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。

The diagnosis and treatment of small cell carcinoma of the prostate and a review of the literature

Objective To investigate the histological features, clinical presentation, treatment and prognosis of small cell carcinoma of the prostate. Methods The clinical, pathological and follow-up data of two cases of small cell carcinoma of the prostate were respectively analyzed, and the related literature was reviewed.Results Two cases of small cell carcinoma were diagnosed by transtectal prostate biopsy. Microscopically, the tumor arranged in nest structures and exhibited small round cells with the nuclei extremely hyperchromatic and scanty. Coagulated necrosis was easily observed. The immunohistochemical testing was positive for NSE and negative for PSA 、PAP. Case 1 received palliative surgery and postoperative chemotherapy of EP (VP-16, Cisplatin), and died of recurrence and distant metastasis after six months. Case 2 received palliative surgery and oral bicalutamide treatment, and died of recurrence and liver metastasis after three months.Conclusions Small cell carcinoma of the prostate has the biological behavior of invasive growth with an unfavorable prognosis, which is often in an advanced stage at first diagnosis. The ultimate diagnosis depends on histopathology and surgery combined with systemic chemotherapy and radiotherapy is the most effective treatment.