前列腺交界性叶状肿瘤一例报告并文献复习

目的 探讨前列腺叶状肿瘤的分型、临床表现、病理特征、治疗方法及预后情况.方法 2006年10月收治前列腺交界性叶状肿瘤患者1例.患者32岁,因渐进性排尿困难2周、尿潴留1 d入院.直肠指诊示前列腺明显增大,质软、囊性感,表面光滑.血清PSA 20.62 ng/ml.B超及MRI显示前列腺右侧叶多囊性肿大结节,前列腺穿刺活检考虑为良性间叶源性肿瘤,分化欠成熟.结果硬膜外麻醉下行前列腺肿瘤剜除术,切除标本约40 g.病理报告为前列腺交界性叶状肿瘤,肿瘤由上皮和间质成分构成,间质细胞明显增生,细胞有异型性,可见核分裂象;上皮细胞增多,无明显异型性;免疫组化染色Vimentin强阳性,PSA和PAP阳性,SMA阴性.术后40 d患者肿瘤复发,遂行前列腺根治切除术.病理报告为前列腺低度恶性叶状肿瘤,未侵及被膜外,前列腺尿道切端可见肿瘤组织;细胞增生活跃.术后1个月行体外盆腔放射治疗.随访6个月患者生存良好,仍在随访中.结论前列腺叶状肿瘤由增生的上皮和间质成分组成,穿刺活检很难穿到增生的上皮成分而不能确诊;复发恶性度增高,前列腺根治性切除术是目前最可靠的治疗方法.

Borderline phyllodes tumor of the prostate(a case report and literature review)

Objective To review the clinical manifestation,pathological characteristics,treatment and prognosis of borderline phyllodes tumor of the prostate. Methods A case of borderline phyllodes tumor of the Prostate was reported and relative literature was reviewed. Results A 32-year-old man was admided to hospital with a history of aggravated dysuria 2 weeks and urinary retchtion one day. The enlarged prostate was palpated softly and smoothly by DRE.The serum PSA was 20.62 ng/ml.Transrectal ultrasonography and MRI revealed a well-demarcated poly-cystiform tumor which compressed the right lobe of the prostate to flattening.The diagnosis of benign stroma tumor which was not differentiated maturity obtained after transrectal sextant needle biopsy,and the transvesical enucleation was performed under epidural anesthesia.The tumor was histologically diagnosed as borderline phyllodes tumor of the prostate. Microscopic examination showed the tumor was composed of epithelial and stroma cells.The stroma cells proliferated obviously with atypia and mitosis,and the epithelial cells propagated without atypia.Immunohistochemical staining was performed.Vimentin was typically positive,PSA and PAP was positive,and SMA was negative.Forty days after the enucleation,the tumor recurrenced then radical prostatectomy was performed.The diagnosis of low potential malignant phyllodes tumor of the prostate was made.The tumor was limited in tegument and the cross-section of urethra was infiltrated.The patient received external radiation to the whole pelvis(66 Gy)1 month postoperatively.At 6 months'follow up,the patient was asymptomatae. Conelusions The right diagnosis can not be obtained by needle biopsy because hyperptastic epithelial cells can not get and the recurrences of phyllodes tumor increase malignant potential.Radical prostatectomy is the most reliable method of treatment at present.