Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 18386

AbstractMaterial and MethodsResultsDiscussionConclusionReferencesDOI and Others
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : November | Volume : 16 | Issue : 11 | Page : EC32 - EC36 Full Version

Status of Mast Cells in Autopsy Specimens of Prostate: A Cross-sectional Study


Published: November 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/57283.17162
Swapan Kumar Sarkar, Anumoy Mukherjee, Rabiul Alam, Suman Ghosh, Shikha Das, Anadi Roy Chowdhury

1. Assistant Professor, Department of Pathology, Mushidabad Medical College, Berhampore, West Bengal, India. 2. Assistant Professor, Department of Pathology, Mushidabad Medical College, Berhampore, West Bengal, India. 3. Demonstrator, Department of Pathology, Mushidabad Medical College, Berhampore, West Bengal, India. 4. Associate Professor, Department of Pathology, Mushidabad Medical College, Berhampore, West Bengal, India. 5. Ex-Professor and Head, Department of Pathology, R.G. Kar Medical College, Kolkata, West Bengal, India. 6. Professor and Head, Department of Pathology, Mushidabad Medical College, Berhampore, West Bengal, India.

Correspondence Address :
Dr. Suman Ghosh,
Associate Professor, Department of Pathology, Murshidabad Medical College, Berhampoe-742101, West Bengal, India.
E-mail: drsumanghosh123@gmail.com

Abstract

Introduction: Mast cells are found in areas rich in connective tissues and beneath epithelial surfaces. Mast cells have been extensively studied for their orchestration of allergic reactions and autoimmunity. Mast cells infiltrate various prostatic lesions in varying concentrations. Autopsy specimens had not been investigated extensively in the previous literature.

Aim: To find out a quantitative estimation of mast cells and the association of the number of mast cells in various prostatic lesions that included both inflammatory and neoplastic lesions in autopsy cases.

Materials and Methods: A cross-sectional, analytical study was carried out in the Department of Pathology, R.G. Kar Medical College and Hospital, Kolkata, India from April 2017 to March 2018. Sixty autopsy specimens of the prostate were dissected from the deceased males above 30 years of age. Four to six paraffin embedded sections from different lobes and peri-urethral areas were taken. Haematoxylin and Eosin (H&E) stained sections for histopathological diagnosis and toluidine-blue stain after water mounting to demonstrate mast cells by its metachromasia were performed. Mast cell densities were estimated by a light microscope under high power magnification (400X) on an average of 100 fields. Gross and microscopic findings were recorded. Data analysis correlation was done using Statistical Package for the Social Sciences (SPSS) software version 18.0. Mean and standard deviations were determined for different prostatic lesions. Group means were compared using the student’s t-test. For statistical significance p-value of less than 0.05 was considered.

Results: A total of 60 autopsy specimens of the prostate were studied comprising 8 (13.5%) specimens of normal prostate, which acted as a control, 6 (10%) specimens of prostatitis, 27 (45%) specimens of Benign Hypertrophy of Prostate (BHP), 12 (20%) specimens of BHP with Prostatic Intraepithelial Neoplasia (PIN), 3 (5%) specimens of prostatitis with focal PIN and 4 (6.5%) specimens of prostatic adenocarcinoma. Mast Cell Density (MCD) was higher in prostatitis {6-8 per High Power Fields (HPF)}, compared to normal (1-3/HPF) and BHP (3-5/HPF), lowest in adenocarcinoma (1-2/HPF) and intermediate in PIN (2-4/HPF).

Conclusion: Mast cell density was the lowest in prostatic adenocarcinoma and significantly higher in prostatitis, probably due to a lack of antitumour immunity in higher grades, whereas it was significantly higher in chronic non specific prostatitis possibly because of inflammatory response.

