prostate tumor pathology

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I- Anatomy of the prostate :

McNeal distinguished in prostate :
→ 4 zones glandulaires: Central Zone (25%), Transition Zone (5%) and Zone Device: 70%
→ Stroma Fibro-Muscular Previous (SFMAJ.

II- normal histology channels and acini :

2 seated cell lining the acini and ducts:
– seat inner cell (glandular), to’origin of adenocarcinomas.
– seat outer cell (basic) labeled immunohistochemistry : P63 positively and negatively to the P504S III prostate pathology :

1- nodular prostatic hyperplasia : adenomyoma

dystrophic injury, representing most of the benign pathology of the prostate

  • Macroscopie : Increase in the volume of the gland between 30 and 60 gr, rarely > 200gr. Farm Consistency, often elastic. The cutting: heterogeneous appearance, nodular and cystic microphone, lactescent (appearance of bread).
  • Microscopy :

a- adenomatous hyperplasia : characterized by a predominance of the epithelial element; always with presence of basal cells (P63 +)

The light of the acini is often occupied by thick secretions : sympexions body or starch

b- hyperplasia leiomyomateuse : Rare, consists only of smooth muscle bundles

c- hyperplasia fîbromyomateuse : fibroblastic component is predominant and muscle

d- fibrous hyperplasia frequently contains vascular branches +- plentiful.

2- Prostate cancer :

  • In 85% it is an adenocarcinoma.

a- Role of the pathologist :

  • Cancer diagnosis of metastatic prostate
  • Diagnosis of localized cancer : sure :

– adenomectomy : This is stage Tla and Tlb (s’observe dans 10 % of cases)
– Chips resection (Hrituf) 2%
– Biopsy : driven by an abnormality of the SI and / or abnormal PSA

  • Establish histoprognostic factors

b- histological prostate carcinoma :

Prostate cancer is multicentric

The malignancy diagnosis is placed under the microscope to the combination of several criteria :
→ Proliferation tubes with loss of architecture. invasiveness, existence of a fibrous stroma.
→ Signs minimum level tubes : absence of basal cells (p63-), voluminous nucleoli, secretion abnormality.

c- factors histoprognostic :

1- Le grading de Gleason : includes 5 increasing dedifferentiation grades

→ this classification is based on 2 principles :
– The architectural abnormalities are retained without evaluating cytologic abnormalities.
– the chosen grade is not the most pejorative but most abundantly represented.

→ Gleason score is the sum of 2 grades (3+4=7). When the tumor is homogeneous the existing grade is doubled (3+3=6)

Architectural criteria of Gleason grade defined low magnification.

Prostatic Adenocarcinoma (Histologic Grades)

Established by Gleason 1966, first amended in 2005 then a second time by Epstein 2014 as groups 5 grades :
Grades 1 and 2 : very well-differentiated carcinoma
Grade 3 : Carcinoma moderately differentiated
Grade 4 : carcinoma poorly differentiated
Grade 5 : undifferentiated carcinoma

Grade 1 : exceptional, currently considered adenosis. he s’acts of’a monotonous proliferation of rounded simple glands, closely grouped normal size, lined with’a single layer of clear cells, forming a well rounded nodules, although limited at low magnification. Occurs essentially at the transition area

Grade 2 : Proliferation rounded simple glands, dispersed different size. The tumor foci are loosely rounded poorly defined.

Siege of choice :Transition Zone, found on resection chips +++ Rare but on biopsies.

Grade 3 : Neoplastic tubes are round

evenly spaced and relatively uniform size

Grade 4 : Proliferation disorganized glands merged and infiltrating.. Aspect cribriforme

Grade 5 : Undifferentiated carcinoma makes Beaches or independent cells, Beddingplant filled with necrotic centers (comédocarcinome) Or spans of independent cells

NB/ * bleachers 3,4 and 5 are the most common of the peripheral zone
* bleachers 4 and 5 are the most aggressive and the most extensive

2- prognostic value of the Gleason score :

  • Grade 3 (3+3) : increased mortality 20 %
  • Grade 4 : increased mortality 80 %
  • the degree of volume 4-5 is the best indicator of tumor progression.

