ZNAČAJ PERIACINUSNIH PUKOTINA KAO POMOĆNOG KRITERIJUMA U DIJAGNOZI ADENOKARCINOMA PROSTATE GLEASON SCORE-A 7 (3+4) I GLEASON SCORE-A 7 (4+3) I NJIHOV ODNOS PREMA PARAMETRIMA OD PREDIKTIVNOG ZNAČAJA
Dijagnostikovanje različitih patohistoloških promena u prostati u najvećem broju slučajeva bazira se na sigurnim benignim, odnosno malignim karakteristikama. Periacinusne pukotine (PP) spadaju u pomoćne dijagnostičke kriterijume i opisuju se kao nesigurne maligne karakteristike. Na osnovu prisusutva i obima PP, pregledanih na velikom mikroskopskom povećanju (400x), žlezde su svrstane u 3 grupe: grupa 1–žlezde bez periacinarnih pukotina ili kod kojih su periacinarne pukotine prisutne u ≤50% žlezdane cirkumferencije; grupa 2–žlezde sa periacinarnim pukotinama prisutnim u >50% žlezdane cirkumferencije, a nalaze se u <50% prisutnih žlezda i grupa 3-žlezde sa periacinarnim pukotinama prisutnim u >50% žlezdane cirkumferencije, a nalaze se u ≥50% prisutnih žlezda. Cilj našeg rada bio je da se utvrdi značaj prisustva PP u adenokarcinomu prostate (ADKP) Gleason score-a 7(3+4) i 7(4+3) i da se korelacionom analizom njihovog odnosa prema parametrima od prediktivnog značaja (preoperativne vrednosti serumskog prostata specifičnog antigena, tumorski volumen, klinički stadijum i stepen fokalne neuroendokrine diferencijacije) utvrdi postojanje razlike u njihovoj pojavi u navedenim ADKP. Istraživanje je obuhvatilo 33 ADKP Gleason score-a 7, odnosno 26 (78,79%) ADKP 7(3+4) i 7 (21,21%) ADKP 7(4+3). Kod ADKP Gleason 7(3+4) periacinusne pukotine se češće javljaju kod tumora koji su manji, bolje diferentovani (stvaraju više PSA), koji se dijagnostikuju u manje uznapredovalim kliničkim stadijumima i koji pokazuju manji stepen fokalne neuroendokrine diferencijacije. Kod ADKP Gleason 7(4+3) periacinusne pukotine se češće javljaju kod tumora kod kojih se stvara manja količina serumskog PSA (slabije diferentovani) i kod tumora koji su dijagnostikovani u uznapredovalim kliničkim stadijumima. Periacinusne pukotine predstavljaju češći nalaz kod adenokarcinoma prostate Gleason score-a 7(4+3) koji imaju goru prognozu, što PP svrstava u red važnih pomoćnih kriterijuma za dijagnozu adenokarcinoma prostate.
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