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目的探讨前列腺非典型腺瘤样增生(AAH)的病理形态学特征和鉴别诊断。方法收集AAH标本12例,应用光镜、免疫组化EliVisionTMPlus二步法,检测34βE12、p63、P504S、PSA和PSAP抗体,观察其病理形态和免疫组化特点。结果 12例AAH均来自良性前列腺增生手术切除标本,12例腺泡均呈结节状增生,增生的腺泡排列紊乱、结构完整,基底细胞难以辨别,需要与高分化腺癌的腺泡鉴别。其中8例由大小基本一致的中、小腺泡构成,4例腺泡大小不均;11例腺泡呈低乳头状结构,5例伴有前列腺萎缩后增生。免疫组化显示,增生的腺泡边缘34βE12或p63均呈(+),P504S均(-);其中5例基底细胞基本完整,7例断续存在。结论 AAH是较少见的前列腺瘤样病变,易误诊为前列腺高分化腺癌。基底细胞标记物34βE12、p63和癌性上皮标记物P504S联合应用对AAH的诊断具有实际应用价值。
Objective To investigate the pathological features and differential diagnosis of atypical adenomatous hyperplasia (AAH) in the prostate. Methods 12 cases of AAH specimens were collected. The antibodies of 34βE12, p63, P504S, PSA and PSAP were detected by light microscopy and immunohistochemical EliVisionTMPlus two-step method. The pathological features and immunohistochemistry were observed. Results All 12 cases of AAH were from benign prostatic hyperplasia surgically resected specimens. All of the 12 acini showed nodular hyperplasia, hyperplastic acinus arranged disorder, the structure was intact, basal cells were indistinguishable, and acinar differentiation with well differentiated adenocarcinoma was required. Among them, 8 cases were composed of medium and small acini with the same size and 4 cases with uneven size of acini; 11 cases with low papillary structure, and 5 cases with prostatic atrophy and hyperplasia. Immunohistochemistry showed that 34βE12 or p63 in the edge of hyperplastic acinus showed (+) and P504S (-) respectively. Five basal cells were basically intact and 7 were intermittent. Conclusion AAH is a rare prostate tumor-like lesions, often misdiagnosed as benign prostatic hyperplasia adenocarcinoma. Basal cell markers 34βE12, p63 and cancer marker P504S combined application of the diagnosis of AAH has practical value.