Urothelial carcinoma of the urinary bladder with a component of acinar/tubular type differentiation simulating prostatic adenocarcinoma

We report a case of an 83-year-old man with a high-grade carcinoma of the urinary bladder who underwent cystoprostatectomy. The invasive carcinoma showed mixed, morphologically distinct patterns consisting of conventional high-grade urothelial carcinoma, glandular differentiation resembling enteric type adenocarcinoma, and acinar/tubular type differentiation, morphologically similar to Gleason grade 3 prostatic adenocarcinoma. Immunohistochemical studies revealed the acinar/tubular component of the tumor to be negative for prostate-specific antigen and prostatic acid phosphatase, but positive for cytokeratin 7, cytokeratin 20, high molecular weight cytokeratin (34 beta E12), and thrombomodulin, consistent with origin from the bladder rather than the prostate. Although bladder carcinomas composed of mixed morphologic patterns are not uncommon, to our knowledge, the presence of acinar/tubular type features simulating prostatic adenocarcinoma in such tumors has not been described elsewhere.     

Identification of isolated and early prostatic adenocarcinoma in radical prostatectomy specimens with correlation to biopsy cores: clinical and pathogenetic significance

Prostatic adenocarcinoma (PAC) is a multifocal disease. In this study, we identified isolated and small foci of PAC (ISPAC) in radical prostatectomy specimens, described the histopathologic features, investigated their zonal distribution in the prostate and their relationship with large tumor nodules, and correlated the findings with those of preceding biopsy cores. One hundred and thirty radical prostatectomy specimens performed for PAC or for urothelial carcinoma of the urinary bladder with incidental PAC were reviewed for identification of ISPAC. Prostates were serially sectioned in the horizontal plane and submitted in toto for microscopic examination. ISPAC were defined as foci of PAC measuring less than 3 mm in maximum diameter. There were 461 ISPAC identified in 114 cases. They were distributed in the transitional zone (TZ) (18 foci), the apex (73 foci), the anterior horn of the non-TZ (NTZ) (118 foci), the base (8 foci), and the remaining NTZ (244 foci). ISPAC usually consisted of groups of small acini with a GS ranging from 2 to 7 (3 + 4). GSs of ISPAC consisted of single grade or two consecutive grades equal to or lower than those of the main PAC. ISPAC were more often located in close proximity to large tumor nodules. The number of ISPAC increased with the tumor volume up to 3 cm3, then decreased as the PAC became more extensive (p value = 0.02, statistically significant). Prostates with NTZ PAC <1.5 cm3 and TZ PAC or prostates containing 4 or more than 4 ISPAC tended to be frequently associated with small foci of PAC in biopsy cores In this study, we identified ISPAC that likely represent foci of PAC in early development and account for the multicentricity and heterogeneity of PAC. ISPAC in the NTZ were common and may account for small foci of PAC or atypia in biopsy cores. Although these small foci of PAC or atypia in biopsy cores without accompanying higher GS PAC were often associated with significant PAC, they may also occasionally represent insignificant or vanishing PAC in subsequent radical prostatectomies.     

锌指转录因子Snail 1在糖尿病大鼠肾组织中的表达

目的： 观察锌指转录因子Snail 1在糖尿病大鼠肾组织中的表达并探讨其与糖尿病肾病（DN）发生、发展的关系。方法: 链脲佐菌素（STZ）诱发大鼠糖尿病（DM），分为2、4、8、12、16、20、24周以及16周A、20周A和24周A组，其中A组动物从第13周起用胰岛素控制血糖至正常水平，每个时点均设鼠龄匹配的正常对照组。测定各组血糖、24 h尿蛋白、血肌酐（Scr）、肾脏指数。PAS染色光镜观察肾脏病理改变。免疫组化、RT-PCR方法检测肾皮质Snail 1和纤连蛋白（FN）的蛋白及mRNA水平，Western blotting检测Snail 1蛋白表达。结果: DM各组大鼠的血糖、24 h尿蛋白、血肌酐、肾脏指数明显高于正常对照组（P<0.05,P<0.01），A组上述指标均明显低于DM组（P<0.05,P<0.01）。Snail 1免疫组化阳性染色见于各组DM大鼠肾小管，正常对照组未见阳性表达，A组见弱阳性表达，并随治疗时间延长而减少。DM组肾皮质Snail 1、FN蛋白和mRNA的表达水平高于正常对照组（P<0.01），而A组显著低于DM组（P<0.01）。Snail 1与FN mRNA的表达水平呈显著正相关（P<0.01），Snail 1蛋白表达水平与血糖、尿蛋白、血肌酐、肾脏指数亦呈正相关（ P<0.01）。结论: Snail 1基因和蛋白在DM大鼠肾组织过度表达，提示Snail 1可能参与了DN的发生、发展机制。     

