前列腺黏液腺癌2例报告及文献复习

目的：探讨前列腺黏液腺癌的病理和诊疗特点。方法：回顾性分析我院1995年1月～2011年3月收治的2例前列腺黏液腺癌患者的临床资料,并结合文献复习,分析其特点。结果：2例患者年龄分别为73和84岁,因不同程度的排尿困难入院。1例误诊为前列腺增生,行经尿道前列腺电切术;另1例直肠指检、B超、CT、MRI及PSA检查均提示为前列腺癌,行穿刺活检后确诊,根据患者全身状况行硬膜外麻醉下经尿道前列腺电切术,以改善排尿症状,术后病理检查回报为前列腺黏液腺癌,免疫组织化学检查有较特异性表现。术后给予抗雄激素治疗等。结论：前列腺黏液腺癌在前列腺癌中罕见,没有特征性的临床表现,确诊主要依靠病理和免疫组织化学检查;治疗方法可采用根治性前列腺切除术。     

前列腺导管腺癌一例报告并文献复习

目的探讨前列腺导管腺癌的临床、病理特征及治疗方法。方法1例反复血精5个月，血尿4个月的患者直肠指诊示：前列腺右侧可及直径约1cm质软肿物。血清前列腺特异抗原（PSA）0.7ng/ml。前列腺穿刺活检提示前列腺腺癌。患者行根治性前列腺切除术。结果病理报告：前列腺右叶大导管腺癌，向外浸润右侧精囊，Gleason分级5/4（Sum=9），pT3b;免疫组化染色PSA（＋），前列腺酸性磷酸酶（PAP）（＋＋），雄激素受体（AR）（-）。患者术后恢复良好，血精、血尿消失，随访7年仍存活。结论前列腺导管腺癌是前列腺癌罕见的亚型，难于早期诊断，确诊主要依靠病理和免疫组化检查，治疗方法可采用根治性前列腺切除术。     

前列腺导管腺癌临床病理和诊治特点分析

目的 探讨前列腺导管腺癌的临床病理特征和诊治特点.方法前列腺导管腺癌患者9例.年龄59～106岁,平均76岁.以进行性排尿困难、夜尿频多就诊6例,其中伴无痛性肉眼血尿2例;首发症状为无痛性肉眼血尿2例;常规体检PSA升高行穿刺检查1例.行根治性前列腺切除术1例,根治性前列腺切除术加双侧睾丸切除术加放疗1例,前列腺等离子电切加绿激光汽化术加双侧睾丸切除术5例,前列腺等离子电切加绿激光汽化术1例,双侧睾丸切除加放疗1例.术后8例予氟他胺治疗3～45个月,定期随访.结果 9例手术均获成功.肿瘤呈乳头状或菜花状,累及前列腺精阜及中央导管.组织结构主要为导管内乳头和复分支腺结构,被覆不同层次高柱状上皮,核仁大,易见核分裂象.免疫组化检测显示PSA、雄激素受体(AR)、前列腺酸性磷酸酶(PAP)阳性率分别为89%(8/9)、100%(5/5)、100%(5/5).病理诊断均为前列腺导管腺癌,合并前列腺腺癌5例.Gleason评分6～7分3例,≥8分6例.9例患者平均随访20(3～48)个月.术后生化复发5例,其中伴骨、肺转移1例,死于全身骨转移、多器官功能衰竭3例;无复发3例;1例高龄患者术后6个月仍存活.结论 前列腺导管腺癌发病率低,早期缺乏典型症状,确诊主要靠病理检查,预后较差,应按照高危前列腺癌的治疗原则进行治疗并密切随访.     

根治性膀胱切除原位回肠新膀胱术后尿道肿瘤复发的原因及治疗

目的：探讨膀胱尿路上皮癌行根治性膀胱切除原位回肠新膀胱术后尿道复发的原因及治疗方法。方法：回顾403例膀胱尿路上皮癌行根治性膀胱切除原位回肠新膀胱术的患者资料,总结尿道肿瘤的复发率、原凼、诊断、治疗和预后。结果：6例患者出现尿道肿瘤复发,复发率为1．5％,均为男性。2例浸润性尿道肿瘤和1例尿道广泛表浅性乳头状瘤行全尿道切除术和新膀胱造瘘术,3例尿道表浅性乳头状瘤行经尿道肿瘤切除术和尿道内灌注化疗,术后2例复发,再次行全尿道切除术。2例浸润性尿道肿瘤和1例尿道广泛表浅性乳头状瘤在2年内因肿瘤复发或转移死亡。结论：膀胱多发原位癌、肿瘤侵犯前列腺尿道和基质、女性膀胱颈部是尿道复发主要原因。原位新膀胱的尿道复发率低于其他尿流改道术,全尿道切除术是尿道复发更可靠的治疗方案,尿道表浅性肿瘤的预后明显好于浸润性肿瘤。     

