前列腺小细胞癌二例报告并文献复习

Small cell carcinoma of the prostate (report of 2 cases and review of the literature)

目的探讨前列腺小细胞癌的临床、病理特征及治疗方法。方法总结2例前列腺小细胞癌患者的临床资料并进行文献复习。例1,50岁,因排尿困难伴会阴部疼痛3个月入院。直肠指检前列腺Ⅲ度(5．0 cm×6．0 cm)增生,质硬,表面欠光滑。血清PSA 0．31 ng／ml,fPSA 0．09ng／ml。B超示低回声块,CT示前列腺密度不均。经直肠穿刺活检示前列腺癌,行前列腺癌根治术。例2,82岁,因排尿困难伴间歇性血尿4个月入院。直肠指检前列腺Ⅱ度(4．0 cm×5．0 cm)增生,质硬伴多发性结节,表面欠光滑。血清PSA 2．61 ng／ml,fPSA 0．05ng／ml。B超示低回声块,CT示前列腺密度不均,精囊及膀胱颈部受侵犯。经直肠穿刺活检示前列腺小细胞癌,行双睾切除术加TURP。结果2例术后病理均诊断为前列腺小细胞癌。肿瘤呈弥漫性片巢状结构,伴大片凝固性坏死,核小、燕麦状或圆形、染色深、核仁不明显、胞质少,类似肺小细胞癌。精囊及膀胱颈部均有肿瘤细胞浸润。免疫组化染色检查:LCA、L-26、34βE12(-),PSA、AE1／AE3、AR(+),CA、S-100(±)。例1术后1个月死于广泛肺转移,例2术后3个月发现后腹膜转移,仍在随访中。结论前列腺小细胞癌少见,确诊依靠临床及病理表现。对早期前列腺小细胞癌,根治性前列腺癌切除术加激素及化疗是可行的,晚期患者则无较满意的治疗方法,且预后差。

Objective To evaluate the clinical and pathological characteristics and treatment of small cell carcinoma of the prostate. Methods Two patients with small cell carcinoma of the prostate were reported. Case 1 was 50 year-old. He was admitted with a history of dysuria and perineal pain for 3 months. Digital rectal examination （DRE） showed that the enlarged prostate was 5.0 cm x 6.0 cm and palpated hard and rough. Low-echo mass was shown on ultrasonography, and heterogeneous density of the prostate on CT. His serum PSA level was 0, 31 ng/ml,and fPSA level was 0, 09 ng/ml. Prostate cancer was suspected by biopsy,and radical prostatectomy was performed, Case 2 was 82 year-old. The complaints consisted of dysuria and intermittent gross hematuria for 4 months. The enlarged prostate was 4.0 cm × 5, 0 cm and palpated hard and rough with multiple nodes by DRE. Low-echo mass was shown on uhrasonography, and heterogeneous density of the prostate and involvement of seminal vesicle and bladder neck on CT, His serum PSA level was 2, 61 ng/ml,and fPSA level was 0.05 ng/ml, Prostate carcinoma was indicated by biopsy, and orchiectomy plus TURP was performed, Results The diagnosis of small cell carcinoma of the 2 cases were confirmed by postoperative pathology. Microscopically, the tumor cells were arranged in solid-sheet and nest structures, showing the histologic type of diffuse infiltrative carcinoma, Coagulated necrosis could be found easily. Small round or oval cells resembling lymphocytes or oat cells were the main constituents of the tumor, The nuclei were extremely hyperchromatic and scanty. The seminal vesicle and bladder neck had tumor infiltration. The immunohistochemical staining results were negative for LCA, L-26 and 3413E12 ,but positive for PSA, AE1/AE3 and AR,and suspected positive for CgA and S-100. Case 1 died of extensive lung metastasis 1 month after operation. Case 2 had retroperitoneal metastasis of the tumor 3 months after operation, and has been followed till now. Conclusions Small cell cancer of the prostate is rare but can be diagnosed properly based on clinical and pathological features. Radical prostatectomy combined with hormone and chemotherapy is reliable treatment for early stage cancer; but for late stage cancer, there is no effective treatment and the prognosis is poor.