The dangerous prostatic intraepithelial neoplasia?

intraepithelial neoplasia

Official statistics registers annually 10 million cases of cancer in the world, with 30% of malignant tumors are virusozavisimymi, t. E. tumors have an increased risk of developing high or in the presence of viral infections in the body.

In the structure of oncological morbidity of the population of St. Petersburg virusozavisimye tumors account for men 40%, women 30%. In recent years, it shows the relationship of HPV dysplasia and squamous cervical carcinoma (Gaidukov S. N. and etc.

, 2004), as well as skin cancer, head and neck (Safronnikova N. R. V. Merabishvili M., 2005).

In addition to manifestations of a clinically-defined PVI emit more latent and subclinical infection form, and HPV-associated diseases (Handlley Y. et al., 1994). They are inherently considered as intraepithelial neoplasia of various degrees of severity. So, Bosch F. et al.

(2002) showed that more than half of women with anogenital warts are cervical intraepithelial neoplasia (CIN I-III). In foreign literature commonly used name intraepitelialnaya cervical neoplasia (cervical intraepithelial neoplasia - CIN) of varying severity.

All of these options are combined pathology called intraepithelial neoplasia (LN) or squamous intraepithelial lesions (squamous intraepithelial lesions - SIL). It should be noted, that CIN I (CINI) is synonymous with the more familiar to Russian readers the term "mild dysplasia".

CIN II (CIN II) corresponds to the "moderate dysplasia". CIN III (CIN III) is used to refer to as "severe dysplasia" and predinvazivnoy carcinoma (Table. 5, 6).

In addition to the concepts of cervical intraepithelial neoplasia (CIN) are found in foreign literature and the terms «vulvar intraepithelial neoplasia (VIN)», «penile intraepithelial neoplasia (PIN)» (Ludicke F. et al, 2001).

Inverted (or endophytic) warts in many respects identical to flat warts, however, they have the ability psevdoinvazivnogo penetration into the underlying stroma or into the holes glands. Endophytic warts have many morphological features resembling carcinoma in situ, with which they may be associated.

Cytological marker HPV infection is the detection koylotsitov. Koylotsity - squamous cells of surface or intermediate layers having pronounced bleaching zone around the nucleus, the so-called "perinuclear halo". Its origin is connected with partial necrosis of the cytoplasm perinuclear zone as a result of the cytopathic effect.

On the periphery of the necrotic areas are concentrated cytoplasmic fibrils, which leads to a drastic limitation of the perinuclear zone. The initial manifestations of HPV lesions are characterized by having individual vacuoles in the perinuclear region. The term "koylotsitarnaya dysplasia" was introduced StegnerH.S. (1981).

Some authors have noted the presence of so-called "stamped vacuoles" in koylotsitah "ballonizatsiyu cytoplasm." For HPV detection characteristic of epithelial cells with varying degrees of keratinization and dual-core and multicore cells.

Furthermore koylotsitarnoy atypia manifestations of HPV infection is acanthosis, proliferation of basal cells, metaplasia, hyper-, para-, dyskeratosis superficial layers of the epithelium, the presence of mitosis.

All this diversity complicates the clinical classification of the disease. In 1994 J. Handley and W. Dismure based on their own experience and literature data classification proposed clinical forms of HPV infection and its associated diseases (Handlley Y.

et al., 1994). It is to some extent arbitrary and schematic, but in general allows to present a complete picture of the clinical manifestations of this pathology. Table. 5 shows the classification of the forms anogenital PVI.

It identifies the different clinical forms, visible or invisible to the naked eye. Subclinical asymptomatic, are detected only when colposcopy or cytological, histological studies.

Latent forms are characterized otsustvie changes recorded on cytological and histological levels.

Table 5. Manifestations of anogenital HPV infection (Handlley J., Dinsmore W., 1994)

Features of a current	forms of expression
clinical forms	Warts (genital warts, flat warts, vulgar warts)
Symptomatic HV (CIN, VIN, PIN) in the early stages - koilocytosis, dyskeratosis, in the absence of dysplasia (flat warts)
subclinical forms	Asymptomatic HV (CIN, VIN, PIN) in the early stages koilocytosis, dyskeratosis in the absence of dysplasia
latent forms	The absence of morphological or histological changes. Detection of human papillomavirus DNA

There are some difficulties identifying classical HPV infection occurring in the form of benign lesions (flat warts, subclinical form of the disease).

