Gleason Grading System

From Wikipedia, the free encyclopedia

Gleason grade Lower grades are associated with small, closely packed glands. Cells spread out and lose glandular
architecture as grade increases. Gleason score is calculated from grade as described in the text.
The Gleason Grading system is used to help ealuate the prognosis of men with prostate cancer.
Together with other parameters, it is incorporated into a strategy of prostate cancer staging which
predicts prognosis and helps guide therapy. ! Gleason score is gien toprostate cancer based upon
its microscopic appearance.
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Cancers with a higher Gleason score are more aggressie and hae a
worse prognosis.
Contents
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# %rostate specimens and processing
& 'istologic patterns # through (
) %rimary, secondary and tertiary grades
* +cores and prognoses
( 'istory
, -eferences
. /xternal links
Prostate specimens and processing[edit]
0ost often, a urologist or radiologist will remoe a cylindrical sample 1biopsy2 of prostate tissue
through the rectum, using hollow needles, and biomedical scientists in a 'istology laboratory prepare
1
microscope slides for '3/ staining and 4mmunohistochemistry for diagnosis by a pathologist. 4f the
prostate is surgically remoed, apathologist will slice the prostate for a final examination.
Histologic patterns 1 through 5[edit]
Gleason %attern ). '3/ stain.
Gleason pattern *. '3/ stain.
Gleason pattern * 1left of image2 and Gleason pattern ( 1right of image2.'3/ stain.
! pathologist microscopically examines the biopsy specimen for certain 5Gleason5 patterns. These
Gleason patterns are associated with the following features6
%attern # 7 The cancerous prostate closely resembles normal prostate tissue. The glands are
small, well7formed, and closely packed. This corresponds to a well differentiated carcinoma.
%attern & 7 The tissue still has well7formed glands, but they are larger and hae more tissue
between them, implying that the stroma has increased. This also corresponds to a moderately
differentiated carcinoma.
2
%attern ) 7 The tissue still has recogni8able glands, but the cells are darker. !t
high magnification, some of these cells hae left the glands and are beginning to inade the
surrounding tissue or haing an infiltratie pattern. This corresponds to a moderately
differentiated carcinoma.
%attern * 7 The tissue has few recogni8able glands. 0any cells are inading the surrounding
tissue in neoplastic clumps. This corresponds to a poorly differentiated carcinoma.
%attern ( 7 The tissue does not hae any or only a few recogni8able glands. There are often
9ust sheets of cells throughout the surrounding tissue. This corresponds to an anaplastic
carcinoma.
4n the present form of the Gleason system, prostate cancer of Gleason patterns # and & are rarely
seen. Gleason pattern ) is by far the most common.
Primary, secondary and tertiary grades[edit]
! pathologist then assigns a grade to the obsered patterns of the tumor specimen.
%rimary grade 7 assigned to the dominant pattern of the tumor 1has to be greater than (:; of
the total pattern seen2.
+econdary grade 7 assigned to the next7most fre<uent pattern 1has to be less than (:;, but
at least (;, of the pattern of the total cancer obsered2.
Tertiary grade 7 increasingly, pathologists proide details of the 5tertiary5 component. This is
where there is a small component of a third 1generally more aggressie2 pattern.
Scores and prognoses[edit]
The pathologist then sums the pattern7number of the primary and secondary grades to obtain the
final Gleason score. 4f only two patterns are seen, the first number of the score is that of
the tumor=s primary grade while the second number is that of the secondary grade, as described in
the preious section. 4f three patterns are seen, the first number of the score would be the primary
grade and the second number the pattern with the highestgrade. For example, if the primary tumor
grade was & and the secondary tumor grade was ) but some cells were found to be grade *, the
Gleason score would be &>*?,. This is a slight change from the pre7&::( Gleason system where the
second number was the secondary grade 1i.e., the grade of the second7most common cell line
pattern2.
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There could be a Gleason score of )>* with a tertiary component of pattern ( 7 this would
be considered to be more aggressie than a prostate cancer that was Gleason score of )>* with no
tertiary pattern (. 'oweer, the full significance of the tertiary component on the aggressieness of a
cancer is debatable.
Gleason scores range from & to #:, with & representing the most well7differentiated tumors and #:
the least7differentiated tumors. Gleason scores hae often been categori8ed into groups that show
similar biologic behaior6 low7grade 1well7differentiated2, intermediate7grade, moderate to poorly7
differentiated or high7grade.