Keywords

Benign hypertrophy of prostate, Hyperplasia, Intraepithelial neoplasia, Prostate cancer

Mast cells are heavily granulated wandering cells that are found in areas rich in connective tissues beneath epithelial surfaces. Their granules contain heparin, histamine and many proteases. The heparin appears to play a role in granule formation. They have Immunoglobulin E (IgE) receptors on their cell membranes and like basophils, they degranulate when IgE-coated antigens bind to their surface. They are involved in anti-inflammatory responses initiated by immunoglobins IgE and IgG. The inflammation combats infection. Marked mast cell degranulation produces clinical manifestations of allergy upto and including anaphylaxis. Mast cells are plentiful in the anterior and posterior lobes of the pituitary gland. Masts cells are present in the fibrous capsule of the liver, along the blood vessels, beneath the mucosa of alimentary and respiratory tracts, prostatic tissues, and in other parts of the body. Each cell is round in shape and presents a central nucleus. The cytoplasm is closely packed with large membrane-bound granules, which stain metachromatically with toluidine blue, methylene blue, etc. Granules become purple-coloured when treated with toluidine blue. Histochemically the granules are produced by the sulfated mucopolysaccharides. Substances contained in the granules are heparin histamine, hexosaminidase, eosinophil and chemotactic factors.

Basic aniline dyes extracted from dahlia were first used to identify the mast cell. The mast cell granules were distinguished by giving a metachromatic staining reaction. The blue colour of the aniline dye is changed to red-violet by the replacement of histamine with amine molecules in the dye without morphological change (1).

Gupta RK first reported the presence of mast cells around Prostatic Carcinoma (PC) (2). Many studies also reported mast cell aggregations at the periphery of PC as a significant prognostic factor. Moreover, the antitumour effect of mast cells had been postulated by many authors probably related to Tumour Necrosis Factor (TNF) and non TNF cytotoxicity. The majority of studies involving mast cells in human cancers remain correlative. Inflammatory cells are increasingly recognised to play a key role in the tumour micro environment in many human cancers. Mast cells have been extensively studied for their orchestration of allergic reactions and autoimmunity. Mast cells infiltrate various prostatic lesions in varying concentrations (3).

Mast cell infiltration is often observed around human tumours. Inflammatory cells such as macrophages, neutrophils and mast cells infiltrating around tumours are known to contribute to tumour growth; however, the clinical significance of mast cell invasion in Prostate Cancer (PC) has not been investigated extensively. The significance of mast cell infiltration around prostatic tumours has not been well studied, even though the accumulation of mast cells around the tumour was first reported more than a decade ago (2). The study showed the distribution of mast cells varies in routine prostatic biopsies. Utilisation of mast cell count to separate benign from atypical and malignant lesions requires further evaluation because only a few studies are there in the literature. Although animal studies were carried out in canine prostate biopsies, this study was the first of its kind in eastern India after searching extensively in the literature (4).

Stawerski P et al., studied prostate cancer with mast cell density and infiltration of mast cells suggested the promoter function of mast cells in prostate cancer formation and development, whereas no evidence was found for their opposite activity. A significant increase in mast cells is seen in benign prostatic hyperplasia (5). Hempel Sullivan H et al., in their work based on the infiltration of mast cells and density of microvessels in prostatic carcinoma performed mast cell subtyping and reported a higher minimum number of the tryptase-only (MCT) subset of extratumoural mast cells is associated with an increased risk of biochemical recurrence (6).

The aim of the present study was to find out a quantitative estimation of mast cells and the association of the number of mast cells in various prostatic lesions that included both inflammatory and neoplastic lesions in autopsy cases.

Material and Methods

A cross-sectional, analytical study was carried out in the Department of Pathology, R.G. Kar Medical College and Hospital, and attached police morgue, Kolkata, India. Ethical approval was obtained from the Institutional Ethical Committee (No. RKC/6024). Informed written consent was taken from the relatives of the deceased and the study was initiated.

Sample size calculation: Considering 20% inclusion of autopsy cases for this study with 10% absolute precision and 95% confidence level using the formula= z2×p(1-p)/d2 sample size of 60 was obtained. Due to some medicolegal reasons, prostates from all deceased males above the age of 30 years could not be collected.

Inclusion criteria: Autopsy specimens of the prostate were dissected from the deceased male persons above 30 years of age, passed away less than 12 hours at the Police Morgue attached to R.G. Kar Medical College and Hospital, Kolkata, India were included in the study.

Exclusion criteria: Autopsy specimens of the prostate from deceased male persons less than 30 years of age and cases more than 12 hours of death were excluded from the study.