Typically, when the lesions associated with HPV only, with a marked acanthosis characteristic dyskaryosis less than when dysplasia with co-infection when the expression koylotsitarnoy atypia with an increase of dysplastic processes decreases.

In the case of malignancy appear following features: pleomorphism, anaplasia cell elements, the appearance immature epithelial cells with classical signs of malignancy (basophils, increasing core content atypical chromatin).

Found specific morphological change when Bowenoid papulleze: in this case there is giperparakeratoz, granulosa, vacuolation of keratinocytes in combination with acanthosis, inflammatory infiltrates in the dermis. The epidermis is showing signs of atypia, abnormal mitosis and keratinocytes with hyperchromatic nuclei. In epithelial cells and dermal papilla melanophages pigment is melanin.

There are some difficulties identifying classical HPV infection occurring in the form of benign lesions (flat warts, subclinical form of the disease).

Typically, when the lesions associated with HPV only, with a marked acanthosis characteristic dyskaryosis less than when dysplasia with co-infection when the expression koylotsitarnoy atypia with an increase of dysplastic processes decreases.

In the case of malignancy appear following features: pleomorphism, anaplasia cell elements, the appearance immature epithelial cells with classical signs of malignancy (basophils, increasing core content atypical chromatin).

Found specific morphological change when Bowenoid papulleze: in this case there is giperparakeratoz, granulosa, vacuolation of keratinocytes in combination with acanthosis, inflammatory infiltrates in the dermis. The epidermis is showing signs of atypia, abnormal mitosis and keratinocytes with hyperchromatic nuclei. In epithelial cells and dermal papilla melanophages pigment is melanin.

The role of combined HPV and herpes infections in malignant transformation of cervical epithelium. It has been shown that approximately 15% of clinically healthy women infected with HPV, and therefore they are at risk.

When serological survey of women with cervical cancer (CC) 2-3-th stage revealed a strong correlation between clinical diagnosis, and the presence of antibodies to HPV and HSV-1 but not found between tumor development and carriage HSV-1.

This confirms the view that the HPV carriage is not a sufficient condition for malignancy. An important role in the development of tumor processes as contributing factor is removed by the herpes virus.

In studying the effect of the genome of HSV-1 replication in HPV-18 and cell lines A431 Nega bearing genome of HPV-18, infected with HSV-1 virus is a virus. In the future, determined active stimulation of multiplication of the virus HPV-18.

Moreover, HSV-1 not only stimulated the HPV replication, but also contributed to the integration of its genome into the host cell genome, which is an important condition for malignant transformation (Y. Naga et al., 1997).

It should be noted the possible role of HSV-2 (in association with papilloma viruses, CMV, chlamydia and mycoplasma) in the development of neoplastic processes in humans, particularly cervical cancer and prostate cancer. It is believed that in the case of HSV-2 can act as a cofactor carcinogenesis initiating development of dysplasia and maintaining it in a state stabilization. It was concluded that a key role in the induction of tumor play an HPV-16, HPV-18 and HSV-2 in combination with additional factors, the nature of which is unclear and needs clarification (Dmitriev G. A. O. Bitkina A., 2006; Kiselev AND. et al., 2000).

Table 6. HPV-associated disease (Handlley J., Dinsmore W., 1994)

forms of the disease	stage of the disease	forms of expression
subclinical	Early BHI	Mild dysplasia can be koilocytosis, dyskeratosis
late VNII	Severe dysplasia can be koilocytosis, dyskeratosis
VNIII	Severe dysplasia or carcinoma in situ, can be koilocytosis, dyskeratosis
clinical	—	Micro-invasive squamous cell carcinoma

USE IN THERAPY CYCLOFERON PAPILLOMAVIRUSNOI INFECTION
Recommendations for doctors

A source: https://medi.ru/info/7716/

Analysis of the results of a biopsy of the prostate gland and rebiopsy circumferentially urology department of the Western Administrative District of Moscow for a three-year period

To date, prostate cancer (PCa) is one of the most important medical problems. This is due to the fact that prostate cancer is the most common solid tumor in Europe (as of 2004

, Calculated an incidence of 214,000 cases) and is superior in terms of the incidence of lung cancer and colorectal cancer [1]. In addition, prostate cancer is currently the second leading cause of death from cancer in men [2]. In Russia, the incidence of prostate cancer has been steadily increasing: in the period 1999-2009.

it increased from 15.69 to 38.41 per 100 thousand. population (+ 144.8%) and 10.7% of cancer incidence in the structure of the male population [3].