细胞周期蛋白依赖性激酶cdk2和cdk4在前列腺增生和癌变组织中的表达

目的：探讨细胞周期蛋白依赖性激酶ｃｄｋ２和ｃｄｋ４在前列腺增生（ＢＰＨ）和前列腺癌（ＰＣ）的发生发展过程中作用及其与ＰＣＮＡ之间关系。方法：应用免疫组化ＳＰ法检测１８例正常前列腺（ＮＰ）、６２例ＢＰＨ和３３例ＰＣ组织中ｃｄｋ２、ｃｄｋ４和ＰＣＮＡ的表达。结果：前列腺上皮和间质组织中均见ｃｄｋ２和ｃｄｋ４表达。ＮＰ中两者表达均分别显著低于ＢＰＨ和ＰＣ;ＢＰＨ的上皮细胞中两者表达均分别显著低于ＰＣ,但ＢＰＨ的间质细胞中两者表达与ＰＣ相比均无显著性差异。ＢＰＨ和ＰＣ中ｃｄｋ２及ｃｄｋ４表达与ＰＣＮＡ指数均呈正相关。结论：ｃｄｋ２和ｃｄｋ４异常表达参与ＢＰＨ和ＰＣ的发生发展过程,其可能是通过改变细胞周期及促进细胞异常增殖而起作用的。     

Occurrence of cell death (apoptosis) in prostatic intra-epithelial neoplasia

The aim of our study was to assess the frequency and location of apoptotic bodies (ABs) in haematoxylin and eosin-stained sections of prostatic intra-epithelial neoplasia (PIN) and then to compare the patterns with those in benign prostatic hyperplasia (BPH) and prostatic invasive adenocarcinoma (PAC). ABs were identified in all epithelial cell layers of the ducts, acini and tumour islands, as well as in the lumina contained in such structures. In the epithelial cell layers, ABs were found in general in the intercellular space and occasionally in the cytoplasm of epithelial cells. The frequency of ABs increased from BPH through PIN up to PAC. The proportions of ABs in PIN lesions of low grade (PINlow) and high grade (PINhigh) were greater than in BPH, the values decreasing from the nuclei in the basal position towards those in the luminal layer. In PINlow, the mean category values were 0.85% (standard error, SE, 0.311%) in the basal, 0.623% (SE 0.065%) in the intermediate and 0.474% (SE 0.138%) in the luminal position. In PINhigh, the mean category values were 1.006% (SE 0.16%) in the basal position, 0.713% (SE 0.182%) in the intermediate and 0.618% (SE 0.172%) in the luminal position. The proportions of ABs in adenocarcinoma with cribriform pattern decreased from the basal towards the luminal layer, as for PIN: 1.806% (SE 0.346%) in the basal position, 1.15% (SE 0.172%) in the intermediate and 0.886% (SE 0.137%) in the luminal position. In the solid/trabecular adenocarcinomas, the mean category value in the cell layer adjacent to the stroma was 2.154% (SE 0.203%), whereas in the other cell layers it was 2.052% (SE 0.239%). In small and large acinar adenocarcinomas, the proportions of positive nuclei were 1.022% (SE 0.1%) and 0.922% (SE 0.163%), respectively. The evaluation of the frequency and location of ABs gives accurate information on cell death in PIN in comparison with BPH and PAC.     

