Arista-Nasr J, Gómez-Bustamante D, Aguilar-Magaña FA, Saqui-Salces M, Martínez-Benítez B

Language: Spanish
References: 23
Page: 88-93
PDF size: 253.40 Kb.

ABSTRACT

Introduction. Detailed revision of prostate biopsies with benign alterations may show potentially malignant lesions limited to isolated fields, which may be overviewed in routine analysis. Aim. To exam the morphological alterations in patients with suspicious of prostatic carcinoma and benign diagnosis in needle biopsies Materials and methods. During 2000-2001, one hundred consecutive patients with first prostate biopsy diagnosed as benign were included. Biopsies were performed by sextants or modified sextants technique. Slides were reviewed by two observers with knowledge of original diagnosis and this was accepted or modified in accordance to the findings found during the review. Results. Patients age ranged between 57 and 79 years old. Nine per cent of biopsies originally diagnosed as benign revealed different potentially malignant lesions, which should be noted due to possible association with carcinoma. In this group, there were five biopsies with atypical small acinar proliferation, three with few isolated glands with xanthomatous cytoplasm, and one with scarce atypical cells in the prostatic stroma. In contrast with Caucasian and Afro-American population, frequency of high grade intraepithelial neoplasia in needle biopsy seems to be very low and this lesion was not found in any of the 100 biopsies reviewed. Some lesions that simulate carcinoma, as atypical basal cell hyperplasia, post-atrophic hyperplasia, and adenosis were diagnosed as benign, and there was none false positive result. Conclusions. A small but significant group of the biopsies originally diagnosed as benign lesions, showed atypical lesions in isolated fields that were overlooked in the routine analysis. It is necessary the urologist to ask for a directed review of the biopsies if clinical and laboratory data strongly suggest prostatic carcinoma. Additional histological cuts, immunohistochemical studies and more than one observer may increase the frequency of detection of potentially malignant lesions.

REFERENCES

1. Bostwick DG, Quian J. High-grade prostatic intraepithelial neoplasia. Mod Pathol 2004; 17: 360-79.

2. Prostate biopsy interpretation. Third edition. Biopsy Interpretation Series. Epstein JI, Ximing JY. Lippincott, Williams & Wilkins; 2002.

3. Srigley JR. Benign mimickers of prostatic adenocarcinoma. Mod Pathol 2004; 17: 328-48.

4. Bignardi P. Prostatic carcinoma of xanthomatous type and metaplasia of similar type in the prostate. Arch de Vecchi Anat Patol 1961; 35: 645-61.

5. Schindler S, Usman NI, Yoko H. Foamy gland carcinoma. Am J Surg Pathol 1997; 21: 616-18.

6. Nelson RS, Epstein JI. Prostatic carcinoma with abundant xanthomatous cytoplasm. Am J Surg Pathol 1996; 20: 419-26.

7. Berman DM, Yang J, Epstein JI. Foamy gland high-grade prostatic intraepithelial neoplasia. Am J Surg Pathol 2000; 24: 140-4.

8. Llarena IR, Lecumberri CD, Padilla NJ, Crespo AV. Foamy carcinoma of the prostate. Arch Esp Urol 2003; 56: 833-5.

9. Tran TT, Segupta E, Yang XJ. Prostatic foamy gland carcinoma with aggressive behavior: clinicopathologic, immunohistochemical, and ultra structural analysis. Am J Surg Pathol 2001; 25: 618-23.

10. Sakr WA, Grignon DJ, Haas GP, Heilburn LK, Pontes JE, Crissman JD. Age and racial distribution of prostatic intraepithelial neoplasia. Eur Urol 1996; 30: 138-44.

11. Prostate cancer in the African American: is this a different disease? Semin Urol Oncol 1998; 16: 221-6.

12. Sakr Wa, Grignon DJ, Haas GP. Pathology of premalignant lesions and carcinoma of the prostate in African-American men. Semin Urol Oncol 1998; 16: 214-20.

13. Shirley SE, Escoffery CT, L.A. Clinicopathological features of prostate cancer in Jamaican men. BJU Int 2002; 89: 390-6.

14. Algaba F. Evolution of isolated high-grade prostate intraepithelial neoplasia in a Mediterranean patient population. Eur Urol 1999; 35: 496-7.

15. Carver BS, Bozeman CB, Simoneaux WJ, Venable DD, et al. Race is not a predictor of prostate cancer detection on repeat prostate biopsy. J Urol 2004; 172; 1853-5.

16. Lam JS, Desasai M, Mansukhani MM, Benson MC, Goluboff ET. Is Hispanic race an independent risk factor for pathological stage in patients undergoing radical prostatectomy? J Urol 2003; 170: 2288-91.

17. Whiteman HR. Atypical small acinar proliferations. Hum Pathol 1999; 30: 1403-4.

18. Helpap B. Suspicious acinar proliferations of the prostate. Verh Dtsch Ges Pathol 1999; 83: 162-7.

19. Helpap B. Differential diagnosis of glandular proliferations in the prostate. A conventional and immunohistochemical approach. Virchows Arch 1998; 433: 397-405.

20. Helpap B, Kollerman J. Limiting the diagnosis of atypical small glandular proliferations in needle biopsies of the prostate by the use of immunohistochemistry. J Pathol 2001; 193: 350-3.

21. Epstein JI. Adenosis (atypical adenomatous hyperplasia): histopathology and relationship to carcinoma. Pathol Res Pract 1995; 191: 888-98.

22. Gaudin PB, Epstein JI. Adenosis of the prostate. Histologic features in needle biopsy specimens. Am J Surg Pathol 1995; 19: 737-47.

23. Arista-Nasr J, Keirns C. The focus of “atypical glands, suspicious for malignancy” in prostatic needle biopsy specimens. Am J Clin Pathol 1998; 110: 408-9.