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 & rsquo; 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. it s & rsquo; d & rsquo acts; a monotonous proliferation of rounded simple glands, closely grouped normal size, lined & rsquo; 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 made by J & rsquo; ISUP 2014 and approved by the & rsquo; 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 & rsquo; invasive pre Stage 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.
Glands hyper basophils lined & rsquo; epithelial proliferation or cells exhibit abnormal cytonuclear (l & rsquo; ductal 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 : Reaching more than half of d & rsquo; a lobe without involvement of the & rsquo; 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 : Reaching more than half of d & rsquo; a lobe without involvement of the & rsquo; 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 bullpen of & rsquo; anus, pelvic wall)
3- R : postoperative residual tumor
L & rsquo; absence or presence of & rsquo; a residual tumor after radical prostatectomy (surgical margins) is described in U ICC dassification (International Union against Cancer) to & rsquo; using the symbol R. 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