Study Procedure

At the time of autopsy the specimens of the prostate gland were examined thoroughly to find out any pathological lesions grossly. The collected glands were fixed in 10% formalin. The gross descriptions like size, shape, weight, surface, dimension, cut surface, etc. were noted. Attached organs like seminal vesicles, vas deferens, and lymph nodes including the urethra, if present were examined. Photographs of the specimen were taken. After gross examination, the prostate gland was serially sectioned in a plane perpendicular to the urethra at 3-5 mm intervals using a scalpel blade. Cut surfaces were examined. Two surgical margins including bladder neck surgical margin (one bit) and another urethral (apical) surgical margin (1-2 bits) were taken carefully during grossing. Sections from the apparently abnormal sites were taken. Routine paraffin-embedded sections were prepared for microscopic examination by H&E stain. The slides thus prepared were examined to detect the pathological lesion. For mast cell identification, deparaffinised sections were rapidly stained by 1% toluidine blue. The count of mast cells was principally done under a light microscope by identifying their metachromasia and was done manually in 10 different fields of each section at a high magnification of 400X. After examination, the result was analysed according to the World Health Organisation (WHO) tumour classification of prostatic neoplasms and the Gleason system of grading prostatic adenocarcinomas (7).

Study parameters

• History from the relatives of the deceased regarding any relevant information such as the clinical history of urinary hesitancy or urgency, Prostate-Specific Antigen (PSA) level, or previous Transurethral Resection of the Prostate (TURP). However, due to medicolegal issues detailed history could not be elicited from the relatives of the deceased in all the cases.
• Gross and microscopic examination of the specimens.
• Evaluation of number of mast cell infiltration (mast cell density) in the prostatic tissues.

Assessment of mast cells: Freshly stained toluidine blue sections were used for immediate observation of mast cells. Only mast cells with apparent cytoplasmic granules and an obvious nucleus were counted. Microscopic foci of metachromatic granules without nuclei were excluded. Sections were observed under a binocular light microscope (Olympus CH20i). Mast cells were detected by identifying their deep purple metachromatic granules and counted manually in each high power field at 400X magnification by using a 10X eyepiece and 40X high power objective. MCs were counted in consecutive High Power Fields (HPF) in each anatomical zone starting from one end and proceeding along the entire length of the section to the other end. The maximum number of high power fields that could be accommodated in each zone was counted. The counting of MCs was performed by two independent observers to minimise subjectivity. They recorded the findings of the same slides to reduce interobserver bias. The interobserver reliability was 81% with a kappa value of 0.9 signifying a strong level of agreement.

Statistical Analysis

Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) software version 18.0. Mean, and standard deviations were determined for different prostatic lesions. Group means were compared using the student’s t-test. For statistical significance p-value of less than 0.05 was considered.

Results

A total of 60 autopsy specimens of the prostate were studied. Among these, eight (13.5%) specimens were of normal prostate with age ranging from 30-47 years and mean age of 40.7 years, which acted as controls. Six (10%) specimens of prostatitis (age ranging from 36-50 years and mean age of 44 years), twenty-seven (45%) specimens of BHP (age ranging from 42-58 years, mean age of 51.1 years), twelve (20%) specimens of BHP with a PIN (age ranging from 48-68 years, mean 57 years), three (5%) specimens of prostatitis with a focal PIN (age ranging from 52-70 years, mean age of 63 years), four (6.5%) specimens of prostatic adenocarcinoma (age ranging from 68-87 years, mean age of 75 years) (Table/Fig 1). The mean age of carcinoma in prostate cases was 75 years ranging from 68-87 years. The mean age of BHP cases was 57 years ranging from 42-58 years.

Among all types of prostatic lesions, prostatitis showed the highest number of mast cell infiltration in and around glandular and ductal areas of the prostate with mean±Standard Deviation (SD) of MCD was 7±2.99 (Table/Fig 2). The median lobe of the prostate is the common area for the occurrence of BPH. In the present study, it was found that 27 specimens of prostates (45%) had the features of BPH. Among the total of 27 BPH specimens,14 specimens showed mast cell accumulation (MCD-4/HPF, mean), detected by toluidine blue stain. Grossly BPH as a multilobulated surface, with variably sized nodules typically located around the prostatic urethra with the increased weight of the gland (40 grams average) (Table/Fig 3)a,b.

The study revealed that mast cell infiltration occurs in BHP in 14 (51.8%) cases, which is lesser than in prostatitis (n=5, 83.5%), but higher than PIN or prostatic adenocarcinoma i.e., 1 (25%) case as shown in (Table/Fig 3)c-f.

