Small cell carcinoma of the prostate with hypercalcemia

We present a case of small cell prostate carcinoma with hypercalcemia in a 75-year-old man. He was diagnosed as having stage T3bN1M0 adenocarcinoma of the prostate. His serum prostate-specific antigen level was reduced to below the normal range after a combination treatment of a luteinizing hormone-releasing hormone agonist and flutamide for prostate carcinoma. He subsequently experienced increasing fatigue, poor appetite, short time loss of consciousness and pain in his lower abdomen. His serum calcium level and carcinoembryonic antigen were increased. He died 5 months from the start of treatment. The autopsy revealed small cell carcinoma of the prostate and multiple metastasis of the lung, liver, pancreas, lymph nodes and spine.     

Small cell carcinoma of the prostate: Three case reports and a literature review

Small cell carcinoma (SCC) of the prostate is a high-grade malignant neoplasm with neuroendocrine differentiation and accounts for only 0.5–2% of all prostate cancers. From 2005 to 2010, there were a total of three cases of SCC at our hospital. The disease onset age was 61, 74, and 84 years, respectively. Initial presentations include urinary difficulty, bone pain, and gross hematuria. One patient had mixed tumors of both SCC and adenocarcinoma, and two had prior adenocarcinomas that recurred as SCC. The diagnosis of SCC was all made via transurethral resection. Two patients died of their diseases 7 and 15 months after diagnosis, and one survived for more than 65 months. The serum prostate specific antigen (PSA) was 1660 ng/mL, 72.8 ng/mL, and 35.7 ng/mL before definitive diagnosis. Notably, the only surviving patient was diagnosed with SCC after the transurethral resection of prostate because of the presence of lower urinary tract symptoms. The serum PSA prior to the operation was 0.11 ng/mL, and he received chemotherapy with 5 courses of cisplatin and VP-16. Palliative transurethral resection of the prostate (TURP) not only solved the obstructive symptoms of voiding but helped in removing the prostate tissue, which might have the SCC component in patients with prostate adenocarcinoma under androgen deprivation therapy.     

非转移性膀胱小细胞癌预后多因素分析及列线图的构建

目的探讨非转移性膀胱小细胞癌(BSCC)的独立预后因素,并建立可以个体化预测患者癌症特异性生存率(CSS)的列线图。方法回顾性分析SEER数据库中2004年至2016年确诊并登记的BSCC患者的临床病理资料,簇选后共纳入360例患者,应用Kaplan-Meier法计算患者的生存率并绘制生存曲线,Log-rank检验评价不同亚组生存差异的显著性,并根据Cox多因素分析结果,运用R软件绘制列线图。列线图的预测性能由校准图和ROC曲线下面积(AUC)进行内部验证。结果年龄>80岁、肿瘤最大径>5.0 cm及T4期是CSS的独立危险因素;术中盆腔淋巴结清扫、(术前或术后)辅助化疗或联合放化疗是独立保护因素。所建列线图预测确诊后1、3、5年CSS的预测精准度分别为0.79、0.72和0.71。结论基于SEER数据库,本研究确定了非转移性BSCC的独立预后因素,并建立了可以个体化预测非转移性BSCC患者预后的列线图,这将有助于设计临床试验和促进医患沟通。     

Rapid progression of small cell carcinoma in a renal transplant recipient

Immunosuppression is thought to be responsible for the increased incidence of tumor development after organ transplantation. Natural history of these tumors may be more aggressive than would be expected for a similar tumor in a patient without transplant. We describe the fulminant course of small cell carcinoma, likely of prostatic origin, in a kidney transplant patient. Small cell carcinoma (SCC) and especially SCC of the prostate is an aggressive and rare type of tumor. Due to its rarity, only case reports have been published. To our knowledge, this is the first case of SCC, likely of prostatic origin, in an organ transplant recipient (OTR). The case illustrates the aggressiveness of the disease as reflected by its fulminant progression, which may have been further accentuated by the immunosuppression.     

Squamous cell carcinoma of the prostate

Squamous cell carcinoma of the prostate is rare, accounting for 0.5-1% of all prostatic cancers. It is highly aggressive and responds poorly to any mode of therapy. We present a case of squamous cell carcinoma of the prostate that developed in a patient with prostatic adenocarcinoma following radiation therapy.     

