前列腺肉瘤样癌二例报告并文献复习

目的 探讨前列腺肉瘤样癌的临床表现、病理特点和诊治方法. 方法 前列腺肉瘤样癌患者2例.例1,51岁.因排尿困难、会阴部不适2个月,急性尿潴留入院.实验室检查PSA值2.31 ng/ml,CT检查示前列腺密度不均,左叶弥漫性增大、浸润膀胱.经直肠穿刺活检诊断为前列腺肉瘤样癌.行全膀胱、前列腺切除加尿流改道(Bricker手术),术后行局部放射治疗和内分泌治疗.例2,54岁,因排尿困难伴间歇性肉眼血尿1个月入院.实验室检查PSA 2.61 ng/ml.B超检查示低回声块.CT检查示前列腺密度不均.经直肠穿刺活检诊断为前列腺肉瘤.行全膀胱、前列腺切除加尿流改道(Bricker手术). 结果 2例术后病理均诊断为前列腺肉瘤样癌.镜下肿瘤组织由上皮癌细胞和肉瘤样间质2种成分组成,之间可见移行区过渡.免疫组化:2种成分中细胞角蛋白、上皮膜抗原均呈阳性表达.癌细胞波形蛋白阴性,肉瘤样细胞阳性.例1术后41个月出现广泛转移,2个月后死亡.实验室检查PSA正常.例2术后16个月出现骨转移并有局部复发,手术去势联合比卡鲁胺最大限度雄激素阻断治疗3个月无效,术后19个月死亡.实验室检查PSA<4.0 ng/ml.结论前列腺肉瘤样癌是一种罕见、高度恶性的肿瘤,预后不良,确诊需依赖病理表现及免疫组织化学检查.根治性切除辅以局部放射治疗和内分泌治疗可行.

Prostate sarcomatoid carcinoma (with 2 cases report and literature review)

Objective To investigate the clinical presentations, pathologic features, and the di-agnosis and treatment of prostate sarcomatoid carcinoma. Methods Two cases of prostate sarcoma-told carcinoma were analyzed with review of the relevant literature. Case 1, a 51-year-old man com-plained of dysuria and perineal discomfort for 2 months, was admitted because of acute urinary reten-tion. His serum PSA was 2.31 ng/ml. Heterogeneous density of the prostate left lobe and bladder neck involvement was shown on CT scan. Prostate sarcomatoid carcinoma was confirmed by transrec-tal prostate biopsy, and patient accepted radical cystoprostatectomy and ideal conduit followed with lo-cal radiotherapy and hormonal therapy. Case 2 was a 54-year-old male. This ease was admitted with a history of dysuria and intermittent gross hematuria for 1 month. Hypoechoic lesion was found by ul-trasonography,and heterogeneous density of the prostate was shown on CT scan. His serum PSA was 2.61 ng/ml. The prostate biopsy result showed prostate sarcoma. Radical cystoprostatectomy and ide-al conduit was performed on this case. Results The diagnosis of prostate sarcomatoid carcinoma in the 2 cases was confirmed by postoperative pathology. Under microscope, the neoplasm was mainly composed of epithelial and sarcomatoid mesenchymal cells,with a transitional region of these cells. Im-munohistochemical staining showed that the cells were positive for cytokeratin and epithelial membrane antigen. Vimentin was negative in the epithelial cells, but was positive in the majority of sarcomatoid cell. Both patients died of multi-metastasis at 43 and 19 months after surgery respectively. Conclu-sions Sarcomatoid carcinoma of the prostate is extremely rare with a high grade of malignancy,and its prognosis is poor. The diagnosis depends on pathological features and immunohistochemical studies. Radical resection combined with endocrine therapy and radiotherapy is considered to be the most relia-ble treatment so far.