前列腺原发移行细胞癌（附1例报告）

目的 提高对前列腺原发移行细胞癌的认识，探讨其诊治方法。方法 通过诊治1例原发前列腺移行细胞癌（PTCC）患者，并复习相关国内外文献进行讨论。结果 患者行根治性前列腺膀胱切除术，病理证实为PTCC，免疫组化染色：S100阴性（-），CK阳性（＋＋＋），P53阳性（＋＋＋），PSA阴性（-），术后随访至今无瘤存活。结论 原发PTCC比较少见，其临床表现无特异性，确诊依靠病理学检查，其恶性程度高，对激素治疗不敏感。早期发现并手术，术后联合放疗有望提高疗效。     

Primary transitional cell carcinoma of prostate

Primary transitional cell carcinoma of the prostate (TCC-P) is a rare tumor for which definitive therapy remains undefined. To establish a basis for therapy, we analyzed 3 new cases and reviewed the literature. The following points were observed: (1) the true diagnosis is often missed at initial pathologic examination; (2) the tumor has a propensity for extensive local invasion; and (3) it commonly presents with obstructive symptoms in relatively young patients. Treatment recommendations based on our review include: maintenance of a high index of suspicion, especially for fifty to sixty-year-old men with prostate tumors or for suspected prostatic adenocarcinoma that is rapidly progressive and/or unresponsive to hormonal therapy; preoperative pelvic irradiation followed by radical cystoprostatourethrectomy is the treatment of choice in low-stage disease, and combined radiation therapy and chemotherapy should be used for disease beyond the prostate.     

Primary squamous cell carcinoma of the prostate: a case report

The patient was a 72-year-old man who visited our hospital with a chief complaint of pollakisuria. Digital rectal examination suggested prostatic carcinoma, but prostate specific antigen level was within normal limits. Transperineal needle biopsy was performed and histology was squamous cell carcinoma. Because of the urinary retention, transurethral resection of the prostate was performed and histological examination revealed squamous cell carcinoma. In spite of radiotherapy and chemotherapy with cis-platinum, the progression of cancer continued. The patient died about 13 months after the diagnosis.     

Primary transitional cell carcinoma of the male urethra: report of a case

A case of primary transitional cell carcinoma of the male urethra is reported. A 24-year-old man, who complained of tumor of the urethral orifice with hypospadias, was admitted to our Hospital on November 30, 1983. Urethrocystoscopy and biopsy revealed grade 1 papillary transitional cell carcinoma of the anterior urethra. Partial resection of anterior urethra including tumor was performed on December 20, 1983. Histopathological diagnosis revealed grade 2 transitional cell carcinoma without submucosal invasion. Postoperatively, the patient was treated with Tegafur and Krestin as adjuvant immuno-chemotherapy. The patient has shown no evidence of disease for 3 years after surgery. There have been reported 23 cases of primary transitional cell carcinoma of the male urethra in Japan.     

Primary ureteral carcinoma composed of both transitional cell carcinoma and mucinous carcinoma: a case report

We present a case of primary ureteral carcinoma composed of both transitional cell carcinoma and mucinous carcinoma. A 79-year-old woman visited her home doctor with the chief complaint of right lower abdominal pain. Abdominal computed tomographic scan (CT) disclosed a tumor measuring about 5 cm in diameter at the right lower quadrant of the abdomen. Percutaneous nephrostomy was performed for hydronephrosis and pyonephrosis. The urinary cytology revealed class V, transitional cell carcinoma. Re-abdominal CT showed further enlargement of tumor diameter, but the primary site of the tumor was not identified. Her general condition worsened, and she died 42 days after her initial complaint. Pathologic examinations upon autopsy revealed both mucinous carcinoma and transitional cell carcinoma in the right ureter. Pathogenesis and management of this rare condition are discussed.     

Primary squamous cell carcinoma of the prostate forming a rectourethral fistula: a case report

Eleven cases of squamous cell carcinoma of the prostate have been previously reported in the Japanese medical literature. Patients with this type of carcinoma have dismal prognoses. Herein, we report a case in a 61-year-old man who was admitted to our hospital and whose chief complaints were dysuria and high fever. Pyuria, bacteriuria, and the results of a digital rectal examination suggested acute prostatitis. Despite the administration of antibiotics, the dysuria did not improve. A transrectal needle biopsy was performed, and histology of the tissue showed squamous cell carcinoma. After chemotherapy using methotrexate, pirarubicin, and cisplatin, total pelvic excentration was performed. At 12 months after the operation, the patient is alive with no evidence of the disease.     

