Prognostic significance of mast cells and vascular density in prostatic adenocarcinoma

Context: Though mast cells infiltrate solid tumors, the exact role of mast cells in tumor biology is controversial. Mast cell density (MCD) may vary depending on its location in the tumor and tumor vascularity. MCD may influence the tumor aggressiveness. Aims: This study evaluates MCD and tumor vascularity in different histopathological grades of adenocarcinoma prostate. Settings and Design: Descriptive study with purposive sampling. Methods and Material: The subjects of study were 42 adenocarcinoma patients. 20 cases were of intermediate grade (Gleason score 2–7) and 22 were of high-grade (Gleason score 8-10). Histological diagnosis was made by examining sections stained with hematoxylin and eosin. Additional sections from the same block were stained for mast cells using Giemsa stains as per standard protocol. Mast cell count was done in minimum six random high-power microscopy fields in four different regions- intratumoral, peritumoral, stromal and perivascular regions. Statistical Analysis Used: SSPS software version 13.0. Descriptive statistics, Student's t test and ANOVA test. Results: In high-grade adenocarcinoma, mast cell counts were higher in perilesional, stromal and perivascular regions, whereas it was lower in intralesional areas as compared to the intermediate grade. However, statistical significance was observed only for the perivascular region. There was significantly higher number of blood vessels in high-grade adenocarcinoma as compared to intermediate grade adenocarcinoma. Conclusions: In this study, perilesional mast cells and vascularity increased with increased severity of adenocarcinoma. These findings suggest a possible influence of mast cells on the tumor microenvironment such as vessel density and aggressiveness of tumor. However, further studies are required to substantiate results of this study.

Assessment of Utility of Immunohistochemical Marker Prostein for Evaluation of Primary and Metastatic Prostatic Carcinomas

Background: To assess utility of immunohistochemical marker prostein for evaluation of primary and metastatic prostatic carcinomas.Methods:Fifty- six samples of clinically suspected carcinoma prostate was included. Immunohistochemistry (IHC) was performed for assessment of Prostein (P501S). The intensity of positivity was scored from 0 to 3 as follows: score 0 = non-stained; score 1 = weak; score 2 = moderate; and score 3 = strong. The percentage of positively stained cells for each staining intensity was estimated in the respective lesions.Results:Age group 18-28 years comprised of 6 patients, 28-38 years had 12, 38- 48 years had 16 and >48 years had 22 cases. Type of cases were normal prostatic epithelium in 11, benign prostate hyperplasia in 23, HGPIN in 10, primary prostatic adenocarcinoma in 7 and metastatic prostatic adenocarcinoma in 5 cases. Prostein expression was seen in 100% in normal prostatic epithelium with intensity score of 1.8-2.1, benign prostate hyperplasia having 2-2.7, HGPIN with 2-2.3, primary prostatic adenocarcinoma having 1-1.6 and metastatic prostatic adenocarcinoma with 0.8-1.4 intensity score. Conclusion:Prostein is a new prostate specific marker which showed 100% sensitivity and specificity to identify normal and prostatic lesions.

Histopathological study of prostatic lesions in correlation with serum prostate specific antigen levels in elderly men

Background: Prostatic lesions are common among elderly men with urinary complaints. Variety of prostatic lesions range from inflammatory, benign to malignant pathologies. The Prostate specific antigen (PSA) is secreted by glandular epithelium of prostate shows raised serum levels in these pathologies. Usually significant rise is commonly associated with Prostatic adenocarcinomas (PCa) with exceptions.Methods: In this retrospective study, total 63 diagnosed cases of prostatic lesions over a one-year period for which serum PSA levels were available, were selected. Cases without serum PSA levels & inadequate biopsies were excluded. Histological diagnosis of prostatic lesions reconfirmed and its correlation with serum PSA was done.Results: Study included patients with mean age 67.84 years (range: 48-60) at the time of diagnosis. Benign lesions were commonest prostatic lesions accounting for total 54 cases (85.71%) out of which 38 were of Benign prostatic hyperplasia (BPH), 14 cases of BPH with prostatitis while single case each for BPH with granulomatous prostatitis and basal cell hyperplasia. Mean PSA value for benign lesions was 6.57 ng/ml. Total 8 were malignant which included 7 (11.11%) PCa while single (1.59%) case of metastatic transitional cell carcinoma. Mean PSA for PCa were 35.05 ng/ml. Single case (1.59%) of high grade prostatic intraepithelial neoplasia also detected.Conclusion: Common age group at the time of presentation of prostatic pathologies is 60-70 years. The most common prostatic lesions are benign predominantly BPH. PCa are commonest malignancies. Elevated PSA levels >20 ng/ml are commonly observed in PCa. However lower or normal values don’t rule out PCa.