Widespread screening study of men for prostate cancer by determining the level of prostate-specific antigen (PSA) resulted in a significant increase in the number transrectal prostate biopsies - a method which is considered the "gold standard" for diagnosis of cancer Prostate. Prostate biopsies performed on appropriate indications and using the best methods, the doctor provides the necessary information about a patient precancerous lesions (prostatic intraepithelial neoplasia (PIN), a high degree), or cancer Prostate.

Furthermore, according to the prostate biopsy physician can determine the location and extent of tumors in biopsy specimens, the presence of perineural invasion or invasion of the prostate capsule, the step of differentiation of tumor cells (on scale gradation Gleason).

These indicators in conjunction with other clinical data allow to determine the stage (T) and the degree of risk disease progression and / or recurrence after radical prostatectomy or other therapeutic intervention.

Without this information it is impossible to choose the right method of treatment and to determine the strategy for the further management of the patient, and because interpretation of the results of prostate biopsy - one of the biggest challenges faced by those with experience in the field of urology and oncourology.

Fence material is mainly along the peripheral parts of the gland, which advantageously detected early forms of prostate cancer.

When transrectal biopsy needle goes back to front direction kosovertikalnom [4], wherein adjudged to biopsy large the number of hyperplastic tissue transition zones, the volume of withdrawn tissues at its peripheral zone substantially atrophy less.

Despite the fact that this method is considered the "gold standard" for the diagnosis of prostate cancer, the number of repeat biopsies is increasing. According to different authors, only 17-33% of biopsies were positive. [5]

Why is the low sensitivity "gold standard" diagnosis of prostate cancer? In many cases, the analysis of pathological study of biopsy revealed non-cancerous changes in the glandular epithelium associated with an increased risk of prostate cancer in the patient and in this regard, requiring re biopsy. These findings are alarming atypia c suspected adenocarcinoma or atypical proliferation melkoatsinarnaya (Atypical Small Acinar Proliferation, ASAP) and PIN. PIN The diagnosis is made when the biopsy found prostate acini and ducts which lined atypical cells, but is present intact basal layer that differs from the PIN adenocarcinoma. It is believed that the PIN - a precancerous condition that can have a high or low degree of neoplasia, depending on the severity of the observed spectrum and neoplastic changes.

Studies of past years have shown that IDUs are highly associated with a 27-65% ethyl risk of prostate cancer detection when rebiopsii [6], however, more modern works, including advanced data biopsies show that the risk is not so high and is approximately 10–20%. In accordance with the recommendations of the US National Comprehensive Cancer Service (National Comprehensive Cancer Network, NCCN), in case of a high degree after the PIN standard sextant biopsy (biopsy or with the number of samples less than 10) must be repeated for extended biopsy procedure after 3 months (10 and more biopsies). If from the very beginning has been in an extended biopsy, the patient should undergo repeat biopsy in 6-12 months using the extended or saturation techniques.

The term "atypical melkoatsinarnaya proliferation" was first proposed by K. Iczkowski to characterize the gland with signs of architectural and cellular atypia, which can not be attributed to the reactive atypia, atypical adenomatous hyperplasia, PIN or prostate adenocarcinoma.

ASAP is not a precancerous condition, and expresses only the uncertainty of the diagnosis, that is, it is impossible at ASAP with say for sure whether the observed pattern of adenocarcinoma or benign defeat.

In this regard, upon receipt of the diagnosis it is recommended ASAP other expert consultation (preferably peer level) histology to revision glasses may use immunohistochemistry assays biopsies.

It is shown that atypia with suspected cancer is associated with about 50% probability of diagnosis of adenocarcinoma re-biopsy, and the localization adenocarcinoma in most cases corresponds to a region previously detected atypia. According to P.

Humphery, in 18-75% of cases by ASAP focus lies adenocarcinoma [7].

That is why for 3 months after the first biopsy is recommended to re-biopsy of enlarged scheme, and for improving the diagnostic value rebiopsii NCCN recommends taking additional samples of Lot atypia.

