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Therapieinduzierte Tumorregression des Prostatakarzinoms

Therapy induced regressive changes of prostate cancer

  • Schwerpunkt: Tumorregression
  • Published:
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Zusammenfassung

Therapieinduzierte histomorphologische Alterationen stellen eine große diagnostische Herausforderung in der Befundung von Prostatagewebe dar.

Typische Veränderungen nach antihormoneller Therapie im benignen Prostatagewebe sind eine glanduläre Atrophie, eine Prominenz und/oder eine Hyperplasie der Basalzellen sowie eine stromale Hyperzellularität. Charakteristische Veränderungen des vorbehandelte Prostatakarzinoms auf zellulärer Ebene sind ein klarzelliges Zytoplasma, z. T. mit Vakuolisierungen, Kernpyknosen, vereinzelt auch komplette Zelluntergänge. Auf histoarchitektonischer Ebene findet sich ein Kontinuum an glandulärem Strukturverlust. Das Spektrum reicht von histologisch unberührt wirkenden Tumoren bis hin zu im Stroma versprengten apoptotischen Tumoreinzelzellen. Generell kommt es zu einer glandulären Atrophie und dadurch bedingt subjektiv zu einem erhöhten interglandulären Stromaanteil.

Das Wissen um diese spezifischen morphologischen Alterationen, der gezielte Einsatz ergänzender immunhistochemischer Untersuchungen sowie die gründliche histologische Aufarbeitung der Operationspräparate sind essenziell für die korrekte histologische Befundung und die Beantwortung der von der Klinik gestellten Fragen.

Abstract

Regressive changes following pretreatment of prostate cancer may represent a big challenge for the histopathologist not familiar with the assessment of pretreated specimens. Characteristic changes after antiandrogen therapy in non-malignant prostate tissue include glandular atrophy, basal cell prominence and/or basal cell hyperplasia as well as a hypercellular stroma. Morphologic changes in prostate cancer include cytoplasmic clearing and vacuolization, nuclear pyknosis and even complete cell destruction. On the glandular level, changes are characterized by various degrees of involutional changes, ranging from almost non-regressive tumor glands to complete glandular disruption with scatterd isolated tumor cells dispersed in the stroma.

Knowledge about these changes, the selective use of immunohistochemistry as well as a very thorough histological workup is essential for the correct assessment of these specimens.

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Authors and Affiliations

  1. Institut für Pathologie, Hegau-Klinikum, Akademisches Lehrkrankenhaus der Universität Freiburg, Singen

    B. Helpap

  2. Klinik für Urologie und Kinderurologie, Klinikum Fulda, Akademisches Lehrkrankenhaus der Universität Marburg, Fulda

    J. Köllermann

  3. Institut für Pathologie, Hegau-Klinikum, PO-Box 720, 78207, Singen

    B. Helpap

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  1. B. Helpap
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Correspondence to B. Helpap.

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Helpap, B., Köllermann, J. Therapieinduzierte Tumorregression des Prostatakarzinoms. Pathologe 25, 461–468 (2004). https://doi.org/10.1007/s00292-004-0708-3

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  • DOI: https://doi.org/10.1007/s00292-004-0708-3

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