Prostatic FNAC, Evaluation as a Diagnostic Tool and Correlation with Serum Prostate Specific Antigen.

BACKGROUND For proper diagnosis of prostatic diseases there are many investigations starting from per rectal examination, transurethral cystoscopy, fine needle aspiration cytology, six quadrants core biopsy, serum enzymes estimation like prostate specific antigen and acid phosphatase and ultrasound examination. Out of these, only FNAC and core biopsy prostatic tissue can be examined for final diagnosis. For examination of core biopsy, a complete histopathology set up is required with a trained technician but FNAC is a simple outpatient procedure where no trained technician is required. It requires only few reagents and a qualified pathologist. Since geriatric population is increasing day by day and prostatic adenocarcinoma is now second commonest malignancy in males, diagnosis is very important to reduce morbidity and mortality caused by this disease.METHODSThe study group consisted of 40 patients who presented with symptoms of obstructive uropathy and on DRE (Direct Rectal Examination) had prostatic enlargement. FNAC was done with Franzen canula using non aspiration technique and serum PSA was done by ELISA method. RESULTSAll the patients in our study were above 50 yrs. of age. Out of 40 cases 5 cases were of prostatitis they were mostly bellow 70 yrs. of age. 10 BHP and 25 prostatic adenocarcinomas. The carcinoma cases were almost all above the age of 70 yrs. BHP and carcinoma cases were correlated with histopathology whereas prostatitis cases were followed up clinically. Our sensitivity for benign lesion was 100% and for malignancy 92%. The serum PSA was up to 6.8 ng/ml in benign conditions and above 10 ng/ml in adenocarcinomas.CONCLUSIONSFNAC prostate is very sensitive and reliable diagnostic tool. It is painless OPD procedure without complications and can be done easily in any small setup, where facility of histopathology is not available. The procedure is well accepted by geriatric population due to its simplicity and being a painless OPD procedure. Serum PSA cannot be used as screening test for prostatic carcinoma but can be used for prognostic indicator.

Rectal Invasion by Prostatic Adenocarcinoma That Was Initially Diagnosed in a Rectal Polyp on Colonoscopy

Despite anatomical proximity, prostatic adenocarcinoma with rectal invasion is extremely rare. We present a case of rectal invasion by prostatic adenocarcinoma that was initially diagnosed from a rectal polyp biopsied on colonoscopy in a 69-year-old Korean man. He presented with dull anal pain and voiding discomfort for several days. Computed tomography revealed either prostatic adenocarcinoma with rectal invasion or rectal adenocarcinoma with prostatic invasion. His tumor marker profile showed normal prostate specific antigen (PSA) level and significantly elevated carcinoembryonic antigen level. Colonoscopy was performed, and a specimen was obtained from a round, 1.5 cm, sessile polyp that was 1.5 cm above the anal verge. Microscopically, glandular tumor structures infiltrated into the rectal mucosa and submucosa. Immunohistochemically, the tumor cells showed alpha-methylacyl-CoA-racemase positivity, PSA positivity, and caudal-related homeobox 2 negativity. The final diagnosis of the rectal polyp was consistent with prostatic adenocarcinoma. Here, we present a rare case that could have been misdiagnosed as rectal adenocarcinoma.

