前列腺摘除病检和穿刺活检的形态学差异

目的：探讨前列腺摘除病检和穿刺活检的形态学差异。方法：对340例穿刺标本和280例因良性前列腺增生（BPH）而摘除的前列腺标本进行形态学对比分析。结果：在穿刺活检中,前列腺癌,上皮内新生物（PIN）和非特异性肉芽肿性前列腺炎（NSGP）的检出率明显高于摘除者,在前列腺摘除的标本中,梗死,磷化,间质增生性结节,腺性尿道炎和非典型性腺瘤样增生（AAH）的检出率明显市政地穿刺活检,结论：形态学差异是由于穿刺和摘除标本分别取自前列腺不同解剖并且并且部位所致,对穿刺和摘除前列腺的病理诊断,应该有不同的鉴别诊断思路。     

The continuing role of fine-needle aspiration of the prostate gland into the 21st century: a tribute to Torsten Löwhagen

A brief review of the history of transrectal fine-needle aspiration (FNA) of the prostate gland is reported in this article; the authors'experience of FNA during the last 20 yr is described also. Despite the worldwide acceptance of the thin-needle core approach, the use of transrectal FNA of palpable abnormalities of the prostate still is advocated because it is cheaper, faster, easier to perform, and results in lower morbidity than any other technique so far developed. High sensitivity, specificity, and efficacy account for its reliability. Appropriate training in performing transrectal FNA of the prostate and in interpreting the smears is, of course, essential. Transrectal FNA should be the initial diagnostic procedure for suspected prostatic cancer and will continue to be a useful diagnostic tool in the 21st century.     

Utility of immunohistochemistry for alpha-methylacyl-CoA racemase in distinguishing atrophic prostate cancer from benign atrophy

Small atrophic prostate cancers on needle biopsy are rare and difficult to distinguish from benign atrophy on needle biopsy. We report on a study of 23 needle biopsy specimens with small foci of atrophic prostate cancer from the consult service of one of the authors. In 19 cancer cases the atrophic component was pure; in 4 cases it was dominant with a minor (<5%) nonatrophic cancer component. These atrophic cancers and 16 cases of florid benign atrophy on needle biopsy were examined by immunohistochemistry for alpha-methylacyl-CoA-racemase (AMACR). All cases of cancer and atrophy were verified immunohistochemically with antibodies to basal cells (34betaE12 and p63). AMACR staining were scored as 1+ (5% to 25% of glands expressing AMACR), 2+ (26% to 50% of glands expressing AMACR), or 3+ (>50% of glands expressing AMACR). Positive staining was defined as staining above that of surrounding benign glands. AMACR was expressed in 69.6% of atrophic prostate cancers (3+, 11 cases; 2+, 3 cases; 1+, 2 cases); 30.4% (7 cases) of atrophic prostate cancer exhibited no AMACR expression. In the 4 cases with a few glands of ordinary (nonatrophic) prostate cancer, the nonatrophic cancer demonstrated more intense and a greater extent of AMACR staining. Fourteen cases (87.5%) of benign atrophy showed no AMACR expression. In 2 cases (12.5%) of benign atrophy, background immunostaining made it difficult to assess AMACR expression. We conclude that AMACR immunostaining alone is not sufficiently discriminatory in the differential diagnosis of atrophic prostate cancer versus benign atrophy. Atrophic prostate cancers are not as frequently or as strongly positive as ordinary prostate cancer. Using a panel of immunostains including AMACR, 34betaE12 and p63 (positive AMACR immunostaining along with negative basal cell markers) is recommended in the differentiation of atrophic prostate cancer and benign atrophy.     