碱性成纤维细胞生长因子在前列腺增生和癌组织中表达的临床意义

目的 :探讨碱性成纤维细胞生长因子 (b FGF)在前列腺增生和前列腺癌组织中表达的临床意义。方法 :采用斑点杂交技术和免疫组化染色 ,测定 40例正常前列腺 (NP)、3 8例前列腺增生症 (BPH )和 3 6例前列腺癌组织 (Pca)中b FGF的表达。结果 :BPH和Pca组织中 ,b FGF的表达明显高于NP组织 (P <0 .0 1)。b FGF表达升高的程度与BPH的分度、Pca的病理分级和临床分期均无明显关系。结论 :b FGF可能为BPH和Pca组织自身分泌 ,与其发生发展过程密切相关     

Heterogeneous expression of alpha-methylacyl-CoA racemase in prostatic cancer correlates with Gleason score

AIMS: Alpha-methylacyl-CoA racemase (AMACR) is a sensitive and specific immunohistochemical marker of prostatic malignancy, staining 80-100% of prostatic cancers with absent staining in benign glands. However, positive staining in benign conditions as well as low rates of AMACR reactivity in prostatic cancer variants have been described. Preliminary use of AMACR immunohistochemistry in our institution has suggested lower specificity and sensitivity for prostatic cancer than initially proposed. The aim of this study was to establish true rates of AMACR reactivity in prostatic cancer and benign prostatic hyperplasia (BPH). METHODS AND RESULTS: AMACR immunohistochemistry was performed on sections from 57 prostatic cancers and 44 BPH resections. Ninety-one percent of cancers were AMACR+, with diffuse (> 75%) tumour staining in 53% of cases. Thirty-eight percent of tumours showed heterogeneous expression (1-75% tumour staining). This was significantly correlated with increased Gleason score. High-grade prostatic intraepithelial neoplasia (PIN) was AMACR+ in 87% of cancers. Eleven percent of BPH showed moderate or strong staining in benign glands, focally mimicking the malignant staining pattern. CONCLUSIONS: This study confirms heterogeneous AMACR expression in prostatic cancer and shows a correlation with Gleason score. Positive staining in BPH is also documented, thus emphasizing the importance of interpreting AMACR immunohistochemistry in the context of other findings in a diagnostic setting.     

钬激光前列腺剜除术与经尿道等离子前列腺剜除电切术治疗良性前列腺增生患者的临床效果分析

目的:比较钬激光前列腺剜除术(Holmium laser enucleation of the prostate,HOLEP)与经尿道等离子前列腺剜除电切术(Transurethral plasmakinetic enucleation of prostate,PKEP)治疗良性前列腺增生的效果。方法:选取2017年3月至2019年12月间我院收治的68例良性前列腺增生患者,随机分成两组(n=34),其中对照组患者采用HOLEP术式而试验组患者采用PKEP术式进行治疗。比较手术指标、恢复时间和术后并发症,评价前列腺症状和疼痛程度。结果:两组患者手术时间、术中出血量、住院时间无显著差异(P>0.05)。与试验组相比,对照组术后并发症发生率更低(P<0.05)。与术前相比,两组的国际前列腺症状评分(International prostate symptom score,IPSS)和视觉模拟评分(Visual analogue score,VAS)评分均明显降低(P<0.05),其中对照组更为显著(P<0.05)。结论:HOLEP术式治疗良性前列腺增生的疗效优于PKEP术式,能减少术后并发症、改善前列腺症状,具有推广价值。     

大肠腺癌中Sema4D和VEGFR2的表达及意义

目的探讨Sema4D和血管内皮生长因子受体2(VEGFR2)在大肠腺癌组织中的表达及其临床意义。方法运用组织芯片和免疫组化SP法检测115例大肠腺癌组织、19例大肠腺瘤组织和12例正常大肠黏膜组织中Sema4D与VEGFR2的表达,并分析其与临床病理特征的关系。结果 Sema4D在正常大肠黏膜表达阳性率8.33%,在腺瘤和腺癌中阳性表达率为15.79%和39.13%,差异有统计学意义且与淋巴结转移、Dukes临床分期明显相关(P<0.05)。VEGFR2在正常大肠黏膜中阳性率16.67%,在腺瘤和腺癌中表达率为21.05%和51.3%,差异有统计学意义其表达与淋巴结转移、浸润程度、Dukes临床分期明显相关(P<0.05)。结论大肠腺癌中Sema4D与VEGFR2的表达可能在大肠腺癌的发生、发展中发挥重要作用。     