Differential Immunohistochemical Profiles for Distinguishing Prostate Carcinoma and Urothelial Carcinoma

BACKGROUND: The pathologic distinction between high-grade prostate adenocarcinoma (PAC) involving the urinary bladder and high-grade urothelial carcinoma (UC) infiltrating the prostate can be difficult. However, making this distinction is clinically important because of the different treatment modalities for these two entities. METHODS: A total of 249 patient cases (PAC, 111 cases; UC, 138 cases) collected between June 1995 and July 2009 at Seoul St. Mary's Hospital were studied. An immunohistochemical evaluation of prostatic markers (prostate-specific antigen [PSA], prostate-specific membrane antigen [PSMA], prostate acid phosphatase [PAP], P501s, NKX3.1, and α-methylacyl coenzyme A racemase [AMACR]) and urothelial markers (CK34βE12, p63, thrombomodulin, S100P, and GATA binding protein 3 [GATA3]) was performed using tissue microarrays from each tumor. RESULTS: The sensitivities of prostatic markers in PAC were 100% for PSA, 83.8% for PSMA, 91.9% for PAP, 93.7% for P501s, 88.3% for NKX 3.1, and 66.7% for AMACR. However, the urothelial markers CK34βE12, p63, thrombomodulin, S100P, and GATA3 were also positive in 1.8%, 0%, 0%, 3.6%, and 0% of PAC, respectively. The sensitivities of urothelial markers in UC were 75.4% for CK34βE12, 73.9% for p63, 45.7% for thrombomodulin, 22.5% for S100P, and 84.8% for GATA3. Conversely, the prostatic markers PSA, PSMA, PAP, P501s, NKX3.1, and AMACR were also positive in 9.4%, 0.7%, 18.8%, 0.7%, 0%, and 8.7% of UCs, respectively. CONCLUSIONS: Prostatic and urothelial markers, including PSA, NKX3.1, p63, thrombomodulin, and GATA3 are very useful for differentiating PAC from UC. The optimal combination of prostatic and urothelial markers could improve the ability to differentiate PAC from UC pathologically.

Adenocarcinoma de próstata de volumen mínimo: estudio de 12 casos en piezas de prostatectomía / Minimal volume prostatic adenocarcinoma: study of 12 cases in specimens of radical prostatectomy

Adenocarcinoma de volumen mínimo es aquella neoplasia menor de 0,5 cm³ en prostatectomía radicales. Son tumores de pronóstico excelente, generalemente ógano-confinados y totalmente resecados. Seleccionamos 12 casos de adenocarcinoma con un volumen de 0,5 cm³ en piezas de prostatectomias radicales. El promedio de edades fue 60,55 años. Los tumores eran órgano-confinados y el Gleason osciló entre 5 y 9. El promedio del diámetro tumoral fue 4,9 mm y del volumen fue 0,129 cm³. Las biopsias por punción fueron revisadas en 9 de los 12 pacientes. En ellas el porcentaje tumoral ocupaba entre 3% y 30% de la totalidad de la biopsia. Consideramos que para el diagnóstico del adenocarcinoma de volumen mínimo en la pieza de prostatectomía radical se debe estudiar la totalidad del espécimen en forma sistemática, ya que el diagnóstico de carcinoma de volumen mínimo en la biopsia por punción puede no corresponder con un tumor menor de 0,5 cm³ en la prostatectomía radical

Minimal volume prostactic adenocarcinoma is defined as a neoplasia less than 0.5 cm³ in radical prostatectomy. These are tumors of excellent prognosis, generally organ confined, and totally resected. We selected 12 cases of adenocarcinoma with less than 0.5 cm³ in volumen in specimens of radical prostatectomy. The average age was 60.55 years. Tumors were organ-confined and the Gleason score rangel from 5 to 9. The average tumor diameter was 4.9 mm and volume was 0.129 cm³. Needle biopsies were studied in 9 out of 12 patients. In these, the tumor percentage in biopsy was from 3% to 30%. We consider that for the diagnosis of a minimal volume adenocarcinoma in the specimen of radical prostatectomy, the specimen must be totally and systematically submitted and studied, since the diagnosis of minimal volume carcinoma in the core biopsy might not correspond with a tumor of less than 0.5 cm³ in the radical prostatectomy

Nonspecific granulomatous prostatitis with prostatic adenocarcinoma.

Granulomatous prostatitis is an infrequently seen entity in routine practice. One of its most common subtypes is nonspecific granulomatous prostatitis (NSGP), the etiology of which is still under debate. Such cases may be mistaken for adenocarcinoma clinically and radiologically. Histological resemblance to adenocarcinoma may arise when there is a xanthogranulomatous pattern or a prominence of epithelioid histiocytes. However, NSGP may rarely coexist with adenocarcinoma and it is critical to sample these cases thoroughly to exclude the presence of malignancy.