If the re-biopsy cancer is detected, it is shown careful observation with periodic PSA level measurement, performing digital rectal examination and repeat biopsy (known, however, that no two repeated biopsies after initial diagnosis is sufficient for the vast majority of tumors prostate).

Materials and methods

We carried out a study to assess the results of repeat prostate biopsies performed for the presence of PIN and ASAP high in the initial biopsy. The study included 932 men over 50 years, which in 2009-2011.

They were sent to the district on the basis of the urology department of the city polyclinic № 147 West District of Moscow for further examination in connection with suspected prostate cancer. Patients measures the level of PSA, performed a physical examination, including digital rectal and transrectal ultrasound of the prostate research.

Patients with a PSA value of greater than 4 ng / ml multifocal performed transrectal prostate biopsy of 12 points followed by histological examination including determination of the degree scale on prostate cancer aggressiveness Gleason. The age of patients ranged from 50 to 79 years and the average age was 62 year.

According to the results of histological examination of prostate cancer was detected in 40% of patients (n = 371). Mid PSA among all patients was 14.6 ng / ml. At 65% (n = 607) of patients with diagnosed prostate cancer PSA value is in the so-called "gray zone" (4-10 ng / ml).

The average value of PSA "gray zone" of this group of patients was 6.7 (4,02-9,85) ng / mL. analysis of the relationship PSA and Gleason score was conducted (table. 1). Distribution of patients IDU low and high and ASAP is shown in Table 2.

results

In histological assessment of the material revealed that approximately 23% (n = 214) comprise PIN biopsies high levels in combination with different background pathology (benign prostatic hyperplasia, chronic prostatitis). PCa was verified in 40% (n = 371) of cases. The combination of PIN + PCa detected in 4,1% (n = 39) histological specimens.

If the age group 50-59 years 13,3% (n = 124) contained biopsies PIN, then aged 70 to 79 years, their proportion was 11,2% (n = 105).

When carrying out repeated biopsies from 16 patients with a high degree of pin 3 months PCa detected in 6 (37.5%) patients, 6 months in 28 patients the number of verified prostate cancer was 13 (46.4%), after 12 months in 14 patients revealed 4 more (28.5%) cases PCa.

ASAP was detected in 89 patients (9.5%). Repeat biopsy after 3 months 68 patients were subjected to.

The rest of the diagnosis of prostate cancer has been confirmed by a change in material using histological and immunohistochemical analysis.

Among the 68 patients with the ASAP, underwent repeat biopsy after 3 months, the diagnosis of prostate cancer has been exhibited in 26 cases (38.2%). Among patients with ASAP availability and high degree of pin 11 repeat biopsies revealed prostate cancer in 10 patients (90.1%).

conclusions

Thus, within 1 year in 23 (39.6%) of 58 patients with a high degree of PIN repeat biopsies confirmed the diagnosis of prostate cancer.

Detectability of PCa in the presence ASAP in our study was 38.2% and 90.1% at ASAP availability and combining ASAP c PIN highly biopsy respectively. Our study confirmed that PIN is a high degree of pre-cancerous condition.

The results of this study suggest that the detection pin and a high degree of ASAP is an indication for rebiopsy prostate.

A source: http://umedp.ru/articles/_analiz_rezultatov_biopsiy_i_rebiopsiy_predstatelnoy_zhelezy_v_okruzhnom_urologicheskom_otdelenii_za.html

Cervical intraepithelial neoplasia - CIN (cervical dysplasia)

June 19, 2018

The main cervical pathology dangerous to a woman's life, is a cancer of the cervix (cervical cancer). Every two minutes in the world a woman dies from cervical cancer. Globally today cervical cancer - the third in frequency cause of death of women from cancer, after breast and lung cancer.

In the Russian Federation, each year more than 12 500 new cases of cervical cancer disease kills more than 6,000 women each year.

In the last decade clearly observed increase in the incidence of cervical cancer among young women in the age group 40 years and is especially noticeable increase in incidence in the group of women under 29 years.

Cancer development is preceded by dysplasia of the cervical epithelium.

The modern name Cervical dysplasia - cervical intraepithelial neoplasia (CIN). This pathological process is accompanied by the appearance in the thickness of the epithelial layer of atypical cells with different the degree of violation of their differentiation, subsequently affecting all cell layers of stratified squamous epithelium of the cervix uterus.

