Three-dimensional microscopic image reconstruction of prostatic adenocarcinoma

Context.-Routine microscopy provides only a 2-dimensional view of the compl ex 3-dimensional structure that makes up human tissue. Three-dimensional mi croscopic image reconstruction has not been described previously for prosta te cancer. Objectives.-To develop a simple method of computerized 3-dimensional image reconstruction and to demonstrate its applicability to the study of prostat ic adenocarcinoma. Methods.-Serial sections were cut from archival paraffin-embedded prostate specimens, immunostained using antikeratin CAM5.2, and digitally imaged. Co mputer image-rendering software was used to produce 3-dimensional image rec onstructions of prostate cancer of varying Gleason grades, normal prostate, and prostatic intraepithelial neoplasia. Results.-The rendering system proved easy to use and provided good-quality 3-dimensional images of most specimens. Normal prostate glands formed irreg ular fusiform structures branching off central tubular ducts. Prostatic int raepithelial neoplasia showed external contours similar to those of normal glands, but with a markedly complex internal arrangement of branching lumen s. Gleason grade 3 carcinoma was found to consist of a complex array of int erconnecting tubules rather than the apparently separate glands seen in 2 d imensions on routine light microscopy. Gleason grade 4 carcinoma demonstrat ed a characteristic form of glandular fusion that was readily visualized by optically sectioning and rotating the reconstructed images. Conclusions.-Computerized 3-dimensional microscopic imaging holds great pro mise as an investigational tool. By revealing the structural relationships of the various Gleason grades of prostate cancer, this method could be used to refine diagnostic and grading criteria for this common tumor.