adenocarcinoma of the prostate, bone metastases ICD-10: C61, C79.5; ICD-O: 8140/3, 8140/6
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Mann, 78 J., Prostatektomie wegen Karzinom vor 6 Jahren, in letzter
Zeit Knochenschmerzen. Autopsiepräparat, Lumbalwirbel
- Stark vermehrte, netzartig angeordnete, unorganisierte, neugebildete
Knochenbälkchen, Markräume
unterschiedlich weit
- Im Markraum Tumorgewebe:
- Kleindrüsig (Drüsen
kleiner als normale Prostatadrüsen), hochdifferenziert
- Drüsenauskleidung einschichtig
- Drüsen liegen dos-à-dos, fast kein Stroma
- Kerne leicht vergrössert, wenig polymorph, hyperchromatisch
- Spärlich Mitosen
- Zwischen den Tumorzellsträngen neugebildete, reaktive Knochenbälkchen:
Osteoplastische Metastase (typisch für das Prostatakarzinom)
- Braunes Reaktionsprodukt im Zytoplasma der Tumorzellen: PSA. Diese
Reaktion erlaubt die Diagnose "Metastase eines Prostatakarzinoms".
Röntgen: Verdichtete Knochenstruktur
78-year-old male underwent radical prostatectomy six years prior to demise because of
cancer of the prostate. (Specimen from autopsy. Section of a lumbar vertebra is shown).
- The bone is infiltrated by an adenocarcinoma consisting of small, well formed glands, arranged back-to-back with hardly any
intervening stroma. The glands are lined by a uniform layer of cuboidal cells exhibiting slightly enlarged quite monomorphic
hyperchromatic nuclei. In some instances, distinct nucleoli are visible. Few mitotic figures are present. (Of note, the tumor
glands (Drüsen) are smaller than the typical glands of the prostate).
- In between glands, a high number of newly formed bone spicules (Knochenbälkchen) are present (osteoblastic metastasis). The latter form
unorganized net-like structures, surrounding different sized marrow spaces which are packed with tumor glands.
- The cytoplasm of the tumor cells stains positive for prostate-specific antigen (PSA), allowing identification of the tissue
of origin of the malignant glands.
Osteoblastic metastases are typically observed in cancer of the prostate. The X-ray correlate is the increased radiopacity of the sclerotic bone lesions.