Through the present study, authors have found 12 (20%) specimens of BHP with PIN and 3 (5%) specimens of prostatitis with PIN. MC infiltrations in BHP with PIN were seen in 5 (41.7%) specimens whereas, in prostatitis with focal PIN, it was in two out of three cases (66.6%). So mast cell infiltration is seen to be intermediate grade in PIN (highest in prostatitis and lowest in malignancy) as shown in (Table/Fig 4). The present study demonstrated a total of four cases of prostatic adenocarcinoma with a Gleason Score of six and seven. The present study showed that it was lowest in poorly differentiated adenocarcinoma of the Prostate and significantly higher in Prostatitis (Table/Fig 5). MCD was significantly higher in chronic non specific prostatitis. MCD in chronic non specific prostatitis was seven, which was significantly high in comparison to MCD one in prostatic adenocarcinoma. Mast cells were clearly seen under a light microscope as round, oval, or spindle shaped mononuclear cells with round to oval nuclei staining metachromatically a bright purple-red with toluidine blue (Table/Fig 5)a-d.

Discussion

The mast cell is a mystifying cell type whose pathophysiological function has engaged researchers for decades. These cells have been incriminated in diverse conditions, both inflammatory and tumoural. A predominance of MC has been found in various inflammatory and neoplastic disorders of prostate glands by several investigators who suggested that MC could be implicated in the pathogenesis of these lesions. However, the significance of MC infiltration around prostatic tumours had not been well studied, even though the accumulation of MC around tumours was first reported decades ago by Dimitriadou V and Koutsilieris M (8).

Talukder Sl et al., studied surgical specimens of the prostate in a government-approved laboratory in the town of Mymensingh, Bangladesh, and observed different patterns of the disease (9). The present study showed the occurrence of benign hyperplasia of the prostate (BHP) is 45%, whereas the study by Talukder SI et al., recorded an incidence of 77.4% BHP in their series which may be due to a large number of cases compared to the present study (9).

The present study showed that MCD is reduced to a minimum in poorly differentiated adenocarcinoma of the prostate and significantly higher in prostatitis presumably because of the paucity of antitumour immunity in the higher grade malignant tumours. Poorly differentiated tumours may lack antitumour response, which is associated with its invasive character and may explain the decreased MCD. In the present study, the occurrence of mast cell infiltrations in prostatitis appeared to be higher than lesions of the prostate with BHP. Infiltration of mast cells was significantly higher in prostatitis (p-value=0.001) probably due to antiinflammatory responses of mast cells. Deng WB et al, while studying the distribution profile of mast cells in benign and malignant prostatic lesions didn’t observe any significant relations of mast cell distributions with inflammation (10). 10% of cases in the present study showed specific prostatitis. MCD in such lesions is observed to be between 6-8/HPF (mean being 7 HPF). Apart from Deng WB et al., who observed that there is no significant relationship between mast cell distribution and infiltration in BHP, other authors have concentrated on neoplastic lesions of the prostate only. In contrast to the present study, Amir T et al., observed mast cell count was significantly lower in inflammatory lesions (p-value <0.0001) (11). This could have been probably due to degranulation of the mast cells.

Of the 12 cases of BHP with prostatic intraepithelial neoplasia (PIN), only 5 cases (41.7%) showed mast cell density (MCD) of 2 to 4/HPF. The rest of the seven cases failed to demonstrate mast cell infiltration in spite of extensive search through examination of multiple sections. The occurrence of mast cell infiltration in PIN had not been an area of interest amongst most of the authors as the studies were made on cases of carcinoma of the prostate (11). Inspite of the examination of several sections in the remaining seven cases of PIN where mast cell could not be demonstrated, more blocks may have had to be studied in greater detail for a comment. Of the three cases of prostatitis with PIN, mast cell infiltrations were 3-5/HPF as shown in (Table/Fig 2). Hence, it can point out that MCD is mildly higher in prostatitis (3-5/HPF) with PIN compared to (2 to 4/HPF) BHP with PIN, which may be due to the element of inflammation in such lesions.