Primary transitional cell carcinoma of the prostate presenting as a rectal ulcer

Primary transitional cell carcinoma of the prostate is a rare clinicopathological entity. It is an aggressive tumor with a poor prognosis. Presentation is usually late, with obstructive voiding complaints. Radical surgery offers locoregional control of the disease. We report a case with an atypical presentation of bleeding per rectum and associated obstructive voiding symptoms. Examination revealed a rectal ulcer overlying an enlarged prostate and fixed to it. Histopathology showed a picture of transitional cell carcinoma of the prostate infiltrating the rectum. Imaging studies revealed an enlarged prostate with altered echo pattern with locoregional spread, infiltrating the rectum. Bladder involvement and distant metastases were not evident. External beam radiotherapy achieved good local control. At 3 months of follow-up, the patient was free of urinary symptoms and his rectal ulcer had healed. The patient declined subsequent treatment.     

Primary localized amyloidosis of the renal pelvis coexisting with transitional cell carcinoma: a case report.

Primary localized amyloidosis of renal pelvis is very rare, and only 12 cases have been reported. More than half of the reported cases were treated by nephrectomy, and the preoperative diagnosis could not be made correctly because of its resemblance to renal pelvic tumor. The ureteroscopy is a useful diagnostic means in such a condition. This case is unusual in that a papillary transitional cell carcinoma was present coincidentally.     

Small cell carcinoma of the prostate: a case report

A 79-year-old man was admitted to our department with a chief complaint of urinary incontinence. The prostate was enlarged (145 cc), although the serum level of prostate specific antigen (PSA) was within the normal range (1.09 ng/ml). Digital rectal examination showed an enlarged, irregular prostate with stony hardness. We performed a prostate biopsy and histological examinations indicated poorly differentiated adenocarcinoma with a Gleason score of 5+5=10. A computed tomographic (CT) scan revealed a prostatic tumor invading the bladder, seminal vesicle and rectum. He was diagnosed with a stage T4N1M0 adenocarcinoma of the prostate. He was started-on hormonal therapy, but died one month from the start of treatment. Histological and immunohistological examinations were repeated; suggesting small cell neuroendocrine carcinoma of the prostate.     

Small cell carcinoma of the prostate: a case report

An 80-year-old man visited our hospital because of dysuria and pollakisuria. He had undergone anti-androgen therapy for prostate cancer for 8 months at another hospital. His serum prostate specific antigen (PSA) level was 14.4 ng/ml. We performed a prostate biopsy and identified poorly differentiated adenocarcinoma with Gleason score 4 + 5. After 4 months, his serum PSA level increased to 24.8 ng/ml, and we started maximum androgen blockade therapy using additional luteinizing hormone-releasing hormone (LH-RH) analogue. Subsequently, although his serum PSA level declined favorably, his condition worsened rapidly and he died at 16 months after the diagnosis. The autopsy pathology of his prostate revealed small cell carcinoma. We reviewed the initial biopsy specimens and found both small cell carcinoma and adenocarcinoma histologic types of prostate cancer.     

Small cell carcinoma of the prostate: a case report

A 81-year-old man was admitted to our department with the chief complaints of pollakisuria and difficulty in voiding. He presented with increased serum PSA level (over 100 ng/ml). We performed biopsy of the prostate and found a moderately differentiated adenocarcinoma. Various urological examinations showed metastases to paraaortic lymph nodes and systemic bones. He was started-on hormonal therapy. Nine months from the start of hormonal therapy, this therapy was effective and the serum PSA level was decreased to 14 ng/ml. Thereafter, the serum PSA level and the tumor volume were increased and he died 29 months from the start of treatment. The autopsy revealed small cell carcinoma with adenocarcinoma of the prostate.     

Basal cell carcinoma of the prostate: a case report

A 69-year-old man presented with gross hematuria and irritative urinary symptoms. He underwent transurethral resection of his prostate. The prostate chips revealed 70% poorly differentiated carcinoma with neuroendocrine features, initially read as small cell carcinoma, later as basal cell carcinoma. PSA at this time was 0.3. He received 4 cycles of etoposide and cisplatin. After which, rebiopsy of the prostate showed tumor consistent with poorly differentiated basal cell carcinoma. Given progression on chemotherapy, decision was made to proceed with radical prostatectomy. Metastatic workup was negative. Gross extraprostatic invasion was noted but lymph nodes were free of metastatic disease.     

Small cell carcinoma of the prostate: a case report

Pure small cells carcinoma of the prostate is a rare tumour with a pejorative forecast. We report a case of neuroendocrine small cells carcinoma developed at a 68 years old patient. This tumour expressed a positive marking immunohistochimic with chromogranin A, the rate of PSA was on the other hand normal (2.9 ng/ml). The patient was treated by chemotherapy associating etoposide and cisplatinium and external radiotherapy. He is deceased 4 months afterwards.     

