前立腺
2014年4月作成，
2015年8月改訂, 2017年5月改訂
TUR-P検体
12g重以下の検体はすべて(約8カセット分)。
残りは，5g毎に1カセット追加。
診断は全体に占めるおよその割合(5%未満かどうか)を記載。
記載例
Prostate, robotic-assisted radical prostatectomy, status post hormonal
therapy:
- Adenocarcinoma, acinar, Gleason
score 7 (4+3), tertiary pattern 5 (1%).
pTNM: ypT3a ypN1
Prostate
weight: 47 g
Prostate size:
4.5 x 4.0 x 4.0 cm
Percent of
prostate involved by tumor: 20%
Size of tumor:
lt/post (PZ), 20 x 12 mm,
GS 4 + 3 = 7, EPE1, RM0, ly0, v0, pn1, sv0, n1
rt/post (PZ), 8 x 5 mm, GS 4 + 3
= 7
Therapeutic effect: Grade 1 (<1/2 non-viable)
Periprostatic fat
invasion: Present (EPE1)
Resected Margins:
Negative for malignancy (RM0)
Lymph-vascular
invasion: Not identified (ly0, v0)
Perineural
invasion: Not identified (pn0)
Seminal vesicle
invasion: Not identified (sv0)
Lymph node, dissection:
- Metastatic adenocarcinoma (1/20)
Therapeutic effect: Grade 0a (no degeneration)
追加になったもの [詳しくは CAP protocol を
みた方が...]
Grade Group
≤6 Grade group 1
3+4 Grade group 2
4+3 Grade group 3
8 Grade group 4
9-10 Grade group 5
Percentage of Pattern 4 in Gleason Score
3+4=7 Cancer: ____%
+ Percentage of Gleason Patterns 4 and 5
(applicable to Gleason score ≥7)
+ Percentage of pattern 4: ____% + Percentage
of pattern 5: ____%
+ Intraductal Carcinoma (IDC) (Note F)
+ ___ Not identified
+ ___ Present
+ Gleason Pattern at Positive Margin(s)
+ ___ Pattern 3
+ ___ Pattern 4 or 5
The value of perineural invasion as an independent prognostic factor
has been questioned in a multivariate analysis.
Procedures
• Needle Biopsy
• Transurethral Prostatic Resection
• Suprapubic or Retropubic Enucleation (Subtotal Prostatectomy)
• Radical Prostatectomy
Radical Prostatectomy
pT2: Organ confined
pT3a: EPE+ あるいは bladder neck invasion
pT3b: 精嚢浸潤
pT4: 他臓器浸潤（括約筋・直腸・膀胱・挙筋・骨盤壁）
pN1: Regional lymph node (s)
pM1a Nonreginal lymph node (s)
pM1b: Bone (s)
pM1c: Other site metastasis
Total linear milimeters of carcinoma (mm) / Total linear milimeters of
needle core tissue (mm)
Histologic Type
• Adenocarcinoma (acinar)
• Prostatic duct adenocarcinoma
• Mucinous (colloid) adenocarcinoma
• Signet-ring cell carcinoma
• Adenosquamous carcinoma
• Small cell carcinoma
• Sarcomatoid carcinoma
• Undifferentiated carcinoma, not otherwise specified
Gleason Score
The primary and secondary grades should be reported in addition to the
Gleason score,
that is,
Gleason score 7(3+4) or 7(3+4).
>95% Gleason 3 + <5% Gleason 4 = 7(3+4).
>95% Gleason 4 + ≥5% Gleason 3 = 8(4+4).
Margins: If Positive (apical, bladder neck, anterior, lateral,
postero-lateral/neurovascular bundle, posterior)
Gleason pattern
1: 中型腺管，均一，腫瘍全体の境界明瞭 (まず診断しない)
2: 中型腺管，やや不均一，腫瘍全体の境界明瞭 (めったに診断しない)
3: 明瞭な小型腺管 (最も多いパターン)
4: 癒合，篩，hypernephroid, 不明瞭な管腔の小腺腔 (最も多いパターン)
予後が違うので 3+4と4+3は意識して区別のこと
5: 充実，索状，孤立散在，面皰 (比較的まれなパターン)
診断記載
生検はPrimary
(Predominant)
Pattern
+ Worst
Remaining Pattern
コア毎に記載。
secondary
が 5%未満でprimaryよりgradeが低ければ記載必要なし。
陽性のコア数と全体のコア数を記載。
%で癌の割合 and/or mmで癌の長さ/針生検コア組織の長さ。
【寺本先生の注意を改変】
Some urologists want to know what percentage
of the cancer is pattern 4, if yours do, then report it
pattern 4 の割合を記載しよう(10% increment でOK）
IDC-Pを記載
Ductal vs. acinar の区別
pN
Pnの見落とし注意
RM1 は，patternを附記
ypT...ではGleason 不要
pT分類のミス頻発
摘出標本
手術材料では The most predominant + The second most
common
Tertiary
patternはそれよりも大きいパターンがある場合に記載
腫瘍の占める範囲(%)か、dominant
noduleの大きさを記載
high-grade PIN, AAH (adenosis), 炎症の有無
重量(精嚢外す?)、大きさ、リンパ節サンプルの有無
2つ別の腫瘍は別々にGleason scoreを記載
腺外浸潤; 精嚢浸潤(平滑筋に入ったら浸潤) アミロイド注意
pT分類, 予後グループ分類 (病理にT1, Group Iはない)。
解剖学的なT2a, T2b, T2cの予後的な意義は不明。
Group IIA pT2ab and <PSA20 and ≤ GS7
Gropu IIB T2c or ≥PSA20 or ≥ GS8
Group III pT3a, 被膜外/頸部浸潤 or pT3b, 精嚢浸潤
Group IV pT4 (直腸、挙筋、骨盤壁) or N1 or M1
Prostate Prognostic Grouping (UICC 7th)
Group
I (Stage I T2a)
T1a-c N0 PSA <10 Gleason ≤6
T2a N0 PSA <10 Gleason ≤6
GroupIIA (Stage II T2b, c)
Tla-c N0 PSA <20 Gleason 7
T1a-c N0 PSA ≥10 <20 Gleason ≤6
T2a N0 PSA<20 Gleason ≤7
T2b N0 PSA <20 Gleason ≤7
T2b N0 PSA X Gleason X
Group IIB
T2c N0
Tl-2 N0 PSA ≥20
T1-2 N0 Gleason ≥8
Group III (Stage III)
T3a-b N0
GroupIV (Stage IV)
T4 N0 or N1 or M1