前列腺透明细胞腺癌3例报道并文献复习

Prostate clear cell adenocarcinomas: a report of 3 cases and literature review

目的 探讨前列腺罕见肿瘤原发透明细胞腺癌(CCA)的临床病理学特征及鉴别诊断。方法 分析3例前列腺CCA临床病理学特点并复习相关文献。采用一组免疫组化抗体进行鉴别诊断。结果 3例患者年龄29~54岁;2例发生于前列腺小囊,1例发生于前列腺内。2例临床表现为血精,1例为进行性排尿困难。肿瘤由腺管状、乳头状及实体型三种结构混合存在。腺管和乳头表面可见肿瘤细胞呈鞋钉样排列。3例肿瘤细胞均表达CK7、PAX-8、HNF-1β,部分区域表达AMACR、NapsinA、CA125。术后随访12~15个月,其中1例复发,并肺及腹股沟淋巴结转移;1例未见复发和转移;1例失访。结论 前列腺原发CCA血清前列腺特异性抗原(PSA)水平不高,可伴有CA125升高,出现血精症状的年轻男性需提高警惕,诊断主要依靠组织病理学检查及免疫表型,发生于前列腺内的较发生于前列腺小囊的预后差。

Objective To explore the clinicopathological features and differential diagnosis of primary clear cell adenocarcinoma(CCA) of the prostate. Methods The pathological data of 3 cases of primary prostate CCA were retrospectively analyzed and relevant literature was reviewed. Immunohistochemistry(IHC) was performed with a group of differential antibodies. Results The patients aged 29 to 54 years. The CCA was located in prostatic utricle in 2 cases and in prostatic parenchyma in 1 case. The clinical manifestation was hematospermia in 2 cases and progressive dysuria in 1 case. Microscopically, a mixture of three histological structures were observed, including glandular, papillary and solid patterns. The so-called hobnail pattern was visible in the glandular and papillary surfaces. Immunohistochemically, CK7, PAX-8, HNF-1β were positive, and AMACR, NapsinA, CA125 were partially positive. During the follow-up of 12 to 15 months, 1 patient was lost, 1 developed metastases of the lung and inguinal lymph nodes, and the other had no recurrence or metastasis. Conclusion The serum CA125 level might be elevated while prostate specific antigen(PSA) level is normal for patients with prostate CCA. Young patients with hemospermia should be altered. The diagnosis relies on histopathological examination and immunohistochemical staining. The prognosis of patients with tumor located in prostatic parenchyma is worse than that located in prostatic utricle.