前列腺恶性叶状肿瘤伴胚胎性横纹肌肉瘤样分化临床病理观察

Malignant phyllodes tumor of the prostate with embryonal rhabdomyosarcoma-like differentiation: a case report and review of literature

目的探讨前列腺恶性叶状肿瘤伴胚胎性横纹肌肉瘤样分化(MPTERD)的临床病理学特征。方法报告1例前列腺MPTERD,结合文献分析其临床特征、病理特征和免疫组化。结果患者男性,40岁。排尿困难2月余。前列腺肿瘤组织由上皮和间叶成分组成,上皮细胞增生,无异型性,由上皮细胞形成的囊腔被增多的间质成分挤压形成类似叶状的裂隙。间质细胞异型性明显,核分裂>21个/10 HPF,有坏死。另外,局部还伴有胚胎性横纹肌肉瘤样分化。免疫组化:上皮细胞AE1/AE3(+),PSA局部(+);间质细胞vimentin(+),局部间质细胞desmin、myogenin(+),SMA、H-caldesmon、CD34和PR均(-)。结论前列腺MPTERD罕见,该肿瘤易复发和转移,预后差。

Objective To explore the clinicopathologic features of malignant phyllodes tumor with embryonal rhabdomyosarcoma-like differentiation（ MPTERD） of the prostate to increase our acknowledge of the disease. Methods The clinical data,pathological features and immunohistochemical findings of one case of MPTERD were reported and were discussed through literature review. Results A 40-year-old man who had complained of dysuria for 2 months. The histopathology of his prostate showed epithelial and mesenchymal components composition. The epithelial cells proliferated without atypia. The cystic cavity formed by epithelial cells were squeezed by increasing mesenchymal elements and shaped similar leaf-like fissures. The mesenchymal cells demonstrated marked cytological atypia with necrosis and high mitotic count（ more than 21 /10HPF）. In addition, there was a local accompanied by embryonal rhabdomyosarcoma-like differentiation. Immunohistochemical staining showed positive expression of AE1 / AE3 and PSA in epithelial cells and positive expression of vimentin in mesenchymal cells. We also found positive expression of desmin and myogenin in focal mesenchymal cells,while expression of SMA,H-caldesmon,CD34 and PR were all negative. Conclusions MPTERD of the prostate is rare. This tumor is easy to relapse and metastasis,and its prognosis is poor.