Prostatın Benign, Premalıgn Ve Malign Lezyonlarında; Proliferatif Aktivite, Anjiyogenezis, Bazal Membran Ve Apoptozis’in İmmunohistokimyasal Ve Histopatolojik Olarak Değerlendirilmesi

Prostat karsinomu (PK) erkeklerde görülen en yaygın karsinomdur. Kanserden ölüm nedenleri içerisinde, akciğer karsinomundan sonra ikinci sırada yer almaktadır. Son yıllarda tanımlanan prostatik intraepitelial neoplazi (PİN), prostat karsinomunun öncül lezyonları arasında yer almaktadır. Prostat karsinomunda tanı zorluğu oluşturan PİN’in, prostat karsinomu ve benign prostat hiperplazilerinden (BPH) ayrımı önemlidir. Bu çalışmada, PIN’in BPH ve prostat karsinomu olgularında, Ki-67, CD31 ve Laminin immünreaktiviteleri ve apoptozis indeksinin ayırıcı tanıdaki yerinin araştırılması amaçlandı. Atatürk Üniversitesi Tıp Fakültesi Patoloji Anabilim Dalı laboratuarında 1991 – 2001 yılları arasında tanı konan 50 prostat adenokarsinomu, 50 prostatik intraepitelial neoplazi ve 50 benign prostat hiperplazisi olmak üzere 150 olguya ait örnekler çalışmaya alındı. Olgulardan elde edilen parafin kesitlere immunohistokimyasal yöntemle Ki-67, CD31, Laminin uygulandı. Ayrıca apoptotik indeksi değerlendirmek için aynı olgulara ait parafin bloklardan hemotoksilen-eozin boyalı kesitler hazırlandı. Ki-67 için nükleer koyu kahverengi boyanma, CD31 için stoplazmik endotelial hücrelerin boyanması ve Laminin için ise gland epiteli altındaki bazal membrandaki kesintisiz lineer boyanma pozitif olarak kabul edildi. Ki-67 immunreaktivitesi, prostat karsinomunda en yüksek ve BPH’da en düşüktü. Ayrıca prostat karsinomu olgularında Ki-67 immunreaktivitesi, PIN olgularından anlamlı derecede yüksek iken (p<0.001), PİN ile BPH arasında p<0.05 düzeyindeydi. CD31 immunreaktivitesi ve apoptotik indeks açısından bakıldığında, değerler en yüksek olarak prostat karsinomunda ve en düşük olarak ta BPH’ta izlendi. Gruplar kendi içerisinde CD31 ve apoptotik indeks açısından karşılaştırıldığında, prostat karsinomunun hem PIN (p<0.001) hem de BPH’tan (p<0.001) anlamlı derecede yüksek olduğu izlendi. Laminin immunreaktivitesinin değerlendirilmesinde ise BPH ile PIN grupları arasında anlamlı bir fark yokken (p>0.05), prostat karsinomu hem PIN hem de BPH olgularından anlamlı derecede yüksek değerlere sahipti (p<0.001). Sonuç olarak, PİN’in PK ve BPH’dan ayrımında Ki-67, CD31 ve apoptotik indeksin faydalı olabileceği kanısına varıldı. Laminin’in ise PK’nun, BPH ve PİN olgularından ayrımında faydalı olabileceği fakat BPH ile PİN olgularının ayrımda aynı faydayı sağlamayacağı kanısına varıldı.

Anahtar Kelimeler:

Prostat, Anjiyogenezis, Ki-67, CD31 ve Laminin

Histopathological And Immunohistochemical Evaluation Of The Proliferative Activity, Angiogenesis, Basement Membrane And Apoptosis In Benign, Premalignant And Malignant Lesions Of The Prostate

Prostate carcinoma (PC) is the most common malignancy among males and it is the second most common cause of death due to cancer (after lung cancer) in men. Prostatic intraepithelial neoplasia (PIN) is a premalignant lesion described recently. The differentiation of PIN from BPH or PC is important. In this study, it was aimed to investigate the place of Ki-67, CD31, Laminin immunoreactivities and apoptotic index in the differentiation of PIN (accepted as a precursor lesion of PC) from BPH or PC. A total of 150 specimens (50 PC, 50 PIN and 50 BPH cases) which were evaluated and diagnosed in the Department of Pathology, Medical Faculty, Ataturk University between 1991– 2001 were included in the study. Ki-67, CD31 and Laminin were applied to the paraffin sections with immunohistochemical method. Additionally H&E stained sections were prepared from paraffin blocks from the same cases for the evaluation of apoptotic index. The staining was accepted as positive for Ki-67 if dark-brown stained nucleus is present, for CD31 if cytoplasms of endothelial cells are stained, and for Laminin if continuous linear staining of basal membrane under the prostatic glandular epithelium is observed.Ki-67 immunoreactivity was the highest in PC group and the lowest in the BPH group. Moreover, while Ki-67immunoreactivity was significantly higher in PC group than in PIN group (p<0.001), the difference between PIN and BPH was p<0.05. Both CD31 immunoreactivity and apoptotoic index were found to be the highest in PC group and the lowest in BPH group. In the comparison of groups, PC group had higher CD31 immunoreactivity and apoptotic index values than in both PIN (p<0.001) and BPH (p<0.001) did. As a conclusion, it was suggested that Ki-67, CD31 immunoreactivities and apoptotic index were useful in the differentiation of PIN from BPH and PC. For Laminin, although it may be useful in the differentiation of PIN from PC, it cannot be used for PIN – BPH differentiation.

Keywords:

Prostat, Angiogenezis, Ki-67, CD31 and Laminin,

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