Immunohistochemical Evidence of Telocytic Stroma Associated with Tumor Grade and Acinar Heterogeneity in Prostate Cancer

Prostate cancer (PCa) progression involves dynamic interactions between neoplastic cells and the reactive stroma (RS). Although myofibroblasts are established components of the RS, the role of other stromal populations, such as telocytes, remains poorly understood. This study investigated the presence and distribution of a telocytic stromal phenotype (CD34⁺/Vimentin⁺) in PCa across different histological grades and acinar patterns. We used digital image analysis and standardized immunohistochemistry to assess biopsy samples from 120 patients with confirmed PCa. The telocytic phenotype showed a heterogeneous distribution and was significantly enriched in high-grade tumors and specific acinar architectures, particularly Patterns B and D. In contrast, well-differentiated regions exhibited lower telocyte density, resembling non-neoplastic prostate tissue. Although the myofibroblastic phenotype (α-SMA⁺/Vimentin⁺/CD34^-) also increased overall with tumor grade and varied across acinar patterns, this association was comparatively weaker and less statistically robust than that observed for telocytes. These results suggest that stromal remodeling encompasses a spectrum of cellular phenotypes influenced by local architectural constraints. It is proposed that telocytes serve as key mediators of tissue organization and biomechanical signaling, contributing to a feedback loop that promotes tumor progression. Combining acinar architecture with stromal phenotyping provides a refined framework for understanding epithelial-stromal co-evolution in PCa.