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0ore recently, an inestigation of the @ohns 'opkins -adical
%rostatectomy Aatabase 1#BC&7&:##2 led to the proposed reporting of Gleason grades
3
and prognostic grade groups as6 Gleason score D , 1prognostic grade group 42E Gleason score )>*?.
1prognostic grade group 442E Gleason score *>)?. 1prognostic grade group 4442E Gleason score *>*?C
1prognostic grade group 4F2E Gleason scores B7#: 1prognostic grade group F2.
"*$
%rostate cancers with
a Gleason score D , usually hae rather good prognoses.
History[edit]
The scoring system is named after Aonald Gleason, a pathologist at the 0inneapolis Feterans !ffairs
'ospital who deeloped it with other colleagues at that facility in the #B,:s.
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4n &::( the Gleason
system was altered by the 4nternational +ociety of Grological %athology. The criteria were refined and
the attribution of certain patterns changed.
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4t has been shown that this =modified Gleason score= has
higher performance than the original one, and is currently assumed standard in urological pathology.
4n this form, it remains an important tool.
References[edit]
#. Jump up ^ 50ale Genital %athology5. -etrieed &::B7:(7#).
&. Jump up ^ /pstein @4, !llsbrook WC @r, !min 0H, /gead LLE 4+G% Grading Committee.
The &::( 4nternational +ociety of Grological %athology 14+G%2 Consensus Conference on
Gleason grading of prostatic carcinoma. !m @ +urg %athol &::(E&B1B26#&&C7*&.
). Jump up ^ Iumar F, !bbas !I, Fausto J. -obbins and Cotran %athologic Hasis of
Aisease. +eenth ed6 /lseier +aundersE &::(.
*. Jump up ^ %ierora8io %0, Walsh %C, %artin !W, /pstein @4. %rognostic Gleason grade
grouping6 data based on the modified Gleason scoring system. H@G 4nternational.
&:#)E###1(26.()7.,:.
(. Jump up ^ 0anage !ccount 7 0odern 0edicine
,. Jump up ^ Gleason, A. F. 1#B..2. 5The Feteran=s !dministration Cooperatie Grologic
-esearch Group6 histologic grading and clinical staging of prostatic carcinoma5. 4n Tannenbaum,
0. Urologic Pathology: The Prostate. %hiladelphia6 Lea and Febiger. pp. #.#K#BC. 4+HJ :7C#&#7
:(*,7L.
.. Jump up ^ /pstein @4, !llsbrook WC @r, !min 0H, /gead LL. 1&::(.2 The &::(
4nternational +ociety of Grological %athology 14+G%2 Consensus Conference on Gleason Grading
of %rostatic Carcinoma, !m @ +urg %athol, &B1B26#&&C7*&.
External links[edit]
Thorson, %hatarapornE 'umphrey, %eter !. 1&:::2. 50inimal !denocarcinoma in %rostate
Jeedle Hiopsy Tissue5. American Journal of Clinical Pathology 114 1,26 CB,K
4
B:B.doi6#:.#):BMIF%L7C#/07#*&L7#0,W. %04A ##))C*.B. %athology slides and explanation.
"Free$
W'N, Genea Foundation for 0edical /ducation and -esearch, %rostate cancer, Gleason
score. (# images.
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Gleason klasiranja
+a Wikipedi9e, slobodne enciklopedi9e
Gleason stupnja niOih ra8reda su poe8ana s malim, usko pakiran Oli9e8de. +tanice raPirena i i8gubiti Ol9e8dani
arhitekturu kao stupan9 raste.Gleason i8raQuna se i8 ra8reda, kao Pto 9e opisano u tekstu.
Gleason klasiranja se koristi kako bi se proci9enila progno8u od muPkaraca s rakom
prostate . Ra9edno s drugim parametrima, 9e ugraSen u strategi9u raka prostate skele ko9i prediSa
progno8u i odiQ pomaOe terapi9u. Gleason score se da9e prostate raka na temel9u
sog mikroskopske po9ae.
" # $
-ak s iPim Gleason score su agresini9i i ima9u loPi9u progno8u.
Sadraj
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# prim9erci i obradu prostate
& 'istoloPki u8orci # do (.