Causes

Home CIN of reason - is infection with oncogenic types of women human papilloma virus (HPV), Which include: 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68, 73, 82. However, not every infection leads to the development of CIN and its progression to cervical cancer. This requires predisposing factors:

• Early age at first sexual intercourse (16 years);
• frequent change of sexual partners;
• weakening of local immune defenses, shows a significant decrease in immunoglobulin type A and G in the cervical mucus;
• long course of inflammatory processes of genitals caused by a bacterial infection, infections, sexually transmitted infection - chlamydia, genital mycoplasmosis, trichomoniasis, cytomegalovirus, herpes simplex virus Type 2;
• frequent recurrences of bacterial vaginosis;
• deviation of the results of cytological smears from the norm;
• HIV infection;
• frequent delivery, especially complicated trauma of the birth canal;
• two or more surgical abortion method;
• active and passive smoking increases the risk of developing CIN 4 times;
• individual genetic predisposition to gynecological malignancies - 1.6 times increased risk of developing the disease;
• Folate deficiency in foods, beta-carotene, vitamins A and C leads to disruption of the hormonal metabolism in the liver;
• women with low social responsibility.

The degree of precancerous changes in the cervix (CIN)

Against the background of infection with oncogenic strains of HPV are three degrees of precancerous changes, since infection of cells and the appearance of abnormal cells that can develop into cervical cancer and CIN uterus:

1 degree (CINI): Low degree of epithelial damage (LSILs). This step is a change in the cells caused by the human papilloma virus, which produces new virus particles.

2 degree (CINII): Damage cervical epithelium high degree (NSILs). At this stage, precancerous cell changes more pronounced. Women who have identified such changes, shows a local surgical treatment.

Grade 3 (CINIII): Abnormal cells distributed throughout the entire thickness of the surface layer and the cervix pathological changes growing cells.

Persistent infection with oncogenic strains of human papillomavirus is indicative of the presence of precancerous lesions such as CIN I, II and III, and eventually carcinoma in situ (cancer in situ). Invasive cervical cancer following stage carcinoma in situ.

symptoms

CIN does not allow independent clinical and asymptomatic. Pain in of CIN, as a rule, absent. The woman did not even dogadyvaetsya that she has such a dangerous disease.

That is why it is important to undergo routine check-ups with your doctor obstetrician-gynecologist every six months, as During these procedures each time held the primary screening method for identifying CIN - cervical study smears.

Upon joining the CIN secondary microbial infection, the patient begins to complain of bleach (as they discharge) from the genital tract unusual color, texture or smell. Especially a concern contact spotting after sex! The presence of these symptoms - this is an urgent reason to see a doctor obstetrician-gynecologist.

The lack of specific clinical symptoms in CIN bring to the fore in the diagnosis of instrumental and laboratory research methods.

Diagnostics

In our clinic we use the following protocol CIN diagnosis.

1. Gynecological examination using vaginal mirrors - to detect visible to the eye changes in the mucosa: changes in color, luster around the external os, stains, and epithelial proliferation et al.
2. Cervical cancer smear from the cervix and vaginal part of the cervix reveals abnormal cells and cell markers papillomovirusnoy infection. If necessary, we conduct liquid-based cytology - the most modern and informative diagnostic method.
3. Colposcopy - examination of the cervix colposcope, an optical device that increases the image is more than 10 time and simultaneous diagnostic tests - cervical treatment with acetic acid and a solution of Lugol.
4. If necessary, performed cervicoscopy - examination of the cervical canal.
5. Biopsy - taking a small portion of this cervical tissue to detect changes for histological examination.
6. Analysis of cervical scrapings and vagina by polymerase chain reaction (PCR) to detect HPV infection, establishing types of virus and viral load, allowing you to identify the tactics of patient treatment with CIN.
7. Ultrasound procedure.

Treatment

The choice of method of treatment is determined by the degree of CIN lesions, lesion size, age, women, co-morbidities, the patient's reproductive plans.

In our clinic we use only modern methods of immunostimulatory therapy of HPV infection and methods of radio wave surgery, making up an individual treatment plan for each woman.

Observation and Prevention

For each treated patient is offered an individual plan for cure monitoring. During the first year held 4 quarterly inspection, during which the material is taken for cytology, if necessary, PCR diagnosis of HPV infection, colposcopy and ultrasound research.