Fleischmann A et al., studied the Immunological microenvironment in prostate cancer: high mast cell densities are associated with favourable tumour characteristics and good prognosis. This observation suggests the immune defense mechanism of mast cells in prostatic cancer. Stimulation of mast cells may be considered for immunotherapeutic treatment strategies in prostatic carcinoma (12). Globa T et al., studied most cell phenotypes in benign and malignant tumours of the prostate and observed that the mast cell heterogenicity of phenotype is utilised as a promising therapeutic target in cancer treatment (13).

The count of mast cell infiltration was seen to be lowest in prostatic adenocarcinoma due to some unknown mechanism. Gupta RK reported the presence of mast cells around prostatic carcinoma (PC) which was s similar to Nonomura N et al., Çandir O¨, Aydin OA et al., (2),(14),(15),(16). A higher Gleason score was associated with increased mast cell count in contrast to samples with a low Gleason score (14). They identified mast cells as independent prognostic markers in PCA using large cohorts of untreated patients with a long follow-up. Taverna G et al., also found mast cells as a potential prognostic marker in prostate cancer (17). Johansson A and co-workers commented that peritumoural mast cell stimulates the expansion of human prostate tumour, whereas intratumoural mast cell negatively regulates angiogenesis and tumour growth and concluded that mast cells are novel independent prognostic markers in PCA and affect tumour progression (18).

The present study demonstrated a total of four cases of prostatic adenocarcinoma with a Gleason Score of 6 and 7. Among four specimens of prostatic adenocarcinoma, one specimen having mast cell infiltration of about 1/HPF was found (Table/Fig 5). Amir T et al., observed mast cell profile in common prostatic lesions in their study (11). They observed that absence or low count was the most significant finding in adenocarcinoma irrespective of the grade of the tumour with a concentration of mast cells around the tumour. Heparin, combined with a range of heparin-binding factors such as bFGF or TGF beta is able to promote neovascularisation and mast cell proteases causing cell structural alterations and the loss of the extracellular matrix integrity. Proangiogenic and antiangiogenic factors tightly regulate angiogenesis. Mast cell secretion stimulates angiogenesis through interacting pathways (19). The role of mast cells in a tumour is rather controversial. They can have a poor antitumour effect depending on the tumour type and tumour microinvasion (17). There is strong evidence that mast cells significantly influence angiogenesis and thus growth and progression in human cancers. Poorly differentiated carcinomas because of their invasive character may result in loss of antitumour response and therefore show scarcity of mast cells (20). Probably by this mechanism, researchers have found the lowest mast cell infiltration in prostatic adenocarcinoma in comparison with normal or other prostatic lesions like prostatitis, BHP, PIN, etc.

Limitation(s)

Due to the limited number of cases available, the study sample size for calculating significance was rather small, which was reflected in the result. Further study with larger samples is required for more accurate findings. Furthermore, the method used for identifying mast cells was a simple one and better methods like ultrastructural study and immunohistochemistry could increase the accuracy of the findings.

Conclusion

The present study showed that the count of mast cell infiltration is seen to be highest in prostatitis, lowest in malignancy and intermediate in PIN. A high mast cell density in the glandular element probably can be taken as an indicator that the lesion is not neoplastic. Poorly differentiated tumours may lack antitumour response, which is associated with its invasive character and may explain the decreased MCD. Therefore, MCD can be of value as a prognostic marker during the evaluation of prostatic biopsies. Also, stimulating mast cell activity might expand immunotherapeutic strategies in prostate cancer further study is required to explain the role of mast cells in tumour progression.