HOXA11在子宫内膜单纯性增生和内膜癌中表达增加

目的探讨HOXA11基因在子宫内膜单纯性增生和子宫内膜癌中表达的意义,以及与雌激素受体(estrogen receptor,ER)、孕激素受体(progestogene receptor,PR)表达的关系。方法用免疫组化法检测增生期子宫内膜、子宫内膜单纯性增生及子宫内膜癌组织中HOXA11、ER及PR蛋白的表达。结果在子宫内膜单纯性增生和内膜样腺癌中,HOXA11的表达明显高于增生期子宫内膜(P<0.05),而ER、PR的表达明显低于增生期内膜(P<0.05)。结论HOXA11的过度表达可能参与了子宫内膜异常增生或癌变的过程;这种效应可能与ER、PR表达下降相关。     

Lycopene for the prevention and treatment of benign prostatic hyperplasia and prostate cancer: a systematic review

Background

Prostate cancer is a leading cancer affecting men worldwide. Benign prostatic hyperplasia (BPH) is a common disease of the prostate affecting men as they age, and a risk factor for developing prostate cancer. Lycopene is a member of the carotenoid family, whose strong anti-oxidant properties have been hypothesised to assist in the prevention and treatment of BPH and prostate cancer. The aim of this systematic review was to examine the effectiveness of lycopene for the prevention and treatment of BPH and prostate cancer.

Methods

A search of the MEDLINE, EMBASE, AMED (Allied and Complementary Medicine) and the Cochrane Library databases was performed for published randomised controlled trials (RCTs) comparing lycopene to placebo (or other interventions) for the treatment of BPH and prostate cancer. All included studies were assessed for methodological quality using the Cochrane Collaboration's risk of bias tool.

Results

Eight RCTs met the inclusion criteria for this systematic review. All included studies were heterogeneous with respect to their design and implementation of lycopene. Methodological quality of three studies was assessed as posing a ‘high’ risk of bias, two a ‘low’ risk of bias and the remaining three an ‘unclear’ risk of bias. Meta-analysis of four studies identified no significant decrease in the incidence of BPH (RR (relative risk) = 0.95, 95%CI 0.63, 1.44) or prostate cancer diagnosis (RR = 0.92, 95%CI 0.66, 1.29) between men randomised to receive lycopene and the comparison group. Meta-analysis of two studies indicated a decrease in PSA levels in men diagnosed with prostate cancer, who received lycopene (MD (mean difference) = −1.58, 95%CI −2.61, −0.55).

Conclusions

Given the limited number of RCTs published, and the varying quality of existing studies, it is not possible to support, or refute, the use of lycopene for the prevention or treatment of BPH or prostate cancer.     

Anti-Leu 7 immunoreactivity with human tumours: its value in the diagnosis of prostatic adenocarcinoma

The reactivity of the anti-Leu 7 monoclonal antibody (Leu 7) was tested on 83 human tumours and on non-neoplastic prostatic, hepatic and pancreatic tissues. A four-step peroxidase-anti-peroxidase method was used on paraffin embedded tissues and we observed strong cytoplasmic positivity in all 19 primary prostatic tumours, in two metastatic, poorly differentiated prostatic adenocarcinomas, and in normal and hypertrophic prostatic epithelium. All the primary prostatic tumours also stained positively for prostate-specific antigen and for prostatic acid phosphatase using polyclonal antisera. The degree of positivity for these antigens varied from case to case. Adenocarcinomas arising from the gastrointestinal tract, pancreas and gallbladder were anti-Leu 7 negative. Focal Leu 7 positivity, largely confined to cell membranes, was observed in some ovarian, endometrial, renal, lung and breast adenocarcinomas. These tumours, as well as some of the gastrointestinal, hepatic and pancreatic tumours, also showed focal cytoplasmic positivity for prostate-specific antigen and prostatic acid phosphatase. Our findings suggest that the anti-Leu 7 monoclonal antibody is a marker that may facilitate the detection of metastatic prostatic adenocarcinoma, especially when used in conjunction with staining for prostate-specific antigen.     

