Guzki stromalne prostaty (STUMP/PSS/carcinosarcoma)

Guzki stromalne prostaty (STUMP/PSS/carcinosarcoma)

Nieprzeczytany postautor: zosia bluszcz » 18 kwie 2018, 00:50

Stromal tumor of uncertain malignant potential (STUMP) /Prostatic Stomal Sarcoma (PSS)/carcinosarcoma

Stromal tumor of uncertain malignant potential (STUMP)

Definition / general
Stromal neoplasms that involve only the prostate are divided into stromal tumor of uncertain malignant potential (STUMP), stromal sarcoma and carcinosarcoma
STUMP, prior to 1998, was termed atypical stromal hyperplasia (Am J Surg Pathol 1998;22:148)

Essential features
Rare prostatic tumors with stromal degenerative atypia featuring vacuolated nuclei
Some resemble breast phyllodes tumors
May recur rapidly after resection; rarely progress to stromal sarcoma

STUMP occurs in a broad age range with median age of 58 years (Am J Surg Pathol 1998;22:148, J Urol 2004;172:894)

Clinical features
Usually presents with urinary obstruction, followed by hematuria, hematospermia and rectal fullness
Many STUMPs are incidental findings and behave indolently
A minority recur after surgery or metastasize
Up to 46% reportedly recur without definitive surgery (Am J Surg Pathol 1998;22:148)

Microscopically, STUMP should have rare to no mitotic activity and lack necrosis
Atypical stromal cells insinuate between benign acini
CD34 and cytokeratin are the most helpful immunostains

Positive stains
Only a few immunostains are discriminatory for STUMP; others are not helpful:
CD34 and vimentin are most often positive (CD34 positivity helps rule out smooth muscle proliferations)
Optional immunostains are progesterone receptor and androgen receptor, which should be positive (Prostate 1990;16:245, Arch Pathol Lab Med 2008;132:1729)
Variable staining for smooth muscle actin and desmin (J Urol 2004;172:894, Am J Surg Pathol 2006;30:694)

Negative stains
STUMP should be cytokeratin negative, ruling out sarcomatoid carcinoma

Differential diagnosis
Carcinosarcoma: has malignant epithelial (CK+) and stromal components
Sarcomatoid carcinoma: malignant stroma cells; epithelial cells are ERG+ (Histopathology 2015;66:898)
Stromal nodule of nodular hyperplasia / benign prostatic hyperplasia: hyperplastic, not atypical stromal cells

Iczkowski, K.A. Stromal tumor of uncertain malignant potential (STUMP). website. ... rolif.html Accessed April 17th, 2018.

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