前列腺孤立性纤维瘤二例报告

目的探讨前列腺孤立性纤维瘤的诊断和治疗.方法总结2例前列腺孤立性纤维瘤患者资料.例1 40岁,表现为进行性排尿困难,会阴部胀痛不适,B超示前列腺增大,周边整齐.血清PSA 1.92 ng/ml,尿流率呈下尿路梗阻尿流曲线.例2 56岁,主要症状为进行性尿频、尿急、夜尿增多,B超、CT提示前列腺不均匀增大,前列腺穿刺活检确诊后,患者拒绝手术转放射治疗后失访.结合文献复习讨论.结果例1行经尿道前列腺电切（TURP）,切除前列腺组织83 g,随访8个月,未见肿瘤复发,排尿通畅.例2失访.病理检查,2例肿瘤均由梭形细胞和胶原束构成,镜下见特征性黏液样变和血管外皮瘤样变.例1有丝分裂相为1个/10 HP,免疫组化：CD34（＋）,CD99（＋）,bcl-2（＋）,S-100（-）,SM-A（-）.病理诊断：前列腺孤立性纤维瘤.例2有丝分裂相为4个/10 HP.免疫组化：CD34（＋）,CD99（＋）,bcl2（＋）,CK（-）,S-100（-）,SM-A（灶性＋）,desmin（-）.病理诊断：前列腺孤立性纤维瘤（恶性）.结论前列腺孤立性纤维瘤是一种罕见肿瘤,确诊依赖病理学及免疫组织化学检查.主要治疗方式是TURP和前列腺根治术,良性病变预后好.

Solitary fibrous tumor of the prostate ( report of 2 cases)

Objective To investigate the diagnosis and treatment of solitary fibrous tumor of the prostate.Methods Two case of solitary fibrous tumor of the prostate were reviewed retrospectively.One case was a 40-year-old man presenting with dysuria and perineal swelling pain gradually.B-ultrasound showed enlarged prostate with well-defined margin.The serum PSA was 1.92 ng/ml.Urodynamic study dis- played lower urinary tract obstruction curve.The other case was a 56-year-old man presenting with frequent and urgent urination,and nocturia.Uneven prostatic hyperplasia in texture was indicated by B-ultrasound and CT.After prostatic paracentesis biopsy,the patient refused operation and resorted to radiotherapy and he was lost to follow-up.Their clinical data were analyzed in combination with the relevant literature.Results Case 1 was diagnosed with solitary fibrous tumor of the prostate and underwent transurethral resection of the prostate(TUBP)with 83g prostatic tissue resected.The patient was followed for 8 months with good voiding and no sign of recurrence.Case 2 was lost to follow-up.Pathology showed that the tumors were composed of mixture of spindle cells with dense collagenous bands in both cases.Microscopically,characteristic myxoid changes and hemangiopericytoma-like area of solitary fibrous tumor of the prostate were observed.In case 1, the mitotic rate was 1/10 hlgh-power field(HPF).Immunohistochemical test result was positive for CD_(34), CD_(99) and bcl-2,negative for S-100 and SM-A.Case 2 was diagnosed with malignant solitary fibrous tumor of the prostate.Pathology showed the mitotic rate of 4/10 HPF.Immunohistochemical test result was positive for CD_(34),CD_(99),SM-A and bcl-2,negative for S-100,CK and desmin.Conclusions Solitary fibrous tumor of the prostate is a rare tumor.Its diagnosis depends on histopathologic and immunohistochemical studies. Radical prostatectomy and TURP are main treatment options with good prognosis.