Thus, the center has a modern and effective methods of diagnosis and treatment of CIN of any degree, which allows to avoid its transformation into cervical cancer. Early detection of the disease, the appropriate diagnosis and treatment, a further regular medical control allow one to cure virtually any stage of the disease.

For advice on the prevention, diagnosis and treatment of CIN, refer to the obstetrician-gynecologist of our center

Kudinov Sergey Viktorovich, Candidate of medical sciences.

Also, you can get tested for cervical dysplasia (CIN).

A source: https://vera-72.com/eto-interesno/tservikalnaya-intraepitelialnaya-neoplaziya-cin.html

Prostatic intraepithelial neoplasia (PIN) and prostate cancer

Morphologically prostate cancerin most cases represented by a typical adenocarcinoma.

According to the World Health Organization classification, along with benign papillary adenomas, there are precursors of cancer lesions as Prostatic intraepithelial neoplasia (PIN).

The types of cancer lesions presented classical adenocarcinoma and its various options. In addition to the typical morphological picture adnenokartsinomy prostate cancer it has numerous options for rare types of cancer.

No correlation between increasing concentration of PSA (prostate specific antigen) serum, and the presence and severity of PIN.

The concentration of PSA in patients with pin high and low level was not significantly would differ from those obtained in patients with benign results of morphological study.

This increase should be linked with the accompanying PIN changes in the tissue of the prostate: prostatitis in patients with low-grade PIN, or cancer, not identified in the primary biopsies of patients with PIN high degree.

No direct effect of IDU on blood PSA level is also confirmed by detection pin high and low level in the operating material in patients undergoing surgery for BPH and had no suspicion of cancer, including according to the study PSA blood.

The high incidence of cancer on repeat biopsy of the prostate gland, even at normal rates the concentration of PSA serum allows urologists consider PIN highly independent risk factor for cancer Prostate.

Prostatic intraepithelial neoplasia (PIN) - precancerous condition, which is an indication to re-implement the prostate biopsy. The larger glands detected with a PIN, the greater the probability of detecting prostate adenocarcinoma.

Thus, Prostatic intraepithelial neoplasia (PIN) It is most likely a precursor to prostate adenocarcinoma.

Currently, the World Health Organization does not support PIN gradation of powers (previously isolated high and low degree of IDUs). Diagnosis corresponds PIN changes characteristic only for the PIN high degree. Changes characteristic of low grade PIN have been called atypical hyperplasia.
Management of patients after discovering their PIN remains largely a moot point. It is believed that men with a high degree of IDUs should be subject to regular inspection to the definition of PSA and repeated biopsies for early detection of cancer, as there is a very high potential likelihood of whether they have latent cancer Prostate.

IN treatment of IDUs there are the following possible approaches:

• close observation
• diet therapy
• hormonal and radiation therapy.

The optimum can be considered a dynamic control of the level of serum PSA.
Prostatic intraepithelial neoplasia (PIN) is a high degree of hormone-Sensitive lesion but effective influence on it is possible only with long-term and active treatment, which can be implemented in the appointment of maximal androgen blockade.

see also:

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A source: https://prosto-prostata.com.ua/menuprostatitis/mainmenuprostdiagn/55.html

Paget's disease; intraepithelial neoplasia; vulval cancer

Differential diagnosis of benign, preinvasive and neoplastic diseases is an important prerequisite for improving treatment outcomes.

Preinvasive vulvar disease

Preinvasive neoplastic disease of the vulva are divided into two categories: Paget's disease, and intraepithelial neoplasia of the vulva.

Any areas of chronic irritation of the vulva, accompanied by itching and resistant to topical treatment, especially in postmenopausal women, subject to mandatory biopsy, or, in the absence of visible lesions - colposcopy with biopsy for histologic diagnosis. Histologically, Paget's disease, intraepithelial neoplasia of the vulva melanoma, and are sufficiently similar, so for the purpose of differential diagnosis is also used immunohistochemistry.

Paget's disease

Paget's disease of the vulva appears intraepithelial neoplasia of the skin in the anogenital area.

About 20% of patients with Paget's disease have in common adenocarcinoma of the other sites (breast, cervix, bladder, rectum) that has hidden features.

In these cases, usually already have tumor metastasis. Except for metastatic lesions, Paget's disease may be subject to local treatment.