子宫内膜样腺癌组织中PRRX1蛋白的表达及临床意义

目的探讨配对相关同源框1(paired related homoeobox 1,PRRX1)蛋白在子宫内膜样腺癌组织中的表达及临床意义。方法选取安徽医科大学第一附属医院以及安徽医科大学附属巢湖医院267例子宫内膜组织标本,其中正常子宫内膜86例,子宫内膜上皮内瘤变90例,子宫内膜样腺癌91例,均行免疫组化EliVision法检测,观察不同子宫内膜组织中PRRX1表达及子宫内膜样腺癌临床病理特征与PRRX1的关系。结果PRRX1蛋白表达主要定位于子宫内膜样腺癌组织的细胞核中,91例子宫内膜样腺癌组织中PRRX1阳性率为79.1%,高于正常子宫内膜组织(0)、子宫内膜上皮内瘤变组织(10.0%),差异有统计学意义(P<0.05)。子宫内膜样腺癌患者按FIGO分级分类,FIGO1级的PRRX1阳性率低于FIGO 2、3级,差异有统计学意义(P<0.05);按患者年龄、临床分期、有无淋巴结转移分组,PRRX1阳性率差异均无统计学意义(P>0.05)。结论子宫内膜样腺癌组织中的PRRX1表达量高,且与FIGO分级相关。     

转录因子Snail及黏附分子E-cadherin在胃癌中的表达及意义

目的探讨转录因子Snail及黏附分子E—cadherin在胃癌中的表达及意义。方法采用免疫组化sP法检测96例胃癌组织和80例癌旁组织中Snail、E—cadherin的表达,分析两者在不同组织类型与分化程度胃癌中的表达,以及与临床病理因素之间的关系。结果胃癌组织E—cadherin的阳性率（37．5％）显著低于癌旁组织（100％）（P〈0．05）,E—cadherin的表达与胃癌不同分化程度、组织学类型、浸润深度、淋巴结转移、临床分期及远处转移有关（P〈0．05）。胃癌组织Snail阳性率（83．3％）显著高于癌旁组织（41．25％）（P〈0．05）,Snail的表达与胃癌不同分化程度、组织学类型、浸润深度、淋巴结转移及远处转移有关（P〈0．05）。胃癌组织中E—cadherin与Snail的表达呈负相关（P〈0．05）。结论E—cadherin蛋白低表达与Snail蛋白高表达可能是胃黏膜恶性转变以及胃癌发生浸润转移的重要生物学标志。联合检测E—cadherin及Snail对预测胃癌浸润转移有重要意义。     

ALK protein expression in pulmonary adenocarcinoma of Tunisian patients

Background. It is now necessary to determine ALK status in order to use targeted therapy. Aim: herein, we assess immunohistochemical profile of ALK protein in a series of Tunisian patients with pulmonary adenocarcinoma.

Materials and Methods. ALK protein expression was studied applying the D5F3 antibody with a fully automated Ventana CDx technique on a series of 19 patients.

Results. Positive ALK expression was found in one case (5.2%) corresponding to a papillary adenocarcinoma which showed a strong granular and homogenous cytoplasmic staining. The patient was a 30-years-old woman.

Conclusion. The frequency of positive ALK expression based on immunohistochemistry in our series was similar to that reported in the world literature.     

Absence of serum prostate-specific antigen and loss of tissue immunoreactive prostatic markers in advanced prostatic adenocarcinoma after hormonal therapy: A report of two cases

We report two cases of advanced prostatic adenocarcinoma (PA) showing complete loss of three tissue immunoreactive prostatic markers, ie, prostate-specific antigen (PSA), prostatic acid phosphatase (PAP), and Leu-7 (CD57), with absence of elevated serum PSA level, despite tumor progression after hormonal therapy with or without radiotherapy. The pretreatment serum PAP in the first case and serum PAP and PSA in the second case were elevated. In both cases, the prostatic adenocarcinoma in the initial transurethral resection specimens showed positive immunoreactivity with three prostatic markers. After treatment, in both cases, the serum PSA were undetectable, and tumor cell immunostaining for three prostatic markers was negative. In addition, the posttreatment tumors in both cases showed increased number of tumor cells with neuroendocrine differentiation in comparison those in the pretreatment tumors. Although early PA without elevated serum level of PSA is common, advanced PA with absence of elevated serum PSA, associated with presence of tissue immunoreactive prostatic markers are rare. This is the first report of advanced prostatic adenocarcinomas showing loss of tumor cell prostate-specific markers with absence of elevated serum PSA level after hormonal therapy despite tumor progression.