非腺癌前列腺恶性肿瘤19例诊治报告

目的探讨非腺癌前列腺恶性肿瘤的诊断及治疗方法。方法非腺癌前列腺恶性肿瘤19例。年龄2～64岁，平均32岁。病程5d～10年。临床症状以尿道刺激症、排尿困难及会阴部胀痛为主。直肠指诊提示前列腺部位肿瘤。12例血清前列腺特异性抗原、5例酸性磷酸酶检查正常。B超、CT、MRI检查初步诊断为前列腺恶性肿瘤。19例术前均行前列腺穿刺活检术。12例仅行姑息性尿流改道术，7例行根治术，其中6例术后予以放疗和（或）化疗。结果病理报告侵袭性血管纤维瘤病1例、鳞癌2例、平滑肌肉瘤5例、横纹肌肉瘤3例、纤维肉瘤2例、恶性外周性原始神经外胚层肿瘤2例、间叶肉瘤3例、恶性间质瘤1例。12例行姑息性尿流改道术者术后15个月内因肿瘤全身转移死亡，5例行根治术的患者生存15～26个月后死于肿瘤全身转移，1例恶性间质瘤患者根治术后辅以化疗已生存13个月，1例间叶肉瘤行根治性膀胱前列腺全切加回肠膀胱术，术后予以放疗及化疗，已生存3个月。结论非腺癌前列腺恶性肿瘤患者的临床表现、直肠指诊、B超及CT检查对诊断有重要意义，有效治疗是早期根治术为主的综合治疗。

The diagnosis and treatment of prostatic malignant tumor other than adenocarcinoma(report of 19 cases)

Objective To investigate the diagnosis and treatment of prostatic malignant tumor other than adenocarcinoma. Methods Overall 19 patients with prostatic malignant tumor other than adenocarcinomas were treated from 1978 to 2006. The patient age ranged from 2 to 64 years (mean,32 years). The disease duration was 5 d to 10 years. The clinical manifestations mainly included urethral irratating symptoms,dysuria and distending pain of the perineal region. Digital rectum examination indicated prostatic tumor. Serum prostatic specific antigen level was normal in 12 cases and acid phospha-tase was normal in 5. B-ultrasonography,CT scan and MRI indicated malignant prostatic tumor. Prostate puncture biopsy was carried out in all the cases before operation. Of them, 12 cases underwent palliative urinary diversion,and 7 cases underwent radical excision (6 cases received radiotherapy and/ or chemotherapy). Results The pathologic findings indicated invasive angiofibroma in 1 case,squa-mous cancer in 2, leiomyosarcoma in 5, rhabdomyosarcoma in 3, fibrosarcoma in 2, maligant peripheral primitive neuroectodermal tumor in 2, interlobar sarcoma in 3 and malignant interstitialoma in 1. Twelve cases who underwent palliative urinary diversion died of systemic tumor metastasis within 15 months. Five cases,treated with radical excision and combined therapy, survived for 15 to 26 months and then died of systemic tumor metastasis. One case of malignant interstitialoma who underwent chemotherapy after radical excision had survived for 13 months. One case of interlobar sarcoma who underwent radical cystoprostatorectomy plus ileal conduit and received radiotherapy and chemotherapy had already survived for 3 months. Conclusions The clinical manifestations,ultrasonography, rectal examination and CT are valuable for the diagnosis of prostatic malignant tumor other than adenocarcinoma. Final diagnosis depends on pathological examination. Up to now,early radical surgery and com- bined therapy primarily are effective treatments for prostatic non-adenocarcinoma malignant tumor.