前列腺孤立性纤维瘤二例报告

Solitary fibrous tumor of the prostate(report of 2 cases)

目的探讨前列腺孤立性纤维瘤的诊断和治疗。方法总结2例前列腺孤立性纤维瘤患者资料。例140岁,表现为进行性排尿困难,会阴部胀痛不适,B超示前列腺增大,周边整齐。血清PSA 1.92 ng/ml,尿流率呈下尿路梗阻尿流曲线。例256岁,主要症状为进行性尿频、尿急、夜尿增多,B超、CT提示前列腺不均匀增大,前列腺穿刺活检确诊后,患者拒绝手术转放射治疗后失访。结合文献复习讨论。结果例1行经尿道前列腺电切(TURP),切除前列腺组织83 g,随访8个月,未见肿瘤复发,排尿通畅。例2失访。病理检查,2例肿瘤均由梭形细胞和胶原束构成,镜下见特征性黏液样变和血管外皮瘤样变。例1有丝分裂相为1个/10 HP,免疫组化：CD_(34)(+),CD_(99)(+),bcl- 2(+),S-100(-),SM-A(-)。病理诊断：前列腺孤立性纤维瘤。例2有丝分裂相为4个/10 HP。免疫组化：CD_(34)(+),CD_(99)(+),bel2(+),CK(-),S-100(-),SM-A(灶性+),desmin(-)。病理诊断：前列腺孤立性纤维瘤(恶性)。结论前列腺孤立性纤维瘤是一种罕见肿瘤,确诊依赖病理学及免疫组织化学检查。主要治疗方式是TURP和前列腺根治术,良性病变预后好。

Objective To investigate the diagnosis and treatment of solitary fibrous tumor of the prostate. Methods Two case of solitary fibrous tumor of the prostate were reviewed retrospectively. One case was a 40-year-old man presenting with dysuria and perineal swelling pain gradually. B-ultrasound showed enlarged prostate with well-defined margin. The serum PSA was 1.92 ng/ml. Urodynamie study displayed lower urinary tract obstruction curve. The other case was a 56-year-old man presenting with frequent and urgent urination,and noeturia. Uneven prostatic hyperplasia in texture was indicated by B-ultrasound and CT. After prostatic paracentesis biopsy,the patient refused operation and resorted to radiotherapy and he was lost to follow-up. Their clinical data were analyzed in combination with the relevant literature. Results Case 1 was diagnosed with solitary fibrous tumor of the prostate and underwent transurethral resection of the prostate （TURP） with 83g prostatic tissue resected. The patient was followed for 8 months with good voiding and no sign of recurrence. Case 2 was lost to follow-up. Pathology showed that the tumors were composed of mixture of spindle cells with dense collagenous bands in both cases. Microscopically, characteristic myxoid changes and hemangiopericytoma-like area of solitary fibrous tumor of the prostate were observed. In case 1, the mitotic rate was 1/10 high-power field （HPF）. Immunohistochemical test result was positive for CD34, CD99 and bcl-2 ,negative for S-100 and SM-A. Case 2 was diagnosed with malignant solitary fibrous tumor of the prostate. Pathology showed the mitotic rate of 4/10 HPF. Immunohistochemical test result was positive for CD34 ,CD99,SM-A and bel-2,negative for S-100,CK and desmin. Conclusions Solitary fibrous tumor of the prostate is a rare tumor. Its diagnosis depends on histopathologic and immunohistochemical studies. Radical prostatectomy and TURP are main treatment options with good prognosis.