Small cell neuroendocrine carcinoma of the prostate: incidence and a report of four cases with an examination of KIT and PDGFRA

Because there have been no reports on the incidence and expressions and mutations of KIT and PDGFRA in small cell neuroendocrine carcinoma (SCNEC) of the prostate, the author surveyed archival specimens of 2,642 prostatic specimens (biopsy, 1,503 cases; transurethral resection, 1,009 cases; prostatectomy, 130 cases). Of these, 706 cases were malignant tumors. In equivocal cases (n = 16) of Gleason 5 adenocarcinoma resembling SCNEC, several neuroendocrine markers were immunohistochemically examined. As the results, four cases of SCNEC were identified; therefore the incidence of SCNEC was 0.5% of all prostatic malignancies. All the four cases were biopsies. The remaining 686 cases were adenocarcinomas. In case 1 (50 years of age), the SCNEC tumor cells were positive for cytokeratin, P504S, synaptophysin, KIT, and PDGFRA, but negative for PSA, neuron specific enolase, CD56, and TTF‐1. In case 2 (70 years of age), the tumor cells were positive for cytokeratin, PSA, P504S, chromogranin, and synaptophysin, but negative for neuron‐specific enolase, CD56, TTF‐1, KIT, and PDGFRA. In case 3 (72 years of age), the SCNEC tumor cells were positive for cytokeratin, PSA, P504S, synaptophysin, CD56, KIT, and PDGFRA, but negative for neuron‐specific enolase, chromogranin, and TTF‐1. In case 4 (81 years of age), the SCNEC tumor cell were positive for cytokeratin, PSA, P504S, chromogranin, synaptophysin, neuron‐specific enolase, KIT, and PDGFRA, but negative for CD56 and TTF‐1. A molecular genetic analysis using PCR‐direct sequencing showed no mutations of KIT (exons 9, 11, 13, and 17) and PDGFRA (exons 12 and 18) genes in three informative cases of SCNEC. The present cases were the first of prostatic SCNEC with an examination of KIT and PDGFRA expression and KIT and PDFGRA gene mutations. Prostate 72:1150–1156, 2012. © 2011 Wiley Periodicals, Inc.     

前列腺小细胞癌1例报告并文献复习

目的 提高前列腺小细胞癌的诊治水平.方法 报告前列腺小细胞癌1例,结合文献复习,进行回顾和分析.前列腺体积明显增大,质地硬,表面尚光滑,轻度触痛;B超、MRI提示盆腔巨大肿块,分叶状,质地不均匀,大小为9 cm×9 cm×10cm,压迫并突向膀胱和直肠腔,双侧肾盂积水.结果 前列腺穿刺活检,病理为小细胞癌,免疫组化提示PSA(-),CgA(-),Syn( ),CD56( );因无手术适应证,以及患者拒绝化疗,故施以内分泌治疗,其临床症状无缓解,排尿困难及双肾积水进行性加重,并出现不完全性肠梗阻,全身状况进行性恶化,3月后死于多系统器官功能衰竭.结论 前列腺小细胞癌须病理和免疫组化来确诊,其发病率低,恶性度极高,生长迅速,应与前列腺肉瘤鉴别.治疗以化疗为主,但缓解期短;对内分泌治疗不敏感,姑息性手术和局部放疗可以改善患者生存质量.     

Primary and secondary small cell neuroendocrine carcinoma of the larynx: a review

Primary laryngeal small cell neuroendocrine carcinoma (SCNC) is an unusual malignancy accounting for <0.5% of laryngeal carcinomas. To date, approximately 200 cases of primary and 5 of secondary SCNC of the larynx have been reported. This tumor most often presents in the sixth and seventh decades in men who are heavy cigarette smokers. The lesion may be associated with different paraneoplastic syndromes (ectopic adrenocorticotropic hormone syndrome, Schwartz-Bartter syndrome or syndrome of inappropriate secretion of antidiuretic hormone, and Eaton-Lambert myasthenic syndrome) or with ectopic hormone production. The diagnosis is based essentially on the histologic appearance of the tumor, confirmed by immunocytochemical investigations. Concurrent chemoradiotherapy regimens offer potential for long-term survival. This tumor is biologically aggressive, and the extent of the disease is the most significant independent prognostic factor of survival. The survival rate is similar to that with pulmonary SCNC.     

