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PATHOMORPHOLOGICAL FEATURES OF PROSTATE CANCER
Boimuminov Nodirbek Iskandar ugli
Kashkadarya branch of the Republican Specialized Center of Oncology and
Radiology of Scientific and Applied Medicine
https://doi.org/10.5281/zenodo.13365635
According to the World Health Organization, in 2018, 1.3 million new
cases of prostate cancer (PC) diagnosis and 359 thousand deaths due to this
disease were registered, in connection with which PC was the second most
common malignant neoplasm and the fifth leading cause of death in men
worldwide [4; 8]. Improvement of diagnostic methods and the availability of an
algorithm for screening patients increases the frequency of early diagnosis, thus,
the percentage of cases with stage I-II of the disease from 2011 to 2021
increased from 47.7% to 60.7%. However, the detection rate of stage IV prostate
cancer remains quite significant (22% of all cases of the disease), which causes a
high mortality rate - within the first year from the moment of diagnosis, the
mortality rate is 6.5%. In addition, a relapse often develops after radical surgical
treatment [3].
In 70% of cases, prostate carcinoma is localized in its peripheral zone
(usually in the posterior part of the gland, which allows palpating the tumor
during a digital rectal examination). It is characteristic that on a section of the
gland, the tumor tissue is granular and dense. If the tumor is located in the
thickness of the prostate tissue, it is poorly visualized, but is easier to detect by
palpation. With local spread, periprostatic tissue, seminal vesicles and the base
of the bladder are usually affected, which in advanced forms of the disease can
lead to urethral obstruction. Metastases initially spread through the lymphatic
vessels to the level of the obturator lymph nodes and reach the para-aortic
lymph nodes. Hematogenous dissemination occurs mainly to bone, especially
the axial skeleton, but in some cases massive dissemination to viscera has been
observed (rather the exception than the rule). Bone metastases are usually
osteoblastic and, when found in men, strongly suggest prostate cancer. The
lumbar spine is most commonly affected, followed in decreasing order of
frequency by the proximal femur, pelvic bones, thoracic spine, and ribs.
Histologically, most prostate tumors are adenocarcinomas, which are
characterized by the presence of well-defined, easily identifiable glandular
structures [5]. The tumor glands are usually smaller in size and lined by a single
layer of cuboidal cells or low columnar epithelial cells. The tumor glands are
located closer to each other and characteristically lack ramifications or papillary
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invaginations. The tumor glands lack the outer basal layer characteristic of
glands of the normal organ. The cytoplasm of tumor cells varies from dull-light,
characteristic of cells of unchanged glands, to distinctly amphophilic. The nuclei
are large and often contain one or more large nucleoli. Some differences in the
size of the nuclei and their shape are observed, but in general pleomorphism is
not very pronounced. Mitotic figures are not characteristic. The problem of
cancer diagnosis is not only in the insufficient amount of tissue obtained during
needle biopsy for histological examination, but also in the fact that often biopsy
samples contain only a few tumor glands among many normal ones.
Pathological diagnosis of prostate cancer is also difficult because the signs of
malignancy can be subtle, which increases the likelihood of a false negative
result. There are also many benign processes that mimic malignancy, which can
also lead to misdiagnosis. Although there are several histological features
specific for prostate cancer, such as perineural invasion, the diagnosis is made
with a combination of tissue, cellular and some additional features. As noted
earlier, the main distinguishing feature of a benign process in the prostate gland
is the presence of basal layer cells, while their absence indicates prostate cancer
[4]. Pathologists exploit this feature by using immunohistological markers to
identify basal layer cells.
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