Pathogenesis. Development of Paget's disease is associated with chronic inflammatory changes. It is also believed that Paget's cells can be derived from sweat and sebaceous glands.

Clinic and diagnostics. The disease most often develops in women after age 60, although the itching and vulvodynia course years preceding the onset of the disease.

The characteristic symptom is a persistent long-term itching of the vulva, which is associated with a velvet-red spots on the skin that over time, subject to change and eczema are covered with white plates giperkeratinizovanogo epithelium, and sometimes - ulcers.

Paget's disease can affect the labia, perianal area, crotch and tends to spread. Sometimes there is a simultaneous defeat breast nipple.

The diagnosis is confirmed by biopsy of the vulva and immunohistochemistry.

Treatment is carried out by wide local excision intraepithelial lesion (for> 5 mm larger than it edge) with mandatory histological control of the removed tissue margins and excluding joint adenocarcinoma. But despite adequate local excision, Paget's disease can recur many times that require numerous repeated local excision.

Sometimes there is a progression to invasive Paget's disease. Minimum dermal invasion (

A source: https://www.eurolab.ua/encyclopedia/patient.gynecology/48697/

I hate to melkoatsinarnoy atypical proliferation of the prostate

Timely detection of prostate has now become the main task of urology cancer. Currently, all countries are faced with the problem of the mass distribution of oncological disease patterns.

In our country, prostate cancer is the second most common after their skin cancer. It is very dangerous even in comparison with malignant tumors of the stomach or lung.

This increases not only the number of cases themselves. The mortality rate from prostate cancer is also growing. These data urologists associated with the disease and improve screening prostate biopsy techniques.

Now pass this examination must all men over 45 years.

Method sextant biopsies at 6 points was developed at the end of the last century. He involves the simultaneous use of transrectal ultrasonography. Prostate cancer is a result of the biopsy on 12 basic points with ultrasound detected much more frequently.

To repeat biopsy needed initially identified highest pin. It must also be identified places of atypical proliferation. Most often, prostate adenocarcinoma located in the peripheral zone. It looks like glandular atypia.

Adenocarcinoma has the form of small glands. These cells are small nucleoli. But this is not observed basal cells. Also missing and lobed structure.

When present in the biopsy foci of atypical glands can have a diagnosis of atypical proliferation. These tricks should be suspect in terms of the further development of adenocarcinoma.

But while these figures may not be appropriate under the criteria for prostate cancer. Their presence is simply a basis for carrying out a prostate biopsy once.

In this atypical melkoatsinarnaya proliferation is adenocarcinoma. This is confirmed by the results of the survey. In case of doubt regarding the need to carry out a biopsy of the prostate for prostate cancer. It is performed with use of immunohistochemical staining procedure of tissue.

As a result of their use can reduce the number of repeat tests. They are appointed in the case of detected intraepithelial neoplasia. These studies must necessarily be carried out at atypical proliferation. Such states are precancerous lesions.

They require you to perform re-examination of the prostate gland.

Correctly executed prostate biopsy gives all the necessary information about the possible pre-cancerous lesions of the pancreas. It may also confirm the presence of prostate cancer. This survey allows you to find a place of localization of the tumor and its size.

It gives an opportunity to identify perineural invasion and differentiation stage of tumor cells. With these indicators can determine the stage of disease and the risk level after prostatectomy.

Analysis of the results of prostate biopsy allows you to choose the best treatment option.

The material for the biopsy is taken along the peripheral parts of the prostate. This enables the identification of prostate cancer at an early stage. During transrectal biopsy needle must be vertical.

The result is a part of tissue from hyperplastic transition zones. Analysis of pathological biopsy to determine the changes in the character-malignant glandular epithelium. They often support the risk of prostate cancer. These indicators also require repeat biopsy. Such cases can be attributed atypia c suspected adenocarcinoma.

The indication is the presence and suspected proliferation. For the diagnosis of PIN enough to find in the prostate biopsy with atypical cells and intact basal layer. This provides a basis for dividing the PIN and adenocarcinoma. At the moment, the PIN is considered a precancerous condition with varying degrees of neoplasia. This indicator is expressed in the degree of manifestation of neoplastic changes.

In early studies, the highest rate of IDU actually meant the risk of prostate cancer at rebiopsii. But carrying out an extensive biopsy shows a much smaller percentage of the risk.

