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Carcinoma and dysplastic lesions of the prostate

A histomorphological analysis of 50 total prostatectomies by step-section technique

Carcinom und Dysplastische Veränderungen der Prostata

Histomorphologische Analyse von 50 totalen Prostatektomiepräparaten mittels der Stufenschnittmethode

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Summary

50 prostate carcinomas which were totally prostatectomized together with removal of the seminal vesicles in all cases and pelvic lymphadenectomy in 38 cases were studied histologically. The material was cut by step-section technique in 5 mm thick slices and “large area slides” were made. 4 of the 50 carcinomas were morphologically circumscribed (stage I), 6 tumors were limited to the organ (stage II) and 40 prostate carcinomas had already penetrated the capsule, i.e. fascia of Denonvillier (stage III). In 12 cases the seminal vesicles were involved, regional lymph node metastases were seen 8 times. The carcinomas were mainly localized in the peripheral part of the organ (28 x in the periphery, 21 x both peripherally and centrally and only 1 x in the centre). Multifocal tumor growth was found in 30 cases (60%). The main mass of tumor was mostly situated in the middle (25 x) and caudal (15 x) zone of the prostate. During the course of tumor growth the expansion was directed centrally but then mainly longitudinal and parallel to the urethra. By progressing tumor volume there was a noticeable increase in capsular penetration as well as infiltration of the seminal vesicles and lymph node metastases. Histologically 10 carcinomas showed a uniform pattern, a unique solid and/or cribriform tumor architecture was never observed. 90% of the pluriform carcinomas consisted of the morphological stage III.

Other, non-malignant organ lesions such as hyperplasia (26 x)-subdivided in nodular, diffuse and atypical hyperplasia, atrophy and postatrophic hyperplasia (21 x), transitional cell metaplasia (21 x) and inflammatory process (31 x) were often distinct. A certain number of these changes, especially the group of atypical hyperplasia (19 cases), are suggested to be dysplastic on account of their unusual proliferation manner, cellular atypia and disintegration of the morphological unity between prostatic glands and fibromuscular stroma. The discussion that these lesions may be premalignant is based on their quantitative extension and their topographical relationship to the prostate carcinoma.

Zusammenfassung

50 totale Prostatektomiepräparate bei manifestem Carcinom mit Entfernung der Samenblasen und pelviner Lymphknoten (38 Fälle) wurden histologisch untersucht. Die Organe wurden mittels der Stufenschnitt-methode in 5 mm dicke Horizontalscheiben zerlegt und in Großflächenschnitten aufgearbeitet. 4 der 50 Carcinome waren klein (Stadium I), 6 auf das Organ beschränkt (Stadium II); 40 mal fand sich mikroskopisch bereits ein Tumordurchbruch durch die Prostatakapsel (Stadium III). Von diesen Fällen zeigten 12 eine Infiltration der Samenblasen, 8 eine Metastasierung in die Lymphknoten. Die Carcinome waren bevorzugt in peripheren Zonen der Prostata lokalisiert (28 mal peripher, 21 mal peripher und zentral, 1 mal zentral). Multifokale Carcinomherde wurden in 30 Fällen (60%) beobachtet. Die Tumorhauptmasse fand sich zumeist im mittleren (25 mal) und caudalen Organdrittel (15mal). Die intraprostatische Tumorausbreitung war durch eine zentrale und vor allem caudocraniale Wachstumsrichtung parallel zum Verlauf der Urethra gekennzeichnet. Bei großen Tumorvolumina waren auch zentrale, periurethrale Organzonen befallen; zudem stieg die Frequenz des Kapseldurchbruchs und gleichzeitig die Zahl der Samenblaseninfiltration und Lymphknotenmetastasen an. Histologisch waren 10 Carcinome uniform glandulär strukturiert, ein alleiniges solides und/oder cribriformes Muster gab es nicht. In 90% der pluriform gebauten Carcinome lag ein morphologisches Stadium III vor. Von den übrigen Organveränderungen waren die benigne Hyperplasie 26mal, die Atrophie und postatrophische Metaplasie 21mal, die urotheliale Metaplasie 21 mal und entzündliche Infiltrate 31 mal deutlich ausgeprägt. Unter allen diesen Alterationen, insbesondere aber aus der Gruppe der atypischen Hyperplasie (19mal) fand sich eine bestimmte Anzahl von Drüsenläsionen, die aufgrund der cytologischen Atypie, des ungewöhnlichen Proliferationsmusters und der Desintegration der morphologischen Einheit zwischen Drüsenepithel und umgebendem Organstroma als Dysplasien definiert wurden. Ihr quantitatives Ausmaß und die räumliche Beziehung zum Carcinom waren ausschlaggebend für die Diskussion als eventuell prämaligne Veränderungen.

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Supported by the foundation: „Hamburger Gesellschaft zur Förderung der Krebsbekämpfung“

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Kastendieck, H., Altenähr, E., Hüsselmann, H. et al. Carcinoma and dysplastic lesions of the prostate. Z. Krebsforsch. 88, 33–54 (1976). https://doi.org/10.1007/BF00284745

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Key words

  • Prostate
  • Carcinoma
  • Dysplasia
  • Histomorphology
  • Prostatectomy