药物去势治疗后前列腺癌骨转移灶的组织病理变化

目的 了解药物去势治疗后前列腺癌骨转移灶的组织变化。方法 对7例前列腺及骨转移灶穿刺结果阳性的前列腺癌骨转移患者采用药物去势治疗，对比观察原发肿瘤和骨转移灶组织去势前后变化。结果 7例治疗后2个月前列腺肿物消失。5例PSA在2个月内恢复至正常水平，其中2例因脊髓压迫症状行骨科手术，骨病灶病理检查发现腺泡型癌细胞消失，肿瘤骨小梁数量减少，免疫组化PSA染色阴性。2例局部骨灶进行性发展者行骨病灶切除，病灶处组织学检查发现腺泡型癌细胞，其中夹杂大量的肿瘤样骨组织，免疫组化PSA染色阳性。PSA及影像学检查见有与骨灶局部改变相对应的表现。结论 去势治疗可使前列腺及骨转移灶的肿瘤细胞部分或全部消失，PSA及影像学检查可表现出骨转移灶的相应变化，并为治疗提供确切依据。

Histopathological features of bone metastases from prostatic carcinoma after castration

Objective To understand the histologic changes of prostatic carcinoma's bone metastases and other associated observations,and to provide histopathological basis for clinical therapy. Methods Seven patients with prostatic carcinoma bone metastases,whose needle biopsy of prostate and bone metastases was positive,were treated by hormone castrative therapy.The changes of prostatic primary carcinoma,bone metastases and correlated examinations were observed,and the results were compared with those before treatment. Results The prostatic tumors of 7 patients disappeared in 2 months after treatment.The prostate specific antigen (PSA) level of 5 patients returned to normal within 2 months.Two patients had orthopedics surgery because of spinal epidural compression symptom,and their pathologic examination of bone metastases showed that the transparent cells disappeared,the number of tumor bone trabecula reduced and immunohistochemical stains of PSA was negative.Another 2 patients had bone excision because of the development of bone metastases.Transparent acinose cells,mixed with many tumor-like bone tissues,could be found in the focus,with immunohistochemical stains being positive compatible with the changes of focal bone,PSA and imageology examination showed corresponding results. Conclusions Castration therapy can make carcinoma cells of the prostate and bone metastases,partially or completely,disappear.However,part of bone metastases changes may not be consistent with those of primary carcinoma.PSA and imageology examination may show the correlated changes of bone metastases,and provide exact basis for the clinical treatment.