References

1.
Yong LC. The mast cell: Origin, morphology, distribution, and function. Experimental and Toxicologic Pathology. 1997;49(6):409-24. [crossref] [PubMed]
2.
Gupta RK. Mast cell variations in prostate and urinary bladder. Archives of pathology. 1970;89(4):302-05.
3.
Defourny SV, Romanucci M, Grieco V, Quaglione GR, Santolini C, Della Salda L, et al. Tumor-microenvironment interaction: Analysis of mast cell populations in normal tissue and proliferative disorders of the canine prostate. Veterinary Sciences. 2019;6(1):16. [crossref] [PubMed]
4.
Moon TC, Befus AD, Kulka M. Mast cell mediators: Their differential release and the secretory pathways involved. Frontiers in Immunology. 2014;5:569. [crossref] [PubMed]
5.
Stawerski P, Wagrowska-Danilewicz M, Stasikowska-Kanicka O, Tuka E, Danilewicz M. Augmented mast cell infiltration and microvessel density in prostate cancer. Contemporary Oncology. 2013;17(4):378. [crossref] [PubMed]
6.
Hempel Sullivan H, Maynard JP, Heaphy CM, Lu J, De Marzo AM, Lotan TL, et al. Differential mast cell phenotypes in benign versus cancer tissues and prostate cancer oncologic outcomes. The Journal of Pathology. 2021;253(4):415-26. [crossref] [PubMed]
7.
Humphrey PA, Moch H, Cubilla AL, Ulbright TM, Reuter VE. The 2016 WHO classification of tumours of the urinary system and male genital organs-part B: Prostate and bladder tumours. European Urology. 2016;70(1):106-19. [crossref] [PubMed]
8.
Dimitriadou V, Koutsilieris M. Mast cell-tumor cell interactions: For or against tumour growth and metastasis? Anticancer Research. 1997;17(3A):1541-49.
9.
Talukder SI, Roy MK, Azam MS, Huq MH, Haque MA, Saleh AF. Histopathological patterns of prostate specimens in Mymensingh. Dinajpur Med Col J. 2008;1(2):29-32. [crossref]
10.
Deng WB, Li P, Li GX, Zhao Y. The distribution of mast cells in benign and malignant prostate lesions and its biological significance. Sichuan da xuexue bao. Yi xue ban= Journal of Sichuan University. Medical Science Edition. 2004;35(5):623-25.
11.
Amir T, Pai RR, Raghuveer CV. Mast cell profile in prostatic lesions. Indian Journal of Medical Sciences. 1998;52(11):507-13.
12.
Fleischmann A, Schlomm T, Köllermann J, Sekulic N, Huland H, Mirlacher M, et al. Immunological microenvironment in prostate cancer: High mast cell densities are associated with favorable tumor characteristics and good prognosis. The Prostate. 2009;69(9):976-81. [crossref] [PubMed]
13.
Globa T, Saptefrti L, Ceauşu RA, Gaje P, Cimpean AM, Raica M, et al. Mast cell phenotype in benign and malignant tumors of the prostate. Polish Journal of Pathology. 2014;65(2):147-53. [crossref] [PubMed]
14.
Nonomura N, Takayama H, Nishimura K, Oka D, Nakai Y, Shiba M, et al. Decreased number of mast cells infiltrating into needle biopsy specimens leads to a better prognosis of prostate cancer. British Journal of Cancer. 2007;97(7):952-56. [crossref] [PubMed]
15.
Çandir Ö. Mast cell variations in tumor tissue and with histopathological grading in specimens of prostatic adenocarcinoma. BJU International. 1999;84(7):851-53. [crossref] [PubMed]
16.
Aydin O, Dusmez D, Cinel L, Doruk E, Kanik A. Immunohistological analysis of mast cell numbers in the intratumoral and peritumoral regions of prostate carcinoma compared to benign prostatic hyperplasia. Pathology-Research and Practice. 2002;198(4):267-71. [crossref] [PubMed]
17.
Taverna G, Giusti G, Seveso M, Hurle R, Colombo P, Stifter S, et al. Mast cells as a potential prognostic marker in prostate cancer. Disease markers. 2013;35(6):711-20. [crossref] [PubMed]
18.
Johansson A, Rudolfsson S, Hammarsten P, Halin S, Pietras K, Jones J, et al. Mast cells are novel independent prognostic markers in prostate cancer and represent a target for therapy. The American Journal of Pathology. 2010;177(2):1031-41. [crossref] [PubMed]
19.
Norrby K. Mast cells and angiogenesis. APMIS. 2002;110(5):355-71. [crossref] [PubMed]
20.
Theoharides TC, Conti P. Mast cells: The Jekyll and Hyde of tumor growth. Trends in Immunology. 2004;25(5):235-41. [crossref] [PubMed]

DOI and Others

DOI: 10.7860/JCDR/2022/57283.17162

Date of Submission: Apr 23, 2022
Date of Peer Review: May 23, 2022
Date of Acceptance: Aug 30, 2022
Date of Publishing: Nov 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? No
• For any images presented appropriate consent has been obtained from the subjects. No

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Apr 26, 2022
• Manual Googling: Jul 20, 2022
• iThenticate Software: Aug 29, 2022 (8%)

ETYMOLOGY: Author Origin

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)
  • www.omnimedicalsearch.com