谢谢王主任的关注，在回答问题之前让我们共同学习一下有关内容：

Variability in Diagnostic Opinion Among Pathologists
for Single Small Atypical Foci in Prostate Biopsies

(Am J Surg Pathol 2010;00:000–000)

Abstract: Pathologists are increasingly exposed to prostate
biopsies with small atypical foci, requiring differentiation
between adenocarcinoma, atypical small acinar proliferation
suspicious for malignancy, and a benign diagnosis. We studied
the level of agreement for such atypical foci among experts in
urologic pathology and all-round reference pathologists of the
European Randomized Screening study of Prostate Cancer
(ERSPC). For this purpose, we retrieved 20 prostate biopsies
with small (most <1 mm) atypical foci. Hematoxylin and eosinstained
slides, including 10 immunostained slides were digitalized
for virtual microscopy. The lesional area was not marked.
Five experts and 7 ERSPC pathologists examined the cases.
Multirater k statistics was applied to determine agreement and
significant differences between experts and ERSPC pathologists.
The k value of experts (0.39; confidence interval, 0.29-0.49) was
significantly higher than that of ERSPC pathologists (0.21;
confidence interval, 0.14-0.27). Full (100%) agreement was
reached by the 5 experts for 7 of 20 biopsies. Experts and
ERSPC pathologists rendered diagnoses ranging from benign
to adenocarcinoma on the same biopsy in 5 and 9 biopsies,
respectively. Most of these lesions comprised between 2 and 5
atypical glands. The experts diagnosed adenocarcinoma (49%)
more often than the ERSPC pathologists (32%) (P<0.001). As
agreement was particularly poor for foci comprising <6 glands,
we would encourage pathologists to obtain intercollegial consultation
of a specialized pathologist for these lesions before a
carcinoma diagnosis, whereas clinicians may consider to perform
staging biopsies before engaging on deferred or definite therapy.
Key Words: prostate cancer, prostate biopsy, pathology,
diagnostics, interobserver variation, virtual microscopy

 谢谢，好文！

本主贴图片中显示的病变腺体超过6个许多。

本主帖发言网友（包括您我）18人，8人考虑是癌，8人待表态（有的有倾向但未明示），1人认为不是癌，1人弃权。嘿嘿，等待中。

注意：18楼中除了2张图片（一张HE、一张IHC）是前列腺腺癌外，其他都不是癌, 而是前列腺腺病和前列腺部分萎缩。

照片均来自：Epstein JI and Netto GJ. Biposy interpretation of the prostate. 4th Edition, 2008.

这是一例非常好的讨论和学习病例，诊断比较困难，会有分歧。

鉴别诊断还是要围绕：

1）前列腺腺病；

2）前列腺部分萎缩；

3）前列腺腺癌；

4）IHC标记结果的判断；

谢谢张主任提供的好病例！

 没有见过 学习了

谢谢分享

P504S这个抗体做出来有时是会使人困惑，这其中有技术方面的原因，也有抗体供应方面的问题。

  技术上的问题主要可能有固定是否及时的因素，因为P504s是一种参与脂肪酸支链及其之间产物代谢的酶，如果固定不及时或固定不良，容易导致该酶降解。技术上的因素还有抗原修复的步骤没掌握好火候，这个平常要拿阳性对照片去试，看什么样的修复温度和修复时间比较合适。还有一些IHC操作细节问题。

  抗体供应上的问题主要是这个抗体使用的相对较少，所以在购买前供应商那里可能储藏的时间较长，其效价降低，特别是即用型抗体，买来后很少用而久存，也会降低效价。这时，解决的办法就是在即用型抗体中，加几滴未稀释的原始一抗，以提供有效抗体效价，说不定使用起来效果会好些。

  仅供参考。