American Cancer Service recommends that, in some cases, re-biopsy. This is necessary at high rates of IDU. This procedure is important to do in 3 months.

To improve the diagnosis is recommended to take samples from the place of location of atypia.

In the absence of cancer it is important to continuously monitor the patient and measure the PSA level. You must also perform a rectal examination and spend two more repeat biopsies. This is quite enough to detect most prostate tumors. After the first extended biopsy it must re-conduct of the carbonation procedure after 6 or 12 months.

The concept of atypical proliferation melkoatsinarnoy earlier used to describe the features glands with architectural and cellular atypia. They were not to apply to atypical adenomatous hyperplasia.

This diagnosis is not a precancerous condition. He questions benign lesions. Therefore, in this case it is necessary to turn to another specialist.

For the analysis of biopsy samples may be used immunohistochemical methods.

Among the most popular markers can be identified antibodies to cytokeratin. They reveal the differences of cancer cells from benign. They also include antibodies to the protein p63 and anti-alfametilatsilkoenzim A racemase. Upon detection of prostate cancer is important to analyze the picture of the disease and to draw some conclusions about the tactics of the patient.

In order to identify the stage of prostate cancer for many years widely used system is the Gleason grading. It provides analysis of the histological structure of the tissue. But at the same time, this technique does not allow for cytological signs of atypia. For evaluation scale used is 5 points. Wherein 1 point is high differentiated structure. Little differentiation is 5 points.

Prostate cancer is composed of several sections of varying degrees of differentiation. During the study, determined the amount of points. It is called the Gleason score. This figure includes the most common points in the histology of the tumor. It is necessary to determine the value of the sum and its components.

Recent studies have shown the need to amend the Gleason system. She often does not coincide with the results of prostatectomy and does not give a reliable assessment of the stage of development of the tumor.

In the 2000s, the Gleason system was modified and introduced into medical practice. She replenished some amendments. This significantly improved the quality of a diagnosis.

Also increased reproduction evaluation of the results and the percentage of coincidence of the diagnosis by biopsy and radical prostatectomy.

Gleason system allows to predict the risk of recurrence after radical prostatectomy and radiotherapy. The value coincides with the other measurement values. These include the level of PSA in the blood serum and stage of cancer. Through the study of prostate tissue pathologist can give qualitative and quantitative assessment of malignant lesions of the prostate gland.

Studies have shown a positive correlation between the amount of tumor tissue in biopsy material and its size. The percentage of tumor tissue biopsy may help forecast the dynamics of PSA levels and disease outcome.

Urological Association in Europe confirmed the predictive value equal to the amount of tumor in millimeters and as a percentage.

But so far there is no unity on the issue of predictive value obtained separately from other parameters indicative of the amount of tumor tissue. To correct prediction it should be considered along with other factors.

A small volume of swollen can not always eliminate the biochemical and clinical cancer recurrence after radiotherapy. Therefore, it can not act as a positive predictive test.

For histomorphological assessment of biopsy is also important perineural invasion. It is the main mechanism for the spread of cancer. Detection of PNI in the preparation of many researchers consider the fact extraprostatic tumor and biochemical recurrence after radical prostatectomy.

While the doctors there is no unity on the PNI. I do not quite understand its role as an independent prognostic factor after controlling for PSA and Gleason sum. While the results of studies are conflicting.

This is due to a large number of variants or biopsy specimens containing no nerves. They are always treated as negative. For certain conclusions need to spend a lot of research.

you can make a true prognosis for the treatment of prostate cancer through proper conduct of prostate biopsy and professional interpretation of the results. In this way, determined not require urgent medical intervention patients.

On the recommendations of the US onkosluzhby waiting is applicable in respect of a group of patients of low and medium risk. It is to monitor the patient and intervene only when the disease progresses.

The approximate life expectancy of these patients must be at least 10 years.

In addition to these criteria, many researchers consider other options. These include kinetics and PSA density. No less important is the percentage of positive samples after the biopsy.

It is of great importance and volume of the tumor tissue in the worst sample. The problem of selecting patients for observation quite relevant.

They may suffer more from wrong diagnosis and the treatment.

A source: https://kaklechitprostatit.ru/vidy/atipicheskaya-melkoatsinarnaya-proliferatsiya.html