WHO-前列腺癌少见组织学类型介绍课件.pptx

1、 WHO 前列腺癌少见组织学类型介绍第4次编辑、21个国家、110位作者，600多幅图表，3000多条参考文献主要涵盖了国际泌尿病理协会（ISUP）近十年来提出的关于泌尿生殖各器官病理诊断的共识和进展。1.膀胱非浸润性尿路上皮肿瘤的分类和演进2.对新增的肾细胞癌类型的认识和分类3.前列腺和肾脏肿瘤规范化的取材、诊断和病理报告的一系列共识意见。4.前列腺癌 Gleason 评分的分级和新分组5.新增前列腺腺癌亚型6.免疫组化以及分子遗传学检测在泌尿男性生殖系统肿瘤的病理诊断和治疗以及预后评估中的作用 2014版 2004版atrophic-microcystic variantatrophic-

2、microcystic variant萎缩性腺癌(伴萎缩特征的前列腺腺癌）散发、放疗后、激素治疗后 穿刺活检腺癌2%；Pca RP 16%常与普通腺癌并存 Cytoplasmic volume loss 类似萎缩腺体，但呈浸润性生长,常为 Gleason 3 核变扁平，核仁可不突出 AMACR（+）70%，P63/HCK（-）与预后无明显关联 Diagnostic CriteriaDiagnostic Criteria1)Infiltrative growth pattern2)Macronucleoli3)Presence of adjacent non-atrophic cancer萎缩性

3、腺癌与前列腺萎缩形态学类似单纯性萎缩基底细胞存在萎缩性癌，下图示 部分基底细胞消失炎性萎缩是前列腺腺癌的癌前病变？炎性萎缩是前列腺腺癌的癌前病变？-尚未达成共识尚未达成共识正方观点：两者共存 通常都在外周带 前列腺萎缩伴炎症时KI-67增加 炎症已被证实能够诱导肿瘤转化 萎缩的腔缘分泌细胞呈现不成熟表型（ARPSAPSAP弱表达）基因改变类似前列腺腺癌或HGPIN(x染色体 70%，AR突变30%,8P22 21%，GSTP1甲基化6%等）反方观点：文献1 100例男性尸检的前列腺外周带。文献2 202例前列腺活检病例，8年随访。文献3 前列腺腺癌和HGPIN中存在TMPRSS2-ERG基因融

4、合，前列腺萎缩中不存在此基因的融合。均提示萎缩与癌、PIN无关。1.Billis A.prostatic atrophy:an autopsy study of a histologic Mimic of adenocarcinoma.Mod pathol 1998;11(1):47-542.Kaleem Z;et al.Prostatic adenocarcinoma with atrophic features:a study of 202 consecutive completely embedded radical prostatectomy specimens.American Jo

5、urnal Of Clinical Pathology 1998.3.Perner S,Mosquera JM.et al TMPRSS2-ERG fusion prostate cancer:an early mocular event associated with invasion.AM J Surg Pathol 2002;52(4):27-287microcystic variantmicrocystic variant微囊型前列腺腺癌Pca RP 11%Intermediate gland size (10 x usual small acinar Pca)Cystic dilat

6、ation;round profile,flat luminal layer Cytoplasmic volume loss(cystic atrophy-like)AMACR（+），P63/HCK（-）Gleason 3Gleason4+3 Pseudohyperplastic variantPseudohyperplastic variant 假增生型前列腺腺癌 PZ or TZ Pca RP:often with small acinar Pca Needle biopsy:may predominant BPH-like:nodular;luminal cell hyperplasia

7、,undulations,papillary infoldings,branching Round nuclei,prominent nucleoli;AMACR（+）77%，P63/HCK（-）Gleason 3 Prognosis may be favorable HOXB13 G84E-related familial Pca(transcription factor of homeobox gene family,locus 17q21-22)前列腺增生前列腺增生foamy gland variantfoamy gland variant 泡沫腺腺癌 Seen in 16-22%of

8、acinar Pca Rarely pure：0.2-2%patient age and PSA similar to non-foamy ca Abundant foamy（xanthomatous）cytoplasm Pyknotic nuclei,nucleoli usually not prominent;Nucleoli may be prominent in higher grade(GS 7,16%;GS7,52%)Desmoplasia in GS=7 cases GS 7(60%),6(32%),9-10(5%),8(3%)AMACR（+），P63/HCK（-）CD68(-)