Development and validation of a nomogram for predicting the overall survival of prostate cancer patients: a large population-based cohort study

BackgroundProstate cancer (PC) is the second most common malignant tumor, and its survival is of great concern. However, the assessment of survival risk in current studies is limited. This study is to develop and validate a nomogram for the prediction of survival in PC patients using data from the Surveillance, Epidemiology, and End Results (SEER) database.MethodsA total of 153,796 PC patients were included in this cohort study. Patients were divided into a training set (n=107,657) and a testing set (n=46,139). The 3-, 5- and 10-year survival of the PC patients were regarded as the outcomes. Predictors based on the demographic and pathological data for survival were identified by multivariate Cox regression analysis to develop the predictive nomogram. Internal and subgroup validations were performed to assess the predictive performance of the nomogram. The C-index, time-dependent receiver operating characteristic (ROC) curves, and corresponding areas under the ROC curves (AUCs) were used to estimate the predictive performance of the nomogram.ResultsAge at diagnosis, race, marital status, tumor node metastasis (TNM) stage, prostate specific antigen (PSA) status, Gleason score, and pathological stage were identified as significantly associated with the survival of PC patients (P<0.05). The C-index of the nomogram indicated a moderate predictive ability [training set: C-index =0.782, 95% confidence interval (CI): 0.779–0.785; testing set: C-index =0.782, 95% CI: 0.777–0.787]. The AUCs of this nomogram for the 3-, 5-, and 10-year survival were 0.757 (95% CI: 0.756–0.758), 0.741 (95% CI: 0.740–0.742), and 0.716 (95% CI: 0.715–0.717), respectively. The results of subgroup validation showed that all the AUCs for the nomogram at 3, 5, and 10 years were more than 0.70, regardless of marital status and race.ConclusionsWe developed a nomogram with the moderate predictive ability for the long-term survival (3-, 5-, and 10-year survival) of patients with PC.     

Locally advanced prostate cancer: a population-based study of treatment patterns

Study Type – Therapy (practice patterns) Level of Evidence 2b What's known on the subject? and What does the study add? The treatment of locally advanced prostate cancer varies widely even though there is level one evidence supporting the use of multimodality therapy as compared with monotherapy. This study defines treatment patterns of locally advanced prostate cancer within the United States and identifies predicators of who receives multimodality therapy rather than monotherapy.

OBJECTIVE

• ? To identify treatment patterns and predictors of receiving multimodality therapy in patients with locally advanced prostate cancer (LAPC).

PATIENTS AND METHODS

• ? The cohort comprised patients ≥66 years with clinical stage T3 or T4 non‐metastatic prostate cancer diagnosed between 1998 and 2005 identified from the Surveillance, Epidemiology and End Results (SEER) cancer registry records linked with Medicare claims.
• ? Treatments were classified as radical prostatectomy (RP), radiation therapy (RT) and androgen deprivation therapy (ADT) received within 6 and 24 months of diagnosis.
• ? We assessed trends over time and used multivariable logistic regression to identify predictors of multimodality treatment.

RESULTS

• ? Within the first 6 months of diagnosis, 1060 of 3095 patients (34%) were treated with a combination of RT and ADT, 1486 (48%) received monotherapy (RT alone, ADT alone or RP alone), and 461 (15%) received no active treatment.
• ? The proportion of patients who received RP increased, exceeding 10% in 2005.
• ? Use of combined RT and ADT and use of ADT alone fluctuated throughout the study period.
• ? In all 6% of patients received RT alone in 2005.
• ? Multimodality therapy was less common in patients who were older, African American, unmarried, who lived in the south, and who had co‐morbidities or stage T4 disease.

CONCLUSIONS

• ? Treatment of LAPC varies widely, and treatment patterns shifted during the study period.
• ? The slightly increased use of multimodality therapy since 2003 is encouraging, but further work is needed to increase combination therapy in appropriate patients and to define the role of RP.

     

前列腺小细胞癌诊治再分析

目的 探讨前列腺小细胞癌的组织学特性、临床表现、治疗以及预后。 方法 报告2例前列腺小细胞癌患者的临床、病理和随访资料,复习相关文献并进行讨论。 结果 2例术后病理检查均诊断为前列腺小细胞癌。术前均经直肠前列腺穿刺活检确诊为前列腺小细胞癌,切片可见肿瘤呈弥漫性巢状结构,细胞小,胞质少,核染色深,核仁不明显,可见燕麦形小细胞,伴凝固性坏死。免疫组化示：PSA、PAP阴性;NSE阳性。例1行前列腺姑息切除术并行EP（VP-16,顺铂）方案化疗,6个月后因肿瘤复发及全身转移死亡。例2行前列腺姑息切除术并行口服比卡鲁胺治疗,3个月后因颅内病灶复发及肝转移死亡。 结论 前列腺小细胞癌具有浸润性生长的生物学特性,恶性程度高,预后不良。确诊依赖病理学检查,早期行根治术并联合放化疗是目前治疗最有效的方法。     

