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.
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).
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.
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 :
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  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