Pitfalls and infrequent findings in fine-needle aspiration of the prostate gland

Based on the experience accumulated over two decades and in more than 7,000 transrectal fine-needle aspirations (FNAs) of the prostate gland, several benign and malignant unusual cytologic findings are described. Infrequent benign cytologic findings and possible pitfalls are atrophic prostatic epithelium, squamous metaplasia, transitional cells, granulomatous prostatitis, seminal vesicle epithelium, ganglion cells, lubricant artifacts, and treatment effects. Infrequent variants of carcinoma are foamy-cell carcinoma, prostatic duct adenocarcinoma, mucinous adenocarcinoma, transitional-cell carcinoma, small-cell carcinoma, squamous-cell carcinoma of the prostate, metastatic solid tumor within the prostate, and mesenchymal tumors. Cytopathologists must be able to diagnose these variants of prostate adenocarcinoma because on most occasions the variants imply a worse clinical prognosis. Appropriate training is essential to achieve success in this field of cytopathology. FNA of the prostate provides in a matter of minutes useful information concerning clinical management, prognosis, and treatment of patients.     

Fine needle aspiration of metastatic prostate carcinoma simulating a primary adrenal cortical neoplasm: A case report and review of the literature

Adrenal metastases usually occur in prostate cancer patients with widespread bone and visceral disease. Autopsy studies have shown that adrenal metastases may be found in up to 23% of these patients. However, the finding of an isolated adrenal metastasis without the involvement of other organs in a patient with prostate cancer is exceedingly rare. Thus, it may cause a diagnostic dilemma on FNA cytology. We report a patient with a history of prostate cancer, status post radiation, and hormonal therapy 4 years before, who presented with a new, single adrenal mass on abdominal imaging studies. The ultrasound‐guided FNA cytology of the adrenal mass revealed cytomorphological features that were suggestive of a primary adrenal cortical neoplasm, but overlapped with those of a prostate metastasis. To our knowledge, FNA findings of metastatic prostate cancer simulating an adrenal cortical neoplasm have not been previously reported in the English literature. The purpose of our study is to discuss the differential diagnosis of these entities. The accurate diagnosis is important because of different prognosis and treatment implications for the various diseases. Diagn. Cytopathol. 2010. © 2009 Wiley‐Liss, Inc.     

Prostatic adenocarcinoma metastases mimicking small cell carcinoma on fine-needle aspiration

Prostate adenocarcinoma (PA) is known to metastasize widely to bone, lung, lymph nodes, and other sites. We have observed a rare, although distinctive, neuroendocrine (NE) cytomorphology of metastatic PA on fine-needle aspiration (FNA) that mimics small cell carcinoma (SCC). From a total of 117 cases, eight cases of metastatic PA diagnosed on FNA showed cytomorphologic features indistinguishable from SCC. All specimens were reviewed, along with immunoperoxidase (IPOX) studies using prostate specific (PSA, PSAP) and NE markers (synaptophysin, chromogranin, etc.). The patients ranged in age from 51-68 (mean age = 63). The PSA levels at the time of FNA ranged from <0.1 to 2,892 ng/ml (normal postprostatectomy <0.2 ng/ml). Sites of FNA included liver (two), soft tissue (five), and lymph node (one). FNA was performed from 11 mo to 6 yr after the initial diagnosis of the primary tumor. All primary PA were of high Gleason grade ranging from 7-9. None of the primary PA showed neuroendocrine morphology. Cytomorphologic characteristics observed on FNA included predominantly single cells with occasional sheets or loose cell aggregates. A predominant NE nuclear morphology was evident (i.e., hyperchromasia, fine dusty chromatin, inconspicuous nucleoli, nuclear molding, chromatinic crush artifact, karyorrhexis, mitoses, etc.), with none of the tumors displaying glandular formation. Taken together, these features gave these metastases a cytomorphology indistinguishable from SCC. IPOX studies revealed PSA-positivity (5/7), PSAP-positivity (4/7), and only focal NE markers positivity (3/6). Metastatic prostate carcinoma may rarely mimic a SCC (6.8% in this study). This often necessitates further patient workup to identify the primary source for the patient's metastasis, particularly if the patient has multiple lesions. An accurate diagnosis of these lesions as PA metastases is essential for effective, timely treatment and therapeutic design.     