原发女性尿道腺癌诊断及治疗1例报告

目的:探讨女性尿道腺癌的诊治特点、临床及病理特点。方法:报告我院收治的1例女性尿道腺癌患者,应用免疫组化方法对标本进行分析并对相关文献进行复习。结果:患者行经尿道肿物切除术,术后病理回示:弥漫浸润性中分化尿道腺癌,免疫组化:CK20+、CK7+、PSA-、CEA+、CD10+。术后建议患者行根治性切除手术+全身化疗,患者改中药治疗,目前严密随访中。结论:尿道腺癌是一种罕见尿道肿瘤,目前治疗方法多参照尿道肿瘤治疗,根治性切除术,术后辅以放化疗;局部早期可行局部肿物切除术,疗效也较满意。     

前列腺黏液腺癌1例报告

前列腺黏液腺癌是前列腺癌中罕见的病理分型, 本文报道1例。患者因间断血尿就诊, 术前诊断为前列腺腺癌, 行腹腔镜根治性前列腺切除术, 术后病理检查示前列腺黏液腺癌, 术后随访6个月, 影像学检查无复发、转移征象, tPSA正常。     

TUR术治疗原位新膀胱术后再发尿道癌

目的 探讨膀胱癌全膀胱切除原位新膀胱术后再发尿道癌的治疗方法.方法 膀胱癌行全膀胱切除原位新膀胱术患者89例,术后发生尿道癌5例(5.6%),再发尿道癌平均时间18(9～32)个月.5例患者病理分期为T1～T2.因复发性膀胱癌行全膀胱切除术4例,因膀胱多发癌行全膀胱切除术1例.采用乙状结肠原位新膀胱术3例,回肠原位新膀胱术2例.5例患者术后因排尿不畅(3例)、肉眼血尿(1例)、血性分泌物(1例)再次就诊.尿道镜检查发现尿道肿物位于前列腺部尿道2例、阴茎部尿道3例.肿物呈菜花状向尿道腔内生长,可见基底部,肿物直径1～3 cm.尿道镜活检报告均为尿道尿路上皮癌,病理分期为T1～T2.5例均行TUR术,术后病理报告为尿道非浸润性尿路上皮癌Ⅰ～Ⅱ级.术后辅以羟基喜树碱尿道灌注,每周1次,共6周.结果 5例TUR术后平均随访37(24～52)个月,控尿满意,血尿和血性分泌物均消失,尿细胞学检查均为阴性,尿道镜检查无阳性发现.肿瘤未见复发、转移.结论 膀胱癌膀胱全切术后再发尿道尿路上皮癌可以选择保全尿道的TUR术和尿道灌注治疗,疗效较满意且生活质量良好.     

前列腺导管腺癌1例报告并文献复习

目的：探讨前列腺导管腺癌的临床表现、病理特征、治疗方法等。方法：报告1例前列腺导管腺癌疾病的情况,并结合文献对之诊断治疗行进一步探讨。1例82岁男性患者主因“尿频、尿急7年,加重3个月”入院,误诊为其他疾病。血清总PsA为2．38μg／L,行TURP后方明确诊断。后行根治切除和相应药物治疗等。结果：病理报告：前列腺导管腺癌,Gleason8分。免疫组化染色PSA（＋）,前列腺酸性磷酸酶（PAP）（＋）,低分子角蛋白（CKAE）（＋）,高分子角蛋白（CKHW）（＋）,雄激素受体（AR）（-）。患者术后恢复可,长期疗效需进一步随访。结论：前列腺导管腺癌在前列腺癌中罕见,难于早期诊断,确诊主要依靠病理和免疫组化检查,治疗方法可采用根治性前列腺切除术。     

男性球海绵体悬吊术治疗前列腺术后尿失禁的探讨

目的：探讨男性球海绵体悬吊术治疗前列腺切除术（包括根治性切除术）后尿失禁的疗效。方法：采用经尿道球海绵体悬吊术治疗前列腺切除术后严重尿失禁患者7例。结果：术后随访14-26个月（平均20.4个月）,6例患者完全自控排尿,1例改善非常明显。结论：男性球海绵体悬吊术是治疗根治性前列腺切除或其他原因引起尿道括约肌损伤所致尿失禁的理想方法。     

