical Prostata- Pin2 of prostatic carcinoma, with histopathologic correlations.
In: Prostate pathology. JAMA — Prostate 57 93— J Urol — Mod Pathol 11 —