Effects of radiation on the normal prostate gland

Prostate cancer is one of the commonest tumours of adult males. It shows a range of biological behaviour: many tumours are discovered incidentally; others will kill by producing widespread metastatic disease. Despite the fact that radiation is frequently used in the treatment of a range of pelvic lesions, including adenocarcinoma of the prostate itself, studies on the morphological changes in the normal prostate gland after irradiation are limited. This seems particularly surprising following the increasing use of needle biopsy specimens to assess the prostate. Patients who receive pelvic irradiation often suffer from lower urinary tract symptoms such as frequency and dysuria and it is possible that these may be related to prostatic and/or periprostatic injury. We therefore investigated the prostate glands removed at cystoprostatectomy for transitional cell carcinomas of the bladder which had received radiotherapy pre-operatively. The changes were compared to control prostatic tissue from transurethral resection specimens for benign myoadenomatous hyperplasia. We found a range of inflammatory, fibrotic and reactive cytological features, including many of the changes seen in benign hyperplasia, but these were significantly more exaggerated in the post-radiation group. In addition intraprostatic vascular and neural changes were prominent. This study documents radiation-induced changes throughout the normal prostate gland and neighbouring soft tissue and has particular importance in current pathological practice with the increasing and widespread use of needle biopsies in the diagnosis and follow-up of prostate cancer.     

Fine-needle aspiration diagnosis of plasmacytoma presenting as breast masses in a patient on estrogen therapy for prostate cancer

We describe a 79-yr-old man with a history of androgen-independent metastatic prostate cancer treated with exogenous estrogens presenting with bilateral breast masses associated with bilateral axillary lymphadenopathy. Although the findings on physical examination with the concomitant history of estrogen therapy for metastatic prostate cancer raised the clinical suspicion of breast cancer, fine-needle aspiration (FNA) cytology identified the lesions as multiple myeloma.     

Threshold for diagnosing prostate cancer over time

Paralleling the detection of earlier prostate cancer over the last several years, there have been numerous efforts to educate practicing pathologists on the diagnosis of limited prostate cancer on needle biopsy via journal articles, Web sites, books, and educational courses. The current study was undertaken to assess whether the threshold for the diagnosis of prostate cancer on needle biopsy has lowered over time. One thousand twelve prostate needle biopsy cases obtained in consultation by 1 of the authors because of diagnostic concerns over a period of 12 weeks (November 15, 2001 to February 15, 2002) were reviewed. Cases referred by either the patient or clinicians were excluded. The final diagnoses in this series were compared with a previously published series of needle biopsy cases of the prostate seen in consultation by the same author in 1993-1994. The percentage of cancer in the 2001-2002 series was 55.1%, compared with 69.6% for the 1993-1994 series. The mean and median numbers of malignant glands in the 2001-2002 series (mean, 21.9; median, 14; range, 2 to 296) were significantly smaller than in the 1993-1994 series (mean, 31.0; median, 20; range, 2 to 300; P<0.00001). The incidence of atypical glands that were suspicious for but not diagnostic of carcinoma was 23.9% in the 2001-2002 series and was 10.7% in the 1993-1994 series. The mean and median numbers of atypical glands in the 2001-2002 series were 9.4 and 6, respectively (range, 1 to 70); these parameters were not available for the previous series. The percentage of high-grade prostatic intraepithelial neoplasia diagnoses was similar in the 2001-2002 and 1993-1994 series (5.1% and 4.6%, respectively), as was the overall frequency of benign cases (15.8% and 15.1%, respectively). The percentage of cases that were accompanied by immunohistochemical stains for 34betaE12 in the 2001-2002 series was 44.4%, which was much more than the 2.5% seen in the 1993-1994 series; if anything, this should have resulted in a lower atypical rate in the current series. In more recent years, cases sent for consultation have more limited cancer, with a correspondingly higher percentage of cases that are diagnosed as atypical, yet not diagnostic of cancer. The number of atypical glands in the recent series was very limited, such that a change over time in the threshold for diagnosing cancer by the consultant is an unlikely explanation. It appears that pathologists are becoming more skilled at diagnosing limited prostate cancer and are referring predominantly cases with fewer cancer glands and more difficult atypical cases with few glands.     