膀胱移行细胞癌伴前列腺癌的诊断与治疗

目的　提高膀胱移行细胞癌伴前列腺癌的诊治水平。　方法　对 8例膀胱移行细胞癌伴前列腺癌患者的临床资料进行分析。　结果　 8例术前均经膀胱镜检查及活检病理证实为膀胱移行细胞癌。 7例经直肠前列腺穿刺活检确诊前列腺癌 ,1例为前列腺增生症 ,行膀胱前列腺全切术后病理证实为前列腺癌。 4例行经尿道膀胱肿瘤电切及双侧睾丸切除术 ,术后使用丝裂霉素或BCG等膀胱灌注及氟他胺内分泌治疗。 1例行膀胱前列腺全切加回肠膀胱术。 8例中 2例失访 ,3例因多发性转移 ,术后存活 <1年 ,3例行根治性膀胱前列腺全切术 ,术后随访 1.5～ 4.0年 ,经胸片、CT、同位素和PSA等检查未见肿瘤复发或转移。　结论　血清PSA测定、前列腺直肠指诊、经直肠前列腺B超检查、活检及膀胱镜检查是诊断膀胱移行细胞癌伴前列腺腺癌的主要方法 ,根治性膀胱前列腺切除是影响预后的重要因素     

Prostatic duct adenocarcinoma with pagetoid spread on the glans penis: a case report

A 75-year-old male visited our division with asymptomatic erythema on the glans penis which he first noticed six months earlier. The patient underwent total cystoprostatectomy under the diagnosis of urothelial carcinoma of the urinary bladder four years earlier. At the time, the prostatectomy specimen incidentally revealed a prostatic acinar adenocarcinoma at the bilateral peripheral zone. A skin biopsy of the erythema revealed intraepithelial Paget's cells, and the patient underwent total penectomy under the diagnosis of extramammary Paget's disease. Histopathological examination revealed continuous intraepithelial Paget's cells from the glans penis to the urethral navicular fossa, and a ductal carcinoma was detected beneath the urethral mucosa to the excisional margin. Because the Paget's cells expressed cytokeratin 20, the tumor was diagnosed as Pagetoid spread rather than Paget's disease. Re-examination of the previous prostatectomy specimen revealed prostatic duct adenocarcinoma with prostatic acinar adenocarcinoma. Therefore, the final diagnosis was prostatic duct adenocarcinoma with Pagetoid spread to the glans penis. Follow up at nine months revealed neither local recurrence, nor distant metastases, although no adjuvant therapy has been given.     

前列腺癌根治术后尿道多发转移1例并文献复习

目的:探讨前列腺癌根治术后尿道转移的转移机制、治疗方案。方法:总结收治的前列腺癌根治术后尿道转移1例:79岁男性,13年前因前列腺癌行前列腺癌根治术。术后予以内分泌治疗。2周前无明显诱因出现尿痛、伴肉眼血尿。尿道外口可见一1.0 cm×0.5 cm类圆形肿物。膀胱尿道镜检见尿道多发肿物,并行肿物切除活检,提示前列腺癌尿道转移。术前PSA:3.01μg/L。患者遂行尿道根治性切除术、膀胱造瘘术。结果:术后病理提示:尿道括约肌及海绵体组织中可见癌组织浸润。免疫组化:PSA(+),PsAP(+),AR(+),CK7(-),考虑为前列腺癌。手术切缘未见肿瘤。术后恢复良好,术后PSA:1.00μg/L。结论:前列腺癌根治术后尿道转移临床罕见,外科手术为首选的治疗方案,适当的根治性切除手术应该是有效的治疗方式。     

前列腺副神经节瘤1例报道并文献复习

目的:探讨前列腺副神经节瘤的临床表现、病理特征、治疗和预后。方法:报道前列腺副神经节瘤1例,患者男,39岁,主因"反复血精1年余"入院,误诊为前列腺癌后,行耻骨上前列腺根治性切除术,完整切除肿瘤。结果:术后病理确诊为前列腺副神经节瘤,本例前列腺副神经节瘤为无功能性,免疫组化:NSE(+)、CGA(+)、S100(+)、CK(-)、Desmin(-)。术后血压平稳,2周后拔尿管出院。随访48个月至今未复发。结论:前列腺副神经节瘤缺乏特异的临床特征表现,易误诊,只有靠切除术后病理和免疫组化才能确诊。由于其非常罕见,相关治疗缺乏成熟的经验,故需要进一步研究。     

Successful salvage robotic-assisted radical prostatectomy after external beam radiotherapy failure

We describe the first case of salvage robotic-assisted radical prostatectomy for local recurrence after external beam radiotherapy. A 50-year-old man initially underwent combined external beam radiotherapy and hormonal treatment for Stage T2a prostate adenocarcinoma. The prostate-specific antigen level was 10.5 ng/mL, and the Gleason score was 3+3. Two years later, he developed biopsy-proven recurrent disease. He underwent salvage robotic-assisted radical prostatectomy. The patient was discharged on day 1 postoperatively. The histologic analysis revealed an organ-confined tumor. His prostate-specific antigen at 3 months was <0.03 ng/mL, and he was continent. Salvage robotic-assisted radical prostatectomy is a safe and technically feasible salvage treatment for prostate cancer for which primary radiotherapy has failed.     