Small cell carcinoma of the prostate: a case report

A 76-year-old man had been treated with maximum androgen blockade therapy for a poorly-differentiated prostate adenocarcinoma (T3cN1M0, prostate specific antigen (PSA) 65 ng/ml, Gleason Score 4+5=9) since September 2002. By August 2003, his serum PSA levels were undetectable and the lymph node swelling had vanished. However, in December 2004, his serum PSA levels started rising gradually up to 0.66 ng/ml. Radiation therapy on the prostate was then performed (66 Gy). At that time, no metastasis was detected by computed tomography and bone scintigraphy. In August 2005, multiple bone metastases were detected. Immunohistochemical examination of a biopsy specimen from the bone lesion revealed a small cell carcinoma/neuroendocrine cell carcinoma. He died with undetectable PSA levels (less than 0.008 ng/ml) in December 2005. The autopsy showed multiple organ metastases including bone, liver, lungs and others. The immunohistochemical examination revealed pure small cell carcinoma in all metastatic lesions. A precise histological examination of the lungs using a 1 cm serial section could not reveal any tumors compatible with primary lung cancer. We concluded from the clinical history and autopsy findings that his initial poorly-differentiated adenocarcinoma of the prostate dedifferentiated into a pure small cell carcinoma with neuroendocrine differentiation.     

Alpha-fetoprotein-producing transitional cell carcinoma of the urinary bladder: a case report

We report a 76-year-old man with alpha-fetoprotein (AFP)-producing transitional cell carcinoma of the bladder. Although the serum level of AFP was 1,428 ng/ml, and he was anti-hepatitis C virus (anti-HCV) antibody-positive, liver tumors were not detected by either a computed tomography (CT) scan or a hepatic angiography. However, removal of a bladder tumor by transurethral resection and subsequent pathological examination revealed a grade III transitional cell carcinoma (TCC). Furthermore, immunohistochemical detection of AFP was diffuse-positive. After the tumor partially responded to concomitant chemoradiotherapy, the serum AFP levels decreased to 966 ng/ml. However, the tumor eventually progressed with multiple lung metastases, and serum AFP levels increased to 3,906 ng/ml. In conclusion, AFP-producing TCC of urinary bladder is rare, and the nature and pathophysiology remains unclear and warrants further investigation.     

Primary transitional cell carcinoma of anterior male urethra: a rare case.

We report a rare case of primary transitional cell carcinoma in a man aged 56 years old. Approximately 600 cases of primary carcinoma of the male urethra have been accumulated until today (1). The 30 to 50 per cent of these neoplasms originate in the anterior urethra and only the 15 per cent are of the transitional cell type (2).     

A case of primary transitional cell carcinoma of the prostate

A 58-year-old man was admitted to our hospital with the complaint of pollakisuria and micturitional pain. The urine cytology showed malignant cells suggesting the urothelial cancer, but various examinations could not reveal the malignant lesion. The prostate was also normal by the digital examination, endoscopy, roentgenography, ultrasonography and serum markers, and the transperineal prostate biopsy showed no malignancy. Three years after the first admission the prostate showed slight hardness and the transperineal biopsy suggested adenocarcinoma of the prostate. Hormonal therapy was then started and the prostate showed no remarkable change until about two years later, when rapid progression of the prostatic tumor was recognized. The transperineal biopsy of the prostate revealed the transitional cell carcinoma with negative staining of Alcian-Blue, PAS and PSA (prostate specific antigen). The epithelia of the bladder and posterior urethra were normal. The radical cystoprostatectomy was done and the histological diagnosis was the pure type of primary transitional cell carcinoma of the prostate. The literatures were reviewed and the clinical differentiation between transitional cell carcinoma and adenocarcinoma of the prostate was discussed.     

A case of primary transitional cell carcinoma of the prostate

A 77-year-old man was referred to our hospital with a complaint of dysuria and right ischiodynia. He had had a hemi-thyroidectomy for thyroid cancer and right cervical lymphadenectomy three years and one year, respectively, before this visit. Prostate cancer was strongly suspected by transrectal examination with prostate specific antigen (PSA) elevated to 77.8 ng/ml. Pathological diagnosis of prostate biopsy specimen was transitional cell carcinoma with grade 3 malignancy and negative staining for PSA. Endoscopic examination showed a normal appearance of bladder and prostatic urethral epithelium. Urine cytology showed no malignant cells. However, immunostaining for PSA revealed that the cervical lymph node specimen resected before was moderately differentiated adenocarcinoma of prostate. He had multiple metastases to mediastinal and retroperitoneal lymph nodes and right ischium. Endocrine therapy (goserelin acetate depot, bicalutamide) and systemic chemotherapy (methotrexate, epirubicin, cisplatin) were performed combined with irradiation to right ischium metastasis. Two months later, he showed a complete response in PSA and partial response in lymph node metastases, but died of cancer 13 months later.