Cytologic findings of the Prostate gland at autopsy by Touch imprint cytology

Abstract

Introduction: Pathological conditions of the prostate include inflammation, prostate intraepithelial lesions and many types of carcinomas, 95% of which are adenocarcinomas. The gold standard in diagnosing prostatic carcinoma is trans-rectal ultra sound directedhistological biopsy. Nevertheless, touch imprint cytology in autopsy diagnosis has been investigated and found to have good agreement with histology results. Objective: To describe the cytologic findings of the prostate gland at autopsy by touch imprint preparations. Rationale: To demonstrate the use of imprint cytology in the rapid laboratory diagnosis of neoplasms in autopsy and intra-operative surgical procedures. Study design: Descriptive cross-sectional study conducted from June to October, 20 IO. Setting: University of Nairobi cytology laboratory, Kenyatta National Hospital and City mortuaries. Sample size: Sixty one prostates excised at autopsy from men aged above 30 years. Methodology: The glands were weighed and step-sectioned at regular intervals to increase sample homogeneity. Touch imprints were made from cut surface onto glass slides and fixed immediately in 95% ethanol and sent to the laboratory for processing using Haematoxylin and Eosin technique and examined by use of light microscopy. The imprints were screened and signed out by the two supervisors. Evaluation of cytomorphologic criteria was based on the microscopic appearance of cellular architecture, cytoplasmic and nuclear features, staining characteristics and the background milieu. Interpretations were made depending on the pattern and the degree of cellular atypia. The imprints were then validated by an independent pathologist blinded to the initial findings for quality control Outcome measures: Age, weight of gland, benign prostate hyperplasia, prostatitis, prostate intraepithelial neoplasia and prostatic carcinoma. Statistical considerations: Statistical comparisons of age groups, weight of glands and the resultant diagnostic parameters were determined using the Statistical Package for Social Sciences, version 17. Continuous data (age and weight) was summarized using mean, median, minimum and maximum. Categorical data (diagnostic outcomes) were presented in frequencies and percentages. Analysis of variance was used to compare the mean differences on weight of the prostate gland for the various age groups. The t-test was used to make pairwise comparisons of the two means, to ascertain the groups which are actually different. The associations of various conditions of the prostate were assessed against age, weight and statistical conclusions were drawn as to the significance. Results: The average weight of the 61 prostate glands was 29.6g and the mean age of the decedents was 50.9 years. Prostatic carcinoma was found in 6.2%, suspicious for malignancy in 1.6%, Prostatic intraepithelial neoplasia in 8.2%, benign prostate hyperplasia in 8.2%, prostatitis in 8.2% and corpora amylacea in 13.2% of the study population. Benign prostate hyperplasia, prostatic intraepithelial neoplasia and prostatic carcinoma were detected at the age 0[30, 38 and 46 years respectively. Conclusion: Touch imprint cytology detected malignancy, prostatitis, benign prostate hyperplasia and other findings that compared well with histological studies. The procedure will be of future use both in autopsy and in intra-operative procedures as an adjunct to histology, for rapid detection of tumours In Kenyan district hospitals that lack histology facilities