Mucinous adenocarcinoma of the prostate: a case report of long-term disease-free survival and a review of the literature

A 65-year-old man presented with hematuria, postcoital bleeding, and mucoid-appearing prostatic secretions. The prostate was normal in size, boggy, and with no palpable masses. Cystoscopy revealed a prostatic wall cavity with gelatinous material exuding from the lesion. Extensive transurethral resection was performed, with approximately 37 g of tissue retrieved. Flexible sigmoidoscopy was performed to 60 cm, revealing no lesions, and stool was negative for occult blood. The pathologic diagnosis was mucinous adenocarcinoma of the prostate. Computed tomography and bone scan were negative for metastatic disease. The patient underwent uncomplicated radical prostatectomy. Fifteen years later, the patient was disease free and maintaining a healthy, active lifestyle.     

Two cases of mucinous adenocarcinoma of the prostate]

We report two cases of mucinous adenocarcinoma of the prostate. A 56-year-old man underwent subcapsular prostatectomy under the diagnosis of benign prostatic hyperplasia in 1968, and was found to have mucinous adenocarcinoma of the prostate, which proved to be prostatic acid phosphatase (PAP) and prostate specific antigen (PSA) positive, and carcinoembryonic antigen (CEA) negative by immunohistochemical staining. Subsequently he received 70 Gy of irradiation to the prostate, but died in 1976, when serum PAP was elevated. Autopsy revealed metastases to the liver, lungs, bone, peritoneum, spleen, pancreas, lymph nodes, and no primary gastrointestinal adenocarcinoma. The other case was a 57-year-old man, who underwent transurethral resection (TUR) for papillary tumor located just lateral to the verumontanum in 1982. The tumor was misdiagnosed as adenomatous polyp, and was PSA and PAP negative, and CEA positive. After 3 TURs of the recurrent tumor on the prostatic urethra, he underwent prostatourethrectomy, pelvic lymphadenectomy, and cystostomy for radical cure in 1985. The specimen proved to be mucinous adenocarcinoma of the prostate. He suffered recurrence of the tumor in the retrovesical space in 1987, and died in 1990. Autopsy revealed no evidence of metastasis except the local recurrence and no primary gastrointestinal adenocarcinoma.     

Prostate cancer in men less than 45 years old: influence of stage, grade and therapy

We analyzed patients with histologically proved adenocarcinoma of the prostate to determine the natural history of prostatic cancer in men less than 45 years old. The mean age of the patients was 41 years (range 36 to 44 years). At presentation 5 patients were asymptomatic, 5 had voiding symptoms, 3 had bone pain, 3 had hematuria and 1 had testicular pain. Followup in these patients ranged from 19 to 270 months, with a mean of 111 months. Six patients with clinical stage B disease at diagnosis underwent radical retropubic prostatectomy. These patients enjoy projected 10 and 15-year survival rates of 100 and 82 per cent, respectively. Four patients with stage C disease died of prostatic cancer, although 1 survived for 204 months. Of 4 patients with stage D disease 3 died within 13 months, while 1 still is alive at 48 months. No patient with a Gleason tumor score of 8 to 10 survived more than 13 months. Patient age at presentation appears to be less important than clinical stage, histological grade or treatment modality in the prediction of the course of prostatic cancer. Young men with localized disease at presentation should be treated aggressively and they should have survival rates comparable to actuarial expectancy.     

前列腺移行细胞癌(附2例报告)

目的；提高前列腺移行细胞癌的诊治水平。方法：回顾分析2例前列腺移行细胞癌患者临床资料，结合文献复习讨论。结果：1例行前列腺癌根治术，术后予吡柔比星膀胱灌注化疗，现仍在随访中，另1例行经尿道前列腺切除术加经尿道电气化术，术后半年死亡。结论：本病多以肉眼血尿就诊。确诊主要依赖前列腺穿刺活检及术后病理检查。治疗以手术加膀胱灌注化疗为主，预后较其他前列腺癌差。     

Carcinosarcoma of the prostate with multiple metastases: case report and review of the literature

A case of carcinosarcoma of the prostate in a previously healthy 65-year-old man is reported. The tumor was initially diagnosed as adenocarcinoma, but the prostatectomy specimen showed a 717-g prostate, with evidence of adenocarcinoma and carcinosarcoma without heterologous structures. By 3-month follow-up, local recurrence, and liver, lung, and bone metastases had developed in the patient. He died of disease 10 months postoperatively. Carcinosarcoma of the prostate is a very rare but highly aggressive cancer with limited therapeutic options that should be treated with surgery and managed symptomatically. We believe this article is the forty-second case reported in the literature.