Mucin production in prostatic adenocarcinoma: A retrospective study of 51 radical prostatectomy specimens in Thai population.

Background: Intraluminal and extracellular acid mucin secretion is one of the ancillary findings of prostate adenocarcinoma and can aid in diagnosis. Objective: To determine the actual frequency and percentage of acid mucin production in prostatic adenocarcinoma from radical prostatectomy specimens at the Department of Pathology, Siriraj Hospital. Methods: This is a retrospective study of 51 cases of radical prostatectomy with diagnosis of prostatic adenocarcinoma at the Department of Pathology, Siriraj Hospital from January to March 2008. Results: Forty-nine cases (96%) of these prostatic adenocarcinomas showed positive mucicarmine stain. Among these, 24 (47.1%) cases were graded as Gleason score (GS) 7; 12 (23.5%) cases as GS 9; 8 (15.7%) cases as GS 6; 4 (7.8%) cases as GS 8, and 1 (1.9%) case as GS 5. Two cases (3.8%) without mucin production were gradeda as GS 7 and 9. Conclusion: Intraluminal acid mucin is one of the useful ancillary findings in diagnosing prostatic adenocarcinoma, particularly when combined with other architectural and cytological findings. The high frequency and percentage of actual acid mucin production in prostatic adenocarcinoma studied in radical prostatectomy can be applied to a questionable positive core biopsy with confidence.

Parenchymal Brain Metastasis from Prostate Adenocarcinoma

No abstract available.

Parenchymal Brain Metastasis from Prostate Adenocarcinoma

No abstract available.

Rastreamento do adenocarcinoma prostático em voluntários de uma região da bahia: resultados preliminares

The objective of the study was to assess the prevalence of the prostate adenocarcinoma in volunteers, between 40 and 80 years of age, from a northeastern region of Brazil. All volunteers were submitted to a digital rectal examination and total PSA blood level determination. A total of 499 men were evaluated. Prostatic biopsy guided by transrectal ultrasound (5 cores/ lobe) was indicated to those with PSA higher than 2ng/ml and/or prostatic changes on the DRE. Biopsies were carried out in 120 of 135 men that filled those criteria. Prostate adenocarcinoma was found in 24 volunteers corresponding to 5.1% of the sample. Such prevalence seems higher than that reported for men living in the southeastern area of the country. Differences might be a consequence of racial or environmental factors, but it is not possible to rule out other factors such as a methodological bias.

O estudo teve como objetivo a determinação da prevalência do adenocarcinoma prostático em uma amostra de voluntários entre 40 e 80 anos de idade de uma região nordestina. Os voluntários foram recrutados da comunidade e submetidos ao toque retal e à dosagem do PSA total. Compareceram 499 homens para essa avaliação inicial. Aqueles com PSA maior que 2ng/ml e/ou toque retal suspeito tiveram a biópsia indicada. De 135 homens com indicação de biópsia, 120 compareceram para o exame. A biópsia guiada por ultra-som consistiu da retirada de 10 fragmentos (5/lobo). O adenocarcinoma prostático foi encontrado em 24 voluntários, o que corresponde a 5,1% dos casos. Essa prevalência parece mais elevada que a observada em voluntários da região sudeste do país. A diferença pode ser conseqüência de fatores genéticos ou ambientais, mas não se pode descartar outros fatores como variações metodológicas.

Metástase cerebral como manifestação inicial de adenocarcinoma de próstata / Cerebral metastases as the first manifestation of prostatic adenocarcinoma

O acometimento do sistema nervoso central por neoplasia primária de próstata é raro. Cerca de 2% a 4% dos pacientes com adenocarcinoma de próstata disseminado apresentam metástases parenquimatosas para cérebro ou medula espinhal. A metástase cerebral por adenocarcinoma de próstata ocorre por disseminação hematogênica a distância, somenteapós comprometimento dos ossos e pulmões. Os autores descrevem dois casos de metástases cerebrais como manifestação inicial de adenocarcinoma de próstata, sem acometimento clínico de outros órgãos. Discutem sua via de disseminação e prognóstico. Sem dúvida, pode haver lesão em outros órgãos que não se manifestaram clinicamente e apresentam um péssimo prognóstico.

