前列腺腺癌合并睾丸鞘膜高分化乳头状间皮瘤临床病理观察

Prostate adenocarcinoma associated with well-differentiated papillary mesothelioma of the tunica vaginalis testis

目的探讨前列腺腺癌合并睾丸鞘膜高分化乳头状间皮瘤(WDPM)的临床病理特点、免疫组化、诊断与鉴别诊断要点。方法分析1例前列腺腺癌合并睾丸鞘膜WDPM的临床病理资料、组织学及免疫组化特征,并复习相关文献。结果患者第一次因术前诊断为前列腺增生而行经尿道前列腺电切手术,病理诊断为前列腺腺癌。术后20天再次入院行双侧睾丸切除术。在左侧睾丸鞘膜偶然发现2个灰白色绒毛样赘生物,镜下肿瘤由乳头状结构组成,乳头中心为纤维血管轴心伴间质透明变性,表面被覆单层轻微扁平至立方状的上皮样细胞,异型性小。免疫组化示AE1/AE3、calretinin、vimentin、CK5/6和HMBE-1(+),p63、PSA、PSAP和CEA(-)。结论睾丸鞘膜高分化乳头状间皮瘤和前列腺腺癌并发极为罕见,可被误诊为前列腺腺癌伴睾丸鞘膜癌转移,加深对此肿瘤组织学和免疫组化染色特征的认识有助于正确诊断与鉴别诊断。

Objective To explore the clinicopathological feature,immunophenotype,and the key points of the diagnosis and differential diagnosis of prostate adenocarcinoma associated with well-differentiated papillary mesothelioma of the tunica vaginalis testis. Methods The clinicopathologic data,the characteristics of histology and immunohistochemistry of one case of prostate adenocarcinoma associated with well-differentiated papillary mesothelioma of the tunica vaginalis testis were analyzed. The relevant literature was reviewed. Results The patient was a 83-year-old man. Firstly he was treated with transurethral resection of the prostate（ TURP） because of preoperation clinical diagnosis of benign prostatic hyperplasia.After operation the pathological diagnosis was prostate adenocarcinoma. Twenty days after TURP,he was treated with bilateral orchiectomy. Two gray and villous neoplasms located on the surface of the left tunica vaginalis testis were found occasionally. Histologically,the tumor was composed of papillary structure with fibrovascular core in which the stroma underwent hyalinization. The papillary structure was covered with single layer of flat to cubic epithelioid cells with mild atypia. The tumor cells were positive for AE1 / AE3,calretinin,vimentin,CK5 /6 and HMBE-1,while p63,PSA,PSAP and CEA were all negative. Conclusions Prostate adenocarcinoma associated with well-differentiated papillary mesothelioma of the tunica vaginalis testis is extremely rare. It is easily misdiagnosed as prostate adenocarcinoma with metastasis to tunica vaginalis testis and so on. It is helpful for the correct diagnosis and differential diagnosis to intensify the recognition of the histology and immunohistochemical characteristics of the tumor.