PSA immunoreactivity in a parotid oncocytoma: A diagnostic pitfall in discriminating primary parotid neoplasms from metastatic prostate cancer

Prostate-specific antigen (PSA) is secreted by both normal and neoplastic acinar cells of the prostate gland, and the immunohistochemical detection of PSA is widely accepted as an excellent method for confirming the prostatic origin of metastatic tumor implants in men with prostate cancer. Less recognized is the observation that certain nonprostatic tissues and their neoplastic counterparts also secrete PSA. As one example, salivary gland ducts and certain salivary gland neoplasms have been reported to be immunoreactive for PSA. Potentially, this nonspecificity could be a diagnostic pitfall when using immunoperoxidase on fine-needle aspiration (FNA) biopsy specimens to differentiate metastatic prostate cancer from primary salivary gland tumors. We report on a case where strong PSA immunoreactivity of a parotid oncocytoma led to its confusion with metastatic prostate cancer. Diagn. Cytopathol. 1998;19:221–225. © 1998 Wiley-Liss, Inc.     

Metastases to the thyroid gland: Diagnosis by aspiration cytology

The purpose of this study was to document the incidence, nature and source of neoplasms metastatic to the thyroid gland, which were diagnosed by fine needle aspiration (FNA) cytology. In the seven year period from 1986 to 1992, 21 cases were identified with metastatic malignancies in FNA specimens from the thyroid. This represented 7.5% of neoplastic thyroid lesions aspirated in this unit. All patients presented clinically with thyromegaly or discrete nodules. Only five patients were known to have malignancies of other sites prior to FNA. The majority of metastatic nodules were bronchogenic in origin (nine). The gastrointestinal tract (five) and melanomas (two) were the next most frequent sources in the series. Single cases arose in the prostate, larynx, kidney (all carcinomas), and uterus (a leiomyosarcoma). One patient had a thyroid deposit of acute myeloblastic leukemia. This large study demonstrated that tumors of many histological types may involve the thyroid gland, and furthermore, may masquerade as primary thyroid malignancies. Recognition of an alien cell type not only prevents inappropriate thyroid surgery, but may also direct the search for the unsuspected or unknown primary. Metastases to the thyroid gland occur more frequently than is generally appreciated. FNA is the procedure of choice for evaluation of thyroid nodules in general, and thyroid metastases in particular. © 1995 Wiley-Liss, Inc.     

An update on atypical large glandular proliferations of the prostate

The differential diagnosis of prostatic atypical large gland proliferations includes several benign and malignant entities. This review focusses on issues relevant to the practising pathologist, particularly around areas of controversy such as high-grade prostatic intraepithelial neoplasia (HGPIN) and intraductal carcinoma of the prostate (IDCP). HGPIN is a putative precursor of prostate cancer, but its clinical relevance is as a surrogate marker of unsampled prostate cancer, thereby identifying patients who would benefit from a prompt repeat biopsy. The incidence of missed prostate cancer is much lower in contemporary practice due to pre-biopsy MRI and extended sampling protocols so HGPIN is currently less important. It is however important to distinguish HGPIN from PIN-like carcinoma and IDCP. PIN-like carcinoma is considered a histological subtype/variant of acinar prostate carcinoma and should be graded as Gleason pattern 3. A diagnosis of cribriform HGPIN should not be made in needle biopsies as such a proliferation may represent IDCP. This review discusses controversies related to the diagnosis, reporting and management of IDCP. A personalized approach to management of patients with isolated IDCP in needle biopsies that is based on the histological and radiological features of an individual case is outlined.     

Value of cytopathologist‐performed ultrasound‐guided fine‐needle aspiration as a screening test for ultrasound‐guided core‐needle biopsy in nonpalpable breast masses