Intracranial metastases from adenocarcinoma of the prostate is rare. The incidence of metastatic prostatic cancer in the brain or spinal cord is approximately 2 to 4 percent in large series. Brain metastases tases from prostatic adenocarcinoma can be explained by distance hematogenic widespread after secundary focus in the bone or lung. The authors report two patients with intracranial metastases as the first manifestation of prostate cancer, with no symptoms in other sites.

Nerve sparing radical prostatectomy in an 18-year-old boy with localized poorly differentiated adenocarcinoma

Prostate cancer is predominantly a disease of the elderly male, with more than 75 percent diagnosed older than 65 years. Occurrence of the disease is uncommon in those less than 50 years of age and very rare in the adolescent. The case presented is an 18 year old male who went into urinary retention with associated significant weight loss and gross hematuria. Patient was diagnosed to have clinically localized prostate adenocarcinoma. He underwent radical prostatectomy. Based on literature search, this is the youngest reported case of prostatic adenocarcinoma in the Philippines, the 3rd youngest case in the world and the youngest case of localized prostate cancer who underwent radical prostatectomy. (Author)

Retrospective Study about Prognostic Significance of Gleason Score and PSA Change of Pre- and Post-treatment Period in Hormonally Treated Prostatic Adenocarcinoma / 대한비뇨기과학회지

PURPOSE: Gleason score is well known prognostic factor of prostatic cancer, Especially Gleason score above 8 measns poor prognosis. But in intermediate range(Gleason scorn 5-7), it does not provide useful information about the prognosis. Therefore, in the range of intermediate Gleason score, additional information such as PSA changes in pre and post treatment period may be helpful for predicting prognosis. In this study, we retrospectively evaluated relationship between prognosis and PSA change of pre and post hormonal treatment period in different Gleason score group(intermediate Gleason score group: 5-7/high Gleason score group: 8-10). MATERIALS AND METHODS: Total 42 patients who were diagnosed as stage D1, D2 prostatic cancer with Gleason score 5-10 were studied. All patients were treated by hormonal treatment(Orchiectomy or gonadotropin releasing hormone agonist) between May 1992 and May 1996 in Korea university. Mean follow-up duration was 18.9 months. And mean age of patients was 67.0+/-7.5 years. Patients were classified into two groups. One group was consisted of 28 patients whose Gleason score was 5-7 And in the other group, 14 patients with Gleason score above 8 were included. In each group, pre- treatment PSA, post-treatment nadir PSA, time for post-treatment PSA fall to nadir and time for PSA reelevation were analysed. Also In each group, expired and survived patients were analysed. All data was statistically processed by Exact Fisher's test and Mann-Whitney Rank Sum score. RESULTS: Mean Gleason score of total 42 patients was 7.1 +/-7.5. Mean pre-treatment PSA value of 42 patients was 146.9+/-222.6ng/ml and mean nadir PSA value after treatment was 8.2+/- 15.9ng/ml. The mean time for nadir PSA fall after treatment was 6.2+/-4.4 months and mean time for PSA reelevation was 13.3+/-9.9 months. 14 patients had Gleason score 8 or more and the other 28 patients had Gleason score 5-7. There was significant difference in mortality between patients with intermediate Gleason score(4/28 patients) and high Gleason score(7/14 patients, p=0.024). In patients with high Gleason score(8-10), there were no significant difference of pre-treatment PSA, post-treatment nadir PSA , duration for post-treatment PSA fall to nadir and time for PSA reelevation between survived and expired patients(p> 0.05). But in case with intermediate Gleason score range(5-7), expired patients had significantly higher post-treatment nadir PSA value than survived patients(19.8+/- 0.4ng/ml vs 7.3+/-4.2ng/ml respectively, p=9.036). But in both Gleason scone group, there was no mortality difference between patients with nadir PSA above 4ng/ml and below 4ng/ml. CONCLUSIONS: With these result, we concluded that patients with high Gleason score (especially 8 or more) had poor prognosis. And in patients with high Gleason score PSA change in pre and post-treatment period have no additional prognostic importance on Gleason score. But in patients with intermediate Gleason score(5-7), higher post treatment nadir PSA means poor prognosis. But conventionally used criteria of post-treatment PSA level below normal range(<4ng/ml) cannot discriminate between good and poor prognostic group in both high and intermediate Gleason score patients. So we think that in cases of patients with intermediate Gleason score(5-7), a physician must try to check up post-treatment PSA change(especially post-treatment nadir PSA) thronghly for early detection of tumor recurrence or progression.