) primarne, sekundarne i terci9arne ra8reda
* -e8ultati i progno8e
( %oi9est
, -eference
. Fan9ske poe8nice
5
Uzorci i oradu prostate [ uredi ]
Ja9QePTe, urolog ili radiolog Te ukloniti u8orak cilindriQni 1 biopsi9a 2 tkia prostate kro8 rektum ,
pomoTu Pupl9e igle, i biomedicinskih 8nanstenika u laboratori9u histologi9u pripremiti 8a
mikroskopiran9e 8a ' 3 / bo9en9a i 4munohistokemi9a 8a di9agno8u 9e patolog. !ko se kirurPki ukloniti
prostate, patolog Te nare8ati prostatu 8a 8arPni ispit.
Histolo!ki uzorci od 1 do 5 [ uredi ]
Gleason u8orak ). ' 3 / mrl9a .
Gleason u8orak *. ' 3 / mrl9a .
Gleason u8orak * 1li9eo od slike2 i Gleason u8orak ( 1desno od slike2. ' 3 / mrl9a .
%atolog mikroskopski istraOu9e biopsi9e u8orak 8a nekim 5Gleason5 Pablona. Ne Gleason obrasci su
poe8ane sa sl9edeTim 8naQa9kama6
G8orak # 7 kancerogene prostate sliQi normalnog tkia prostate. Uli9e8de su male, dobro
formirana, te usko pakiran. No se odnosi na dobro diferenciranim karcinomom.
6
G8orak & 7 tkio 9oP ui9ek ima dobro oblikoane Oli9e8de, ali su eTi i ima9u iPe tkia i8meSu
n9ih, Pto 8naQi da traQci poeTao. To takoSer odgoara um9ereno diferenciranim karcinomom.
G8orak ) 7 tkio 9oP ui9ek ima prepo8natl9ie Oli9e8de, ali stanice su tamni9i. Ja
isokim ueTan9a , neke od tih stanica su napustili Oli9e8de i poQin9u da napadnu okolno tkio ili
ima9u infiltratino u8orak. To odgoara um9ereno diferenciranim karcinomom.
G8orak * 7 tkio ima nekoliko prepo8natl9iih Oli9e8de. 0noge stanice napada9u okolno tkio u
nootorina pramenoima. No se odnosi na slabo diferenciranim karcinomom.
G8orak ( 7 tkio ne imati bilo ko9i ili samo nekoliko prepo8natl9iih Oli9e8de. Vesto posto9e
samo listoi stanicama u okolnom tkiu. To odgoara anaplastiQnog karcinoma.
G sadaPn9em obliku Gleason sustaa, raka prostate od Gleason u8oraka # i & se ri9etko idi. Gleason
u8orak ) 9e daleko na9QePTi.
Primarne, sekundarne i terci"arne razreda [ uredi ]
%atolog 8atim dod9el9u9e oc9enu promatranih u8oraka tumora u8orka.
%rimarni stupan9 7 dodi9el9en dominantnom u8orku tumora 1mora biti eTa od (:; od ukupne
uoQeno2.
+redn9a oc9ena 7 dod9el9u9e se u sl9edeTu na9QePTem u8orak 1mora biti man9i od (:;, a
na9man9e (;, na u8orku od ukupnog raka primi9etio2.
Terci9arnog stupn9a 7 se, patolo8i naesti po9edinosti o 5terci9arne5 komponentu. No 9e
m9esto gd9e se nala8i mali dio treTe 1opTenito agresini9i2 u8orak.
Rezultati i prognoze [ uredi ]
%atolog 8atim saOima u8orak7bro9 primarnih i sekundarnih oc9enama dobiti konaQnu oc9enu
Gleason. !ko se idi samo da oblika, pri bro9 re8ultat 9e da 9e od tumora primarni stupan9 a drugi
bro9 ko9i sekundarne ra8reda, kao Pto 9e opisano u prethodnom od9el9ku. !ko su id9eli tri obrasci, pri
bro9 bodoa Te biti primarni stupn9a i drugi bro9 u8oraka s najviom oc9enom. Ja prim9er, ako 9e
primarni tumor bio stupn9a & i sekundarni stupan9 ), ali 9e tumor neke stanice poka8ali su se stupan9
*, Gleason re8ultat Te biti & >* ? ,. To 9e mala prom9ena od pri9e &::( Gleason susta gd9e drugi bro9
9e sekundarno stupn9a 1t9. stupan9 u drugom na9QePTih staniQne lini9e u8orak2.
" & $
Tu bi moglo biti
Gleason score of ) * s terci9arni komponenta u8orak ( 7. to Te se smatrati agresini9i od raka
prostate, ko9a 9e re8ultat Gleason ) >* be8 terci9arnim u8orkom (. 0eSutim, puno 8naQen9e
terci9arnog komponente na agresinosti karcinoma 9e upitno .