Fine‐needle aspiration (FNA) of breast masses in the United States has been on the decline for the last decade and has been largely replaced by ultrasound‐guided core‐needle biopsy (UG‐CNB). Some studies show core‐needle biopsy (CNB) is superior to FNA in terms of absolute sensitivity, specificity, and inadequate rate. However, the importance of a skilled aspirator, experienced cytopathologist, and immediate cytological evaluation (ICE) in FNA is often not considered. CNB is more expensive, invasive, risky, and painful than FNA. This prospective study examines the value of cytopathologist‐performed ultrasound‐guided FNA (UG‐FNA) with ICE as a screening test for cytopathologist‐performed UG‐CNB on nonpalpable or difficult‐to‐palpate solid breast masses visible on ultrasound. One hundred twenty consecutive nonpalpable or difficult‐to‐palpate presumably solid breast masses in 109 female patients from January2, 2008 to June 30, 2008 underwent cytopathologist‐performed UG‐FNA with ICE. Twenty cases were converted to cytopathologist‐performed UG‐CNB because ICE was inadequate, hypocellular, atypical, suspicious, or malignant. Patients with clearly benign cytology did not undergo UG‐CNB. UG‐FNA with ICE reduced the percentage of patients undergoing UG‐CNB by 87%. A new role for cytopathologist‐performed UG‐FNA of nonpalpable breast masses has been identified. Diagn. Cytopathol. 2009. © 2009 Wiley‐Liss, Inc.     

What is the consistency between the results of needle biopsy and prostatectomy specimen pathology results? A pilot study

Background/aim The aim of this study was to establish the relationship between the needle biopsy and the pathology result after radical prostatectomy administrated for prostate cancer. Materials and methods We retrospectively analyzed 67 patients who had undergone radical prostatectomy from 2016 to 2019. All surgeries and all biopsies were performed in the third author’s urology department. Samples were collected through 12-core biopsy under local anesthesia. All specimens were studied in the pathology department of the third author’s center. The results evaluated were needle biopsies’ Gleason scores and prostatectomy specimens’ Gleason scores.Results Inclusion criteria were not having any neo-adjuvant treatment and being treated with surgery after needle biopsy. Gleason scores obtained from needle biopsies and prostatectomy specimens were evaluated. The comparison revealed that 39% of the tumors were undergraded, 7% were overgraded, and 54% had exact scoring in needle biopsies and prostatectomy specimens according to the detailed Gleason scoring as primary and secondary metrics. The patients were grouped into five categories according to the ISUP 2014 prostate cancer grading system. The relationship was strong with 64% of results staying in the same group after the operation; nevertheless, the correlation remained weak based on the kappa coefficient. Conclusion The information obtained from the needle biopsy is not a strong herald of the pathological result. Urologists should have awareness of this restraint when utilizing the needle biopsy’s Gleason score in decision making and treatment planning.     

Histological identification of carcinoma in 21 gauge needle tracks after fine needle aspiration biopsy of head and neck carcinoma.

Six cancer resection specimens were thoroughly sectioned and microscopically examined at areas known to have been around 21 gauge fine needle aspiration (FNA) biopsy sites, in an attempt to identify needle tracks. All cases had an interval of not less than 10 days between FNA biopsy and surgery. Foci of tumour were identified histologically in needle tracks from two patients with carcinoma. This is the first instance, outside of experimental animal models, of histologically confirmed, viable tumour spread in FNA biopsy tracks. Although this complication is not common and is of unknown clinical significance, it is one that all clinicians who undertake FNA of malignant neoplasms should be aware of.     

A case of interdigitating dendritic cell sarcoma/histiocytic sarcoma – a diagnostic pitfall

Interdigitating dendritic cell sarcoma (IDCS) and histiocytic sarcoma (HS) are two distinct rare hematolymphoid neoplasms, and HS derived from a likely pre-existing IDCS has never been reported in the English literature. Diagnosis of such entities in excised specimens is difficult, but becomes more difficult with the scant amount of materials obtained with fine needle aspiration (FNA) and core needle biopsy. Here we present an interesting and unique case of an IDCS located within a mesenteric mass, which was initially diagnosed as IDCS from the cytology of FNA and core needle biopsy specimens. After brief chemotherapy, the patient again developed abdominal pain, and a HS was diagnosed based on the excised segmental small intestinal specimen. While the exact relationship between the IDCS and HS cannot be ascertained, it is most likely that the HS is derived from the IDCS, although co-existing HS in addition to IDCS from the cytology specimen cannot be completely ruled out.     

