原发性前列腺印戒细胞癌诊疗分析

目的 提高对原发性前列腺印戒细胞癌临床特点的认识和诊治水平. 方法 原发性前列腺印戒细胞癌患者23例.年龄57～90岁,平均74岁.有排尿症状者18例,体检偶然发现PSA升高者5例.实验室检查PSA平均45.3(7.4～126.8)ng/ml.MRI多示外周带有异常区呈T1w低信号、T2W高信号,增强后明显强化,中央带见增生结节,呈混杂信号.其中行前列腺癌根治术7例,2例切缘阳性者术后辅以全雄激素阻断治疗及体外放射治疗,16例行全雄激素阻断治疗,其中11例因存在下尿路梗阻而行前列腺绿激光汽化术,3例行体外放射治疗.23例均行消化道内镜或钡餐检查排除转移性印戒细胞癌. 结果 23例均经病理证实为印戒细胞癌,其中纯印戒细胞癌6例,混有典型前列腺癌成分17例,其中典型癌成分均为Gleason评分7～10分的高级别低分化前列腺癌.免疫标记PSA、前列腺酸性磷酸酶均为阳性,AB/PAS阴性,CEA阴性21例.TNM临床分期Ⅱ期7例,Ⅲ期10例,Ⅳ期6例.20例平均随访24(6～56)个月,8例生存6～42个月后因肿瘤转移死亡,5例12～21个月后出现生化复发,失访3例. 结论 原发性前列腺印戒细胞癌侵袭性强、转移快且累及前列腺外各种脏器、复发早,早期诊断及综合治疗或能提高远期生存率.

Clinical and pathologic characteristics of primary prostatic signet ring cell carcinoma

Objective To discuss the clinicopathologic features, diagnosis and treatment of pri-mary prostatic signet ring cell carcinoma (PPSRCC). Methods Clinical data of 23 PPSRCC cases were retrospectively reviewed. The mean age was 74 years and majority of them had aggravated dysu-ria. The mean serum PSA was 45.3 ng/ml (7.4-126.8 ng/ml). To exclude the metastasis from stomach and colon SRCC, upper gastric tract endoscopy and barium enema were carried out. Seven pa-tients received radical prostatectomies and 2 patients who had positive margins received hormonal and radiation therapy. The rest of patients received maximal androgen blockade therapy. Photoselective vaporization of the prostate was performed on 11 patients who had lower urinary tract symptoms. All cases were investigated by routine pathological, immunohistochemical studies. Results Seventeen cases of PPSRCC were associated with concurrent high-grade prostatic carcinoma, only 6 cases were pure SRCC. Immunohistochemical stains were positive in all cases for PSA and PAP. Stains were ne-gative for AB/PAS (23/23) and CEA (21/23). The clinical TNM stages were 7 of Ⅱ , 10 of Ⅲ and 6 of Ⅳ. Follow-up was available on 20 cases with a mean 24 months and 3 cases were lost during follow up. Eight cases died of metastasis. Five cases had evidence of recurrence 12-21 months from presen-tation. Conclusions The diagnosis of PPSRCC depends on pathological and immunohistochemical studys after metastasis from stomach and colon SRCC is excluded. Early diagnosis and combination treatment for PPSRCC might improve its prognosis.