Determinación retrospectiva de marcadores de células basales útiles en el diagnóstico del adenocarcinoma prostático en biopsias prostáticas con diagnóstico dudoso

Inés Benedetti Padrón, Lía Barrios García, Bárbara Arroyo Salgado, Blanca De Oro, José Beleño, Mauricio Meza

DOI: https://doi.org/10.32997/rcb-2010-2719

Resumen

El diagnóstico del cáncer de próstata en una cantidad mínima de tejido como el obtenido en las biopsias transrectales, es un reto para el patólogo que con frecuencia se enfrenta a casos difíciles por la presencia de lesiones benignas que imitan adenocarcinoma. Actualmente se dispone de marcadores para las células basales de la próstata, ausentes en el adenocarcinoma, como el anticuerpo contra citoqueratina de alto peso molecular, 34BE12 y el anticuerpo p63 que facilitan su identificación y permiten llegar a un diagnóstico al evaluar la lesión en el contexto del patrón morfológico, con la coloración de rutina. En nuestra ciudad se realiza un alto número de biopsias transrectales de próstata y su evaluación patológica se llevan a cabo con coloraciones de rutina, llevando en la mayoría de los casos a un diagnóstico; sin embargo, existe dificultad en los casos con lesiones que imitan adenocarcinoma y pueden llevar a errores de diagnósticos por falta de una técnica objetiva para diferenciarlas. El objeto del presente estudio es implementar la utilización de los anticuerpos antiqueratina de alto peso molecular 34BE12 y p63 en el Laboratorio de Histotecnología de la Universidad de Cartagena.

Un total de veinte casos de muestras de tejidos de biopsias de próstata del Laboratorio de Patología y Citología de la ciudad de Cartagena diagnosticados como sugestivos de adenocarcinoma o en los que se describen cambios atróficos, focos de hiperplasia de células basales o de adenosis sospechosos de lesión tumoral maligna fueron seleccionados, tomando nuevos cortes y realizando coloraciones de inmunohistoquímica con los marcadores: 34BE12 y p63.

En la mitad de los casos al realizar los nuevos cortes, desapareció la lesión por agotamiento del tejido, por lo que no fue posible evaluarlos adecuadamente. En dos de los casos (10%) no fue posible evaluar la inmunohistoquímica por falla en la tinción con ambos marcadores, evidenciada en la ausencia de tinción en todas las glándulas benignas usadas como control interno positivo, esto sugiere pérdida de la antigenicidad del tejido, probablemente como consecuencia de la fijación y el procesamiento del mismo. De los ocho casos en los que la lesión sospechosa fue evaluada, por inmunohistoquímica, con ambos marcadores, en un caso 34BE12 y p63 fueron negativos en la mayoría de las glándulas en el foco atípico, con tinción focal débil en algunas glándulas para 34BE12, y positivos en las glándulas benignas vecinas. En los siete casos restantes, ambas tinciones fueron positivas en las glándulas sospechosas, lo que confirmó el diagnóstico de lesión benigna. Se resalta la importancia del uso de 34BE12 y p63 como herramientas invaluables en el diagnóstico diferencial de lesiones prostáticas benignas y malignas, sin dejar de lado la morfología, teniendo en cuenta que en algunas lesiones benignas atípicas se puede presentar tinción parcial con estos marcadores.


Palabras clave

Adenocarcinoma prostático; Células basales; 34BE12; p63;

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