EUS‐guided 22‐gauge fine‐needle aspiration versus core biopsy needle in the evaluation of solid pancreatic neoplasms

Endoscopic ultrasound‐guided fine‐needle aspiration (EUS‐FNA) is widely used for diagnosis of pancreatic lesions. The Echotip Procore Needle (Wilson‐Cook Medical) is a new 22G fine biopsy needle (FNB) for obtaining core biopsy material at time of EUS. This study aimed to compare the technical and diagnostic performance of conventional FNA and FNB. Thirty‐two patients met the design criteria for this prospective paired cohort study. All lesions sampled were solid (non‐cystic) pancreatic masses by EUS appearance. Patients were randomized to receive FNA or FNB by first attempt. A cytopathologist performed on‐site evaluations. Samples were assessed for accuracy of diagnosis, cellularity, contamination, and sufficiency for ancillary studies. Technical and diagnostic performances were compared. Compared to FNA, there was a statistically significant decreased ability of FNB to achieve a diagnosis (FNA 93.8%, FNB 28.1%, P < 0.001). FNB was diagnostically superior to FNA in 1 of 32 cases. Technical failures were observed in five cases due to resistance to advancement of the FNB needle. Regarding operator perceived ease‐of‐use, FNA outperformed FNB (P < 0.001). Eight cases had insufficient FNB material to survive tissue processing. There was no significant difference in mean specimen cellularity between devices. FNA samples showed an increased amount of contaminant (P = 0.036) but were more sufficient for ancillary studies (P = 0.502). Although deemed comparable to FNA when providing material for cytology, the pledged advantage of FNB acting like a core biopsy needle was not apparent in our series. Additional studies are needed before routine adoption of 22G FNB can be recommended. Diagn. Cytopathol. 2014;42:751–758. © 2014 Wiley Periodicals, Inc.     

P53 mutations analysis in benign and malignant breast lesions: using needle rinses from fine-needle aspirations

The fine-needle aspiration (FNA) technique is a widely used method for diagnostic assessment of breast diseases. In the current study we investigated the feasibility of sampling material for genetic studies from the same FNA samples as would be used for breast cytology. After making smears for cytological examination, the needle was rinsed into phosphate-buffered saline (PBS) solution. The material gained was sufficient for a polymerase chain reaction (PCR)-based study. As the FNA samples reflect a broad range of breast diseases, it is possible to study genetic changes at various stages of the neoplastic process. We looked for mutations in the p53 tumor suppressor gene in 198 FNA needle rinses, 42 from carcinomas and 156 from cytologically benign lesions. In the malignant samples, 22% carried mutations in the p53 gene. We also looked for p53 mutations in matching tissue sections from tumors and found the FNA needle rinses to represent the tumor well. In addition, three mutations in cytologically benign lesions were found, but none of these 3 patients were diagnosed with malignant tumors in the time frame of the study. The clinical significance of p53 mutations in benign breast tissue remains to be determined.     

Value of combined use of fine‐needle aspiration and core needle biopsy in palpable breast tumors performed by pathologist: Institut Curie experience

The aim of this study was to determine the accuracy of fine‐needle aspiration (FNA) and core needle biopsy (CNB) for palpable breast tumors (PBTs). FNA and CNB of 492 PBTs from 477 patients were analyzed. Tumors were malignant in 473 cases and benign in 19 cases. There was a strong correlation (P > .05) between FNA and CNB in terms of malignancy. Among 473 malignant tumors, FNA had better accuracy and less unsatisfactory results (95.6%; 2.7%) than CNB (94.9%; 4.9%). Among 19 benign tumors, CNB was accurate in 100% compared to 94.7% using FNA. There were only two (0.4%) cases where result was unsatisfactory by both FNA and CNB. NPV was 56.3% for FNA, 43.2% for CNB, and 95.0% for FNA and CNB combined. Sensitivity was 97.0% for FNA, 94.7% for CNB, and 99.8% for FNA and CNB combined. PPV and specificity was 100% for FNA and CNB both separately and combined. Combined use of FNA with CNB is an optimal diagnostic method for PBTs. In our opinion, this should be recommended as standard for diagnosis of PBTs.