The Change of Clinical Characteristics of Prostatic Cancer before and after the Introduction of Prostate Specific Antigen Assay / 대한비뇨기과학회지

OBJECTIVE: To evaluate the change of clinical characteristics of prostatic cancer after the introduction of PSA (Prostate specific antigen) assay and TRUS (Transrectal ultrasonography), we retrospectively reviewed the medical records of 155 patients with prostatic adenocarcinoma who were managed at Seoul National University Hospital from January 1985 to December 1994. MATERIALS AND METHODS: Patients were stratified into 2 groups (Group I: 45pts{1985-1989} and Group II: 110pts{1990-1994}) by the year 1990 when our hospital began to use PSA assay and TRUS to detect prostatic cancer. PSA was measured by monoclonal radioimmunometric assay (ELSA-PSA). Tumor staging consisted of DRE (digital rectal. examination), TRUS, CT, MRI, simple bone X-ray and radionuclide bone scan. Clinical characteristics of 2 groups were compared. RESULT: Proportion of younger pts increased in group II but this was not statistically significant (p>0.05 by chi-square test). Number of pts were annually increasing , especially after the year 1990 when PSA assay and TRUS were introduced into clinical practice. Despite use of PSA and TRUS, the number of clinically localized pts did not differ between 2 groups. There was no difference in distribution of chief complaints between 2 groups. There were 3 pts who were detected by increased PSA alone. CONCLUSION: Prostate cancer incidence is increasing and will substantially increase in the future on the basis of increasing tendency to the old population, improved cancer detection and improved public awareness. More than 70% of pts have metastases or regional extension (Stage C or D). These dismal statistics constitute the main reason for early detection programs in the population at large.

Prostatic Adenocarcinoma Presenting as an Abdominal Mass / 대한비뇨기과학회지

Adenocarcinomas comprise more than 95% of all prostatic malignancies and osseous metastases constitute the commonest form of hematogenous metastases. It is rare for a patient with a carcinoma of prostate to present with a huge abdominal mass. A few cases have been responded that sarcoma of prostate extended into the rectum or pelvic cavity, but prostatic adenocarcinoma has small volume than sarcoma and its invasion into the rectum is reported rarely. We report a case of 69-year-old man who had a huge prostatic adenocarcinoma, invaded into the lower abdominal cavity.

The Value of PSA as a Molecular Predictor of Bony Metastasis in Prostatic Cancer / 대한비뇨기과학회지

To evaluate the correlation between serum PSA(prostate specific antigen) levels and bone metastasis and to identify better criteria for the selection of appropriate candidates for bone scan, we reviewed the medical records of 53 patients with prostatic adenocarcinoma who were managed at Seoul National University Hospital from January 1990 to December 1993. PSA was measured by monoclonal radioimmunometric assay.(ELSA PSA) Histologic grade, tumor stage as well as status of metastasis were compared with the level of PSA. We stratified bony lesions which were evaluated with bone scan into extent of disease(EOD). The PSA level increased as tumor stage increased but this was not statistically significant. There was positive correlation between the PSA level and Gleason sum. The mean value of PSA in the group of non-metastasis was 106.2ng/ml compared to 711.8ng/ml in the group with metastasis. This was statistically significant. There was no correlation between the PSA level and extent of disease but PSA levels of EOD 1 group was significantly lower than those of remaining group. When we stratified patients with bony metastasis according to the PSA level, only 1 of 13 patients with PSA of 20ng/ml or less had bony metastasis. Its negative predictive value was 92.3%. In conclusion, patients with PSA of 20ng/ml or less are not likely to have bony metastasis. Further large-scaled prospective study is needed to determine the predictability of PSA for bony metastases more accurately.