3- Gleason Changes brought by J’ISUP en 2014 and approved by the’WHO 2016
Grade group 1 (Gleason score 6)
Grade group 2 (Gleason score 3 + 4 = 7)
Grade group 3 (Gleason score 4 + 3 = 7)
Grade group 4 (Gleason score 4 + 4 = 8; 3 + 5 = 8; 5 + 3 = 8)
Grade group 5 (Gleason scores 9-10)

d- Diagnostic immuno-histochimique :

We should use 2 antibody : one to mark the basal cells (P63) and a second mark for tumor cells (P504s).

Results :
P63 (-), P504s (+) : cancer
P63 (+), P504s (-) : benign
P63 (+), P504s (+] : intraepithelial neoplasia Prostate

NB / always have an internal or external indicator to judge the reliability of the immunohistochemical technology.

e- Prostate cancer precursor lesions :

  • PIN (prostatic intraepithelial neoplasia epithelial: refers atypical cell proliferations developed within channels or prostatic acini.
  • This is’a pre-invasive stage of prostate cancer. Prevalence of PIN lesions increases with age ; Above the age of cancer onset 5 years
  • We distinguish two groups : low grade and high grade
  • It is now recognized association PIN High grade prostatic carcinoma in which the interests of their recognition.

histological :

Hyper basophilic glands lined with’epithelial proliferation or cells with cytonuclear abnormalities (l’root canal and acinar architecture is preserved)

f- WHO Classification backs prostate tumors 2016 :

WHO classification of tumours of the prostate

g- TNM classification 2010 :

1- clinical classification :

→ T : primary tumor
– T0 : No tumor
– T1 : tumor not palpable or visible by imaging non
+ T1A < 5 % of tissue resected[1] [2] and Gleason score 6
+ T1b > 5 % of tissue resected * Ebou Gleason 7
+ T1c : discovered by elevated PSA and biopsies
– T2 : Tumor confined to the prostate (apex and including capsule)
+ T2a : Achieving half a lobe or less
+ T2b : Achieved more than half of’a lobe without involvement of the’other lobe
+ T2c : Achievement of two lobes
– T3 : Extending beyond the capsule
+ T3a : extracapsular extension
+ T3b : Extension to the seminal vesicles
– T4 : Extension to adjacent organs (urethral sphincter, rectum, pelvic wall) or fixed tumor
→ N : regional lymph nodes
– Nx : unevaluated regional lymph nodes
– N0 : lymph node metastasis of Absence
– N1 : lymph node involvement(s) regional(s)
– N1mi : lymph node metastasis < 0,2 cm
→ M : Distant metastasis
– M0 : No distant metastasis
– M1 : Distant metastasis
+ M1a : non-regional nodes
+ M1b : The
+ M1c : other websites

2- Classification anatomopathologique (pTNM)

→ pT0 : No identified tumor following prostatectomy
→ pT2 : Tumor confined to the prostate (apex and including capsule)
– pt2 : Achieving half a lobe or less
– pT2b : Achieved more than half of’a lobe without involvement of the’other lobe
– pT2c : Achievement of two lobes
→ pT3 : Extending beyond the capsule
– T3a : Extension extracapsular united- or bilateral including the bladder neck
– T3b : Extension to the seminal vesicles (uni- or bilateral)
→ T4 : Extension to adjacent organs (urethral sphincter externe, rectum, musdes levers of the’anus, pelvic wall)

3- R : postoperative residual tumor

L’absence or presence of’a tumor residue after total prostatectomy (surgical margins) is described in U ICC dassification (International Union against Cancer) to’using the R symbol. The margins after radical prostatectomy are coded as follows :
→ Rx : not evaluated
→ R0 : No macroscopic or microscopic tumoral residue
→ R 1 : microscopic residual (focal or extended to specify). It is then said the pathology report the length of the margin, which is a prognostic factor recognized
R2 → : Macroscopic remainder

Dr K's course. Benabaddou – Faculty of Constantine