9、TMPRSS2-ERG:29%;ERG-IHC(+):42%Prognosis similar to non-foamy ca Partial Atrophy:The most common mimicker of prostate cancer on needle biopsyPartial Atrophy in Prostate Needle Cores:Another diagnostic pitfall for the surgical pathologist.Oppenheimer&Epstein(AJSP 1998)透明细胞型的部分萎缩腺体，极易误诊为泡沫细胞癌 signet ri

10、ng-like cell variantsignet ring-like cell variant 印戒细胞样前列腺腺癌 25%or more signet ring-like cells Not common 30 in 100 000 Pcas Gleason 5 AMACR(+),PSA(+)Major DD:GI/urothelial tract ca invasion/metastases Prognosis poor:29 months mean survival 不是真正的印戒细胞癌，只是细胞内空泡，没有粘液 印戒细胞样前列腺腺癌PSA (+)印戒细胞样前列腺腺癌-容易误诊前列腺

11、炎症激素治疗后的前列腺腺癌mucinous/colloid variant mucinous/colloid variant 粘液腺癌/胶样癌 25%or more areas with extracellular mucin pool Rare:0.2%Pca Diagnosis by RP Biopsy:Pca with mucinous features GS 7 or 8(ignore mucin!)PSA(+),P63(-),ERG(+/-),CDX2（-）Major DD:GI/urothelial tract ca invasion/metastases Prognosis ma

12、y be better than originally considered pleomorphic giantcellvanriantpleomorphic giantcellvanriant 多形性巨细胞癌 Lacking spindle cell component Very rare:10 cases Some with prior history of RT/HT treatment of Pca Admixed with GS 9 Pca Occasionally with other types(DC,SCC,NEC)focally PSA(+)50%,AE1/AE3(+),CA

13、M5.2(+)Major DD:metastases,sarcomatoid ca,osteoclast-like giant cells,trophoblastic giant cells Prognosis poor sarcomatoid variantsarcomatoid variant肉瘤样癌（癌肉瘤）Biphasic:epithelial(usually high GS Pca)and mesenchymal(spindle cell or heterologous)component (same clonal origin)older man(68)50%with prior

14、history of RT/HT treatment of Pca Epithelial:PSA(+),P63(-)DD:STUMP/PSS,other mesenchumal tumors Prognosis poor 2014版 2004版one case:(住院号1290166）男、67岁，夜尿增多1个半月，血尿1个月余入院。原单位B超：左肾囊肿，膀胱内偏高回声，前列腺增生。我院B超：膀胱占位性病变，前列腺肿瘤。MRI：前列腺占位，癌可能。血清PSA 1.22ng/ml 前列腺穿刺病理：左叶前列腺腺癌，Gleason5+4 膀胱三角区活检病理：高级别尿路上皮癌 术中所见：膀胱三角区菜花状

15、肿块1*1CM,行膀胱+前列腺根治术术后病理：术后病理：大导管，筛状 大导管，筛状 伴坏死P504s(+)PSA(-)其他尿路上皮标记：P63(-),34BE12（-）诊断：前列腺导管腺癌，筛状型为主 Cribriform DA前列腺导管腺癌前列腺导管腺癌 Ductal adenocarcinoma,DA Often periurethral 定义:Large glands,tall pseudostratified columnar cancer cells 亚型：Papillary,Cribriform,Solid PSA(+),PSMA(+),AMACR(+),P63(-)TMPRSS2

16、-ERG:11%;ERG-IHC(+):38%3.2%of Pca;pure DA 0.2-0.4%;DA-AA:1-5%血清PSA常升高,但可不明显 易转移；预后较差 Papillary Papillary DADA其他少见前列腺导管腺癌其他少见前列腺导管腺癌其他少见前列腺导管腺癌其他少见前列腺导管腺癌前列腺尿路上皮癌前列腺尿路上皮癌 男、80岁，排尿困难5天，血尿2天入院。CT、MRI：前列腺多发结节，膀胱壁弥漫增厚（提示慢性膀胱炎）血清PSA 2.7ng/ml 34BE12+其他P63+PSA-前列腺穿刺：特点：年龄大 累及尿道周围导管及腺泡 继发性多于原发性 PSA不高 高级别癌 激素治疗无效，预后差总结：少见前列腺腺泡癌 导管癌 尿路上皮癌 萎缩型 经典型（宫内膜样型）微囊型 筛状型 假增生型 乳头状型 印戒样细胞型 实性型 粘液型 泡沫状腺癌 多形巨细胞型 肉瘤样型 Thanks!