经尿道前列腺电切术治疗复发性前列腺囊腺瘤1例

Transurethral resection of prostate treatment for recurrence of a multilocular prostatic cystadenoma: a case report

多房性前列腺囊腺瘤（multilocular prostatic cystadenoma,MPC）是一种罕见的前列腺组织来源的良性肿瘤,肿瘤体积通常较大,位于直肠和膀胱之间[1]。患者主要表现为泌尿系梗阻症状,如排尿中断、尿流较细、尿不尽等。影像学检查如前列腺超声、盆腔磁共振成像不仅可以提供肿瘤的位置信息,以及与周围器官的关系,还有助于与其他恶性肿瘤鉴别。由于MPC罕见且缺乏长期的随访报告,该病的诊断和治疗尚无定论。2017年8月北京大学人民医院泌尿外科收治MPC经尿道电切术后复发1例,并成功行经尿道前列腺电切术（transurethral resection of prostate,TURP）,现报告如下。

Multilocular prostatic cystadenoma（MPC） is a rare benign tumor that originates from the prostate itself. MPC is usually characterized by large multilocular cysts located between the rectum and bladder. The clinical presentation includes obstructive voiding symptoms,such as poor stream,intermittency,sensation of incomplete emptying,acute urinary retention and sometimes constipation symptoms due to mechanical compression of the lower intestine. Most of the previously reported patients with MPC underwent open surgery. Although the natural history of MPC remains unknown,surgical excision may not always be necessary. Here we report the case of a 49-year-old male,treated by transurethral electroresection of prostate（TURP） for prostate cyst one and half years before. His biopsy of TURP showed benign prostatic tissue with no evidence of malignancy. However,the symptoms of urinary tract obstruction were obviously aggravated after the operation. Acute urinary retention occurred intermittently 3 times. In our hospital,his total prostate specific antigen（t PSA） was 5. 440 μg/L,free prostate specific antigen（f PSA） was 1. 528 μg/L. After examination,it was considered as benign lesions clearly. In the operation of TURP,we found that the tumor was multilocular cystic. Histologically,the cell was mucus. Concerning the immunophenotype,CK5/6（＋）,p40（＋）,PSA（＋）,P504 S（＋）,PAX-2（-）,PAX-8（-）,MUC1（＋）,MUC5 ac（＋）,the results of special staining were as follows： AB（＋）,PAS（＋）. At the end of the follow up 3 months later,the routine semen analysis results showed that his semen volume was 3 m L and the sperm density and sperm mobility were normal. At the end of the follow up eight months later,the patient remained free of lower urinary tract symptoms and there were no signs of recurrence. His international prostate symptom score（I-PSS） had dropped from 32 to 4,and quality of life score（QOL）had dropped from 6 to 2. MPC is a rare benign tumor originating from the prostate. TURP may aggravate the symptoms of lower urinary tract obstruction in patients with MPC,and may be temporarily observed for some asymptomatic young and middle-aged patients.