Atrofia inflamatoria proliferativa: potencial lesión precursora de adenocarcinoma prostático
Atrofia inflamatoria proliferativa: potencial lesión precursora de adenocarcinoma prostático
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Introducción: la neoplasia intraepitelial prostática (PIN) es considerada actualmente como la única lesión precursora de cáncer de próstata (CaP); sin embargo se ha sospechado que lesiones atróficas podrían también estar involucradas en su carcinogénesis. En 1999 De Marzo propuso el término atrofia inflamatoria proliferativa (PIA) para denominar una lesión localizada en la zona periférica de la glándula,
con células epiteliales altamente proliferativas, frecuentemente acompañada de inflamación, que ha sido postulada como posible lesión precursora de PIN y CaP.
Objetivo: revisar los conceptos de atrofia inflamatoria proliferativa (PIA), características morfológicas, genéticas, moleculares y explicar la capacidad precursora de PIN y CaP.
Metodología: se revisaron las bases de datos Pubmed, Sciencedirect, EBSCOhost y OvidSP en búsqueda de estudios, revisiones sistemáticas, consensos y meta-análisis con las palabras clave: Proliferative Inflammatory Atrophy, Prostatic Atrophy, Prostatic Carcinoma, usando como fecha límite diciembre de 2012.
Resultados: las alteraciones moleculares descritas en la PIA apoyan el origen de ésta lesión en un contexto de estrés oxidativo, posiblemente originado por las células inflamatorias circundantes, que induce en algunas células epiteliales la expresión de genes de defensa contra el daño oxidativo del genoma, mientras que aquellas que fallan en expresar estos genes se tornan vulnerables a oxidantes y electrófilos,
lo que las hace propensas a desarrollar alteraciones genéticas que favorecerían su transformación en células cancerígenas. Esto, sumado a la asociación morfológica PIA-PIN/CaP, apunta a una relación progresiva entre estas lesiones.
Conclusiones: se ha observado asociación topográfica y transición morfológica de la PIA con la PIN y el CaP. Además se han reportado alteraciones genéticas, somáticas y moleculares en la PIA similares a las observadas en PIN y CaP, por lo que la primera ha sido postulada como posible lesión precursora de las dos últimas. Sin embargo es controversial, algunos estudios no han encontrado pruebas suficientes
para sustentar la postulación. Rev.cienc.biomed.2014;5(1):88-99
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