Primary squamous cell carcinoma of the prostate

BACKGROUND: Primary squamous cell carcinoma (SCC) is an uncommon tumor of the prostate gland. A 65-year old man complained of obstructive symptoms. METHODS/RESULTS: Transrectal palpation and diagnostic imaging indicated an ordinary adenocarcinoma, although serum prostate-specific antigen (PSA) was normal. Biopsy specimens revealed SCC with the serum SCC antigen elevated. The patient was treated with pelvic irradiation and systemic administration of cis-platinum and peplomycin, which resulted in shrinkage of the cancer. CONCLUSION: No evidence of recurrence has been seen for 18 months.     

Basal cell carcinoma of the prostate: Report of a case and review of the published reports

Abstract:   Prostatic basal cell carcinoma (BCC), a distinctive variant of adenocarcinoma, is rare. We report a patient with pure basaloid BCC showing an extraprostatic extension and lymph node metastases. A 67-year-old man with urinary outlet obstruction was referred to our hospital. Digital rectal examination disclosed a stony hard prostate. Serum prostate-specific antigen and prostatic acid phosphatase were within the normal range. Transrectal needle biopsy of the prostate was followed by transurethral resection as symptomatic treatment. The lesion was diagnosed histopathologically as BCC. Despite antiandrogen therapy distant metastases developed, and the patient died 5 months postoperatively. We discuss the histological and immunohistochemical findings in this case.     

A population-based study of renal cell carcinoma and prostate cancer in the same patients

OBJECTIVE: To investigate the incidence of prostate cancer in men with renal cell carcinoma (RCC) and the incidence of RCC in men with prostate cancer. METHODS: We evaluated the database of the Surveillance, Epidemiology and End Results Program of the National Cancer Institute from 1973 to 1996, to calculate the incidence of RCC in men with prostate cancer and the incidence of prostate cancer in men with RCC. The standardized incidence ratio (SIR, observed/expected) was calculated for each of the scenarios of interest, as well as for RCC and prostate cancer in men with other common malignancies. Lung/bronchus cancer, colon/rectal cancer, and non-Hodgkin lymphoma were selected for the control scenarios because they are the most common non-urological cancers among men in the USA. RESULTS: There was a higher incidence of RCC in men with prostate cancer (SIR 1.25, P < 0.01). RCC incidence was also higher in men with each of the other malignancies. Prostate cancer incidence was higher in men with RCC (SIR 1.42, P < 0.001), but was not significantly elevated for any of the control scenarios. CONCLUSIONS: The incidence of RCC is higher in men with each of the index cancers, whereas that for prostate cancer was higher only in men with RCC. A common aetiological factor is possible. However, it is also possible that detection bias explains these findings. Serial imaging might increase the detection of RCC among patients with a variety of index malignancies. Patients with RCC who are followed by a urologist might be screened more rigorously for prostate cancer than patients with other primary malignancies, leading to increased detection in these men.     

Pulmonary small cell carcinoma associated with sarcoid reactions: Report of a case

A 45-year-old male was admitted to our hospital for investigation of a nodular shadow in segment 5 of the right lung on a chest computed tomogram. A right middle lobectomy with mediastinal lymph node dissection was performed under a diagnosis of lung cancer, and histologic examination confirmed small cell carcinoma. There were sarcoid reactions in the resected lymph nodes and the lung parenchyma, but no signs of systemic sarcoidosis were evident. Sarcoid reactions are rarely observed in the regional lymph nodes draining malignant tumors. Moreover, while they are most common in squamous cell carcinoma of the lung, they extremely rare in small cell carcinoma. To our knowledge, this is only the third report of this unusual entity in the English and Japanese literature.     

Primary small cell carcinoma of the ureter

We report a case of primary small cell carcinoma of the ureter. These tumors are very rare, locally aggressive and with poor prognosis. A 77-year-old man presented with left flank pain and microhematuria. Following diagnosis of ureteral carcinoma, nephroureterectomy was carried out, and adjuvant chemotherapy and radiotherapy were given. The patient had no evidence of recurrence or metastasis, 13 months postoperatively. We provide a bibliographic review and comment on its clinical and pathologic characteristics, diagnostic methods and latest modifications in therapy.