The Significance of Proliferating Cell Nuclear Antigen(PCNA) and Nucleolar Organizer Regions(NORs) in Prostatic Adenocarcinoma / 대한비뇨기과학회지

Cell kinetic information is an important adjunct to histologically-based tumor classification. Studies on growth regulation and cellular transformation will be assisted by the identification of proteins that are synthesized in dividing cells. Proliferating cell nuclear antigen(PCNA) also known as cyclin, is a cell cycle-related nuclear protein that is maximally elevated in late G1 and S phases of proliferating cells. PCNA reacts with proliferating cells including tumor cells but gives undetectable immunofluorescence with resting cells of normal tissue. NORs are loop of DNA which occur in nucleoli and possess ribosomal DNA genes. Ribosomal DNA genes are of vital significance in the ultimate synthesis of protein, and that protein associated with NORs are stained with silver nitrate(Ag-NORs). AgNORs were studied in various tumors and may reflect the activity of cells and may be an indicator of the degree of malignancy. To evaluate the correlation between cellular proliferating activity and variable prognostic parameters, an immunohistochemical staining for PCNA and silver nitrate staining of NORs were performed in 23 cases of prostatic adenocarcinoma and 10 cases of benign prostatic hyperplasia, as control. The results were summarized as follows; 1. The mean expression of PCNA in BPH, well, moderately and poorly differentiated adenocarcinoma was 8.17+/-2.77(mean+/-SD ;n = 10), 21.75+/-6.11(n = 6), 19.40+/-6.98 (n=10) 27.93+/-8.23%(n=7), respectively in each group. Statistically significant differences were found in each group (p <0.05) except between well and moderately differentiated adenocarcinoma. 2. The mean number of Ag-NORs in BPH, well, moderately and poorly differentiated adenocarcinoma was 1.24+/-0.10(mean+/-SD;n=10), 1.87+/-0.23(n=6), 2.08+/-0.28(n=10) 4.02+/-0.22 (n = 7), respectively in each group. As the grade of tissues increased, the mean number of Ag-NORs increased too. The results showed statistically significant differences in each group (p < 0.05) except between well and moderately differentiated adenocarcinoma. 3. The mean area of Ag-NORs calculated by morphometry in BPH, well, moderately and poorly differentiated adenocarcinoma was 5.40+/-1.8um2, 7.84+/-3.68um2, 14.02+/-4.95um2, 23.9+/-6.94um2, respectively and significant differences was found statistically in each group (p < 0.05 ). 4. There was significant correlation between the expression of PCNA and the number of AgNORs(r= 0.800, p= 0.0001), the expression of PCNA and the area of AgNORs (r=0.788, p=0.0001). We concluded that the expression of PCNA and the number and area of NORs were increased with the degree of malignancy and may reflect the proliferative activity of cells in prostatic adenocarcinoma. PCNA and Ag-NORs may be a valuable prognostic indicator of patient's survival, but further studies will be needed to confirm its exact prognostic role.

Flow cytometric DNA ploidy and proliferating cell nuclear antigen in prostatic adenocarcinoma / 대한비뇨기과학회지

Clinical significance of flow cytometric DNA ploidy and proliferating cell nuclear anrigen (PCNA) was evaluated in terms of clinical stage. histological grade and tumor markers. using the materials obtained from paraffin embedded blocks of 47 patients with prostatic adenocarcinoma. The incidence of DNA aneuploidy in total population was 51.1 %. Although no significant correlation between histological grade or clinical stage and DNA ploidy pattern was demonstrated, the frequency or aneuploidy was shown to increase as the poorer the histological grade and the higher the clinical stage. All patients in aneuploidy group and 66.7% of the patients in diploidy group had PSA levels of more than 4ng/ml, and 57.1% of those in aneuploidy group and 50% of those in diploidy group had PAP levels of more than 3.2ng/mI. Overall, the difference in survival curves for diploidy and aneuploidy group was not significant. But. in patients of stage D with intermediate histological grade, the survival difference between diploid and aneuploidy tumors was obvious. The PCNA related proliferating index was significantly increased with the progression of the clinical stage. And the proliferating index was inversely related to the degree of glandular differentiation. but without statistical significance. Although proliferating index of prostatic adenocarcinoma didn`t have any significant correlation with the survival, the statistically significant difference was shown in survival between PCNA score+/-group and PCNA score + to +++ group.