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Journal of Clinical Pathology logoLink to Journal of Clinical Pathology
. 2000 May;53(5):391–394. doi: 10.1136/jcp.53.5.391

Histopathological changes associated with high intensity focused ultrasound (HIFU) treatment for localised adenocarcinoma of the prostate

G J L H Van Leenders 1, H Beerlage 1, E Ruijter 1, J J M C H de la Rosette 1, C A van de Kaa 1
PMCID: PMC1731195  PMID: 10889823

Abstract

Aims—Investigation of the histopathological changes in prostatectomy specimens of patients with prostate cancer after high intensity focused ultrasound (HIFU) and identification of immunohistochemical markers for tissue damage after HIFU treatment.

Methods—Nine patients diagnosed with adenocarcinoma of the prostate underwent unilateral HIFU treatment seven to 12 days before radical prostatectomy. The prostatectomy specimens were analysed histologically. Immunohistochemical staining and electron microscopy were performed to characterise more subtle phenotypic changes.

Results—All prostatectomy specimens revealed well circumscribed HIFU lesions at the dorsal side of the prostate lobe treated. Most epithelial glands in the centre of the HIFU lesions revealed signs of necrosis. Glands without apparently necrotic features were also situated in the HIFU lesions, raising the question of whether lethal destruction had occurred. This epithelium reacted with antibodies to pancytokeratin, prostate specific antigen (PSA), and Ki67, but did not express cytokeratin 8, which is indicative of severe cellular damage. Ultrastructural examination revealed disintegration of cellular membranes and cytoplasmic organelles consistent with cell necrosis. HIFU treatment was incomplete at the ventral, lateral, and dorsal sides of the prostate lobe treated.

Conclusions—HIFU treatment induces a spectrum of morphological changes ranging from apparent light microscopic necrosis to more subtle ultrastructural cell damage. All HIFU lesions are marked by loss of cytokeratin 8. HIFU does not affect the whole area treated, leaving vital tissue at the ventral, lateral, and dorsal sides of the prostate.

Key Words: prostate cancer • high intensity focused ultrasound treatment

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Figure 1 Prostate slice showing a high intensity focused ultrasound (HIFU) lesion. The HIFU lesion is characterised by a central yellow/white, necrotic zone surrounded by an outer dark red, haemorrhagic zone. The distance between two cross bars represents 0.5 cm.

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Figure 2 Adenocarcinoma in the centre of a high intensity focused ultrasound lesion without morphological signs of necrosis. Nuclear structures are well preserved and cell borders are locally identified.

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Figure 3 Weak expression of pancytokeratin in histomorpologically unaffected malignant epithelium within the high intensity focused ultrasound lesion. AE1/AE3 antibody.

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Figure 4 Absence of cytokeratin 8 expression in histomorphologically unaffected malignant epithelium within the high intensity focused ultrasound lesion. CAM5.2 antibody.

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Figure 5 Electronmicrograph of an adenocarcinoma within the high intensity focused ultrasound lesion reveals destruction of cellular membranes and organelles but a relatively preserved nuclear structure. Magnification, x 3000.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

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