Gleason re8ultate u rasponu od & do #:, sa & predstal9a na9iPe dobro diferencirane tumore i #:.
na9man9e7diferencirane tumore. Gleason re8ultat Qesto su srstani u skupine ko9e poka8u9u sliQne
bioloPke ponaPan9e6 nekalitetan 1dobro diferencirani2, sredn9eg stupn9a, um9ereno do slabo
diferencirane ili isokog stupn9a.
" ) $
G noi9e ri9eme, istraga @ohns 'opkins radikalnih
prostatektomi9a Aatabase 1#BC&7&:##2 doelo 9e do predloOenog pri9al9ian9e Gleason oc9enama
i prognostiQkim ra8reda skupinama kao Pto su6 Gleason score D , 1prognostiQki stupn9a skupine
42E Gleason score ) >* ? . 1prognostiQki stupn9a skupina 442E Gleason score * >) ? . 1prognostiQki
7
stupn9a grupa 4442E Gleason score * >* ? C 1prognostiQki stupn9a skupina 4F2E Gleason re8ultat B7#:
1prognostiQki stupn9a skupina F2.
" * $
karcinom prostate s Gleason score D , obiQno ima9u rlo dobre
progno8e.
Po#i"est [ uredi ]
+usta bodoan9a 9e dobio ime po Aonald Gleason , patolog u 0inneapolisu bolnici branitel9a ko9a 9e
ra8ila s drugim kolegama u to9 ustanoi u #B,:.
" ( $ " , $
G &::( Gleason susta 9e i8mi9en9en od strane
0eSunarodnog druPta uroloPkih patologi9u . Iriteri9i su bili profin9eni9i i pripisian9e odreSenih
obra8aca promi9enilo.
" . $
To 9e poka8alo da 9e to =modificirani Gleason score= ima eTe performanse
od i8orne, a trenutno 9e preu8eo standard u uroloPki patologi9e. G oom obliku, ona osta9e aOan
alat.
Reference [ uredi ]
#. Skok u vis ^ 5muPkih spolnih %atologi9a5 . Aobal9eno &::BM:(M#) .
&. Skok u vis ^ /pstein @i, !llsbrook WC @r, !min 0H, /gead LLE 4+G% Nc9en9ian9e
odbor. &::( 4nternational +ociety uroloPkih patologi9u 14+G%2 Ionsen8us konferenci9a o
Gleasonoom od karcinoma prostate.!m @ naruPaati estetiku %atol &::(, &B 1B2 6#&&C7*&.
). Skok u vis ^ Iumar F, !bbas !I, Fausto J. -obbins i Cotran patoloPkih Nsnoi
bolesti. +edmi ed6 /lseier +aundersE &::(.
*. Skok u vis ^ %ierora8io %0, Walsh raQunalo, %artin !u, /pstein @i. %rognostiQki Gleason
stupn9a grupiran9e6 %odaci se temel9e na modificiranom Gleason susta bodoan9a. H@G
meSunarodni. &:#), ### 1(2 6.()7.,:.
(. Skok u vis ^ Gpral9an9e raQunom 7 suremena medicina
,. Skok u vis ^ Gleason, AF 1#B..2. 5Hranitel9ske upraa 8adruga uroloPka -esearch
Group6 histoloPka oc9en9ian9a i IliniQki od karcinoma prostate5. G Tannenbaum, 0. uroloka
patologiju: prostate . %hiladelphia6 Lea i Febiger. str #.#7#BC. 4+HJ :7C#&#7:(*,7L .
.. Skok u vis ^ /pstein @i, !llsbrook WC @r, !min 0H, /gead LL. 1&::(.2 &::( 4nternational
+ociety uroloPkih patologi9u 14+G%2 Ionsen8us konferenci9a o Gleasonoom od karcinoma
prostate, !m @ +urg %athol, &B 1B2 6#&&C7*&.
$an"ske po#eznice [ uredi ]
Thorson, %hatarapornE . 'umphrey, %etar !. 1&:::2 50inimalna adenokarcinom prostate u
Jeedle biopsi9a tkia5 . American Journal of Clinical patologiju 114 1,26 CB,7
B:B. AN4 6#:.#):BMIF%L7C#/07#*&L7#0,W . %04A ##))C*.B . patologi9e sla9doa i
ob9aPn9en9e. "Free$
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W'N, Genea 8aklada 8a medicinska istraOian9a i obra8oan9e, raka prostate, Gleason
score. (# slika.
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